ü Chest X ray à painless procedure
ü Bronchoscopy
o AtSO4
§ Anticholinergic à mimics SNR
§ Decreases saliva à dry mouth
o NPO 6 to 8 hours
o Local anesthesia à check gag reflex before feeding
ü ABG
o Hyperventilation à decreased CO2 à increased blood pH à respiratory alkalosis
o Hypoventilation à increased CO2 à decreased blood pH à respiratory acidosis
o Diarrhea à decreased HCO3 à decreased blood pH à metabolic acidosis
o Vomiting gastric content à decreased HCL à increased blood pH à metabolic alkalosis
o Vomiting blood à decreased O2 à anaerobic metabolism à formation of lactic acid à decreased blood pH à metabolic acidosis
o Blood pH à normal 7.35 to 7.45 à If increased à alkalosis; If decreased à acidosis
o Partial CO2 à normal 35 to 45à If increased Respiratory Acidosis; if decreased Respiratory Alkalosis
o Partial HCO3 à normal 22 to 26 à If increased Metabolic alkalosis; If decreased metabolic acidosis
ü Cancer of the larynx à CS, alcohol and over usage of voice (choir member)
o A - nterior neck mass
o B – urning sensation with hot beverages / Bad breath
o C - hange in the voice (hoarseness)
o D – ysphagia/dyspnea
ü Chronic Obstructive Pulmonary Disease
o Chronic Bronchitis
§ Blue bloater
§ Excessive mucus production
o Asthma
§ Periods of bronchospasm and bronchoconstriction
o Emphysema
§ Disequilibrium of elastase and antielastase
§ Pink puffer
o Manifestations
§ A – LTERATION IN
· LOC à decreased O2
· Thoracic anatomy à over distention of alveoli à TD = APD à barrel chest
· Skin
o Temperature à cool clammy skin
o Color à pale to cyanotic
· ABG à Respiratory acidosis à Increased CO2
§ B – reathing à difficulty, purse lip à expiration > inhalation à removal of excess CO2 (diet low CHO)
§ C – ough (mucus production); Chronic hypoxia (2 to 3 lpm of O2 therapy, decreased O2 demand by rest and SFF) à clubbing of the fingers and decreased TP to the kidneys causing polycythemia
§ D – ecreased Metabolism
· Anorexia à weight loss (high calorie diet) à fatigue à weakness
ü Bronchodilators
o Theophylline and aminophylline
§ Primary effect à stimulates beta 2 receptors à smooth muscle relaxation à bronchodilation
§ Side effect à stimulates beta 1 receptors à increases cardiac rate à need not to notify the physician
§ Adverse effect à hypotension à monitor BP à sign of toxicity
§ Evaluation à check breath sounds
ü Acute Respiratory Distress Syndrome
o Causes
§ A – spiration
§ R – espiratory trauma (embolism)
· fracture à embolism à ARDS
§ D – rug toxicity (ASA)
§ S – epsis and shock
· Vomiting, bleeding, dehydrationà hypovolemia à shock à ARDS
o Syndrome
§ Severe hypoxia
§ Bilateral infiltrates
§ Dyspnea
ü Pulmonary embolism
o Restlessness à earliest
ü Water Seal System
o Drainage Bottle ® marked the level every shift
o Water seal bottle
§ Presence of fluctuation ® normal
§ Absence of fluctuation ® lungs are fully expanded ® assess first patient (X ray ® confirm) OR presence of obstruction
§ Intermittent bubbling ® normal
· Absent ® obstruction
· Continuous ® leakage
o Suction Control ® continuous bubbling ® normal
ü Risk factors for cardiovascular disorders
o R – ace à non modifiable
o I – ncresed blood pressure à modifiable
o S – tress à SNR à increased BP and CR, vasoconstriction à modifiable
o K – nowing sedentary life style à modifiable
o F – at foodsà atherosclerosis à modifiable
o A – lcohol (modifiable) / Age à above 40 (non modifiable)
o C – igarette smoking à vasoconstriction (nicotine) à modifiable / Contraceptive pills à clotting of blood à thrombus formation
o T – ype A behavior (modifiable) à competitiveness, perfectionist à high stress level
o O – besity
o R – esult of DM à lipolysis à increased fatty acids à atherosclerosis
o S – ex àgender à males > female (before menopausal because estrogen decreases PVR) after menopausal female eversible}[inverted T wave] à Injury [elevated ST segment] à> male
ü Decreased TP in heart à Ischemia (Angina) {r necrosis (MI) {irreversible}[pathologic Q wave/permanent in the ECG]
ü Eating a heavy meal, strenuous exercise, sex, exposure to cold à Decreased blood flow (heart)à decreased TP (heart)à decreased O2 (heart)à anaerobic respiration à production of lactic acid à PAIN à management decreased O2 demand by rest and SFF
ü Angina
o Pain relieved by rest and NTG
o NTG
§ Vasodilation à orthostatic hypotention à move gradually à Monitor BP
§ Store in a dark and amber container
§ Effective à tingling sensation à no need to notify physician
§ Maximum of 3 tablets with 5 minute interval
ü MI
o Pain relieved by Morphine SO4
§ Narcotic analgesic
§ Can cause respiratory depression à monitor RR and O2 saturation
§ Antidote à narcan
ü Cardioversion à synchronous
ü Defibrillation à unsynchronous
ü Buerger’s disease à CS à vasoconstriction à stop CS à common in men
ü Raynaud’s à stress and cold à vasoconstriction à common in female
ü Congestive heart failure
o Left sided à pulmonary
§ Dyspnea
§ Crackles
§ Polycythemia à due to decrease O2 to the kidneys
§ Clubbing of the fingers à due to prolonged hyxia
§ Orthopnea
o Right sided à systemic
§ Hepatomegaly
§ Distended neck veins
§ Edema
§ Portal hypertension
§ Ascites à weight gain
§ Varicose veins
o Digoxin
§ Cardiac glycoside
§ Positive inotrophic effect à increased strength of myocardial contraction
§ Negative chronotrophic effect à decreased cardiac rate à monitor CR à never give if CR below 60 bpm
§ Adverse effect
· V – omitting
· A – norexia
· N – ausea
· D – iarrhea
· A – bdominal pain
· REMEMBER: earliest à GI; late à halo vision
· Antidote à Digibind
ü Decreased RBC ® Activity in tolerance, Fatigue, provide rest, Anemia
ü Decreased Platelets ® Prone to bleeding, avoid parenteral injection, appl pressure on injection site, high risk for injury
ü Decreased WBC ® prone to infection, reverse isolation
ü Increased WBC ® presence of infection
ü First Day/Newly diagnosed ® Knowledge deficit
ü Diuretic
o D – iet à high K diet except aldactone
o I – input and Output à expected increased output
o U – ndesirable effect electrolyte imbalance (K)
o R – ecord weight à expected decreased weight
o E – lderly à special precaution
o T – ake in AM and with food
o I – ncreased orthostatic hypotension à monitor BP and move gradually
o C – ancel alcohol because of mild diuretic effect
ü Heparin à anticoagulant à prevent further enlargement of clot not dissolve them à monitor APTT/PTT à antidote protamine SO4
ü Coumadin à anticoagulant à prevent further enlargement of clot not dissolve it à monitor PT à vitamin K is the antidote
ü Urokinase/Streptoase ® dissolves the clot
ü Pernicious anemia à absence of intrinsic factor (gastric surgery)à problem in absorption of Vitamin B12 à beefy red tongue schilling’s test à definitive test à 24 hour urine collection à life long Vitamin B12
ü Gastritis à LUQ pain
ü Gastric ulcer à affected area stomach à pain (precipitated by food intake à increased HCl) à pain relieved by antacids
ü Duodenal ulcer à affected area duodenum à pain (2 hour after eating) à pain relieved by food
ü Ulcers à bleeding à (+) occult blood test (guiac)à high fiber diet, avoid red meat, iron, steroids, NSAIDs, indomethacin
ü Vagotomy à resection of vagus nerve à decreased cholinergic stimulation à decreased HCl and gastric movement
ü Dumping syndrome à tachycardia and weakness à 3 D’s (diarrhea, diaphoresis and dizziness) à fluids after meals, lie down after meals and SFF
ü Appendicitis à RLQ pain à avoid heat pads à cause rupture à signs of ruptured appendix à sudden cessation of pain, elevation of temperature and WBC
ü Diverticulitis à LLQ pain ® low fiber diet
ü Diverticulosis ® high fiber diet
ü Ulcerative colitis à bloody diarrhea 20 to 30 times a day à fluid volume deficit
ü Liver cirrhosis à alcohol and malnutrition (laanec’s), infection and drugs (post necrotic), RSCHF (cardiac) and biliary obstruction (biliary)
o Portal hypertention can lead to
§ Blood shifted to the different collateral
· Esophageal varices
· Spider angioma (face and neck)
· Caput medusae (abdomen)
· Hemorrhoids (rectal)
· Management avoid rupture à avoid shouting, valsalva maneuver
§ Increased hydstatic pressure à fluid shifting à ascites
o Decreased albumin à decreased oncotic / colloidal osmotic pressure à fluid shifting à ascites à management high protein diet
o CHON metabolism à by product ammonia à liver cannot convert to urea à increased level of ammonia in the brain à Alteration of LOC and changes of behavior and asterexis àhepatic encephalopathy à management low CHON diet and lactulose for removal of ammonia
ü Hepatitis A à fecal oral à prone plumber
ü Hepatitis B à body secretion à prone working in a dialysis
ü Cholecystitis à 5 F’s (fair, female, fat, fertile and forty) à RUQ pain à after ingestion of fatty food à demerol to relieved pain
ü Cholecystectomy à T tube à level of the incision site à drain excess bile
ü Pancreatitis à alcohol à autodigestion à LUQ pain
ü Anterior Pituitary gland
o Growth hormone
§ Increased before the closure of the epiphysis of the long bones à gigantism à tall
§ Increased after the closure of the epiphysis à acromegaly à big hands (big gloves), big feet (big shoes) and big head (big hat)
§ Decreased à dwarfism
o Prolactin
§ Increased à galactorrhea
§ Decreased à decreased milk production
o ACTH
§ Increased à secondary cushing’s
§ Decreased à secondary addison’s
o TSH
§ Increased à secondary hypethyroidism
§ Decreased à secondary hypothyroidism
ü Posterior pituitary gland
o ADH
§ Increased à water retention à oliguria à edema (fluid volume excess) and weight gain à concentrated urine à increased urine specific gravity
§ Decreased à water excretion à polyuria à dehydration (fluid volume deficit and weight loss) à diluted urine à decreased urine specific gravity
ü Parathyroid gland
o Parathormone
§ Increased à increased calcium in the blood and decrease calcium in the bones à stone formation and decreased bone mass à osteoporosis à management increased water intake
§ Decreased à hypocalcemia à calcium supplement
ü Thyroid Gland
o Increased (hyperthyroidism)
§ T3 and T4 à increased BMR à hyperactive à inability to focus à insomia à increased catabolism à weight loss à increased appetite à increased peristalsis à Diarrhea à fluid volume deficit à Increased CR and RR (due to increased BMR)
· Increased T3 à heat intolerance
§ Calcitonin à decreased calcium in the blood à tetany à compensatory à calcium withdraws from the bones à bone destruction (complication)
§ PTU à decreased synthesis of TH à watch out for SE (similar to signs and symptoms of hypothyroidism) à watch out for agrunulocytosis (fever, skin rash and sore throat)
§ Lugol’s solution à decreased released of TH à before thyroidectomy à decreased vascularity of the thyroid gland
o Decreased (hypothyroidism)
§ T3 and T4 à decreased BMR à hypoactive à sleeps a lot à decreased metabolism à weight gain à anorexia à decreased peristalsis à constipation à decreased CR and RR due to decreased BMR
§ T3 à cold intolerance
§ Calcitonin à hypercalcemia à stone formation
§ Synthroid and Proloid à increased TH
ü Adrenal Gland
o Incresead (cushing’s)
§ Glucocorticoids à hyperglycemia and decrease wound healing
§ Mineral corticoids à increased aldosterone à sodium retention and potassium excretion à hypernatremia and hypokalemia
· Hypernatremia à water retention à oliguria à edema (moon face,buffalohump, fluid volume excess and weight gain) à concentrated urine à increased urine specific gravity à low sodium diet
· Hypokalemia à weakness à Prominent U wave à high potassium diet
§ Epinephrine and Norepinephrine à Increased BP and CR
§ Sex hormones
· Males à gynecomastia and falling of hair
· Females à hirsutism and deepening of the voice
o Decreased (addisons)
§ Glucocorticoids à hypoglycemia and inability to cope with stress
§ Mineralcorticoids à decreased aldosterone à sodium excretion and potassium retention à hyponatremia and hyperkalemia
· Hyponatremia à water excretion à polyuria (dehydration, fluid volume deficit and weight loss) à diluted urine --. Decreased urine specific gravity à increased fluids and Na
· Hyperkalemia à weakness à tall or peaked T waves à low K diet
§ Epinephrine and Norepinephrine à decreased BP and CR
ü Diabetes Mellitus
o Type I à absolutely no insulin à thin à insulin
o Type II à insufficient insulin à obese à OHA
o Diet à 50% CHO, 30% Fats, 20% CHON
o Exercise à Increased uptake of glucose à Decreased insulin requirement
o Oral hypoglycemic agent (OHA)
§ Stimulates pancreas to produce insulin
o Insulin
§ SC; IV if DKA
§ Never massage the area
§ Never administer cold insulin
§ Rotate the site of injection
· PREVENTS LIPODYSTROPHY
§ Mix
· Aspirate clear first
· Inject air to cloudy first
o Hypoglycemia
§ W – eakness
§ H – unger pangs
§ A – alteration of LOC
§ T – achycardia and tremors
§ A – bdominal pain
§ B – blurring of vision
§ C – ool clammy skin
§ D – iaphoresis
§ Give à orange juice (simple sugars)
o DKA ® increased lipolysis increased ketones
o Hyperglycemia à polyuria, polydipsia, polyphagia, kussmaul breathing, glycosuria, ketonuria and warm flush skin
o Glycosylated hemoglobin à reflect BSL for the past 3 to 4 months à most accurate
o Foot care
§ Podiatrist
§ Avoid removing corns and calluses
§ Cut toe nails straight across
§ Avoid walking bare foot
ü Hepatitis A ® fecal oral
ü Hepatitis B ® body and bloody secretions (hemodialysis)
ü Peritoneal Dialysis
o Diasylate output is decreased ® turn patient from side to side
o Complication ® infection ® monitor WBC and temperature, diasylate is cloudy ® boardlike and rigid abdomen ® peritonitis
o Don’t include diasylate solution in the output of the client
o Expected ® decreased weight ® monitor weight before and after ® decreased createnine and BUN
ü Heart block ® decreased tissue perfusion
ü Parkinson’s diasease
o Decreased dopamine in the basal ganglia ® levodopa to increased dopamine ® avoid Vit B6 foods
o Cardinals signs ® tremors (non intentional) ® muscle rigidity ® bradykinesia
o Pill rolling
o Microphonia ® ask your client to speak aloud to be aware
o Artane and Cogentin ® anticholinergic ® decreased muscle rigidity
ü Myasthenia Gravis
o Tensilon test ® confirmatory test
o Decreased Acetylcholine and increased cholinesterase
o Muscle weakness ® priority airway
o NO tranquilizer, Morphine SO4, Muscle relaxant and neomycin
o Cholinergics (mestinon) ® increased muscle strength ® antidote ATSO4
§ Undermedication ® myasthenic crisis ® give cholinergics
§ Over medication ® cholinergic crisis ® give ATSO4
ü Multiple Sclerosis
o Demyelinization of the myelin sheath
o Charcoat’s triad
§ Intentional tremors
§ Scanning of speech
§ Nystagmus
o Visual disturbances ® diplopia
ü Pancreatitis ® autodigestion ® alcohol ® bleeding ® shock
o Elevated amylase
ü Rheumatoid Arthritis
o No specific diagnostic test
o NSAID’s and ASA (antipyretic, analgesic and anti-inflammatory)
o Synovitis ® Pannus formation ® fibrous ankylosis (limited joint movement) ® Bony ankylosis (joint fixation)
o Avoid flexion and promote prone position
ü Gouty Arthritis
o Increased uric acid ® allopurinol and avoid organ meats (liver) ® tophi (ears)
ü Osteoarthritis
o Most common ® related with aging
o Pain after weight bearing exercise or activity ® rest to relieved pain ® weight reduction
ü Diverticulitis ® LLQ pain and low fiber diet
ü Cyclophosphamide (Cytoxan) ® can cause hemorrhagic cystitis ® to avoid increased fluid intake
ü Vincristine (Oncovin) ® increased fiber in the diet
ü Iron supplement ®When is the best time to take (empty stomach), How is best taken (with orange juice)
ü Steroids and NSAID’s
o DEATH ® inflammation
o BIRTH ® side effects
§ B – one marrow depression ® prone to infection ® monitor temperature and WBC
§ I – ncreased gastric irritation ® take it with food or after meals
§ R – enal toxicity
§ T – innitus
§ H – epato toxic
ü Cataract ® common cause is aging (senile) ® opacity of the lens ® position on the unaffected side
ü Glaucoma ® increased IOP ® decreased of peripheral vision first ® halo, tunnel and gun barrel vision ® miotics (constricts pupils) ® avoid ATSO4 (dilates pupil)
ü Retinal detachment ® trauma ® blood clots ® floating spots ® dependent position® scleral buckling
ü Avoid Increased Intraocular pressure ® PRIORITY
o Avoid vomiting, coughing, valsalva maneuver, lifting heavy objects, bending, crying
ü Meniere’s ® Triad ® tinnitus, impaired hearing loss and vertigo ® low Na diet
o Vertigo ® imbalance ® high risk for injury ® decreased vertigo by focusing on one side of the room ® assume a flat or reclining position
ü ASA ® 8th cranial nerve damage ® tinnitus, impaired hearing loss and vertigo
ü Antibiotics ® allergic reactions
ü Normal Values
o BUN = 10 – 20 mg/dl
o Calcium = 9 to 10.5 mg/dl
o Creatinine = 5 to 1.5 mg/dl
o GTT = 70 to 115 mg/dl
o O2 sat = 97 to 98%
ü Signs and Symptoms of Increased Intracranial Pressure
o B – lood pressure and temperature are elevated
o R – espiratory and cardiac rate are decreased
o A – lteration of LOC
o I – rritability
o N – ote for projectile vomiting
o S – eizure
“ I wish you all good luck for your LOCAL BOARD EXAM ….. may you earn more than 2.75 million pesos because you deserve it….. GOD BLESS ….. “
Sunday, May 24, 2009
ER drugs
Commonly Asked Emergency Drugs
Emergency Drug
Initial Dose
Indications
Adenosine
6 mg
Atropine sulfate
0.5 – 1 mg.q 3-5 min
Bradycardia
Epinephrine
1 mg.q 3-5 min
Cardiac arrest
Lasix
0.5-1 mg/kg
Pulmonary edema
Lidocaine
1-1.5 mg/kg
Ventricular fibrillation, Ventricular tachycardia
Magnesium sulfate
1-2 g
Ventricular tachycardia r/t hypomagnesemia
Morphine Sulfate
1-3 mg
Chest pain, pulmonary edema
Narcan
0.02-2mg
Narcotic – respiratory depression
Nitroglycerine
0.4 mg SL
Chest pain, pulmonary edema
Vasopressin
40 units
Cardiac arrest
Antidotes
Agents
Antidotes
Acetaminophen
Acetylcysteine (Mucomyst)
Anticholinesterase
Atropine So4
Anticholinergics
Physostigmine
Benzodiazepines
Flumazenil
Coumadine
Vitamin K
Cyanide
Sodium nitrate
Digoxin
Digoxin immune fab (Digibind)
Dopamine
Phentolamine
Heparin
Protamine sulfate
Iron
Deferoxamine
Lead
Dimercaprol, edetate disodium and succimer
Magnesium Sulfate
Calcium gluconate
Narcotics
Naloxone
Drug Name Endings: What they can suggest you!!!
Endings class
*cain
Local anesthetics
*cillin
Antibiotics
*dine
Antiulcer agent
*done
Opiod analgesics
*ide
Oral hypoglycemics
*lam/
*pam
Antianxiety
*micin/
*mycin
Antibiotics
*mine/
*zide
Diuretics
*olol
Beta blockers
*pril
ACE inhibitors
*sone
Steroids
FREQUENTLY ASKED MEDICATIONS
Drugs Trade /(generics)
Classification
Desired Effects
Best Time to be Taken
Other Considerations
1
Aminophylline (theophylline)
Bronchodilator
To case breathing
AM / empty stomach
· No smoking
· No caffeine
· Check heart rate
2
Amphogel (aluminum hydroxide)
Antacid
âphosphate level
Between meals and HS
· Give with glass of water
· Report melena
3
Antabuse (disulfiram)
Antialcoholic agent
Avoidance of alcohol
After 12 hrs. stoppage from alcohol
· No alcohol in any means
4
Aspirin (ASA)
Anti-inflammatory
Anti-pyretic
Analgesic
â temperature
â pain and inflammation
Full stomach
· Check for bleeding tendencies
· Syrup of inpecae in case of overdose
5
Atropine SO4
Anticholinergic and Vagolytic
á heart rate and decrease secretion s
30 PC
· Observe facial flushing
· Avoid hot environment
6
Bacterium (cotrimoxazole)
Antibiotic
(-) infection
PC
· Reddish urine
· Rashes
· Assess for signs of nephrotoxicity
7
Benadryl (diphenhydramine hcl)
Antihistamine
Anti – EPS
(-) allergy
(-) movement syndrome
Best taken with food
· Avoid alcohol
8
Celestone (betamethazone)
Steroids
ârespiratory distress in newborn
Best taken with food
· Monitor weight
9
Cytoxan (cyclophosphamide)
Antineoplastic
âsize of tumor
AM
· Increase fluids
· Monitor CBC
10
Diabinase (chlorpropaminde)
Antidiabetic agent
Normal glucose range
AM
· Monitor for hypoglycemia
11
Diamox
(acetazolamide)
Antiglaucoma antidiuretics
â urine output
â vertigo
AM with meals
· Photosensitivity
12
Digoxin (lanoxin)
Cardiac glycoside
Normal heart rate
AM
· Assess pulse rate
· Monitor serum K
13
Dilantin (phenytoin)
Anti-convulsant
(-) seizure
Best taken with food
· Taper dosage
14
Diuril (chlorothiazide)
Diuretics
á urine output
Best taken with food
· Report weakness in the extremities
· Increase K in the diet
15
Epinephrine
Bronchodilator
á heart rate
AM
· Don’t operate machineries and drive automobile
· Assess for increase pulse
16
Flagyl (metronidazole)
Antihelmintic
(-) helminth
Best taken with food
· Avoid alcohol
· Not to give with antabuse
· Tetratogenic
17
Haldol (haloperidol)
Antipsychotic
á (+) symptoms of psychosis
AC
· Assess BP
· Photosensitivity
18
Kayexalate
Promote excretions of K
â serum K
· May cause constipation
· Monitor serum potassium
19
Lasix (furosemide)
Diuretic
á urine output
AM
· Increase intake of food rich in K
20
Lithane (LiCO3)
Antimanic
â hyperactivity
PC
· Monitor lithium toxicity
· Decrease activity
21
Lovenox (mevacor)
Antithrombotic
(-) thrombosis
· Soft bristle toothbrush
· No razor
· Keep protamine SO4
22
Magnesium SO4
Anticonvulsant
(-) convulsion
· Assess DTR and PR
· Antidote is Calcium gluconate
23
Mastinon (pyridostigmine)
Cholinesterase inhibitor
á muscle strength
PC
· Monitor for muscle weakness
· Antidote is atropine SO4
24
Mathergine (methylergonovine maleate)
Oxytocic for post partum atony
Firmly contracted uterus
· Monitor BP
· Report dyspnea
25
Monoamine oxidase inhibitor
Antidepressant
Improved sleeping pattern
PC
· No tyramine rich food
· Assess for hypertensive crisis
· Monitor BP
26
Nitroglycerin
Antiangina
(-) chest pain
Best taken before any strenuous activity
· Taken SL; don’t chew
· Keep tablets in dark container
27
Pancrease (pancreatin)
Pancreatic enzyme
(-) fat in the stool
Between meal and snacks
· Preparation is enteric coated, don’t show
· Observe for diarrhea
28
Phenergan (promethazine hyrochloride)
Antihistamine
(-) allergy
Empty stomach
· Antidote is epinephrine
29
Reserpine (serpasil)
Antihypertensive
â BP
Best taken with meals
· No sudden change of position
· Monitor BP and PR
30
Ritalin (methylphenidate)
Stimulant
â hyperactivity
AM / PC
· Monitor growth and development
31
Robaxin (methocarbamol)
Skeletal muscle relaxant
(-) muscle spasm
AM
· No alcohol
· Antidote : Epinephrine
32
Synthroid (levothyroxine sodium)
Thyroid hormone supplement
Normal T4 level
AM
· Monitor BP and PR
33
Tagamet (cimetidine)
Antiacidity
(-) heartburn
Best taken with food
· Avoid smoking
34
Thorazine (chlorpromazine hcl)
Antipsychotic
(-) positive signs of psychosis
PC
· Photosensitivity
· Monitor BP
35
Valium (diazepam)
Antianxiety
(-) anxiety
AC
· No alcohol, caffeine
36
Xylocaine (lidocaine)
Antiarrythmic
Normal heart rate
· Monitor for toxicity – convulsion
· S / E : tinnitus
37
Zyloprim (allopurinol)
Antigout
â uric acid
Best taken with food
· Increase fluid intake, restrict vit. C
Common Tubes
Table or Apparatus
Purpose
Examples of Use
Key points
Miller-Abbott tube
Longer than Levin tube; has mercury of air in bags so tube can be used to decompress the lower intestinal tract
1. Small-bowel obstructions
2. Intussusception
3. Volvulus
1. Care similar to that Levin NG tube irrigated.
2. connected to suction, not sterile technique
3. orders will be written on how to advance the tube gently pushing tube a few inches each hour, patient position may affect advancement of tube
4. X-rays determine the desired location of tube
Cantor Tube
To drain bile from the common bile duct until edema has subscribed
Cholecystectomy when a common duct exploration (CDE) or choledochostomy was also done
1. Bile drainage is influenced by position of the drainage bag.
2. Clamp tubes as ordered to see if bile will flow into duodenum, normally.
T-tube
A type of closed-wound drainage connected to suction-used to drain, a large amount of serosanguineous drainage from under an incision
1. Mastectomy
2. Total hip procedure
3. Total knee procedure
1. May compress unit, and have portable vacuum or connect to wall suction.
2. Small drainage tube may get clogged physician may irrigate these at times
Hemovac
A method of closed wound suction drainage indicate when tissue displacement and tissue trauma may occur with rigid drain tubes (e.g Hemovac)
1. Neurosurgery
2. Neck surgery
3. Mastectomy
4. Total knee and hip replacement
5. Abdominal surgery
6. Urological procedure
Empty reservoir when full, to prevent loss of wound drainage and back contamination
Jackson-Pratt
See Hemovac
See Hemovac
See Hemovac
Three-way Foley
To provide avenues for constant irrigation and constant drainage of urinary bladder
1. Transurethral resection (TUR)
2. Bladder infection
Watch for blocking by clots causes bladder spasms
Irrigant solution often has antibiotic added to normal salin or sterile water
Sterile water rather than normal saline may be used for lysis of clots
Suprapubic catheter
To drain bladder via an opening through the abdominal wall above the pubic bone
Suprapubic prostatectomy
May have orders to irrigate prn or continuously
Ureteral catheter
To drain urine feom the pelvis of one kidney, or for splinting ureter
1. Cystoscopy for diagnostic workups
2. Ureteral surgery
3. Pyelotomy
Never clamp the tube-pelvis of kidney only holds 4-8 mL
Use only 5 mL sterile normal saline if ordered to irrigate
Common Diagnostics Procedures
Noninvasive Diagnostic Procedures
Characteristics:
1. it provides an indirect assessment of organ size, shape, and / or function
2. it is safe
3. it is easily reproducible
4. it requires less complex equipment for recording
5. it does not require the written consent of patient or guardian
General Nursing Tasks:
1. Decrease patients anxieties and offer support by
a. Explain purpose and procedure of test
b. Acknowledge questions regarding safety of the procedure
c. Remain with the patient while the procedure is going on
2. Use procedure in the collection of specimens that avoids contamination
A. Graphic studies of Heart and brain
Electrocardiogram (ECG) – graphic record of electrical activity generated by the heart during depolarization and repolarazation.
- diagnose abnormal cardiac rhythms and coronary heart disease
Echocardiography (ultrasound cadiography) – graphic record of motions produced by cardiac structure as high-frequency sound vibrations are echoed though chest wall into the heart.
- used to demonstrate valvular or other structural deformities, detect pericardial effudion, diagnose tumors and cardiomegaly, evaluate prosthetic valve function.
Electroencephalogram (ECG) – graphic record of the electrical potentials generated by the physiological activity of the brain
- used to detect surface lesions or tumors of the brain and presence of epilepsy.
Echoencephalogram – beam of ultrasound is passed though the head, and returning echoes are graphically recorded.
- used to detect subdural hematomas, intracerebral hemorrhage, or tumors.
B. Roentgenological studies (X-ray)
Chest – used to determine size, contour of the heart; size, location, and nature of pulmonary lesions: pleural thickening and effusions: pulmonary vasculature: disorder of thoracic ones and soft tissues.
- used lead shield to protect pregnant woman
Kidney, Ureter, and Bladder (KUB) – used to determine size, shape, and position of kidney, ureter and bladder
- No special consideration
Breast (Mammography) – examination of the breast with or without the injection of the radiopaque substance into the duct of mammary gland.
- used to determined the presence of tumor or cyst (best done a week after menstruation)
- no deodorant, perfume, powder, or ointment in underarm area on the day of X-ray (contains Calcium oxalate)
- May be uncomfortable due to the pressure on the breast. (uses two x-ray plates)
C. Roentgenological studies (FLUOROSCOPY) – requires the ingestion or injection of a contrast medium to visualize the target organ.
Additional Nursing Task:
a. Administration of enemies or cathartics before the procedure and laxative after.
b. Keeping the patient NPO 6-12 hours before examination
c. Ascertain patient’s allergy and allergic reactions
d. Observing for allergic reactions to contrast medium
e. Providing fluid and food after procedure to prevent dehydration
f. Observe stool for color and consistency until barium passes
Upper GI (Barium swallow) – ingestion of barium sulfate or meglumine diatrizoate (Gastrografin [white and chalky substance], followed by fluoroscopic and x-ray examination)
- used to determine patency and caliber of the esophagus and to detect esophageal varices, mobility of gastric wall, presence of ulcer, filling defects due to tumor, patency of pyloric valve and presence of structural abnormalities
Lower GI (Barium Enema) – rectal instillation of barium sulfate followed by glouroscopic and x-ray examination
- used to determine contour and mobility of colon and presence of any space-occupying tumors. Perform before upper GI
Patients preparations:
- no food after evening meal the evening before the test
- stool softener laxatives and enema suppositories to cleanse the bowel before the test
- NPO after midnight before the test
After care:
- increased fluid intake, food and rest
- laxatives for at least two days or until stools are normal in color and consistency
Cholecystogram – ingestion of organic iodine contrast medium (Telepaque) followed in 12 hour by x-ray visualization
- gallbladder disease is indicated with poor or no visualization of the bladder
- accurate only if GI and liver function is intact
- perform before barium swallow and barium enema
Patients preparations:
- administer large amount of water with contrast capsule
- low-fat meal before evening before x-ray
- oral laxative of stool softener after meal
- no food allowed after contrast capsule
After care:
- increased fluid intake, food and rest
- observe for any untoward reactions
Intravenous Pyelography (IVP) – injection of a radiopaque contrast medium in the vein of the client to visualize ureter, bladder and kidney
Patients preparations:
- Laxative in the evening before the examination
- NPO for 12 hours
- Cleaning enema morning of the procedure
After care:
- increased fluid intake, food and rest;
- observe for any untoward reactions
D. Computed Tomography (CT) – an x-ray beam sweeps around the body, allowing measuring of various tissue densities. Provides clear radiographic deficition of structures that are not visible by other techniques.
- initial scan may be followed by “contrast enhancement” using an injection of contrast agent iodine via vein, followed by a repeat scan.
Patients preparations:
- instructions for eating before test vary
- clear liquids up to 2 hours before the procedure are permitted
E. Magnetic resonance imaging (MRI) – noninvasive technique that produces cross sectional images by exposure to magnetic energy sources. It uses no contrast medium; takes 30-0 minutes to complete. Patient may still for periods of 5-20 minutes at a time.
Patients preparations:
- patient can take food and medications except for low abdominal and pelvic studies (food and fluid withheld) 4-6 hr to decrease peristalsis)
- Restrictions
a. those who have metal implants
b. those with permanent pacemakers
c. those who are pregnant
F. Ultrasound (sonogram) – uses sound waves to diagnose disorders of the thyroid, kidney, liver, uterus, gallbladder, fetus and intracranial structures of the neonate.
Patients preparations:
- advise client not to chew gum or smoke before the procedure
- no x-ray
- for gallbladder studies; NPO for 8 hours
- for lower abdomen and uterus ; 32 ounces of water PO 30 minutes before the procedure
G. Pulmonary function studies
Ventilatory studies – use of incentive spirometer to determine how well the lung is ventilating.
Vital capacity (VC) – largest amount of air that can be expelled after maximal inspiration
Normal = 4000 – 5000 mL.
Decrease = indicate lung disease
Increase or decrease = indicate chronic obstructive lung disease
Forced expiratory volume (FEV) – percentage of vital capacity that can be forcibly expired in 1, 2, or 3 seconds.
Normal = 80 – 83% in 1 sec
90 – 94% in 2 sec
95 – 97% in 3 sec
decrease = indicate expiratory airway obstruction
H. Sputum Studies
Gross sputum evaluations – collection of sputum samples to ascertain quantity, consistency, color and odor
Sputum smear – sputum is smeared thinly on a slide so that it can be studied microscopically.
- used to determine cytological changes or presence of pathogenic microorganism
Sputum culture – sputum samples are implanted or inoculated into special media.
- used to diagnosed pulmonary infection
I. Examination of the gastric contents
Gastric analysis – aspiration of the contents of the fasting stomach analysis of free and total acid
Gastric acidity increase : duodenal ulcer
Gastric acidity decrease : pernicious anemia an cancer of the stomach
J. Doppler ultrasound – measures blood flow in the major veins and arteries. The transducer of the test instrument is placed on the skin, sending ultra-high-frequency sound.
- sound varies with respiration and valsalva maneuver
- no discomfort to the patient.
K. Glucose Testing – to detect disorder of glucose metabolism, such as diabetes.
Fasting blood sugar (FBS) – blood sample is drawn after a 12 fast (usually midnight). Water is allowed.
Normal blood glucose ; 60 – 120 mg/dL
Diabetic patient = 126 mg/dL
2 hr postprandial (PPBS) – blood is taken after meal
Patients preparations:
- offer a high-carbohydrate diet for 2-4 days before testing
- patient fast overnight
- eats a high-carbohydrate breakfast
- blood sample is drawn 2 hr interval
- no cigarette smoking and caffeine for these may increase glucose level
Common Diagnostics Procedures
Invasive Diagnostics Procedures
Characteristics:
it directly records the size, shape and function of an organ;
it requires the written consent of the patient or guardian;
it may result in morbidity and occasionally death.
General Nursing Task:
Before procedure:
have patient sing permit to procedure
ascertain and repot any patient history of allergy or allergic reaction
explain procedure briefly and accurately
explain that contrast medium might cause flushing or warm feeling
keep patient NPO 6-12 hour before procedure if anesthesia is to be used
allow patient to verbalize concerns
administer preprocedure sedatives, as ordered
if procedure done at bed side:
- remain with patient and offer reassurance
- assist with optimal positioning of patient
- observe for indication of complications – shock, pain and dyspnea
After procedure:
observe and record vital signs
check injection or biopsy sites for bleeding, infection, tenderness, or thrombosis
· report untoward reaction to the physician
· apply warm compress to ease discomfort, as ordered
if tropical anesthesia is used during procedure, do not give food or fluid until gag reflex returns
encourage relaxation by allowing patient to discuss experience and verbalize feelings.
A. Procedures to evaluate the cardiovascular system
1. Angiography – intravenous injection of radiopaque solution or contrast for the purpose of studying its circulation through the patient’s heart, lungs and great vessels.
- Used to check the competency of the heart valves, diagnose congenital septal defects, study heart function and structure before cardiac surgery, detect occlusions of coronary arteries.
2. Cardiac catheterization – insertion of a radiopaque catheter into a vein to study the heart great vessels.
- Used to confirm diagnosis of heart disease and determine extent of disease, measure pressures in the heart chamber and great vessels, obtain estimate of cardiac output, and obtain blood samples to measure oxygen content.
a. Right heart catheterization – catheter is inserted through a cut-down in the antecubital vein into the superior vena cava, through the right atrium and ventricle and into the pulmonary activity.
b. Left-heart catheterization- catheter maybe passed retrograde to the left ventricle through the brachial and femoral artery, it can be passed through the left atrium after right-heart catherization by means of a special needle that punctures the septa; or it may be passed directly into the left ventricle by means of a posterior puncture.
Specific nursing considerations:
Preprocedure patient teaching:
a. Fatigue is a common complaint due to lying still for 3 hr
b. Feeling of fluttery sensation while the catheter is passed back into the left ventricle
c. Flushed, warm feeling may occur when contrast medium is injected.
Postprocedure observations:
a. monitor ECG pattern for arrhythmias
b. check extremities for color and temperature, peripheral pulses for quality.
3. Angiography (Arteriography) – injection of a contrast medium in to the arteries to
study the vascular tree.
- Used to determine obstructions or narrowing of peripheral arteries.
B. Procedure to evaluate the respiratory system
Lung scan – injection of radioactive isotope into the body, followed by lung scintiscan, which produces a graphic record of gamma rays emitted by the isotopes in the tissues.
- used to determine lung perfusion when pulmonary emboli and infarctions are suspected.
Pulmonary angioghraphy – x – ray visualization of the pulmonary vasculature after the injection of a radiopaque contrast medium.
- used to evaluate pulmonary disorders such as pulmonary embolism, lung tumor and aneurysms, and changes in the pulmonary vasculature due to such conditions as emphysema.
Bronchoscopy – introduction of a fiberoptic scope into the trachea and bronchi
- used to inspect tracheobronchial tree for pathological changes, remove foreign bodies or mucous plugs causing airway obstruction, and apply chemotherapeutic agents.
a. Prebronchoscopy interventions:
· oral hygiene
· postural drainage as indicated
b. Postbronchoscopy interventions:
· Instruct patient not to swallow oral secretions
· Save expectorated sputum for laboratory analysis
· NPO till gag reflex returns
· Observe for subcutaneous emphysema and dyspnea
· Apply ice collar to reduce throat discomfort
Thoracentesis – needle puncture through the chest wall and into the pleura
- used to remove fluid and occasionally air from the pleural space
- nursing considerations
a. position : high fowler’s position or sitting upon edge of the bed, with feet supported on the chair.
b. If the patient is unable to sit up – turn unto unaffected side
a. Position: high fowler’s position or sitting upon edge of the bed, with feet supported on the chair.
b. If the patient’ is unable to sit up-turn unto unaffected side
C. Procedures to evaluate the renal system
1. Renal angiogram – small catheter is inserted into the femoral artery and passed into the aorta or renal artery, radiopaque fluid is in stilled, and serial films are taken.
- Used to diagnose renal hypertension and pheochromocytoma and differentiate renal cyst from tumors.
Postangiogram nursing actions:
1. Check pedal pulse for signs of decreased circulation.
2. Cystoscopy – Visualization of bladder, urethra, and prostatic urethra by insertion of a
tubular, lighted, telescopic lens (cystoscope) through the urinary meatus.
- Used to directly inspect the bladder; collect urine from the renal pelvis; obtain biopsy specimens from bladder and urethra; remove calculi; and treat lesions in the bladder, urethra, and prostate.
Nursing actions following procedure:
· Observe for urinary retention
· Warm sitz baths to relieve discomfort
3. Renal biopsy – needle aspiration of tissue from the kidney for the purpose of
microscopic examination.
Procedures to evaluate the digestive system:
Esophagoscopy and gastroscopy – visualization of the esophagus, the stomach, and sometimes the duodenum by means of a lighted tube inserted through the mouth.
Proctoscopy – visualization of rectum and colon by means of a lighted tube inserted through the anus.
Peritoneoscopy – direct visualization of the liver and peritoneum by means of a peritoneoscope inserted through an abdominal stab wound.
Liver biospsy – needle aspiration of tissue for the purpose of microscopic examination; used to determine tissue changes, facilitate diagnosis, and provide information regarding a disease course.
Nursing action:
1. Place patient on right side and position pillow for pressure, to prevent bleeding.
5. Paracentesis – needle aspiration of fluid from the peritoneal cavity used to relieve excess fluid accumulation or for diagnostic studies.
a. Specific nursing actions before paracentesis:
a. Have patient void - to prevent possible injury to bladder during procedure
b. Position – sitting up on side of bed, with feet supported by chair.
c. Check vital signs and peripheral circulation frequently throughout procedure
d. Observe for signs of hypovolemic shock – may occur due to fluid shift from vascular compartment following removal of protein – rich ascitic fluid.
b. Specific nursing actions following paracentesis:
a. Apply pressure to injection site and cover with sterile dressing.
b. Measure and record amount and color of ascitic fluid; send specimens to lab for diagnostic studies.
D. Procedures to evaluate the reproductive system in women
1. Culdoscopy – surgical procedure in which a culdoscope is inserted into the posterior vaginal cul-de-sac
- Used to visualize uterus, fallopian tube, and peritoneal contents.
2. Breast biopsy – needle aspiration or incisional removal of breast tissue for microscopic examination.
- used to differentiate among benign tumors, cysts, and malignant tumor in the breast.
3. Uterotubal insufflation (Rubin’s Test) – injection of carbon dioxide into the cervical canal.
- Used to determin fallopian tube patency
E. Procedure to evaluate the neuroendocrine system
1. Cerebral angiography – fluoroscopic visualization of the brain vasculature after injection of a contrast medium into the carotid or vertebral arteries
- used to localize lesions (tumors, abscesses, and occlusions) that are large enough to distort cerebrovascular blood flow.
2. Myelogram – through a lumbar-puncture needle, a contrast medium is injected into the subarachnoid space of the spinal column to visualize the spinal cord.
- Used to detect herniated or ruptured intervertebral disks, tumors and cysts that compress or distort spinal cord.
Nursing consideration:
· Elevate head of bed = with water soluble contrast
· Flat position – with oil contrast
· V/s every 4 hr for 24 hr.
3. Lumbar puncture – puncture of the lumbar subarachnoid space of the spinal cordwith a needle to withdraw samples of cerebrospinal fluid.
- Used to evaluate CSF for infections and determine presence of hemorrhage.
Note: not done if increased ICP is suspected
Position: Before : fetal position / knee chest position
After : flat or supine
Test
Indication
Antigen skin
Test to rule-out cancer of the lungs
Benedict’s test
For glucose monitoring
Bentonite Flacculation Test
Test for filariasis
Beutler’s test
Test for galactosemia
Blanching test
Determines the impairment in circulation
Bronsulpthalein test
Liver angiography
Caloric test
Test done by placing water in the ear canal causes nystagmus. A test for inner ear
CD4 determination
Checking the immune status to AIDS patient
Cerebral perfusion test
Test used to check the cerebral function
Coomb’s test
Determines the production of the antibodies. RhoGAM is given (1st 72 hours)
CPK BB
Test for brain muscles
CPK MB
Test for cardiac muscles: for MI
CPK MM
Test for muscle injury
Dark field illumination test and kalm test
Determination for the presence of syphilis
Dick test
Detect scarlet fever
Dull’s eye test
Determines the presence of blindness. Done in 1st ten days (+) normal (-) abnormal
ELISA test
Determines presence of HIV
Gram staining and Culture of cervical and urethral smear
Determination for the presence of gonorrhea
Gross hearing test
Test used by whispering words or spoken voice test
Guthrie test
Test for PKU
Heat and Acetic acid test
For protein or albumin detection
Immunochromatographic test
A rapid assessment method done for filariasis. The antigen test that can be done at daytime
Jones Criteria
One way of diagnosing Rheumatic heart fever
Lepronin test
A screening test for leprosy
Liver enzyme test
For SGOT and SGPT
Liver profile test
Determines Hepa-b surface antigen
Lumbar puncture
Determines for the presence of meningitis and encephalitis. Position the patient in side lying position
Malaria smear
Test to confirm malaria; specimen is taken at the height or peak of fever
Mantoux test
Determination for TB exposure
Meniere’s test
Test for vestibular function
Methylene blue test
For ketone detection
Moloney test
Hypersensitivity test for Diphtheria
Oxytocin challege test
Determines if the fetus can tolerate uterine contraction; (+) CS is necessary
Pandy’s test
Determines the presence of protein in the CSF
Phenosulpthalein test
Kidney angiogram
Queckkenstedt’s test
Test that involve the compression of jugular veins
Rectal swab
Done in patient with cholera, pinworm detection
Rinne Test
Shifted between mastoid bone and two inches from the ear canal opening
Romberg’s test
Assess gait and station such as ataxia
Schick test
Susceptibility test for diphtheria (+) no immunity (-) with immunity
Schiller’s test
Staining the cervix with an iodine solution. Healthy tissues will turn brown, while cancerous tissue resist the stain
Schilling test
Used to patient with severe chilling sensation; for confirmation of pernicious anemia
Schwabach test
Differentiate between conductive and sensorineural deafness, mastoid of patient and examiner
Shake test
Determines the amount of surfactant in the lungs.
Skin test
Purpose it to produce antigen reaction
Slit skin smear
A confirmatory test for leprosy
Specific gravity test
For diabetes mellitus and insipidus as well as for dehydration
Sperm count test
For male infertility (low sperm count-oversex)
Sputum exam
For defection and sensitivity of causative microorganism, for pneumonia and TB
Sulkowitch test
Urine test detection for calcium deficiency and calcium in the urine
Sweat chloride test
Used to diagnosed cystic fibrosis
Tensilon (Endophonium) test
For rapid detection of myasthenia gravis
Tonometer
Test used to measure ocular tension and helping in detecting early glaucoma N=12-20 mmHg
Torniquet test
Done to determine presence of petechiae in Dengue Hemorrhagic fever
TZANK test
Determination for the presence of herpes simplex
Weber test
Evaluation of bone conduction. Tuning fork is placed on patient’s forehead or teeth
Wedal’s Test
For typhoid fever determination
Western blot test
A confirmatory for AIDS
Arterial Blood Gases
Type
Causes
Manifestations
Management
Respiratory Acidosis
pH<7.35;
PaCO2>45
. COPD
. Respiratory
. Overdose
. Atelectasis
. Pulmonary edema
. Aspiration
. Weakness
. Tachycardia
. Decreased LOC
. Headache
. Assess VS
. Monitor
. ABG
. CPT
. TCDB
Respiratory
Alkalosis
pH>7.45;
PaCO2<35
. Hyperventilation
. Anxiety
. Pain
. Ventilators
. Lightheadedness
. Ringing of the
ears
. Tingling
. Slow
breathing
. Paper bag
Metabolic
Acidosis
pH<7.35;
HCO3,22
. DKA
. Diarrhea
. ASA poisoning
. Renal failure
. Headache
. N/V
. Kussmaul
respiration
. Dysrhythmias
. Administer sodium
bicarbonate
. Monitor I/O
. Use seizure
precautions
Metabolic
Alkalosis
PH>7.45;
HCO3>26
. Vomiting
. NGT
. Diuretics and
Antacids
. Tingling
. Dizziness
. Bradypnea
. Monitor VS
. I/O
. ABG
Remember : Respiratory Opposite; Metabolic Equal
Facts : pH = 7.35 – 7.45 PCO2 = 34 – 45 HCO3=22-26
Emergency Drug
Initial Dose
Indications
Adenosine
6 mg
Atropine sulfate
0.5 – 1 mg.q 3-5 min
Bradycardia
Epinephrine
1 mg.q 3-5 min
Cardiac arrest
Lasix
0.5-1 mg/kg
Pulmonary edema
Lidocaine
1-1.5 mg/kg
Ventricular fibrillation, Ventricular tachycardia
Magnesium sulfate
1-2 g
Ventricular tachycardia r/t hypomagnesemia
Morphine Sulfate
1-3 mg
Chest pain, pulmonary edema
Narcan
0.02-2mg
Narcotic – respiratory depression
Nitroglycerine
0.4 mg SL
Chest pain, pulmonary edema
Vasopressin
40 units
Cardiac arrest
Antidotes
Agents
Antidotes
Acetaminophen
Acetylcysteine (Mucomyst)
Anticholinesterase
Atropine So4
Anticholinergics
Physostigmine
Benzodiazepines
Flumazenil
Coumadine
Vitamin K
Cyanide
Sodium nitrate
Digoxin
Digoxin immune fab (Digibind)
Dopamine
Phentolamine
Heparin
Protamine sulfate
Iron
Deferoxamine
Lead
Dimercaprol, edetate disodium and succimer
Magnesium Sulfate
Calcium gluconate
Narcotics
Naloxone
Drug Name Endings: What they can suggest you!!!
Endings class
*cain
Local anesthetics
*cillin
Antibiotics
*dine
Antiulcer agent
*done
Opiod analgesics
*ide
Oral hypoglycemics
*lam/
*pam
Antianxiety
*micin/
*mycin
Antibiotics
*mine/
*zide
Diuretics
*olol
Beta blockers
*pril
ACE inhibitors
*sone
Steroids
FREQUENTLY ASKED MEDICATIONS
Drugs Trade /(generics)
Classification
Desired Effects
Best Time to be Taken
Other Considerations
1
Aminophylline (theophylline)
Bronchodilator
To case breathing
AM / empty stomach
· No smoking
· No caffeine
· Check heart rate
2
Amphogel (aluminum hydroxide)
Antacid
âphosphate level
Between meals and HS
· Give with glass of water
· Report melena
3
Antabuse (disulfiram)
Antialcoholic agent
Avoidance of alcohol
After 12 hrs. stoppage from alcohol
· No alcohol in any means
4
Aspirin (ASA)
Anti-inflammatory
Anti-pyretic
Analgesic
â temperature
â pain and inflammation
Full stomach
· Check for bleeding tendencies
· Syrup of inpecae in case of overdose
5
Atropine SO4
Anticholinergic and Vagolytic
á heart rate and decrease secretion s
30 PC
· Observe facial flushing
· Avoid hot environment
6
Bacterium (cotrimoxazole)
Antibiotic
(-) infection
PC
· Reddish urine
· Rashes
· Assess for signs of nephrotoxicity
7
Benadryl (diphenhydramine hcl)
Antihistamine
Anti – EPS
(-) allergy
(-) movement syndrome
Best taken with food
· Avoid alcohol
8
Celestone (betamethazone)
Steroids
ârespiratory distress in newborn
Best taken with food
· Monitor weight
9
Cytoxan (cyclophosphamide)
Antineoplastic
âsize of tumor
AM
· Increase fluids
· Monitor CBC
10
Diabinase (chlorpropaminde)
Antidiabetic agent
Normal glucose range
AM
· Monitor for hypoglycemia
11
Diamox
(acetazolamide)
Antiglaucoma antidiuretics
â urine output
â vertigo
AM with meals
· Photosensitivity
12
Digoxin (lanoxin)
Cardiac glycoside
Normal heart rate
AM
· Assess pulse rate
· Monitor serum K
13
Dilantin (phenytoin)
Anti-convulsant
(-) seizure
Best taken with food
· Taper dosage
14
Diuril (chlorothiazide)
Diuretics
á urine output
Best taken with food
· Report weakness in the extremities
· Increase K in the diet
15
Epinephrine
Bronchodilator
á heart rate
AM
· Don’t operate machineries and drive automobile
· Assess for increase pulse
16
Flagyl (metronidazole)
Antihelmintic
(-) helminth
Best taken with food
· Avoid alcohol
· Not to give with antabuse
· Tetratogenic
17
Haldol (haloperidol)
Antipsychotic
á (+) symptoms of psychosis
AC
· Assess BP
· Photosensitivity
18
Kayexalate
Promote excretions of K
â serum K
· May cause constipation
· Monitor serum potassium
19
Lasix (furosemide)
Diuretic
á urine output
AM
· Increase intake of food rich in K
20
Lithane (LiCO3)
Antimanic
â hyperactivity
PC
· Monitor lithium toxicity
· Decrease activity
21
Lovenox (mevacor)
Antithrombotic
(-) thrombosis
· Soft bristle toothbrush
· No razor
· Keep protamine SO4
22
Magnesium SO4
Anticonvulsant
(-) convulsion
· Assess DTR and PR
· Antidote is Calcium gluconate
23
Mastinon (pyridostigmine)
Cholinesterase inhibitor
á muscle strength
PC
· Monitor for muscle weakness
· Antidote is atropine SO4
24
Mathergine (methylergonovine maleate)
Oxytocic for post partum atony
Firmly contracted uterus
· Monitor BP
· Report dyspnea
25
Monoamine oxidase inhibitor
Antidepressant
Improved sleeping pattern
PC
· No tyramine rich food
· Assess for hypertensive crisis
· Monitor BP
26
Nitroglycerin
Antiangina
(-) chest pain
Best taken before any strenuous activity
· Taken SL; don’t chew
· Keep tablets in dark container
27
Pancrease (pancreatin)
Pancreatic enzyme
(-) fat in the stool
Between meal and snacks
· Preparation is enteric coated, don’t show
· Observe for diarrhea
28
Phenergan (promethazine hyrochloride)
Antihistamine
(-) allergy
Empty stomach
· Antidote is epinephrine
29
Reserpine (serpasil)
Antihypertensive
â BP
Best taken with meals
· No sudden change of position
· Monitor BP and PR
30
Ritalin (methylphenidate)
Stimulant
â hyperactivity
AM / PC
· Monitor growth and development
31
Robaxin (methocarbamol)
Skeletal muscle relaxant
(-) muscle spasm
AM
· No alcohol
· Antidote : Epinephrine
32
Synthroid (levothyroxine sodium)
Thyroid hormone supplement
Normal T4 level
AM
· Monitor BP and PR
33
Tagamet (cimetidine)
Antiacidity
(-) heartburn
Best taken with food
· Avoid smoking
34
Thorazine (chlorpromazine hcl)
Antipsychotic
(-) positive signs of psychosis
PC
· Photosensitivity
· Monitor BP
35
Valium (diazepam)
Antianxiety
(-) anxiety
AC
· No alcohol, caffeine
36
Xylocaine (lidocaine)
Antiarrythmic
Normal heart rate
· Monitor for toxicity – convulsion
· S / E : tinnitus
37
Zyloprim (allopurinol)
Antigout
â uric acid
Best taken with food
· Increase fluid intake, restrict vit. C
Common Tubes
Table or Apparatus
Purpose
Examples of Use
Key points
Miller-Abbott tube
Longer than Levin tube; has mercury of air in bags so tube can be used to decompress the lower intestinal tract
1. Small-bowel obstructions
2. Intussusception
3. Volvulus
1. Care similar to that Levin NG tube irrigated.
2. connected to suction, not sterile technique
3. orders will be written on how to advance the tube gently pushing tube a few inches each hour, patient position may affect advancement of tube
4. X-rays determine the desired location of tube
Cantor Tube
To drain bile from the common bile duct until edema has subscribed
Cholecystectomy when a common duct exploration (CDE) or choledochostomy was also done
1. Bile drainage is influenced by position of the drainage bag.
2. Clamp tubes as ordered to see if bile will flow into duodenum, normally.
T-tube
A type of closed-wound drainage connected to suction-used to drain, a large amount of serosanguineous drainage from under an incision
1. Mastectomy
2. Total hip procedure
3. Total knee procedure
1. May compress unit, and have portable vacuum or connect to wall suction.
2. Small drainage tube may get clogged physician may irrigate these at times
Hemovac
A method of closed wound suction drainage indicate when tissue displacement and tissue trauma may occur with rigid drain tubes (e.g Hemovac)
1. Neurosurgery
2. Neck surgery
3. Mastectomy
4. Total knee and hip replacement
5. Abdominal surgery
6. Urological procedure
Empty reservoir when full, to prevent loss of wound drainage and back contamination
Jackson-Pratt
See Hemovac
See Hemovac
See Hemovac
Three-way Foley
To provide avenues for constant irrigation and constant drainage of urinary bladder
1. Transurethral resection (TUR)
2. Bladder infection
Watch for blocking by clots causes bladder spasms
Irrigant solution often has antibiotic added to normal salin or sterile water
Sterile water rather than normal saline may be used for lysis of clots
Suprapubic catheter
To drain bladder via an opening through the abdominal wall above the pubic bone
Suprapubic prostatectomy
May have orders to irrigate prn or continuously
Ureteral catheter
To drain urine feom the pelvis of one kidney, or for splinting ureter
1. Cystoscopy for diagnostic workups
2. Ureteral surgery
3. Pyelotomy
Never clamp the tube-pelvis of kidney only holds 4-8 mL
Use only 5 mL sterile normal saline if ordered to irrigate
Common Diagnostics Procedures
Noninvasive Diagnostic Procedures
Characteristics:
1. it provides an indirect assessment of organ size, shape, and / or function
2. it is safe
3. it is easily reproducible
4. it requires less complex equipment for recording
5. it does not require the written consent of patient or guardian
General Nursing Tasks:
1. Decrease patients anxieties and offer support by
a. Explain purpose and procedure of test
b. Acknowledge questions regarding safety of the procedure
c. Remain with the patient while the procedure is going on
2. Use procedure in the collection of specimens that avoids contamination
A. Graphic studies of Heart and brain
Electrocardiogram (ECG) – graphic record of electrical activity generated by the heart during depolarization and repolarazation.
- diagnose abnormal cardiac rhythms and coronary heart disease
Echocardiography (ultrasound cadiography) – graphic record of motions produced by cardiac structure as high-frequency sound vibrations are echoed though chest wall into the heart.
- used to demonstrate valvular or other structural deformities, detect pericardial effudion, diagnose tumors and cardiomegaly, evaluate prosthetic valve function.
Electroencephalogram (ECG) – graphic record of the electrical potentials generated by the physiological activity of the brain
- used to detect surface lesions or tumors of the brain and presence of epilepsy.
Echoencephalogram – beam of ultrasound is passed though the head, and returning echoes are graphically recorded.
- used to detect subdural hematomas, intracerebral hemorrhage, or tumors.
B. Roentgenological studies (X-ray)
Chest – used to determine size, contour of the heart; size, location, and nature of pulmonary lesions: pleural thickening and effusions: pulmonary vasculature: disorder of thoracic ones and soft tissues.
- used lead shield to protect pregnant woman
Kidney, Ureter, and Bladder (KUB) – used to determine size, shape, and position of kidney, ureter and bladder
- No special consideration
Breast (Mammography) – examination of the breast with or without the injection of the radiopaque substance into the duct of mammary gland.
- used to determined the presence of tumor or cyst (best done a week after menstruation)
- no deodorant, perfume, powder, or ointment in underarm area on the day of X-ray (contains Calcium oxalate)
- May be uncomfortable due to the pressure on the breast. (uses two x-ray plates)
C. Roentgenological studies (FLUOROSCOPY) – requires the ingestion or injection of a contrast medium to visualize the target organ.
Additional Nursing Task:
a. Administration of enemies or cathartics before the procedure and laxative after.
b. Keeping the patient NPO 6-12 hours before examination
c. Ascertain patient’s allergy and allergic reactions
d. Observing for allergic reactions to contrast medium
e. Providing fluid and food after procedure to prevent dehydration
f. Observe stool for color and consistency until barium passes
Upper GI (Barium swallow) – ingestion of barium sulfate or meglumine diatrizoate (Gastrografin [white and chalky substance], followed by fluoroscopic and x-ray examination)
- used to determine patency and caliber of the esophagus and to detect esophageal varices, mobility of gastric wall, presence of ulcer, filling defects due to tumor, patency of pyloric valve and presence of structural abnormalities
Lower GI (Barium Enema) – rectal instillation of barium sulfate followed by glouroscopic and x-ray examination
- used to determine contour and mobility of colon and presence of any space-occupying tumors. Perform before upper GI
Patients preparations:
- no food after evening meal the evening before the test
- stool softener laxatives and enema suppositories to cleanse the bowel before the test
- NPO after midnight before the test
After care:
- increased fluid intake, food and rest
- laxatives for at least two days or until stools are normal in color and consistency
Cholecystogram – ingestion of organic iodine contrast medium (Telepaque) followed in 12 hour by x-ray visualization
- gallbladder disease is indicated with poor or no visualization of the bladder
- accurate only if GI and liver function is intact
- perform before barium swallow and barium enema
Patients preparations:
- administer large amount of water with contrast capsule
- low-fat meal before evening before x-ray
- oral laxative of stool softener after meal
- no food allowed after contrast capsule
After care:
- increased fluid intake, food and rest
- observe for any untoward reactions
Intravenous Pyelography (IVP) – injection of a radiopaque contrast medium in the vein of the client to visualize ureter, bladder and kidney
Patients preparations:
- Laxative in the evening before the examination
- NPO for 12 hours
- Cleaning enema morning of the procedure
After care:
- increased fluid intake, food and rest;
- observe for any untoward reactions
D. Computed Tomography (CT) – an x-ray beam sweeps around the body, allowing measuring of various tissue densities. Provides clear radiographic deficition of structures that are not visible by other techniques.
- initial scan may be followed by “contrast enhancement” using an injection of contrast agent iodine via vein, followed by a repeat scan.
Patients preparations:
- instructions for eating before test vary
- clear liquids up to 2 hours before the procedure are permitted
E. Magnetic resonance imaging (MRI) – noninvasive technique that produces cross sectional images by exposure to magnetic energy sources. It uses no contrast medium; takes 30-0 minutes to complete. Patient may still for periods of 5-20 minutes at a time.
Patients preparations:
- patient can take food and medications except for low abdominal and pelvic studies (food and fluid withheld) 4-6 hr to decrease peristalsis)
- Restrictions
a. those who have metal implants
b. those with permanent pacemakers
c. those who are pregnant
F. Ultrasound (sonogram) – uses sound waves to diagnose disorders of the thyroid, kidney, liver, uterus, gallbladder, fetus and intracranial structures of the neonate.
Patients preparations:
- advise client not to chew gum or smoke before the procedure
- no x-ray
- for gallbladder studies; NPO for 8 hours
- for lower abdomen and uterus ; 32 ounces of water PO 30 minutes before the procedure
G. Pulmonary function studies
Ventilatory studies – use of incentive spirometer to determine how well the lung is ventilating.
Vital capacity (VC) – largest amount of air that can be expelled after maximal inspiration
Normal = 4000 – 5000 mL.
Decrease = indicate lung disease
Increase or decrease = indicate chronic obstructive lung disease
Forced expiratory volume (FEV) – percentage of vital capacity that can be forcibly expired in 1, 2, or 3 seconds.
Normal = 80 – 83% in 1 sec
90 – 94% in 2 sec
95 – 97% in 3 sec
decrease = indicate expiratory airway obstruction
H. Sputum Studies
Gross sputum evaluations – collection of sputum samples to ascertain quantity, consistency, color and odor
Sputum smear – sputum is smeared thinly on a slide so that it can be studied microscopically.
- used to determine cytological changes or presence of pathogenic microorganism
Sputum culture – sputum samples are implanted or inoculated into special media.
- used to diagnosed pulmonary infection
I. Examination of the gastric contents
Gastric analysis – aspiration of the contents of the fasting stomach analysis of free and total acid
Gastric acidity increase : duodenal ulcer
Gastric acidity decrease : pernicious anemia an cancer of the stomach
J. Doppler ultrasound – measures blood flow in the major veins and arteries. The transducer of the test instrument is placed on the skin, sending ultra-high-frequency sound.
- sound varies with respiration and valsalva maneuver
- no discomfort to the patient.
K. Glucose Testing – to detect disorder of glucose metabolism, such as diabetes.
Fasting blood sugar (FBS) – blood sample is drawn after a 12 fast (usually midnight). Water is allowed.
Normal blood glucose ; 60 – 120 mg/dL
Diabetic patient = 126 mg/dL
2 hr postprandial (PPBS) – blood is taken after meal
Patients preparations:
- offer a high-carbohydrate diet for 2-4 days before testing
- patient fast overnight
- eats a high-carbohydrate breakfast
- blood sample is drawn 2 hr interval
- no cigarette smoking and caffeine for these may increase glucose level
Common Diagnostics Procedures
Invasive Diagnostics Procedures
Characteristics:
it directly records the size, shape and function of an organ;
it requires the written consent of the patient or guardian;
it may result in morbidity and occasionally death.
General Nursing Task:
Before procedure:
have patient sing permit to procedure
ascertain and repot any patient history of allergy or allergic reaction
explain procedure briefly and accurately
explain that contrast medium might cause flushing or warm feeling
keep patient NPO 6-12 hour before procedure if anesthesia is to be used
allow patient to verbalize concerns
administer preprocedure sedatives, as ordered
if procedure done at bed side:
- remain with patient and offer reassurance
- assist with optimal positioning of patient
- observe for indication of complications – shock, pain and dyspnea
After procedure:
observe and record vital signs
check injection or biopsy sites for bleeding, infection, tenderness, or thrombosis
· report untoward reaction to the physician
· apply warm compress to ease discomfort, as ordered
if tropical anesthesia is used during procedure, do not give food or fluid until gag reflex returns
encourage relaxation by allowing patient to discuss experience and verbalize feelings.
A. Procedures to evaluate the cardiovascular system
1. Angiography – intravenous injection of radiopaque solution or contrast for the purpose of studying its circulation through the patient’s heart, lungs and great vessels.
- Used to check the competency of the heart valves, diagnose congenital septal defects, study heart function and structure before cardiac surgery, detect occlusions of coronary arteries.
2. Cardiac catheterization – insertion of a radiopaque catheter into a vein to study the heart great vessels.
- Used to confirm diagnosis of heart disease and determine extent of disease, measure pressures in the heart chamber and great vessels, obtain estimate of cardiac output, and obtain blood samples to measure oxygen content.
a. Right heart catheterization – catheter is inserted through a cut-down in the antecubital vein into the superior vena cava, through the right atrium and ventricle and into the pulmonary activity.
b. Left-heart catheterization- catheter maybe passed retrograde to the left ventricle through the brachial and femoral artery, it can be passed through the left atrium after right-heart catherization by means of a special needle that punctures the septa; or it may be passed directly into the left ventricle by means of a posterior puncture.
Specific nursing considerations:
Preprocedure patient teaching:
a. Fatigue is a common complaint due to lying still for 3 hr
b. Feeling of fluttery sensation while the catheter is passed back into the left ventricle
c. Flushed, warm feeling may occur when contrast medium is injected.
Postprocedure observations:
a. monitor ECG pattern for arrhythmias
b. check extremities for color and temperature, peripheral pulses for quality.
3. Angiography (Arteriography) – injection of a contrast medium in to the arteries to
study the vascular tree.
- Used to determine obstructions or narrowing of peripheral arteries.
B. Procedure to evaluate the respiratory system
Lung scan – injection of radioactive isotope into the body, followed by lung scintiscan, which produces a graphic record of gamma rays emitted by the isotopes in the tissues.
- used to determine lung perfusion when pulmonary emboli and infarctions are suspected.
Pulmonary angioghraphy – x – ray visualization of the pulmonary vasculature after the injection of a radiopaque contrast medium.
- used to evaluate pulmonary disorders such as pulmonary embolism, lung tumor and aneurysms, and changes in the pulmonary vasculature due to such conditions as emphysema.
Bronchoscopy – introduction of a fiberoptic scope into the trachea and bronchi
- used to inspect tracheobronchial tree for pathological changes, remove foreign bodies or mucous plugs causing airway obstruction, and apply chemotherapeutic agents.
a. Prebronchoscopy interventions:
· oral hygiene
· postural drainage as indicated
b. Postbronchoscopy interventions:
· Instruct patient not to swallow oral secretions
· Save expectorated sputum for laboratory analysis
· NPO till gag reflex returns
· Observe for subcutaneous emphysema and dyspnea
· Apply ice collar to reduce throat discomfort
Thoracentesis – needle puncture through the chest wall and into the pleura
- used to remove fluid and occasionally air from the pleural space
- nursing considerations
a. position : high fowler’s position or sitting upon edge of the bed, with feet supported on the chair.
b. If the patient is unable to sit up – turn unto unaffected side
a. Position: high fowler’s position or sitting upon edge of the bed, with feet supported on the chair.
b. If the patient’ is unable to sit up-turn unto unaffected side
C. Procedures to evaluate the renal system
1. Renal angiogram – small catheter is inserted into the femoral artery and passed into the aorta or renal artery, radiopaque fluid is in stilled, and serial films are taken.
- Used to diagnose renal hypertension and pheochromocytoma and differentiate renal cyst from tumors.
Postangiogram nursing actions:
1. Check pedal pulse for signs of decreased circulation.
2. Cystoscopy – Visualization of bladder, urethra, and prostatic urethra by insertion of a
tubular, lighted, telescopic lens (cystoscope) through the urinary meatus.
- Used to directly inspect the bladder; collect urine from the renal pelvis; obtain biopsy specimens from bladder and urethra; remove calculi; and treat lesions in the bladder, urethra, and prostate.
Nursing actions following procedure:
· Observe for urinary retention
· Warm sitz baths to relieve discomfort
3. Renal biopsy – needle aspiration of tissue from the kidney for the purpose of
microscopic examination.
Procedures to evaluate the digestive system:
Esophagoscopy and gastroscopy – visualization of the esophagus, the stomach, and sometimes the duodenum by means of a lighted tube inserted through the mouth.
Proctoscopy – visualization of rectum and colon by means of a lighted tube inserted through the anus.
Peritoneoscopy – direct visualization of the liver and peritoneum by means of a peritoneoscope inserted through an abdominal stab wound.
Liver biospsy – needle aspiration of tissue for the purpose of microscopic examination; used to determine tissue changes, facilitate diagnosis, and provide information regarding a disease course.
Nursing action:
1. Place patient on right side and position pillow for pressure, to prevent bleeding.
5. Paracentesis – needle aspiration of fluid from the peritoneal cavity used to relieve excess fluid accumulation or for diagnostic studies.
a. Specific nursing actions before paracentesis:
a. Have patient void - to prevent possible injury to bladder during procedure
b. Position – sitting up on side of bed, with feet supported by chair.
c. Check vital signs and peripheral circulation frequently throughout procedure
d. Observe for signs of hypovolemic shock – may occur due to fluid shift from vascular compartment following removal of protein – rich ascitic fluid.
b. Specific nursing actions following paracentesis:
a. Apply pressure to injection site and cover with sterile dressing.
b. Measure and record amount and color of ascitic fluid; send specimens to lab for diagnostic studies.
D. Procedures to evaluate the reproductive system in women
1. Culdoscopy – surgical procedure in which a culdoscope is inserted into the posterior vaginal cul-de-sac
- Used to visualize uterus, fallopian tube, and peritoneal contents.
2. Breast biopsy – needle aspiration or incisional removal of breast tissue for microscopic examination.
- used to differentiate among benign tumors, cysts, and malignant tumor in the breast.
3. Uterotubal insufflation (Rubin’s Test) – injection of carbon dioxide into the cervical canal.
- Used to determin fallopian tube patency
E. Procedure to evaluate the neuroendocrine system
1. Cerebral angiography – fluoroscopic visualization of the brain vasculature after injection of a contrast medium into the carotid or vertebral arteries
- used to localize lesions (tumors, abscesses, and occlusions) that are large enough to distort cerebrovascular blood flow.
2. Myelogram – through a lumbar-puncture needle, a contrast medium is injected into the subarachnoid space of the spinal column to visualize the spinal cord.
- Used to detect herniated or ruptured intervertebral disks, tumors and cysts that compress or distort spinal cord.
Nursing consideration:
· Elevate head of bed = with water soluble contrast
· Flat position – with oil contrast
· V/s every 4 hr for 24 hr.
3. Lumbar puncture – puncture of the lumbar subarachnoid space of the spinal cordwith a needle to withdraw samples of cerebrospinal fluid.
- Used to evaluate CSF for infections and determine presence of hemorrhage.
Note: not done if increased ICP is suspected
Position: Before : fetal position / knee chest position
After : flat or supine
Test
Indication
Antigen skin
Test to rule-out cancer of the lungs
Benedict’s test
For glucose monitoring
Bentonite Flacculation Test
Test for filariasis
Beutler’s test
Test for galactosemia
Blanching test
Determines the impairment in circulation
Bronsulpthalein test
Liver angiography
Caloric test
Test done by placing water in the ear canal causes nystagmus. A test for inner ear
CD4 determination
Checking the immune status to AIDS patient
Cerebral perfusion test
Test used to check the cerebral function
Coomb’s test
Determines the production of the antibodies. RhoGAM is given (1st 72 hours)
CPK BB
Test for brain muscles
CPK MB
Test for cardiac muscles: for MI
CPK MM
Test for muscle injury
Dark field illumination test and kalm test
Determination for the presence of syphilis
Dick test
Detect scarlet fever
Dull’s eye test
Determines the presence of blindness. Done in 1st ten days (+) normal (-) abnormal
ELISA test
Determines presence of HIV
Gram staining and Culture of cervical and urethral smear
Determination for the presence of gonorrhea
Gross hearing test
Test used by whispering words or spoken voice test
Guthrie test
Test for PKU
Heat and Acetic acid test
For protein or albumin detection
Immunochromatographic test
A rapid assessment method done for filariasis. The antigen test that can be done at daytime
Jones Criteria
One way of diagnosing Rheumatic heart fever
Lepronin test
A screening test for leprosy
Liver enzyme test
For SGOT and SGPT
Liver profile test
Determines Hepa-b surface antigen
Lumbar puncture
Determines for the presence of meningitis and encephalitis. Position the patient in side lying position
Malaria smear
Test to confirm malaria; specimen is taken at the height or peak of fever
Mantoux test
Determination for TB exposure
Meniere’s test
Test for vestibular function
Methylene blue test
For ketone detection
Moloney test
Hypersensitivity test for Diphtheria
Oxytocin challege test
Determines if the fetus can tolerate uterine contraction; (+) CS is necessary
Pandy’s test
Determines the presence of protein in the CSF
Phenosulpthalein test
Kidney angiogram
Queckkenstedt’s test
Test that involve the compression of jugular veins
Rectal swab
Done in patient with cholera, pinworm detection
Rinne Test
Shifted between mastoid bone and two inches from the ear canal opening
Romberg’s test
Assess gait and station such as ataxia
Schick test
Susceptibility test for diphtheria (+) no immunity (-) with immunity
Schiller’s test
Staining the cervix with an iodine solution. Healthy tissues will turn brown, while cancerous tissue resist the stain
Schilling test
Used to patient with severe chilling sensation; for confirmation of pernicious anemia
Schwabach test
Differentiate between conductive and sensorineural deafness, mastoid of patient and examiner
Shake test
Determines the amount of surfactant in the lungs.
Skin test
Purpose it to produce antigen reaction
Slit skin smear
A confirmatory test for leprosy
Specific gravity test
For diabetes mellitus and insipidus as well as for dehydration
Sperm count test
For male infertility (low sperm count-oversex)
Sputum exam
For defection and sensitivity of causative microorganism, for pneumonia and TB
Sulkowitch test
Urine test detection for calcium deficiency and calcium in the urine
Sweat chloride test
Used to diagnosed cystic fibrosis
Tensilon (Endophonium) test
For rapid detection of myasthenia gravis
Tonometer
Test used to measure ocular tension and helping in detecting early glaucoma N=12-20 mmHg
Torniquet test
Done to determine presence of petechiae in Dengue Hemorrhagic fever
TZANK test
Determination for the presence of herpes simplex
Weber test
Evaluation of bone conduction. Tuning fork is placed on patient’s forehead or teeth
Wedal’s Test
For typhoid fever determination
Western blot test
A confirmatory for AIDS
Arterial Blood Gases
Type
Causes
Manifestations
Management
Respiratory Acidosis
pH<7.35;
PaCO2>45
. COPD
. Respiratory
. Overdose
. Atelectasis
. Pulmonary edema
. Aspiration
. Weakness
. Tachycardia
. Decreased LOC
. Headache
. Assess VS
. Monitor
. ABG
. CPT
. TCDB
Respiratory
Alkalosis
pH>7.45;
PaCO2<35
. Hyperventilation
. Anxiety
. Pain
. Ventilators
. Lightheadedness
. Ringing of the
ears
. Tingling
. Slow
breathing
. Paper bag
Metabolic
Acidosis
pH<7.35;
HCO3,22
. DKA
. Diarrhea
. ASA poisoning
. Renal failure
. Headache
. N/V
. Kussmaul
respiration
. Dysrhythmias
. Administer sodium
bicarbonate
. Monitor I/O
. Use seizure
precautions
Metabolic
Alkalosis
PH>7.45;
HCO3>26
. Vomiting
. NGT
. Diuretics and
Antacids
. Tingling
. Dizziness
. Bradypnea
. Monitor VS
. I/O
. ABG
Remember : Respiratory Opposite; Metabolic Equal
Facts : pH = 7.35 – 7.45 PCO2 = 34 – 45 HCO3=22-26
drug codes
Drug Codes:
caine= local anesthetics
ceph/cef - cephalosporin
cillin= antibiotics
cycline – tetracycline (s/e: stains teeth and stunted growth for children)
dine= anti-ulcer agents
done= opiod analgesics
ide= oral hypoglycemics
iam= antianxiety agents
mab – monoclonal anti-bodies
micin= antibiotics
nium= neuromuscular blocking agents
olol= beta blockers
ole= anti-fungal
oxacin= antibiotics
pam= antianxiety agents
pine: calcium channel blockers
pril= ace inhibitors
sone= steroids
statin= antihyperlipidemics
stigmine -cholinergic
vir= antivirals
zide= diuretics
phylline - bronchodilator
cal- calcium
done- opiods
ase- enzyme
line - bronchodilator
vir- antiviral
zide - diuretics
dine - anti-ulcer
ide- oral hyoglycemics
iam-anxiolytics
I would like to give some general rules regarding psychiatry drugs:
1) Cannot be taken with alcohol, stimulants,depressants.
2) Cannot be given to pregnant, lactatingand patients with glaucoma.
3) Cannot be abruptly stooped but mus be tapered slowly
4) All are given after meals except anti anxiety agents( because food interferes with their absorption)
5) All psychiatry drugs have anti cholinergic side effects:
Dizziness, drowsiness, dry mouth, constipation, urinary retention
caine= local anesthetics
ceph/cef - cephalosporin
cillin= antibiotics
cycline – tetracycline (s/e: stains teeth and stunted growth for children)
dine= anti-ulcer agents
done= opiod analgesics
ide= oral hypoglycemics
iam= antianxiety agents
mab – monoclonal anti-bodies
micin= antibiotics
nium= neuromuscular blocking agents
olol= beta blockers
ole= anti-fungal
oxacin= antibiotics
pam= antianxiety agents
pine: calcium channel blockers
pril= ace inhibitors
sone= steroids
statin= antihyperlipidemics
stigmine -cholinergic
vir= antivirals
zide= diuretics
phylline - bronchodilator
cal- calcium
done- opiods
ase- enzyme
line - bronchodilator
vir- antiviral
zide - diuretics
dine - anti-ulcer
ide- oral hyoglycemics
iam-anxiolytics
I would like to give some general rules regarding psychiatry drugs:
1) Cannot be taken with alcohol, stimulants,depressants.
2) Cannot be given to pregnant, lactatingand patients with glaucoma.
3) Cannot be abruptly stooped but mus be tapered slowly
4) All are given after meals except anti anxiety agents( because food interferes with their absorption)
5) All psychiatry drugs have anti cholinergic side effects:
Dizziness, drowsiness, dry mouth, constipation, urinary retention
drug codes
Drug Codes:
caine= local anesthetics
ceph/cef - cephalosporin
cillin= antibiotics
cycline – tetracycline (s/e: stains teeth and stunted growth for children)
dine= anti-ulcer agents
done= opiod analgesics
ide= oral hypoglycemics
iam= antianxiety agents
mab – monoclonal anti-bodies
micin= antibiotics
nium= neuromuscular blocking agents
olol= beta blockers
ole= anti-fungal
oxacin= antibiotics
pam= antianxiety agents
pine: calcium channel blockers
pril= ace inhibitors
sone= steroids
statin= antihyperlipidemics
stigmine -cholinergic
vir= antivirals
zide= diuretics
phylline - bronchodilator
cal- calcium
done- opiods
ase- enzyme
line - bronchodilator
vir- antiviral
zide - diuretics
dine - anti-ulcer
ide- oral hyoglycemics
iam-anxiolytics
I would like to give some general rules regarding psychiatry drugs:
1) Cannot be taken with alcohol, stimulants,depressants.
2) Cannot be given to pregnant, lactatingand patients with glaucoma.
3) Cannot be abruptly stooped but mus be tapered slowly
4) All are given after meals except anti anxiety agents( because food interferes with their absorption)
5) All psychiatry drugs have anti cholinergic side effects:
Dizziness, drowsiness, dry mouth, constipation, urinary retention
caine= local anesthetics
ceph/cef - cephalosporin
cillin= antibiotics
cycline – tetracycline (s/e: stains teeth and stunted growth for children)
dine= anti-ulcer agents
done= opiod analgesics
ide= oral hypoglycemics
iam= antianxiety agents
mab – monoclonal anti-bodies
micin= antibiotics
nium= neuromuscular blocking agents
olol= beta blockers
ole= anti-fungal
oxacin= antibiotics
pam= antianxiety agents
pine: calcium channel blockers
pril= ace inhibitors
sone= steroids
statin= antihyperlipidemics
stigmine -cholinergic
vir= antivirals
zide= diuretics
phylline - bronchodilator
cal- calcium
done- opiods
ase- enzyme
line - bronchodilator
vir- antiviral
zide - diuretics
dine - anti-ulcer
ide- oral hyoglycemics
iam-anxiolytics
I would like to give some general rules regarding psychiatry drugs:
1) Cannot be taken with alcohol, stimulants,depressants.
2) Cannot be given to pregnant, lactatingand patients with glaucoma.
3) Cannot be abruptly stooped but mus be tapered slowly
4) All are given after meals except anti anxiety agents( because food interferes with their absorption)
5) All psychiatry drugs have anti cholinergic side effects:
Dizziness, drowsiness, dry mouth, constipation, urinary retention
medical mnemonics
MEDICAL MNEmONICS
Olivary nuclei: ear vs. eye rolesSuperior Olivary nucleus: SOund localization.· Inferior olivary nucleus is therefore the one for sight [tactile, proprioception also].
HLA-B27 associated diseasesPAIR:PsoriasisAnkylosing spondylitisInflammatory bowel diseaseReiter's syndrome
Endotracheal tube: troubleshootingDOPEY:Displaced: esophagus, right mainstem, back of throat, etcObstructed: secretions, blood, mucus plug, kink, etcPneumothoraxEquipment: malfunctions, O2, ETT, BVM, ventilator, monitorYou: your approach, technique: missing something?
Hypernatremia: causes6 D's:DiureticsDehydrationDiabetes insipidusDocs (iatrogenic)DiarrheaDisease: kidney, sickle cell, etc
Imprinting diseases: Prader-Willi and Angelman"Pray to an Angel":Prader-Willi and Angelman are the 2 classic imprinting diseases.· Which disease results, depends on whether 15q deletion is maternal or paternal. Keep them straight by:Paternal is Prader-Willi.·Cerebellar damage symptomsVANISHED:VertigoAtaxiaNystagmusIntention tremorSlurred (or Staccato) speechExagerrated broad based gaitHypotonic reflexesDysdiadochokinesia.
Argyll-Robertson Pupil featuresArgyll Robertson Pupil (ARP)Read it from front to back: it is ARP, standing for Accomodation Reflex Present.Read it from back to front: it is PRA, standing for Pupillary Reflex Absent.
Einthoven's Triangle: organizationCorners are at RA (right arm), LA (left arm), LL (left leg).Number of L's at a corner tell how many + signs are at that corner [eg LL is ++].Sum of number of L's of any 2 corners tells the name of the lead [eg LL-LA is lead III].For reference axes, the negative angle hemisphere is on the half of the triangle drawing that has all the negative signs; positive angle hemisphere contains only positive signs.
Edwards' syndrome: characteristicsEDWARDS:Eighteen (trisomy)Digit overlapping flexionWide headAbsent intellect (mentally retarded)Rocker-bottom feetDiseased heartSmall lower jaw
Citric acid cycle compounds"Can I Keep Selling Sex For Money, Officer?":CitrateIsocitratealpha KetogluterateSuccinyl CoASuccinateFumerateMalateOxaloacetate
RLQ pain: differentialAPPENDICITIS:Appendicitis/ AbscessPID/ PeriodPancreatitisEctopic/ EndometriosisNeoplasiaDiverticulitisIntussusceptionCrohns Disease/ Cyst (ovarian)IBDTorsion (ovary)Irritable Bowel SyndromeStones
Endometrial carcinoma: risk factorsENDOMET:ElderlyNulliparityDiabetesObesityMenstrual irregularityEstrogen therapyhyperTension
Acute Coronary Syndrome: initial treatmentABCD:AspirinBeta blockerCoagulation (anticoagulation with heparin/LMW Heparin)Double product control (decrease heart rate and blood pressure)
Potter syndrome: featuresPOTTER:Pulmonary hypoplasiaOligohydrominiosTwisted skin (wrinkly skin)Twisted face (Potter facies)Extremities defectsRenal agenesis (bilateral)
Atrioventricular valves"LAB RAT":Left Atrium: BicuspidRight Atrium: Tricuspid
Cranial nerves: sensory, motor or both"Some Say Marry Money But My Brother Says Big Brains Matter More":· From I to XII:SensorySensoryMotorMotorBothMotorBothSensoryBothBothMotorMotor· Alternatives for "Brains": Boobs, Buns, Bras.
Deep tendon reflexes: root supply· God designed body reflexes according to a nursery rhyme:One, two-- buckle my shoe. Three, four-- kick the door. Five, six-- pick up sticks. Seven, eight-- shut the gate.S1,2 = ankle jerkL3,4 = knee jerkC5,6 = biceps and brachioradialisC7,8 = triceps
Cubital fossa contents"Really Need Booze To Be At My Nicest":· From lateral to medial:Radial NerveBiceps TendonBrachial ArteryMedian Nerve
Syncope causes, by systemHEAD HEART VESSELS:· CNS causes include HEAD:Hypoxia/ HypoglycemiaEpilepsyAnxietyDysfunctional brain stem (basivertebral TIA)· Cardiac causes are HEART:Heart attackEmbolism (PE)Aortic obstruction (IHSS, AS or myxoma)Rhythm disturbance, ventricularTachycardia· Vascular causes are VESSELS:VasovagalEctopic (reminds one of hypovolemia)SituationalSubclavian stealENT (glossopharyngeal neuralgia)Low systemic vascular resistance (Addison's, diabetic vascular neuropathy)Sensitive carotid sinus
Axillary artery branches"Screw The Lawyer Save A Patient":Superior thoracicThoracoacromiolLateral thoracicSubscapularAnterior circumflex humeralPosterior circumflex humeralAlternatively: "Some Times Life Seems A Pain".
COPD: blue bloater vs. pink puffer diseasesemPhysema has letter P (and not B) so Pink Puffer.chronic Bronchitis has letter B (and not P) so Blue Bloater.
Pancreatitis: causesBAD S#!T:Biliary: gallstones, 1% of ERCP patientsAlcoholism/ AzotemiaDrugsScorpion bite/ Sea anenome/ SLEHyperlipidemia/ HypercalcemiaIdiopathic/ Infectious (mumps, coxsackie, salmonella, ascariasis)Tumor/ Trauma· The drugs are: penacillamine, furosemide, thiazides, ethacrynic acid, steroids, sulfas, ace inhibitors, N-SAIDs, erythromycin, estrogen.
Pneumonia: risk factorsINSPIRATION:ImmunosuppressionNeoplasiaSecretion retentionPulmonary oedemaImpaired alveolar macrophagesRTI (prior)Antibiotics and cytotoxicsTracheal instrumentationIV dug abuseOther (general debility, immobility)Neurologic impairment of cough reflex, (eg NMJ disorders)
Splenomegaly: causesCHIMP:CystsHaematological ( eg CML, myelofibrosis)Infective (eg viral (IM), bacterial)Metabolic/ Misc (eg amyloid, Gauchers)Portal hypertension
Thrombotic thrombocytopenic purpura: signsFAT RN:FeverAnemiaThrombocytopeniaRenal problemsNeurologic dysfunction
Autonomic Nervous System: Hypothalamic ControlAPPS:Anterior hypothalamic area controls Parasympathetic nervous systemPosterior hypothalamic area controls the Sympathetic.
Lithium: side effectsLITH:LeukocytosisInsipidus [diabetes insipidus, tied to polyuria]Tremor/ TeratogenesisHypothyroidism
Endotracheal tube: troubleshootingDOPEY:Displaced: esophagus, right mainstem, back of throat, etcObstructed: secretions, blood, mucus plug, kink, etcPneumothoraxEquipment: malfunctions, O2, ETT, BVM, ventilator, monitorYou: your approach, technique: missing something?Show Details / Rate It---Brenda L. Snyder, RN, CEN, PHRN George Washington University Hospital, Washington, D.C.
RLQ pain: differentialAPPENDICITIS:Appendicitis/ AbscessPID/ PeriodPancreatitisEctopic/ EndometriosisNeoplasiaDiverticulitisIntussusceptionCrohns Disease/ Cyst (ovarian)IBDTorsion (ovary)Irritable Bowel SyndromeStonesShow Details / Rate It---Anonymous Contributor
JVP: raised JVP differentialPQRST (EKG waves):Pericardial effusionQuantity of fluid raised (fluid over load)Right heart failureSuperior vena caval obstructionTricuspid stenosis/ Tricuspid regurgitation/ Tamponade (cardiac)Show Details / Rate It---Dr. Mohsin Maqbool Bahawal-Victoria Hospital, Bahawalpur
Syncope causes, by systemHEAD HEART VESSELS:· CNS causes include HEAD:Hypoxia/ HypoglycemiaEpilepsyAnxietyDysfunctional brain stem (basivertebral TIA)· Cardiac causes are HEART:Heart attackEmbolism (PE)Aortic obstruction (IHSS, AS or myxoma)Rhythm disturbance, ventricularTachycardia· Vascular causes are VESSELS:VasovagalEctopic (reminds one of hypovolemia)SituationalSubclavian stealENT (glossopharyngeal neuralgia)Low systemic vascular resistance (Addison's, diabetic vascular neuropathy)Sensitive carotid sinusShow Details / Rate It---Bill Young MD University of Kentucky Dept of Emergency Medicine
Pneumothorax: causesSIT, 3 A's, 3 C's:Spontaneous (often tall thin men)IatrogenicTraumaAsthmaAlveolitisAIDSCOPDCarcinomaCystic fibrosisShow Details / Rate It---Jamal Khan Birmingham University Medical Student
Organophosphates poisoning: symptomsDUMBBELS:DiarrheaUrinationMiosisBradycardiaBronchospasmEmesisLacrimationSalivationShow Details / Rate It---Martin Herman Le Bonheur Children's Medical Center
Seizures: differentialSICK DRIFTER:Substrates (sugar, oxygen)Isoniazid overdoseCations (Na, Ca, Mg)Kids (ecclampsia)Drugs (CRAP: Cocaine, Rum (alcohol), Amphetamines, PCP)Rum (alchohol withdrawl)Illnesses (chronic seizure disorder or other chronic disorder)Fever (meningitis, encephalitis, abscess)Trauma (epidural, subdural, intraparynchymal hemorrhage)Extra: toxocologic (TAIL: Theo, ASA, Isoniazid, Lithium) and 3 Anti's: (Antihistamine overdose, Antidepressant overdose, Anticonvulsants (too high dilanitin, tegretol) or benzo withdrawl.Rat poison (organophospates poisoning)Show Details / Rate It---Joseph Rogers, MD Duke University
PEA/Asystole (ACLS): etiologyITCHPAD:InfarctionTension pneumothoraxCardiac tamponadeHypovolemia/ Hypothermia/ Hypo-, Hyperkalemia/ Hypomagnesmia/ HypoxemiaPulmonary embolismAcidosisDrug overdoseShow Details / Rate It---Carl Roberts A.S.EMS, CCEMT-P, CFP US Army Special Forces
ARDS: diagnostic criteriaARDS:Acute onsetRatio (PaO2/FiO2) less than 200Diffuse infiltrationSwan-Ganz Wedge pressure less than 19 mmHgShow Details / Rate It---Fahed Al-Daour
Atrial fibrillation: causes of new onsetTHE ATRIAL FIBS:ThyroidHypothermiaEmbolism (P.E.)AlcoholTrauma (cardiac contusion)Recent surgery (post CABG)IschemiaAtrial enlargementLone or idiopathicFever, anemia, high-output statesInfarctBad valves (mitral stenosis)Stimulants (cocaine, theo, amphet, caffeine)
Olivary nuclei: ear vs. eye rolesSuperior Olivary nucleus: SOund localization.· Inferior olivary nucleus is therefore the one for sight [tactile, proprioception also].
HLA-B27 associated diseasesPAIR:PsoriasisAnkylosing spondylitisInflammatory bowel diseaseReiter's syndrome
Endotracheal tube: troubleshootingDOPEY:Displaced: esophagus, right mainstem, back of throat, etcObstructed: secretions, blood, mucus plug, kink, etcPneumothoraxEquipment: malfunctions, O2, ETT, BVM, ventilator, monitorYou: your approach, technique: missing something?
Hypernatremia: causes6 D's:DiureticsDehydrationDiabetes insipidusDocs (iatrogenic)DiarrheaDisease: kidney, sickle cell, etc
Imprinting diseases: Prader-Willi and Angelman"Pray to an Angel":Prader-Willi and Angelman are the 2 classic imprinting diseases.· Which disease results, depends on whether 15q deletion is maternal or paternal. Keep them straight by:Paternal is Prader-Willi.·Cerebellar damage symptomsVANISHED:VertigoAtaxiaNystagmusIntention tremorSlurred (or Staccato) speechExagerrated broad based gaitHypotonic reflexesDysdiadochokinesia.
Argyll-Robertson Pupil featuresArgyll Robertson Pupil (ARP)Read it from front to back: it is ARP, standing for Accomodation Reflex Present.Read it from back to front: it is PRA, standing for Pupillary Reflex Absent.
Einthoven's Triangle: organizationCorners are at RA (right arm), LA (left arm), LL (left leg).Number of L's at a corner tell how many + signs are at that corner [eg LL is ++].Sum of number of L's of any 2 corners tells the name of the lead [eg LL-LA is lead III].For reference axes, the negative angle hemisphere is on the half of the triangle drawing that has all the negative signs; positive angle hemisphere contains only positive signs.
Edwards' syndrome: characteristicsEDWARDS:Eighteen (trisomy)Digit overlapping flexionWide headAbsent intellect (mentally retarded)Rocker-bottom feetDiseased heartSmall lower jaw
Citric acid cycle compounds"Can I Keep Selling Sex For Money, Officer?":CitrateIsocitratealpha KetogluterateSuccinyl CoASuccinateFumerateMalateOxaloacetate
RLQ pain: differentialAPPENDICITIS:Appendicitis/ AbscessPID/ PeriodPancreatitisEctopic/ EndometriosisNeoplasiaDiverticulitisIntussusceptionCrohns Disease/ Cyst (ovarian)IBDTorsion (ovary)Irritable Bowel SyndromeStones
Endometrial carcinoma: risk factorsENDOMET:ElderlyNulliparityDiabetesObesityMenstrual irregularityEstrogen therapyhyperTension
Acute Coronary Syndrome: initial treatmentABCD:AspirinBeta blockerCoagulation (anticoagulation with heparin/LMW Heparin)Double product control (decrease heart rate and blood pressure)
Potter syndrome: featuresPOTTER:Pulmonary hypoplasiaOligohydrominiosTwisted skin (wrinkly skin)Twisted face (Potter facies)Extremities defectsRenal agenesis (bilateral)
Atrioventricular valves"LAB RAT":Left Atrium: BicuspidRight Atrium: Tricuspid
Cranial nerves: sensory, motor or both"Some Say Marry Money But My Brother Says Big Brains Matter More":· From I to XII:SensorySensoryMotorMotorBothMotorBothSensoryBothBothMotorMotor· Alternatives for "Brains": Boobs, Buns, Bras.
Deep tendon reflexes: root supply· God designed body reflexes according to a nursery rhyme:One, two-- buckle my shoe. Three, four-- kick the door. Five, six-- pick up sticks. Seven, eight-- shut the gate.S1,2 = ankle jerkL3,4 = knee jerkC5,6 = biceps and brachioradialisC7,8 = triceps
Cubital fossa contents"Really Need Booze To Be At My Nicest":· From lateral to medial:Radial NerveBiceps TendonBrachial ArteryMedian Nerve
Syncope causes, by systemHEAD HEART VESSELS:· CNS causes include HEAD:Hypoxia/ HypoglycemiaEpilepsyAnxietyDysfunctional brain stem (basivertebral TIA)· Cardiac causes are HEART:Heart attackEmbolism (PE)Aortic obstruction (IHSS, AS or myxoma)Rhythm disturbance, ventricularTachycardia· Vascular causes are VESSELS:VasovagalEctopic (reminds one of hypovolemia)SituationalSubclavian stealENT (glossopharyngeal neuralgia)Low systemic vascular resistance (Addison's, diabetic vascular neuropathy)Sensitive carotid sinus
Axillary artery branches"Screw The Lawyer Save A Patient":Superior thoracicThoracoacromiolLateral thoracicSubscapularAnterior circumflex humeralPosterior circumflex humeralAlternatively: "Some Times Life Seems A Pain".
COPD: blue bloater vs. pink puffer diseasesemPhysema has letter P (and not B) so Pink Puffer.chronic Bronchitis has letter B (and not P) so Blue Bloater.
Pancreatitis: causesBAD S#!T:Biliary: gallstones, 1% of ERCP patientsAlcoholism/ AzotemiaDrugsScorpion bite/ Sea anenome/ SLEHyperlipidemia/ HypercalcemiaIdiopathic/ Infectious (mumps, coxsackie, salmonella, ascariasis)Tumor/ Trauma· The drugs are: penacillamine, furosemide, thiazides, ethacrynic acid, steroids, sulfas, ace inhibitors, N-SAIDs, erythromycin, estrogen.
Pneumonia: risk factorsINSPIRATION:ImmunosuppressionNeoplasiaSecretion retentionPulmonary oedemaImpaired alveolar macrophagesRTI (prior)Antibiotics and cytotoxicsTracheal instrumentationIV dug abuseOther (general debility, immobility)Neurologic impairment of cough reflex, (eg NMJ disorders)
Splenomegaly: causesCHIMP:CystsHaematological ( eg CML, myelofibrosis)Infective (eg viral (IM), bacterial)Metabolic/ Misc (eg amyloid, Gauchers)Portal hypertension
Thrombotic thrombocytopenic purpura: signsFAT RN:FeverAnemiaThrombocytopeniaRenal problemsNeurologic dysfunction
Autonomic Nervous System: Hypothalamic ControlAPPS:Anterior hypothalamic area controls Parasympathetic nervous systemPosterior hypothalamic area controls the Sympathetic.
Lithium: side effectsLITH:LeukocytosisInsipidus [diabetes insipidus, tied to polyuria]Tremor/ TeratogenesisHypothyroidism
Endotracheal tube: troubleshootingDOPEY:Displaced: esophagus, right mainstem, back of throat, etcObstructed: secretions, blood, mucus plug, kink, etcPneumothoraxEquipment: malfunctions, O2, ETT, BVM, ventilator, monitorYou: your approach, technique: missing something?Show Details / Rate It---Brenda L. Snyder, RN, CEN, PHRN George Washington University Hospital, Washington, D.C.
RLQ pain: differentialAPPENDICITIS:Appendicitis/ AbscessPID/ PeriodPancreatitisEctopic/ EndometriosisNeoplasiaDiverticulitisIntussusceptionCrohns Disease/ Cyst (ovarian)IBDTorsion (ovary)Irritable Bowel SyndromeStonesShow Details / Rate It---Anonymous Contributor
JVP: raised JVP differentialPQRST (EKG waves):Pericardial effusionQuantity of fluid raised (fluid over load)Right heart failureSuperior vena caval obstructionTricuspid stenosis/ Tricuspid regurgitation/ Tamponade (cardiac)Show Details / Rate It---Dr. Mohsin Maqbool Bahawal-Victoria Hospital, Bahawalpur
Syncope causes, by systemHEAD HEART VESSELS:· CNS causes include HEAD:Hypoxia/ HypoglycemiaEpilepsyAnxietyDysfunctional brain stem (basivertebral TIA)· Cardiac causes are HEART:Heart attackEmbolism (PE)Aortic obstruction (IHSS, AS or myxoma)Rhythm disturbance, ventricularTachycardia· Vascular causes are VESSELS:VasovagalEctopic (reminds one of hypovolemia)SituationalSubclavian stealENT (glossopharyngeal neuralgia)Low systemic vascular resistance (Addison's, diabetic vascular neuropathy)Sensitive carotid sinusShow Details / Rate It---Bill Young MD University of Kentucky Dept of Emergency Medicine
Pneumothorax: causesSIT, 3 A's, 3 C's:Spontaneous (often tall thin men)IatrogenicTraumaAsthmaAlveolitisAIDSCOPDCarcinomaCystic fibrosisShow Details / Rate It---Jamal Khan Birmingham University Medical Student
Organophosphates poisoning: symptomsDUMBBELS:DiarrheaUrinationMiosisBradycardiaBronchospasmEmesisLacrimationSalivationShow Details / Rate It---Martin Herman Le Bonheur Children's Medical Center
Seizures: differentialSICK DRIFTER:Substrates (sugar, oxygen)Isoniazid overdoseCations (Na, Ca, Mg)Kids (ecclampsia)Drugs (CRAP: Cocaine, Rum (alcohol), Amphetamines, PCP)Rum (alchohol withdrawl)Illnesses (chronic seizure disorder or other chronic disorder)Fever (meningitis, encephalitis, abscess)Trauma (epidural, subdural, intraparynchymal hemorrhage)Extra: toxocologic (TAIL: Theo, ASA, Isoniazid, Lithium) and 3 Anti's: (Antihistamine overdose, Antidepressant overdose, Anticonvulsants (too high dilanitin, tegretol) or benzo withdrawl.Rat poison (organophospates poisoning)Show Details / Rate It---Joseph Rogers, MD Duke University
PEA/Asystole (ACLS): etiologyITCHPAD:InfarctionTension pneumothoraxCardiac tamponadeHypovolemia/ Hypothermia/ Hypo-, Hyperkalemia/ Hypomagnesmia/ HypoxemiaPulmonary embolismAcidosisDrug overdoseShow Details / Rate It---Carl Roberts A.S.EMS, CCEMT-P, CFP US Army Special Forces
ARDS: diagnostic criteriaARDS:Acute onsetRatio (PaO2/FiO2) less than 200Diffuse infiltrationSwan-Ganz Wedge pressure less than 19 mmHgShow Details / Rate It---Fahed Al-Daour
Atrial fibrillation: causes of new onsetTHE ATRIAL FIBS:ThyroidHypothermiaEmbolism (P.E.)AlcoholTrauma (cardiac contusion)Recent surgery (post CABG)IschemiaAtrial enlargementLone or idiopathicFever, anemia, high-output statesInfarctBad valves (mitral stenosis)Stimulants (cocaine, theo, amphet, caffeine)
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