TABLE OF CONTENTS

Fundamentals 03 Page
Medical Math 165 Page
Mental Health 170 Page
Mother Baby 195 Page
Pediatrics 238 Page
Pharmacology 341 Page
Med Surg 492 Page
Neuro 492 Page
Respiratory 561 Page
Cardiac 589 Page
Musculoskeletal 639 Page
Gastrointestinal 683 Page
Renal/Urinary 744 Page
Endocrine 771 Page
Hematology 842 Page
Immune System 857 Page
Critical Care 934 Page
Templates & Planners 985 Page
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FUNDAMENTALS
 Fundamentals

Medical Terms & Abbreviations

Assessment-terms

BKA Below Knee Amputation

AKA Above Knee Amputation

AO Awake Alert Oriented

BM Bowel Movement Status

BP Blood Pressure Status

AMS Altered Mental Status

BS Bowel Sound

BMS Beat Per Seconds

CVC Central Venous Line Location

I&O Intake And Output

JVD Jugular Venous Distention LUQ: Left upper quadrant

LBW Low Birth Weight LUL Left upper lobe

LMP Last Mensutrual Period LUE Left upper extremity

NPO Nothing By Mouth LLQ Left lower quadrant

NKDA No Know Drug Allergies LLL: Left lower lobe

MAP Mean Arterial Pressure LLE: Left lower extremity

LOC Level Of Consciousness ETT: Endotracheal tube

WNL Within Normal Limits LE: Lower extremity

VSS Vital Sings Table ABD: Abdomen

SOB Shotnees Of Breath RLE: Right lower extremity

OOB Out Of Bed RLQ: Right lower quadrant

NVD Nausea Vomiting Diarrhea RUE: Right upper extremity

RUL Right upper lobe

RUQ Right upper quadrant

UE; Upper extremity

RLL: Right lower lobe

FA: Forearm
 Fundamentals

Medical Terms & Abbreviations

Measurement

oz: Ounce

mm Millimeter

Mg/dl Milligram/deciliter

m Meter

kl Kiloliter

mL Milliliter

min Minim

mg Milligram

mEQ Mill equivalent

mcg Microgram
CC 30=30ML
lbs Pound 25=25
L Liter
20=20
kg Kilogram

gtt Drops
15=15
gal Gallon 5=5
g Gram

dr Dram

tsp Teaspoon

T, tbs, tbsp Tablespoon

Dosing Cup
pt Pint

qt Quart
 Fundamentals

Medical Terms & Abbreviations

General Terms

BC Bowel sound HX History

ADL Activities of daily living BP Blood pressure

BW Body weight ANA Antinuclear antibody

BMR Basic metabolic rate BUN Blood urea nitrogen

BX Biopsey AV Anti-ventricular

AMA Against medical advice BMP Beat per min

BC Bowel care I&D Incision and drainage

C/O Complaint of MVA Motor vehicle accident

CC Chief complaint OTC Over the counter

D/C Discontinue/ discharge PCP Primary care physician

DNR Discontinue/ discharge PMH Past medical history

DOB Date of birth OTC Over the counter

DX Diagnosis PCP Primary care physician

ETOH Ethanol PSHx Past surgical history

FX Fracture PT Patient

HOB Head of bed R/T Related to

HPI History of present İllness

Rx Prescriptions

ABG Arterial blood gass

S/S Signs and symptoms

SBAR Situation, background

STAT Immediately

Tx Treatment

Vs Vital signs

SX Symptoms
 Fundamentals

Medication Routes

PO Per os-by mouth

NG Nasogastric Sublingual Parenteral:

IV, IM, SC
SI Sublingual

IV Intravenous
Inhalation
IM Intramascular

SUBCUT Subcutaneous

PR Per rectum Oral

PV Per vagina

GUTT Eye drops Transdermal

patch
OCC Eye cream

E/C Enteric coated

Topical
M/R Modified released

GT Gastronomy tube

ID Intradermal

OD Right eye

OS Left eye

OU Both eyes

Rectal
 Fundamentals

Medication Routes

Prefixes Drug Preparation Suffixes

Ante-: Before cap: Capsule ectomy: Excision/ removal

Re-: Again DR: Delayed release itis: inflammation of

Neo-: New (ODT): Orally disintegrating tablets Algia: Pain

macro-: Large ER: Extended release OMA: Tumor

micro-: Small EC: Enteric coated Pnea: Breathing

Dextro-: Right SR: Sustained release Stasis: Stop

Chrono-: Time MRD: Modified-release dosage stomy: new opening

pan-: All Elix: Elixir phagia: Eating/ swallowing

epi-: Above Supp: Suppository poesis: Formation

peri-: Around Susp: Suspension

poly-: Many tab: Tablet

post-: After Drops

pre-: Before

sub-: Below

supra-: Above

hema-: Blood

hypo-: Low

hyper-: High

Tachy-: Fast

Brady-: Slow

Retro-: Back

Levo-: Left

ante-: Before

auto-: Self

brady-: Slow

cephalo-: Head

dys-: İmpaired
 Fundamentals

Banned Abbreviations

DO NOT USE POTENTIALPROBLEM INSTEAD USE

U, u (unit) Mistaken for "0" (zero), the Write "unit"

number "4" (four) or "cc"

Mistaken for IV (intravenous)

IU (International Unit) Write "International Unit"
or the number 10 (ten)

Q.D., QD, q.d., qd (daily) Mistaken for each other Write “daily“

Q.O.D., QOD, q.o.d, qod (every Period after the Q mistaken for
Write "every other day"
other day) "I" and the "O" mistaken for “I”

Trailing zero (X.0 mg)* Write X mg

Decimal point is missed
Lack of leading zero (.X mg) Write 0.X mg

Can mean morphine sulfate

MS Write "morphine sulfate“
or magnesium sulfate

MSO4 and MgSO4 Confused for one another Write "magnesium sulfate"
 Fundamentals

Diagnostic Test

Brain scan: Images of the structures inside of your head.

EKG: (Electrocardiogram (ECG or EKG) Records the electrical signal from the heart to check for different
heart conditions.

MRI: (Magnetic resonance imaging) MRI scanners create images of the body using a large magnet and
radio waves.

CT scan: Imaging test helps detect internal injuries

Biopsy: To remove a piece of tissue or a sample of cells from your body.

Chest X ray: To look at the structures and organs in your chest.

Liver function test(LFT): Symptoms and monitor liver disease or damage.

Ultrasound: Is an imaging test that uses sound waves to make pictures of organs, tissues, and other
structures inside your body.

HIV test: Antibody tests, antigen/antibody test

ECG or EKG): Records the electrical signal from the

Pulmonary function test: The tests measure lung volume, capacity and rates of flow,
 Fundamentals

Medication Time

PC After meal

HS At bed time

Q2H Every 2 hours

Q2min Every 2 min

Q30min Every 30 min

OD Once daily

BD Twice daily

PC After meals

PRN As needed

QH Every hours

QID Four time a day

TID Three time a day

PO By mouth

IM Intramuscular

IV Intravenous

SQ Subcutaneous
Commodities
NPO Nothing by mouth
Stocks
OTC Over the counter OTC Securities
Debt Securities
QAM Every morning
Derivatives
QPM Every evening
 Fundamentals

Healthcare Delivery System

An organization that provides resources and treatments that help people when
they are sick or injured, and helps them stay healthy through preventive care.

Health care delivery systems provide the following benefits:

Care for chronic illness: Advanced health management:

Better public health Supportive information systems
Safety-net providers

Frameworks organize health care delivery systems

Organizational structure: Finances: Service culture:

PatientS Capacity Care infrastructure

LEVELS OF HEALTHCARE

1.Primary care
Tertiary
Includes health promotion, Disease prevention,
Care
Treatment, Rehabilitation, Palliative care.
(highly
Specialised Care)

Secondary Care 2.Secondary care

(Specialised Care) Curative services are provided at this level,
Early detection and intervention

Primary Care 3.Tertiary care

(Universal Healthcare)
Specialized consultative health care, Usually for inpatients
and on referral from a primary or secondary, Restorative
and Rehabilitative care
 Fundamentals

Healthcare Delivery System

HEALTHCARE TEAM

Physician (MD, Nurse(RN, Therapiest Paramedic.

PA, DO, NP) CAN,UAP) (OT,RT) Medical professional
who specializes in
Diagnosis, prognosis and Caring for patients, Diagnoses and treats emergency treatment
treatment of disease, communicating with doctors, mental health disorders
injury, and other physical administering medicine and
and mental impairments. checking vital signs

Social Lab Pharmacist Rediologic Dietitian

Worker Technician Health care technologiest An expert
professional on diet and
Trained professional Involved in every specializing in Perform diagnostic nutrition
who works with all aspect of laboratory the usage and imaging procedures
types of vulnerable work, from recording administration
people, groups, and data to maintaining of medications
communities to help equipment.
them learn to live
better lives
Obtains tests and analyzes patient specimens

REGULATORY ORGANIZATIONS

Care quality FDA (Food and Drug Occupational Safety &

commission Administration) Health Administration
Executive non-departmental public Ensuring the safety, efficacy, and Safe work practices when using portable
body of the Department of Health security of human and veterinary, generators to avoid carbon monoxide, a
and Social Care of the Uk drugs, biological products colorless, odorless, and toxic gas

Centers for The Joint Department of health

Medicare & Commission and social work.
Medicaid Services Improve health care and evaluating Responsible for government policy on
health care organizations and health and adult social care matter.
Dedicated to advancing health inspiring them to excel in providing
equity, expanding coverage, and safe and effective care of the
improving health outcomes highest quality

NURSE PRACTICE ACTS 5 nursing practices

Every state and territory in the US set A violation of Nurse

laws to govern the practice of nursing. Practice Act related,
Nurse Practice Act is a providing suggestions Drug related, Assessment,
universal healthcare for best practices.
Boundary violations, Diagnosis,
document
Required minimum
Sexual misconduct, Planning,
That outlines the educational
responsibilities of all requirements and Abuse and fraud, Implementation,
healthcare professionals, qualifications for
not specific to nursing. licensure positive criminal Evaluation
background checks.
Nurse Practice Act is a
set of recommendations
for nurses,
 Fundamentals

Ethics & Law

PATIENT RIGHTS ETHICS TERMS

Right to get considerate and
Right or condition of
respectful care. Autonomy
self-government.
Right to privacy.
Public support for or
Right to confidential. ADvocacy recommendation of a
Right to get detail of treatment particular cause or policy.
cost/payment.
Act of charity, mercy, and
Right to obtain second opinion. Beneficence
kindness
Right to give informed consent.
Fidelity Ethical decision-making
Right to get copies of all
medical records. Justice Distribute care equally & fairly
Select their own provider. Non- The obligation of a physician
Right to except continuity of care maleficence not to harm the patient.

Veracity Habitual truthfulness.

CONSENT
(Permitting something to be done
or of recognizing some authority)

Informed consent

Ensure the consent is signed by

appropriate person; patient,
guardian, power of attorney

Authorization for a designated

consent forms person to make decisions about Types of consent
another person's property,
Informed consent. finances, or medical care. Blood transfusion
Implied consent. procedure
Explicit consent. In emergencies, when a decision Radiation therapy
must be made urgently, the
Active consent. patient is not able to participate in X-rays or proton therapy
Passive consent. decision making, and the patient's Chemotherapy
Opt-Out consent. surrogate is not available. Anesthetics medicines
Key takeaway NURSE should be present at the Operation.
time of consent Surgical intervention.
Advanced medical tests
Inoculation(VACCINE)
Types of Informed consent
Signed/written consent Online
consent Oral (recorded) consent
Passive/tacit consent
 Fundamentals

Health Insurance Portability

& Accountability Act (HIPAA)

DIAGNOSIS
(Federal law that requires the
creation of national standards to
protect sensitive patient health
information) PHI

Identifying current existing problem

Any information in the medical record or
designated record set that can be used to identify
for a public health purpose that HIPAA allows Hipaa Compliance
Sharing passwords may seem harmless,
Don’t speak about patients in open place .
checklist
locking up physical records and electronic
devices containing PHI Establish a HIPAA compliance committee
Review HIPAA guidelines
Perform gap analysis to identify areas of
concern
LEGAL TERMS NBMAF Build and execute a plan to address
security gaps
Negligence Assault
failure to take proper crime or Review key vendors' interactions with PHI
care over something attempting Perform ongoing monitoring and audits
Establish data breach incident response
Battery False protocols
the intent to inflict Imprisonment
Perform HIPAA training
harmful or offensive restrict a patient's
touching movement Regularly evaluate compliance and
review HIPAA updates
unlawfully
Malpractice Ask subject matter experts for assistance
professional negligence by a health care
 Fundamentals

The Nursing Process

ASSESSMENT
Gathering and discussing information from multiple and diverse sources
-Data verification of gathered information

Remember o for
Objective data Subjective data
objectıve & observatıon

Means making an unbiased, balanced observation Subjective means making assumptions, making
based on facts which can be verified interpretations based on personal opinions
without any verifiable facts
Examples:
Examples:
Auscultating Blood pressure,
bowel sounds Vital signs Patient reporting patient complains
Temperature 6/10 pain of a sore wrist
patient's pain Family member
level and their telling you patient
descriptions of fell last week
symptoms

Four types of
nursing assessment

Initial Focused Emergency Time-lapsed

Identifying an Detailed nursing Performed during Ongoing/ Reassessment
individual's learning assessment of specific emergency procedures.
Performed during
body system.
Nurses and medical It is crucial to evaluate emergency procedures,
practitioners use to Relating to the the patient's airway,
To evaluate how the
assess their patients. presenting problem or breathing and
patient reacts to the
current concern of the circulation
Utilize qualitative and agreed treatment plan
patient.
quantitative data to Assess for cause of and how their condition
evaluate the health Involve one or more presenting urgent is evolving.
problems of a patient. body systems. problem.

Assess the person’s readiness for health education.

a. What are the person’s health beliefs and behaviors?
b. What physical and psychosocial adaptations does the person need to make?
c. Is the learner ready to learn?
d. Is the person able to learn these behaviors?
e. What additional information about the person is needed?
f. Are there any variables (eg, hearing or visual impairment, cognitive issues, literacy issues) that will
affect the choice of teaching strategy or approach?
g. What are the person’s expectations?
h. What does the person want to learn?
Organize, analyze, synthesize, and summarize the collected data.
 Fundamentals

The Nursing Process

NO action is taken, just

nursing diagnosis
DIAGNOSIS
(Early diagnosis and treatment are essential (NANDA approved))

VS
Actual diagnosis Potential diagnosis
(patient issues or problems that are present (describing a suspected problems)
and observable during the assessment phase)

Actual health problems means the problem rise The problem which has risk to develop by
actually with diagnosis of disease diagnosis like risk of infection
We can create a plan of action to treat current Prevention of DVT in hospitalized patients
problem such as, analgesic, Anesthetic medicine decreases the risk of DVT and PE, decreasing
mortality and morbidity .

Example
Mild, Moderate and Severe Pain in Patients
Example
Recovering from Major Abdominal Surgery. Risk for developing DVT after surgery

Nursing Diagnoses Medical Diagnoses

Treat and prevent Implement medical orders for treatment
Independent and monitor status of condition
Dependent

Example
Example
Activity Intolerance related to
decreased cardiac output Myocardial infarction

1. Formulate the nursing diagnoses that relate to the person’s learning needs.
2. Identify the learning needs, their characteristics, and their etiology.
3. State nursing diagnoses concisely and precisely.
 Fundamentals

The Nursing Process

PLANNING
Planning is a deliberative, systematic phase of the nursing
process that involves decision making and problem solving

TYPES OF PLANNING
Initial Planning. The nurse who performs the admission
assessment usually develops the initial comprehensive.
Ongoing Planning. All nurses who work with the client do
ongoing planning.
Discharge Planning. The process of anticipating and
planning for needs after discharg.

Planning Goal
(short-term achievements)
S SPECIFIC (Who and What?): I ASPIRE TO BE PROMATED TO THE DESIGNATION OF NURSING OFFICER
M MEASURABLE (By how much?): With specific criteria that measure your progress toward the
accomplishment of the goal
A ACHIEVABLE (How?): Needs to be realistic and attainable to be successful
R RELEVANT (Why?): Creating an action plan or a goal plan can be a very effective way of giving
your career
T TIMELY(When?): clarify your ideas, focus your efforts, use your time and resources productively

Assign priority to the nursing diagnoses that relate to the individual’s learning needs.
Specify the immediate, intermediate, and long-term learning goals established by teacher
and learner together.
Identify teaching strategies appropriate for goal attainment.
Establish expected outcomes.
Develop the written teaching plan.
Include diagnoses, goals, teaching strategies, and expected outcomes.
Put the information to be taught in logical sequence.
Write down the key points
 Fundamentals

The Nursing Process

IMPLEMENT
(Is the action phase in which the nurse performs the nursing interventions)

Add plans into action.

Implementing consists of doing and documenting the activities that
are the specific nursing actions needed to carry out the interventions.

Process of Implementing Examples

Reassessing the client Assessment Diagnosis Giving medications. Educating patient.
Determining the nurse’s need for assistance
Implementing the nursing interventions
Supervising the delegated care EVALUATE
Documenting nursing activities
(To evaluate is to judge or to appraise) (Resolute outcomes of goals)
OR
1. Put the teaching plan into action.
2. Use language the person can understand. Evaluating is a Modify & assess. Planned, Ongoing, Purposeful
activity in which clients and health care professionals determine.
3. Use appropriate teaching aids and provide
Internet resources if appropriate.
1 Collect objective data. 3 Include the person, family or
4. Use the same equipment that the person significant others, nursing
Observe the person.
will use after discharge. team members, and other
Ask questions to determine health care team members in
5. Encourage the person to participate whether the person the evaluation.
actively in learning. understands.

Use rating scales, checklists,

6. Record the learner’s responses to the
anecdotal notes, and written
4 Identify alterations that need to
teaching actions. be made in the teaching plan.
tests when appropriate.
7. Provide feedback.
2 Compare the person’s 5 Make referrals to appropriate
behavioral responses sources or agencies for
with the expected reinforcement of learning after
outcomes. Determine discharge.
the extent to which the
goals were achieved. 6 Continue all steps of the
teaching process: assessment,
diagnosis, planning,
implementation, and
evaluation.
 Fundamentals

Types of Immunity

HOSPITAL-ASSOCIATED INFECTIONS
CLABI Central line-associated bloodstream infections

CAUTI Catheter-associated urinary tract infections

VAP Ventilator-associated pneumonia. HAND WASHING

with soap removes germs
SSI Surgical Site Infection
from hands
CLABI Central Line Associated Bloodstream Infection

STAGES OF INFECTION
Incubation Period illness Stage
The time elapsed Symptoms characteristic of a
between exposure to a particular disease are recognized.
pathogenic organism

Prodromal Stage Convalescent Stage

The infectious agent The body recovers from a
continues replicating, serious illness, injury or surgery

TYPES OF IMMUNITY
INNATE IMMUNITY ADAPTIVE (ACQUIRED) IMMUNITY
1ST LINE The defense system with which you 2ND LINE Exposure to the disease organism
were born. through infection with the actual disease

TYPES OF ACQUIRED IMMUNITY

(body protection Active Immunity Passive Immunity
against disease)

Active Natural Passive Natural.

Immunity
Is acquired from A newborn baby acquires
exposure to the passive immunity from its
Adaptive Immunity Innate Immunity
disease organism. mother through the placenta.
Active Artificial Passive Artificial.
Vaccine-induced Conferred by the injection of
Natural Atrifficial
immunity antibodies generated by a
different person or animal, or
artificially in the laboratory.
Passive Active Passive Active
(material) (Infection) (antibody (Immunization)
transfer)
 Fundamentals

Types of Immunity

Infectious Agent Reservoir

The pathogen (virus, Area the pathogen
bacteria, fungus, can grow (humans,
parasite) animals, food)

Suseptible Portal
Host of Exit
Host left with CHAIN OF Means by which
compromised the pathogen can
defense INFECTION leave the reservoir
mechanisms (skin, mouth, blood)

Mode of
Portal of Entry Transmission
How the pathogen How the pathogen
can get to the host can spread (contact,
(same as portal of exit) droplet, airborne)
 Fundamentals

Types of Immunity

Infection Control
(the policy and procedures implemented to control and minimize the dissemination of infections)
PRECAUTIONS Hand Hygiene Respiratory Hygiene sharps Safety, gloves & disposable equipment

Standard Care taken in Advance use gown, gloves, goggles, mask as needed per situation

Contact Precaution Airborn Precautions Droplet Precautions

Are Intended to Prevent Bacteria or viruses that are most A patient infected with a
Transmission Of Infectious Agents, commonly transmitted through pathogen through respiratory
Including Epidemiologically air transmission secretions
Important Microorganisms, Which
Personal negative pressure room Personal room
Are Spread By direct or Indirect
Door Always closed Door Always closed
Contact With the Patient.
N-95, goggles, gown, gloves Gown, gloves, mask, goggles
Personal Rooms Gloves
Goggles
Gown Door's always open AAC-IMT CPP-MIR
A Acute Flaccid Myelitis (AFM) C Common cold
RSW-FEE A Anthrax. P Pertussis
R Respiratory Infection (Bronchiolitis) C Chickenpox (Varicella) Precautions
P Pneumonia
Influenza should be Meningococcal disease
S Skin Infections I
Followed until all
M

W Wound Infections Hand washing M Measles (Rubeola) lesions Are I Influenza Meningitis
with soap and Crusted Over.
F Fungal infection water When in T Tuberculosis R Rubella
contact with
E Eye infection (Acute C.Diff strongly
viral conjunctivitis) suspected or
proven
E Enteric (C.Diff )
DONNING

HAND HYGIENE GOWN MASK SHIELD GLOVES

Putting on work clothes, gear, and equipment.

DOFFING

REMOVE GLOVES REMOVE SHİELD REMOVE GOWN REMOVE MASK HAND HYGIENE

To remove (an article of wear) from the body

 Fundamentals

5 Moments of Hand Hygiene

5 MOMENTS OF HAND HYGIENE

BEFORE TOUCHING A PATIENT

BEFORE CLEAN /
ASEPTIC PROCEDURE

AFTER BODY FLUID

EXPOSURE RISK

AFTER TOUCHING A PATIENT

AFTER TOUCHING
PATIENT SURROUNDINGS

SURGICAL ASEPSIS MEDICAL ASEPSIS

Absence of all microorganisms within any type of Kill some microorganisms to prevent them
invasive procedure from spreading.

Sterile technique Clean Technique

Performed to make equipment and areas free Method used to prevent contamination with
from all microorganisms microorganisms, Reduces number of pathogens
To maintain that sterility.
Eliminates all pathogens

Used in Used in
performing surgical procedures. used for all clinical patient care activities.
performing biopsies. prevent contamination from pathogens.
dressing surgical wounds or burns. Surgical asepsis,
suturing wounds. Administration of meds
Administering injections
 Fundamentals

Safety

(the state of being safe; freedom from the occurrence or risk of injury, danger, or loss)

PATIENT SAFETY
the avoidance of unintended or unexpected harm to people during the provision of health care

Fall Seizure Suicide

Precautions Precautions Precautions
Stay physically active. ... Keep the bed away from Special observation
nightstands nurse-patient ratio of 1:1 (patient
Try balance and strength
cannot be left alone at any time)
training exercises. ... Use a seizure alert monitor
while sleeping Express empathy with patient to
Fall-proof your home. ... discuss feelings and anxieties.
Sleep in a room with others
Have your eyes and hearing Don't pressure them
or a place others can hear if
tested
someone is having a seizure Don’t give advice or lecture,
Get enough sleep. ... show love and compassion
Keep electronic devices
Avoid or limit alcohol. ... away from the bed
Suicide prevention starts with
Stand up slowly.
recognizing the warning signs
and taking them seriously

Rope Medical
equipment
Knives
RESTRAINTS Restraint Forks
Mirrors
Alternatives Sharps
Condition that keeps someone or Place a motion alarm in the
something under control. doorway or near the foot of
the bed.
Should not cause harm or be used
as punishment. Use a pressure or tab alarm
in the wheelchair. Good for confused patients in need of
Caregivers in a hospital can use stimulation
restraints in emergencies or when UAP sits with patient with
intention of reorienting and Reduce stimulation such as bright lights
they are needed for medical care
relaxing the(1:1 Supervision and loud noises that may be causing
Restraints should be used only as (Sitter)) agitation
a last resort.
Offer toileting every hour. More frequent monitoring.
It is deemed to be used as a last
resort to prevent patients from
directly harming themselves.
Require MD order Restraints cannot be
administered longer than 4
Patients in non-violent restraints Most hours for adults (> 18 years), 2
should be monitored about every important hours for children and
4 hours or more or less frequently adolescents (9 - 17 years), or 1
if necessary hour for children (<9 years)
 Fundamentals

Safety

FIRE SAFETY NURSE SAFETY

The set of practices intended to Safe patient handling

reduce destruction caused by fire
The use of assistive devices
to ensure that patients can
During a Fire Using an Extinguisher be mobilized safely
Care providers avoid
Install Fire Alarms Hold the extinguisher performing high-risk manual
Plan a Fire Escape Route with the nozzle pointing patient handling tasks.
Keep Flames and Other release the locking Never try to move a patient
Heating Equipment in mechanism up in bed by yourself .
Check. . Squeeze the lever Use Mechanical lifts when
Have a Fire Extinguisher. slowly and evenly. available
Utilize the Cliche Stop, Sweep from side to side
Drop and Roll

Sharp injury protection

injury prevention features

intravascular administration sets

WHAT TO DO FOR NEEDLE STICK Recapping is risking a needle stick-
always use safety lock
Encourage the wound to bleed piston syringes and point needle AWAY
Ideally by holding it under running water. from you at all times
Wash the wound using running water Hypodermic single lumen needles
and plenty of soap all needles and other sharps in a sharps
Do not scrub the wound while you're disposal container immediately after
washing it. they have been used.
 Fundamentals

Scope of Practice

Procedures, Actions, and Processes

Task Registered Nurse licensed practical nurse Unlicensed assistive
personnel

Administer IV Meds
Administer Oral Narcotics
Starting Blood Products
Primary Assessment & Education
Vital Signs
Insert Catheter & NGT
Administer Oral Medications
Monitor Blood Products
Activities of daily living(ADLs)
Measure I&O
Hygiene
Reassessment
Set Up Care Plans

DELEGATION To the Transfer of Responsibility for Specific tasks from one person to Another.

REMEMBER

5 RIGHTS OF Never Delegate E valuate

what you can
DELEGATION A ssess
RIGHT

RIGHT
Task

Circumstance RIGHT direction/

communication
EAT! T each

supervision/
RIGHT Person RIGHT to delegate work And ( managing
evaluation.
TIPS delegation-based decisions)

Identify work to delegate. Clarify priorities. ...

Not everything can be Understand each team
What can you only do?
delegated. ... member's strengths. ...
HOW TO Practice letting go. ...
Provide context and
guidance. ...
DELEGATE How do you prioritize tasks Try to briefly meet with Invest in training. ...
by urgency? CNA's at start of shift to
Ask yourself, Prioritize
get on the same page of communication and
proper way of feedback. ...
each other's workloads to
task delegation What task is the most Focus on results
plan accordingly
URGENT AND Time sensitive ?
 Fundamentals

Prioritization

HOW TO DECIDE WHAT IS URGENT

Stable vs. Unstable Expected vs. unexpected

On all time prioritize patients that are actively ON all time prioritize patients with symptoms
degeneration and decline from their baseline. unpredicted and unanticipated for disease process

Examples: Examples:
TWO PATİENTS WİTH NORMAL HEART RATE . TWO PATİENTS WİTH NAUSEA
Patient A is symptomatic (Disease apparent) Patient A Is surgical procedure
Patient B is asymptomatic (There are no symptoms) Patient B completely nauseas
Shortness of Breath. Low blood pressure, No angina etc.. Abdominal pain, Bloating or swelling etc..

The Disease apparent patient, Patient A, The suddenly symptomatic patient, Patient B, takes
takes precedence. precedence to getting more information

Actual vs. Potential Acute vs. Chronic

On all time prioritize patients with current On all time prioritize patients with acute problems
problems over potential proble over chronic problems

Examples: Examples:
TWO PATIENTS WITH LOW BLOOD PRESSURE TWO PATIENTS WITH NAUSEA
Patient A Dialysis make you hypertensive Patient A Is patients with acute heart failure,
pulmonary hypertension (milrinone )
Patient B Is surgical procedure and hypotensive Patient B Has no history of hypotension and
normal blood pressure.

The patient that presents with a ongoing The patient with an acute problem, Patient B,
issue Patient B, takes precedence. takes precedence to getting more information

MASLOW’S HIERARCHY OF NEEDS FIRST ADDRESS

Airway
Self-fulfillment SELFACTUALIZATION ensure the patient's airway is properly positioned?
needs
achieving one’s full potential
Breathing
Psychological
SELF ESTEEM Is the patient breath appears more comfortable?

needs feeling of accomplishment

Circulation
LOVE & BELONGING
Does the patient have better blood can flow?
intimate relationships, friends

SAFETY & SECURITY

Basic
security, safety
needs
THEN you can address
PHYSIOLOGICA Establish Discomfort Interactive
oxygen, food, Confidence Feelings SAFE Learning
homeostasis, rest
 Fundamentals

Vital Signs

Blood Pressure
The force of your blood pushing against the walls of your arteries.

STAGE SYSTOLIC DIASTOLIC

pressure in your
HYPOTENSIVE 90 60 arteries when your
heart rests between
NORMAL 120 80 beats.(80)
PRE-HTN 120-139 80-89
STAGE 1 140-159 90-99
the pressure in your
STAGE 2 160 100 arteries when your
SEVERE INCREASE IN heart beats.(120)
180 120
BLOOD PRESSURE

Some unconscious patients have Ex: Chronic

obstructive pulmonary disease patients

Oxygen Saturation Normal: 94-100%

hemoglobin is currently bound to oxygen low oxygen content in the blood (hypoxemia).
compared to how much hemoglobin

Pulse Temperature Respirations

The heart rate, or the The degree of internal heat Breathing and the movement of air into
number of times your heart of a PATIENT's body. and out of the lungs.
beats in one minute.
Normal: 97.8-99F Normal: 12-20
Normal: 60-100 (36.5-37.2 C)

Hypothermia: Bradypnea: Tachypnea:

Tachycardia: Caused by prolonged abnormally slow Abnormally rapid
Heart rate of more than 100 exposures to very cold breathing rate breathing.
beats per minute at rest. temperatures
<12: >20:
>100: tachycardia <95F(35c)

Bradycardia: Hyperthermia:
Slower than normal Abnormally high
heart rate(60 – 100). body temperature.

<60:Bradycardia >104F(40C)
 Fundamentals

Pain

PAIN
Subjective data is information given from the viewpoint of the patient OR
Objective data is information directly observed by the healthcare worker.

NUMERICAL SCALE PAINAD SCALE

Patient rates pain on scale 1-10

P Pain Five behaviors
1. Breathing
0 1 2 3 4 5 6 7 8 9 10 A Assessment
2. Negative vocalization
IN in 3. Facial expression
A Advanced 4. body language

No pain Moderate pain Worst possible pain

D Dementia 5. Ability to be consoled

FACES SCALE CCPOT SCALE

Selects pictures on chart C Critical INCLUDE

according to pain level. A Care Facial expression,
Body movement,
P Pain Compliance with
0 1 2 3 4 5 6 7 8 9 10 O Observational ventilator, Muscle
tension.
T TooL

No Hurts Hurts Hurts Hurts Hurts The CPOT is a behavioural assessment pain
Hurt Little Bit Little More Even More Whole Lot Worst
scale for patients unable to verbalise pain.
Use of non-invasive ventilation (NIV) during
bronchoscopy
 Fundamentals

Head-to-toe Assessment

ASSESSMENT ORDER INTRODUCTION

Process of measuring your health Process of measuring your health
and ability to perform everyday and ability to perform everyday
skills during a hospital stay. skills during a hospital stay.

inspect: Visual inspection Knock and associated self hands

wash with soap to remove germs
Palpate: Examine By touch
Provide secrecy and isolation
Per-cuss: gently tap with finger Verify name and date of birth
Auscultate: Examine a patient Explain what are you doing in
by listening to sounds same language .

While introducing self, gain a basic assessment

of the overall appearance of the patient:
Provide diagnostic physician will begin to Any lesions, masses, or
clues to the illness. gather this information skin breakdown noted?
Does the patient immediately upon Any asymmetry in the
appear well groomed? meeting the patient. body or face?

Head, Face & Neck

Cranial Nerve VII – Facial Nerve Neck
Head Face
Patient to smile, Strength of facial Evaluate neck for symmetry
Examine AND Evaluate face for patient's Inspect the thyroid gland
show teeth, muscles.
Evaluate head, head positioned
scalp and hair (asymmetry)=Inspect the Puff out cheeks Evaluate for any scars, masses
Close both eyes,
Touch head, face for colourS Squeeze eyes shut Touch neck for lumps, and/or
puff cheeks,
swelling
scalp and hair Evaluate Cranial Nerve 7 Frown, and raise
Touch carotid pulses
eyebrows
Eyes
Evaluate conjunctiva Evaluates how well Ears Mouth
(PINK IN COLOR) and you see?
sclera (WHITE IN Evaluate for symmetry (Lopsided in Inspect the colour of the teeth. ...
Evaluate for any shape) & present lesions(a region in an
COLOR) color. discharge. Evaluate mucosa color: is it pink, pale,
organ or tissue ) red, discolored?
Evelute Perrla
Evaluate the canal is skin-colored and Inspect the gums for colour, swelling,
has small hairs? and bleeding.
Any hearing devices or trouble hearing? Is it dry or moist?
1 2 3 4 5 6 7 8 9
mm mm mm mm mm mm mm mm mm
Are there old debris or lesions?
 Fundamentals

Head-to-toe Assessment

Neuro
(Nerve and nervous system)
Process of measuring your health
and ability to perform everyday
skills during a hospital stay.

Orientation Respiratory
(Relating to breathing)
01 Who are you?(person) Gas Exchange oxygen and carbon dioxide.
Breathing movement of air.
02 Where are you?(place)

03 What is the date and time? Is it Normal or not?

Regular or irregular?
Does the patient appear comfortable?
Ask patient what the current year is or who the
president is Head-to-toe assessment Assesment
Order 1 2 3 4 (healthy people forget what day it is Palpate chest expansion
so not the best way to assess orientation) Sound Production .
Olfactory Assistance sense of smell.
04 What just happened to you?(situation) Protection .
Auscultation Airflow through the
trachea-bronchial

AAOx1; Person only L1 R1

R5 L5
L2 R2
L3 R3
L4 R4
AAOx2; Person and place R6 L6

AAOx3; Person place, and time

AAOx4; Person place, time and situation

 Fundamentals

Head-to-toe Assessment

Level of Conciousness(LOC)

What is it ?

(LOC) is a measurement of a person's arousability

and responsiveness to stimuli from the environment.

Awake Confused
State of awareness, Alert, Impaired decision-
responds immediately to making, impulsivity, and
verbal commands. risk-taking

Disoriented Lethargic
Requires constant Drowsy, easily aroused
storage and retrieval of with minimal stimuli.
situational information.

Obtunded Stuporous
Evoke by Without painful Only Evoked by repeated
stimuli. vigorous stimulation.

Comatose
No response to verbal or
painful stimuli.
 Fundamentals

Head-to-toe Assessment

Cardiac
Heart and many blood vessels 4 HEART SOUNDS
in your body make up your
cardiovascular system or
circulatory system. S1 & S2 NORMAL
Mediate heart sounds
S3 & S4 PATHOLOGICAL

Are they regular or irregular?

Created from blood flowing

through the heart chambers

Any humming, wrap up or

whistling heart sounds?

Erb’s point
Aortic

Pulmonic
A ALL

P PEOPLE

E ENJOY
Tricuspid
T TIME

M MAGAZINE

Mitral
 Fundamentals

Head-to-toe Assessment

Urinary

Filter blood and create urine as a

waste by-product

Regulate your blood volume and pressure

Controls the level of chemicals and salts.
Examine color and Strength of urine .
Palpate bladder for any distention
Urinary catheters are either internal or external catheters.

Internal Catheters External Catheters

Small, hollow, flexible tubes. Are a sheath that covers the penis and is used to manage
incontinence by collect the urine that leaks out.
To drain the bladder of urine

Hydrated Diabetic Urine Food Dye,

Kidney Disease
Light yellow, Pale or
close-to-clear transparent yellow food dye, kidney
disease

Dehydrated Unhealthy Medication or Liver Disease

Bacterial Infection
Urine is becoming Pink and yellow Liver Disease
a deep amber Green color
 Fundamentals

Head-to-toe Assessment

LOWER EXTREMİTİES
Includes the hip, knee, and ankle joints, and
the bones of the thigh, leg, and foot.
Start at pedal pulse (on the top of the foot)

Pulse check move to a selected landmark press ENTER.

If unable to feel a pulse, check with a

Dorsalis Pedis Doppler.
(artery runs from the anterior
aspect of the ankle joint)

Posterior Tibial
(posterior compartment of the
lower leg)

Popliteal
(in the hollow at the back of
the knee.)

Femoral
(blood vessel supplying blood to
your lower body.)

Inspect

the legs from the groin to the feet noting any

asymmetry Skin changes, Hair distribution
Varicosities, Edema.

Signs of vascular insufficiency Include

Pallor Loss of hair

Coolness Pigmentation along the shin
Cyanosis Ankles, or ulcers
Atrophy
 Fundamentals

Head-to-toe Assessment

Abdomen Musculoskeletal
The part of the body between the Includes bones, muscles, tendons,
ligaments and soft tissues.
thorax (chest) and pelvis

Assessing your patient's abdomen can

provide critical information about his
internal organs.

Inspection Percussion
Auscultation Palpation

palpation may stimulate bowel activity

and thus falsely increase bowel sounds During your assessment take note:
if performed before auscultation
Observing the patient in the standing
position for postural abnormalities
Are there any gait abnormalities?
Awake
Is one side weaker than the other?.
Inspect the skin, noting color, vascularity,
striae, scars, and lesions
Musculoskeletal assessment
Strength Gait Analysis
Disoriented Range of Motion (ROM) Trigger Points
Lightly palpate the abdomen by pressing
Reflexes and Sensory Examination
into the skin about 1 centimeter beginning
in the right lower quadrant (RLQ) And
move clockwise.

Percussion Hyperactive: Abnormally or extremely active.

greater then 30 sounds per minute (may be
Resonance (heard over lungs), tympany able to hear without stethoscope).
(heard over the air-filled bowel loops), and
dullness (heard over fluid or solid organs). Normoactive: Having a normal level of activity
5-30 sounds per minute.

Hypoactive: Abnormally inactive One bowel

sounds every 3-5 minutes.
Palpation
Palpate with light pressure then deep Absent: Must listen for at least 5 minutes to
pressure. chart absent bowel sounds.
 Fundamentals

Head-to-toe Assessment

Upper Extremities Skin

Upper arm, forearm, and hand. It Skin assessment is used to predict the development
extends from the shoulder joint to of pressure ulcers, and therefore is an extremely
the fingers and contains 30 bones. useful preventative tool.

Inspect for lesions, Lesions Moisture

Strength Lashes Discoloration HEAD
Endurance, Temperature Skin breakdown
Motor control Texture
Scars,
Swelling,
Tenderness SHOULDER
Color, texture, etc
Palpate radial pulses bilaterally
Assess strength (have patient squeeze hands) ELBOW

Grade Description
BUTTOCK
A Absent
B Palpable, but thready and weak; easily obliterated.
C Increased pulse; moderate pressure for obliteration.
HEALS
D Full, bounding; cannot obliterate

TOES
Capillary Refill
Upper arm, forearm, and hand. It extends from
the shoulder joint to the fingers and contains
30 bones.
Ensure the safety of yourpatient and
(CRT) is a rapid test used for assessing the points of contact?
blood flow through peripheral tissues inspection should focus on common
Apply pressure to finger and count how long pressure points over bony prominences
it takes to regain color such as the sacrum, buttocks, heels, the
back of the head, elbows.

Normal = LESS THEN 2-3 SECOND

 Fundamentals

Lab Values Cheat Sheet

CBC RENAL

Complete Blood Count Relating to the Kidneys

Red blood cells(RBC) Calcium

carry oxygen from your lungs to the measures the amount of calcium in
rest of your body. your urine.
4.5-5.5 / Ul 9-11 mg/ dL

Red blood cells(RBC) Magnesium

Fight infections and other diseases. amount of magnesium in your blood.
4,000- 11,000 / Ul 1.5-2.5 mg/ dL

Red blood cells(RBC) Phosphate

Fight infections and other diseases. phosphate in blood(monitor: Kidney
4,000- 11,000 / Ul disease, especially chronic kidney
disease).
Measures the number of platelets in 2.5- 4.5 mg/ dL
your blood (PLT)
150,000-450,000 / Ul

Measures the amount of hemoglobin

in your blood(HGB)
Male 13-18 g/dL
Female 12-16 g/dL

GFR: Glomerular filter rate

how much blood in your kidney filter
each minute.
90- 120 mL/min

BUN:blood urea nitrogen

measures the amount of urea
nitrogen in blood.
Percentage of red blood cells in your 10-20 mg/ dL
blood(HCT)
Male 42%-52% Creatinine:
Female 37%-47% Measure of how well your kidneys are
performing their job of filtering waste
from your blood.
0.6-1.2 mg/ dL
 Fundamentals

Lab Values Cheat Sheet

BMP: Basic Metabolic Panel

Blood test helps doctors check the body's fluid balance

and levels of electrolytes.

Sodium: 136 and 145 millimoles per liter (mmol/L).

Potassium: Amount of potassium in the fluid portion

(serum) of the blood.)3.5-5 mEq/L.

Chloride: Between 96 and 106 mEq/L.

PCR
BUN: Between 96 and 106 mEq/L.

Creatinine: (comprehensive metabolic panel) Measure

creatinine in blood.0.6-1.2 mg/ dL.

Glucose: (Blood sugar level) Elevated blood glucose is

often a sign of diabetes.70-100 mg/ dL (fasting).

Calcium: helps blood clot normally.9-11 mg/ dL.

Albumin: identify liver and kidney problems 3.4- 5.4 g/dL.

Total Protein: Help diagnose kidney disease, liver

disease, or nutritional problems.6.2-8.2 g/ L.

LFT A1C

Liver function test ; to detect, Common blood test used

evaluate, and monitor liver to diagnose type 1 and
disease or damage. type 2 diabetes.

3 liver function tests; Non-diabetic: 4-5.6%

Pre-diabetic: 5.7-6.4%
Serum bilirubin test Diabetic: Greater then 6.5%
Serum albumin test Target for Diabetic: Less then 6.5%
Prothrombin time (PT)
ALT: (Alanine aminotransferase) 7-56 U/L
AST: (aspartate aminotransferase) 5-40 U/L
ALP: (alkaline phosphatase) 40-120 U/L
Bilirubin: 0.1-1.2 mg/dL
 Fundamentals

Lab Values Cheat Sheet

COAGS: Coagulation tests LIPIDS

Blood test helps doctors check the body's Monitor and screen for your risk of
fluid balance and levels of electrolytes. cardiovascular disease.

Types of coagulation tests LDL; low-density lipoproteins.

Less then 100mg/dl
Fibrinogen level. ...
Total Cholesterol: 60 mg/ dL
Prothrombin time (PT or PT-INR) ...
Triglycerides: less then 150mg/dl
Platelet count. ...
LOUSY Cholesterol Cholesterol (High
Thrombin time. ... levels of LDL cholesterol raise your risk
Bleeding time. for heart disease and stroke.) want
Complete blood count. LOW levels
Factor V assay. HAPPY Cholesterol (Associated with a
lower risk of heart disease.) want
PT: (prothrombin time) 10-13 secs
HIGH levels
PTT: ( partial thromboplastin time)
25-35 secs
APTT: Activated partialthromboplastin
time) not on warfarin 30-40 secs on
warfarin 47-70 secs
INR: (international normalized ratio)
not on warfarin.

PANCREAS ABG(Arterial blood gas) Other

Identify problems with Measures the oxygen and carbon BMI Normal Range:
your pancreas and dioxide levels in your blood as well (Body Mass Index)
diagnose conditions your blood's pH balance. 18.5- 24.9
such as pancreatitis ICP: (Inductively
and cancer. pH: (acidic or basic) 7.35- 7.45
Coupled Plasma)
paC02: (Partial pressure of carbon detect metals and
Amylase: Helps you dioxide) carbon dioxide can move several non-metals
digest carbohydrates out of your body 35-45 mmHg 5-15 mmHg
30-110 U/ L
HC03: (concentration of I & O Target: > 30/hr
Lipase: (helps the bicarbonate in arterial blood) 22-
body absorb fat) 26mmHg
0-150 U/ L
Pa02 : (Partial pressure of oxygen)
80-100 mmHg or or 10.5 to 13.5
kilopascal (kPa)
 Fundamentals

Lab Values Memory Tricks

BMP( Basic Metabolic Panel) | MEASURE different substances in your blood

sodium 135-145 mEq/ L Potassium 3.5-5 mEq/ L BUN 5-20 mg/ dL

Odd numbers: 1,3,5 = 135 3-5 bananas per bunch & BUN ion: 5 digits/limb, 20
get them HALF off digits total

CreatiNINE 0.6-1.2 mg/ dL Glucose 70-100 mg/ dL Chloride 95- 105 mEq/ L

0.9 (NINE) is right in the Energy is low at 70-100 Best time to go in pool is
middle. years old. when it's 95-105 degrees
outside

0.09

-1 0 1 2

Magnesium 1.5-2.5 mg/ dL Phosphorous 2.5-4.5 mg/ dL Calcium 9-11 mg/ dL

Magnifying glass PHOR=4, US=2 letters CALL 9-11

magnifies 1.5- 2.5X Think of two halves to
remember the 0.5!
9-11
 Fundamentals

Lab Values Memory Tricks

BMP( Basic Metabolic Panel) | MEASURE different substances in your blood

HGB= Male 13-18 g/Dl HCT=Male 39-54%

Female 36-48% WBC 4000-11000 u/d
Female 12-16 g/ dL

HE GOT BIGGER You only need to remember “Kids ages 4-11 always
Think puberty ages HGB range then multiply by: get sick”
Males: 13-18 Women: 12-16
MALE: 13 x 3 = 39
18 x 3 = 54 V

FEMALE: 2 x 3 = 36
16 x 3 = 48

COAGS | Coagulation tests measure your blood's ability to clot

PLT 150,000-450,000 /uL PT 10-13 seconds PTT 25-35 seconds

China PLATES cost PreTeen is 10-13 years old Proper Training Time Age
$150-$400 of most professional
athletes is 25-35 years old
 Fundamentals

Sodium Imbalance (Electrolyte Imbalance)

Sodium Imbalance(Electrolyte Imbalances)

HYPERNATREMIA
Normal Range: FUNCTIONS
135-145 mEq/L

Muscle contraction
The level of sodium in blood is too high. Balances fluid volume
Hypernatremia involves dehydration, which
can have many causes, including not Nerve impulse generation
drinking enough fluids, diarrhea, kidney Balances blood volume
dysfunction, and taking diuretics
Regulates nerve impulses

SIGNS & SYMPTOMS FRIED-FAST CAUSES

REMEMBER Fried Fast
Diarrhea
Flushed skin & muscle twitches and
seizures Vomiting
Restless , Low Grade Fever, dry mouth, Sweating excessively Na
irritable, anxious,. Kidney disease
Hypernatremia
Increased blood pressure, fluid retention Hypernatremia
Edema, confused, peripheral and pitting Confusion
Decreased urine output, fatigue and Dehydration
lack of energy Diabetes insipid us
Sodium & Potassium=
Agitation OPPOSITES
Inability to access water (Salty food and
Skin flushed Outside Outside
hypertonic solution)
Thirst Excessive k k
+ +
Active
100 mM 5mM

Na+ Active Na+

10 mM 150 mM

TREATMENT

Acute hypernatremia: For 5% dextrose

Chronic hypernatremia: 0.45% sodium chloride (half-normal saline)
Excessive intake: Reducing sodium intake is one of the most cost-effective measures to
improve health. Educate patients about nutrition and exercise AND Change IV fluids.
Volume loss: If due to volume loss to start IV fluids.
Inadequate renal excretion: Administer diuretics that promote sodium loss thiazide
diuretics increase the elimination of sodium and chloride IV fluids and electrolytes
 Fundamentals

Sodium Imbalance (Electrolyte Imbalance)

Hyponatremıa
Serum sodium concentration of less than 135 mEq/L. Common electrolyte abnormality
caused by an excess of total body water when compared to total body sodium content

SIGNS & SYMPTOMS HYPERNATREMIA TREATMENT

SALT Excess of fluids Hypovolemia

Seizures. Fluids can cause water toxicity Fluid resuscitation is
Anorexia, Congestive heart failure the mainstay of
(compromised blood supply therapy in patients with
Loss of energy,
to the body) severe hypovolemia
drowsiness
Kidney disease Administer sodium
Tendon Reflexes
Decreased Liver disease chloride infusion
Excessive fluid intake
LOSS Hypervolemia
Inadequate sodium intake
Limp muscles Taking diuretics: Drugs
Orthostatic Vomiting or diarrhea to reduce the amount
Causes of dehydration. of fluid in your body.
Spasms or cramps
Stomach cramping Anorexia (eating disorder)
Increased sodium excretion
Excessive H20 intake
NHCFR Blood pressure increases
Fluid restriction is
Hypokalemia metabolic needed if your body is
Limp muscles
alkalosis(Diuretics). holding water.
Orthostatic
Drains (NGT suction)
Spasms or cramps Educate patient.
gastrointestinal drain
Stomach cramping Dehydration

Nursing Care

135 and 145 Monitor lung sounds.

milliequivalents per liter Monitor the patient's
(mEq/L). serum and urine
sodium levels
Monitor respiratory rate
Monitor blood pressure.

Na Safety precautions
Flash Light on Call
Bed alarm on
Hyponatremia
 Fundamentals

Potassium Imbalance (Electrolyte Imbalances)

Hypokalemia
Lower than normal potassium level in your bloodstream. Potassium helps carry
electrical signals to cells in your body.

SIGNS & SYMPTOMS CAUSES TREATMENT

NAMME REMEMBER Renal potassium losses Treated with oral

potassium supplements
Nausea, Palpitations K+ from extracellular fluid (ECF)
and intracellular fluid (ICF) By mouth (PO) IV
Arrhythmia, Paralysis
(given at 10 mEq/hour).
Muscle cramps Insulin-sensitive cells
Thiazide diuretics may
Muscle weakness Alkalosis( excess base or alkali cause very low levels
Excessive thirst in the body) of potassium.
Poor potassium intake
6 ‘L’
Deficiencies or excesses in never given iv push
Lots of urine nutrient intake,
Lethargy and Not feeling well
confusion Potassium Chloride
Fasting
Limp muscles for Injection
Leg Cramps Dilution of serum potassium Concentrate must be
diluted before
Low, shallow Water intoxication administration
respirations Electrolyte imbalance (CARDIC ARRTHMYIA)
Lethal cardiac
dysrhythmias.
potassium-sparing
Diuretics don't lower
potassium levels
Examine for EKG
changes.
Excess potassium loss Monitor magnesium
& calcium levels;
3.5 to 5.2 mEq/L Vomiting or from
(3.5 to 5.2 mmol/L) nasogastric (NG).
Diuretics can also cause
the body to eliminate more
potassium in the urine.
 Fundamentals

Calcium Imbalance (Electrolyte Imbalances)

Calcium Imbalance; Electrolyte Imbalances:

Hypercalcemia
Condition in which the calcium level in your blood is above normal. Too much calcium
in your blood can weaken your bones, create kidney stones, and interfere with how your
heart and brain work.

SIGNS & SYMPTOMS CAUSES TREATMENT

BACKME REMEMBER Resorption of Ca. Calcitonin (Miacalcin).

(excessive intake)
Bone pain and fragile Body aches, difficulty sleeping, This hormone from
Arrhythmias bone pain salmon controls
Constipation.nausea, Malignancy(the quality of calcium levels in
vomiting being malign.) the blood....
Kidney stones, poor
Hypervitaminosis D Calcimimetics
appetite
Muscle weakness or Too much vitamin D in This type of drug can
twitches. your blood help control overactive
parathyroid glands.
Excessive urination
Increased absorption
Increased absorption
Thiazide diuretics
Thiazides reduce urine
Kidney disease
Calcium levels .
Excessive intake Dialysis

Calcium carbonate -
containing antacids (damage
the kidneys) CA = P
CA = P
CA

Hypercalcemia Normal Range:

9-11 mg/dl
 Fundamentals

Calcium Imbalance (Electrolyte Imbalances)

Hypocalcemia
Abnormally low calcium levels in the blood, can Calcium metabolism disorders are
significantly impact a patient's health and well-being. frequently encountered.

SIGNS & SYMPTOMS CAUSES TREATMENT

CAT REMEMBER Vitamin D deficiency Intravenous (IV)

calcium gluconate
Renal disease
Confused Oral calcium and
Hungry bone syndrome vitamin D supplements
Arrhythmias
Calcium deficiency Add more calcium to
Tetnay the diet
Pancreatitis
MP-CCCC Hypomagnesaemia Cow, goat, sheep
Cheese
muscle cramps. Impaired absorption Yogurt
Paresthesia Vitamin D deficiency Increased Young green soybeans
Cramp excretion
Almonds
Circumoral
Renal disease
numbness, and
seizures Kidney disease Diarrhea
Carpopedal spasm Fluid seeps from a wound FALL RİSK
Chvostek's sign(Low
level of calcium) Pathologic fractures
that occur in long
bones where a
metastatic lesion is
present require
190
50

surgical intervention
Bed alarm
Spasm of Spasm of
hand & wrist facial muscles Care preventive.
caused by with light tap Service bell, reception
inflating BP over facial
cuff nerve
bell,
Start walking with the
Also seen in HYPocalcemia: help of someone
MG + Ca rise & fall togethe

8.5 and 10.5 mg/dL FOR both hypocalcemia

(2.12 to 2.62 mmol/L), & hypercalcemia
 Fundamentals

Magnesium Imbalance (Electrolyte Imbalances)

Magnesium Imbalance; Electrolyte Imbalances:

HYPERMAGNESEMIA
High level of magnesium in the blood.

SIGNS & SYMPTOMS CAUSES TREATMENT

Weakness, nausea Acute or chronic kidney IV administration of

Confusion disease. calcium gluconate
Malnourishment, and possibly
Headache furosemide.
constipation Overuse of magnesium
Intravenous calcium,
Excretion of magnesium by
Think Everything Low diuretics, or water pills
the kidneys.
Magnesium hydroxide
Hypotension Decreased excretion
can be used as an
Bradycardia(HR) Renal artery disease. antacid or a laxative .
Bladder paralysis, Increased extracellular fluid Magnesium
Bradypnea Causing gastric cells to containing foods
preserve hydrogen ions (greens, nuts, seeds,
Bowel activity
dry beans, whole
Drowsiness Medicine that can increase grains, wheat germ)
Dizziness magnesium levels; Excrete magnesium
Aspirin. (Diuretic)
Lithium. Last report; Dialysis
laxatives for constipation. Antidote 10% calcium
gluconate or chloride
solution

1.7 and 2.5 milligrams MG = CA

per deciliter. MG = CA
 Fundamentals

Magnesium Imbalance (Electrolyte Imbalances)

Hypomagnesaemia
Magnesium deficiency, happens when you have a lower-than-normal level of
magnesium in your blood.

SIGNS & SYMPTOMS CAUSES TREATMENT

Anorexia, Too little intake of magnesium Oral Magnesium Salts.

Nausea, into your body.
Vomiting Diabetes, Magnesium gluconate
Lethargy, Hypertension, Magnesium sulfate IV
Weakness, Coronary Heart disease,
Personality change Osteoporosis. Parenteral administration
Seizure precautions
THINK= HIGH Deficiencies or excesses in Eat more foods that contain
HR (tachycardia) nutrient intake magnesium (salad greens,
spinach, kale, chard, and
BP (hypertension) Vomiting,
collards.)
DTR (hyperreflexia) Diarrhea
RR (fast & shallow) Nasogastric tubes

Excessive loss of magnesium

Movement of magnesium from
extracellular fluid into less
accessible locations
190
50

Increased excretion
Spasm of Spasm of
hand & wrist facial muscles Alcoholisms.
caused by with light tap
inflating BP over facial
cuff nerve
Drugs cause
Antibiotics
Also seen in HYPocalcemia:
MG + Ca rise & fall together Diuretics
Antineoplastic drugs
HYPERACTIVE
Confusion
Irritability
1.5 mEq/L MG = CA
Seizures
MG = CA
Twitches
 Fundamentals

Phosphate Imbalance; Electrolyte Imbalances:

Hyperphosphatemia 4 .5 mg/dl.
Condition in which you have too much phosphate in your blood. Causes include
advanced chronic kidney disease AND Respiratory acidosis

SING&SYMPTOMS CAUSES TREATMENT

Same as hypocalcaemia
Chronic kidney Dietary Restriction.
CATT disease(Decreased excretion) Phosphate Binders.
Convulsions Hypoparathyroidism Calcium-based binders.
Arrhythmias
Metabolic
Tingling Magnesium carbonate.
Respiratory acidosis
Tetany Lanthanum
Renal failure
Muscle cramps Carbonate. ...
Perioral numbness sodium phosphate Ferric Citrate.
enemas(Excessive intake) Aluminum Hydroxide
Tingling Excess excretion into blood

Chemotherapy not only kills phosphate rich foods

GO-NUMB fast-growing cancer cells, but
( fish, eggs, nuts,
Numbness in face, also kills or slows the grow.th of
healthy cells. legumes,) Last
fingers, & limbs
resort: dialysis
Severe vitamin D deficiency

fall risk
Troussea's chvostek's
sign sign FUNCTION At risk for pathological
fractures (in both
hypo & hyper) Call
Spasm of Spasm of Formation of bones and teeth
hand & wrist facial muscles bell, bed alarm, safety
caused by with light tap Repair of cells and tissues. precaution.
inflating BP over facial Nerve and muscle production.
cuff nerve
Energy storage
Also seen in HYPocalcemia: Acid-base balance P = CA
MG + Ca rise & fall together Make protein for the growt P = CA
 Fundamentals

Potassium Imbalance (Electrolyte Imbalances)

Hyperkalemıa

SIGNS & SYMPTOMS CAUSES TREATMENT

Moniter
CHEST REMEMBER Renal disease,
electrocardiogram
Diabetes, records the electrical
Chest pain
Chemotherapy, signals in the heart.
Heart palpitations,
Major trauma, Excessive intake
EKG change
Adrenal insufficiency, Remove potassium
Shortness of breath
(AddisonS disease) from the body.
Temoreture hypoaldosteronism, leading to Decreased excretion
K+ retention
Beta-2-adrenergic
MURDER EXCESSIVE INTAKE agonists.
Muscle cramps Lead to high blood pressure, Potassium wasting
&Nausea Urine; heart disease, and stroke diuretics (Furosemide)
oliguria, vomiting Dialysis
MEDICATION
Respiratory distress
Decrease cardiac Loop diuretics stimulate
contractility EKG cellular uptake of potassium, EMERGENT
changes lowering the serum
potassium level.
TREATMENT
Reflexes; decrease
deep tendon reflex. Sodium bicarbonate and
Potassium sparing diuretics IF EKG CHANGES
Angiotensin converting PRESENT:
enzyme inhibitors Membrane stabilization
FUNCTIONS Non-steroidal by calcium salts and
anti-inflammatory drugs. potassium-shifting
Helps carry electrical agents, such as insulin
signals to cells in and salbutamol
your body. Potassium & Sodium = Opposıtes
Heart contractility
Balances fluid K+ = NA
volume K+ = NA
Functioning of nerve
and muscles cells,
 Fundamentals

Phosphate Imbalance; Electrolyte Imbalances:

Hypophosphatemia
Chronic condition that happens when you have a low level of phosphate in your blood.

SIGNS & SYMPTOMS CAUSES TREATMENT

BROKEN REMEMBER Inadequate intake Oral phosphate

Respiratory alkalosis replacement

Bone pain and medication (pills taken
fractures. Severe under nutrition by mouth) Intravenous
Reflexes decreased Nasogastric tubes SUCTION phosphate
(low DTR’s) Antacids supplementation
Osteomalacia (weak Alcoholism
bones) Diet rich in
Severe burns phosphate foods.
Kills immune system
Diabetic ketoacidosis (meats, poultry, fish,
function
nuts, beans and dairy
Extreme weakness
Decreased intake products.)
Numbness.
Malnutrition First line treatment
NB-CA Replace total body
Breathing problems Vitamin D phosphates
Confusion. deficiency Severe
Appetite loss undernutrition fall risk
Neuro Status
Changes Hypercalcemia
can lead to:
Level <2.5 Patient is at risk for
pathological fractures!
Bed alarm
CONFUSION
Safety precautions
irritability Call bell in reach
seizures Assistance with
twitches ambulation
Move CAREFULL
 Fundamentals

Blood Transfusions

Blood Transfusions
Common procedure in which donated blood or blood components are given to you
through an intravenous line (IV).

BLOOD COMPATIBILITY

your body can accept their Why might I need to get

blood without any problems.
a blood transfusion?
If blood is not compatible; Can save your life
your body produces Need a blood transfusion if
antibodies to destroy the you've lost blood from an
donor's blood cells. injury or during surgery

Rhesus (Rh) Factor

Rh factor is an inherited
protein found on the surface
of red blood cells(RBC)
blood has the protein, Rh
positive (+)
blood doesn't have the
protein, Rh negative(-)

Universal Donor

O- O+ B- B+ A- A+ AB- AB+
RH- RH-
AB+
only
compatible
with AB-
Universal Receiver

A+
compatible
with both
RH- A-

RH+ RH+ B+

B-

O+

O-
 Fundamentals

Blood Transfusions

TYPES OF BLOOD PRODUCTS

Magnesium deficiency, happens when you have a lower-than-normal level of
magnesium in your blood.

TYPES INDICATIONS

Platelets leukemia,
myelodysplasia,
PURPOSE aplastic anemia,
Red blood cells solid tumors.
Thrombocytopenia
To prevent and stop bleeding.
Cryoprecipitate Anemia
Carry oxygen from the lungs
and deliver it throughout our Hypofibrinogenemia
body ( fibrinogen
Immune globuline deficiencies)
prevent or control bleeding
immunodeficiency
protecting against bacteria,
Whole blood (PI), idiopathic
viruses, and fungi
thrombocytopenic
Replace RBC, WBC, platelets, purpura (ITP)
Albumin and plasma
Acute blood loss
Helps keep fluid from leaking (trauma or surgery)
Plasma out of your blood vessels into
Liver Failure
other tissues.
coagulation
take nutrients, hormones, and
White blood cells deficiencies
proteins to the parts of the
body that need it leukemia and
lymphoma; and
Cryoprecipitate protecting your body from
bone marrow
infection
disorders
Granulocytes Rid your body of infection or
bacterial or fungal
allergens.
infection
 Fundamentals

Blood Transfusions

Starting A Blood Transfusion

Verify Blood Product

Relay the features of a transfusion
reaction to the patient.
Prepare the Y tubing with 0.9% NaCl and
have the blood unit ready in an infusion
pump
The blood should be run slowly for the first
Blood Transfusion Facts fifteen minutes, for instance, 2 ml/min or
120 ml/hr
All donated blood is screened for Staff should be supervising the patient for
blood-borne diseases such as the first fifteen minutes
hepatitis and HIV.
Start a blood transfusion
Most at risk for reaction during first 15
registered nurses, licensed
minutes of transfusion
vocational nurses.
Blood group and antibody screen
expires 72 hours after collection The rate of transfusion can be increased
Fresh blood products must be after this period.
commenced within 30 minutes of During the transfusion, look for any signs
leaving the blood bank. of transfusion reactions.
4 hours to complete a blood If a reaction is suspected, stop the
transfusion transfusion immediately
Disconnect the blood tubing from the
patient
Inform the provider, stay with the patient
Risks of blood transfusions
and assess the status.

An allergic reaction. This can be Complications

mild or severe. .
Multiple complications of blood transfusions
Fever. ... icluding infections,
Destruction of red blood cells
Hemolytic reactions,
transfusion overload
Allergic reactions,
Iron overloaD
Transfusion-related
Viruses being transmitted. ... lung injury (TRALI)
Electrolyte imbalance
Graft versus host disease.

The host as foreign attack your

own body cells.
 Fundamentals

Blood Transfusions

TYPES OF TRANSFUSION REACTIONS

Most common signs and symptoms include fever, chills, urticaria (hives -skin reaction)
, and itching, high fever, hypotension (low blood pressure), red urine (hemoglobinuria) .

Acute hemolytic reactions Allergic reactions

May occur when either incompatible A spectrum of Hypersensitivity

red blood cells or large amounts of reactions that are the most
incompatible plasma are transfused. common adverse reaction to
platelets and plasma
Signs: Occurring in up to 2% of transfusions
Chills, Dark urine,
Fever, Uncontrolled Signs:
Pain(Low back bleeding Change colour High fever
pain )(along IV ABO Chills, Dizziness.
line, back, chest), incompatibility,
Urticaria (hives) Shortness of
Hypotension breath.
Itching

When people who have one blood

type receive blood from someone
with a different blood type, it may
cause their immune system to react

+ =
 Fundamentals

Blood Transfusions

Anaphylactic reactions. Febrile non-hemolytic reactions

Reactions usually begin within 1 to Occurring with 1–3% of transfusions

45 minutes after the start of the Reactions in which donor RBCs are
transfusion. destroyed by antibodies in the
Acute transfusion reactions . recipient's circulation.
They occur when antigen-positive
Signs: donor RBCs are transfused into a
patient who has preformed
Headache Shock and loss of
antibodies to that antigen.
tachycardia consciousness.
Vomiting, Itching Signs:
Diarrhea Myalgia (muscle aches and pain)
Nausea.
Fever
Rigors(a sudden feeling of cold
with shivering)

Septic (bacteria
Delayed hemolytic reactions
contamination) reactions.

Occurs days to weeks following a Contamination of blood products

transfusion, characterized by mild with gram-Negative bacteria is
Anemia thought to occur when blood is
Hyperbilirubinemia is one of the collected from donors who have
serious complications of blood bacteria in their bloodstream
transfusion. But do not have symptoms of an
infection.
Signs:
Signs:
Inadequate Reticulocytosis
post-transfusion Fever Fever from a bacterial or
rise in Hb, viral infection
High LDH Heart rate increased
low blood sugar
 Fundamentals

Blood Transfusions

Transfusion-associated
circulatory overload (TACO)

(TACO) is a common transfusion reaction

in which pulmonary edema develops
primarily due to volume excess or
circulatory overload.

Signs:
Acute respiratory
distress,
Increased blood
pressure
Acute or worsening
pulmonary edema

Transfusion-related acute
lung injury (TRALI)
NURSING ACTIONS
New acute lung injury (ALI) that occurs
during or within Six hours of transfusion,
Stop transfusion,
not explained by another ALI risk factor
Remove blood tubing,
Signs: Maintain access with 0.9% normal saline.
Fever, Notify the provider and monitor vitals
every 15 minutes.
Chills,
Obtain blood and urine samples and
Tachycardia, send to the lab
Hypotension, Maintain intravenous (IV) access .
Hypoxaemia, Check and monitor the patient's
Dyspnoea,(difficult or vital signs.
laboured breathing.) Repeat all clerical and identity checks;
Tachypnoea,(abnormally ensure the right pack has been given to
rapid breathing) the right patient.
 Fundamentals

Medication Administration

Medication Administration
There are many ways to administer medication, also known as routes

Starting A Blood Transfusion

Prescriptions
Physicians wrote prescriptions by hand, usually
on a prescription pad or preprinted form.

PRN
include pain medications and nausea
medications.
As-needed order,
give a medication when, in the nurse’s
judgment, the client requires it .

STAT.(immediately)
given once immediately.

Single orders.
One-time order is for medication to be given
once at a specified time

Standing
Standing order may be carried out
indefinitely (e.g., multiple vitamins daily)
until an order is written to cancel it,
carried out for a specified number of day.
6 RIGHT OF ADMINISTRATION

RIGHT MEDICATION RIGHT DOCUMENTATION RIGHT CLIENT

RIGHT DOSE RIGHT TO REFUSE RIGHT EVALUATION

RIGHT TIME RIGHT ASSESSMENT RIGHT ROUTE

 Fundamentals

Medication Administration

TYPES OF ROUTES

NONPARENTERAL ROUTES PARENTERAL ROUTES

1. ORAL ROUTE (Given by mouth) 2. Sublingual & buccal

Oral administration of medication Sublingual administration

is a Convenient, Cost-effective, Involves placing a drug under the tongue
Safe, does not break skin barrier
Primary site of drug absorption; Buccal administration
is usually the small intestine Involves placing a drug between the
Bioavailability gums and cheek.
The medication is influenced by
the amount of drug absorbed Rapid absorption ;
across the intestinal epithelium. Due to the abundant mucosal network of
systemic veins and lymphatics, thereby
leading to a rapid onset of action.
How do you administer a drug orally

TIPS Bioavailability;
The bioavailability of a 5-mg sublingually
Remove carefully from packaging.
administered dose is around 35%.
Always sit patient up 90°(angle between
the thighs and the body is bad for the More potent than oral route because
back)
drug directly enters the blood and
Place in mouth and swallow using water bypasses the liver
Avoid chewing the medication
Never crush enteric coated
meds.(Destroyed by stomach acid, or
irritating the stomach lining)
Shake the bottle well before use.
Don't swallow, crush, chew them.
Do NOT give if: place them in a specific area in
mouth to be absorbed
have a dull surface
Patients with altered
gastrointestinal function
Unable to swallow due to a
medical problem.
Unconscious, uncooperative
lack of a gag reflex
Buccal Route Siblingual Route
 Fundamentals

Medication Administration

3. Topical 4. Transdermal 5. Opthalmic

Used for local treatment of skin, The drug agent is applied to The administration of a drug
control of external and internal the skin in a patch or device to the eyes, most typically as
parasites, and transdermal of some type so that sufficient an eye drop formulation.
delivery of therapeutic agents quantity penetrates the skin
to exert a systemic effect. HOW TOAPPLY ?
lotions, Patches,
Gels Powders HOW TOAPPLY ? Pressing your finger on the skin.
Press the patch firmly in
place with your fingertips to Beneath the lower eyelid
Ensure area make sure that the edges
is clean &
of the patch stick well. Pull the lower eyelid away from
dry before
applying the eye to make a space.
Onset of drug action
faster than oral. Keep dropper held 1-2 cm
Few side effects above eye.
Prolonged systemic
effect
Easy administration
Drug can enter body Avoids GI absorption and accepted stability.
through abrasions and problems Rate of
cause systemic effects delivery may be
Leaves residue on the skin variable. Poor in bioavailability
that may soil clothes.

6. OTIC 7. Nasal

Drugs used to treat Drug is to be breathed

ear inflammation in and absorbed
and infection through the thin
mucous membrane
HOW TOAPPLY ? that lines the nasal
Applied directly to the affected ears passages,

Before applying ear drops, clean the ear It must be transformed

with a moist cloth and dry it. into tiny droplets in air
(atomized).
Long-term therapeutic effect
HOW TOAPPLY ?
Slow onset of action. Drug may be
destroyed by digestive enzymes or Hold the dropper over the affected nostril
stomach acid Apply the directed number of drops.
Ear drops Keep your head tilted for a few minutes.
For children younger than 3 years,
Blood–brain barrier penetration
gently pull the outer ear down and toward
the back of the head.
For children older than 3 years, gently pull Weak cellular uptake, enzymatic
the outer ear up. degradation, Bioavailability Less then 1%
 Fundamentals

Parenteral Routes

1. Intradermal (ID) 2. Intramuscular

Intradermal injections (ID) are injections (IM) is installing medications into the
administered into the dermis, just below depth of specifically selected muscles.
the epidermis.
HOW ADMINISTERED?
HOW ADMINISTERED? Hold the muscle around the spot
Place the needle almost flat with your thumb and index finger.
against the patient's skin, put the needle into the muscle
Bevel side up, straight up and down, at a 90
degree angle.
Insert needle into the skin.
Volume: up to 3mL
Insert the needle only about 1/4 in.
Needle gauge: 20-25g
Needle gauge: 25-27g
Needle length: 1-1.5”
Volume: < 0.5mL
Push the medicine into the muscle.
Needle length: 3/8-1/2”
With the entire bevel under the skin
Rapid onset of the action
Absorption is slow (this is an
advantage in testing for allergies The onset and duration of the action
of the drug are not adjustable.
Amount of drug administered
must be small Breaks skin barrier SITE
Deltoid is a large rounded triangular
shape on the outside of the upper arm.
Ventrogluteal injection site is an area on
the most prominent part of the hip.
Vastus lateralis muscle On the lateral side
of the thigh.

90o 45o 25o 10o-15o

Intramuscular Subcutaneous Intravenous Intradermal

 Fundamentals

Blood Transfusions

3. Subcutaneous 4. Intradermal (ID)

administered to the layer of skin referred IM is the most common parental route
to as cutis, just below the dermis and of medication administration into vein
epidermis layers. and can bypass the liver's first-pass
metabolism.
HOW ADMINISTERED?
Short needle is used to inject a
HOW ADMINISTERED?
drug into the tissue layer between Needle is inserted directly into a vein,
the skin and the muscle. solution containing the drug may be given
Volume: 0.5-2mL in a single dose or by continuous infusion.

Needle gauge: 25-27g Appropriate hand hygiene.

Needle length: 3/8-5/8” Use standard precautions.

Rapid effect
Absorption is slower (an advantage for
insulin and heparin administration)
Drug distribution inhibited
by poor circulation
Can produce anxiety Breaks skin barrier
SITE
SITE In the back of the hand, on the forearm, or on
Injection sites include the upper arm, hip, the inside of the elbow.
thigh, and buttocks.

Rotate injection sites to avoid To push any residual medication

lipohypertrophy or fluid through the IV line and
into your vein
 Fundamentals

IV Line Management

PERIPHERAL LINES
The insertion of an indwelling single-lumen plastic conduit across the skin into a peripheral vein

The bigger the number, the smaller the gauge

Color Gauge
Size
External
Diameter
Length
(mm)*
Flow Rate
(mL/min)*
Recommended
Uses
(mm)*

Trauma, Rapid blood

14G ~2.1 mm ~45 mm ~240 mL/min transfusion,

Rapid fluid
16G ~1.8 mm ~45 mm ~180 mL/min replacement,
Trauma,

Rapid fluid
18G ~1.3 mm ~32 mm ~90 mL/min replacement,
Trauma,

Most infusions, Rapid

20G ~1.1 mm ~32 mm ~60 mL/min fluid replacement,

Most infusions,
22G ~0.9 mm ~25 mm ~36 mL/min Neonate, Pediatric,
Older adults

Most infusions,
24G ~0.7 mm ~19 mm ~20 mL/min Neonate, Pediatric,
Older adults

26G ~0.6 mm ~19 mm ~13 mL/min Pediatrics, Neonate

SITES
IV THERAPY MANAGEMENT
Cephalic vein is a superficial
vein of the upper limb Inspect established IV site Discontinue short-term
Prepare and safely peripheral IV
administer Modify the procedure to
Basilic vein runs down the reflect variations.
ulnar side of the arm, Calculate and ensure
designated flow rate Document actions and
Change IV tubing observation
Antecubital the space inside Change IV site dressing Report significant deviations
the crook of the elbow
 Fundamentals

IV Line Management

MIDLINES NURSING CARE

Assessing an IV site.
Midline catheters are appropriate Priming and hanging a primary IV bag.
for all intravenous fluids that would preparing and hanging a secondary IV bag.
normally be administered through
Line flushing (at least q12) is needed to
a short peripheral IV
prevent medicine loss after IV fluid therapy.
Calculating IV rates.
A midline catheter is an 8 - 12 cm Monitoring the effectiveness of IV therapy.
catheter inserted in the upper arm with Cover with sterile, transparent, and
the tip located just below the axilla. semi-permeable dressing to inspect
insertion site.
More experienced PICC Nurses use needle Dscontinuing a peripheral IV.
visualization instead of needle guides for
the Insertion.
Midline catheters (MCs) are commonly
inserted in patients with difficult venous
access (DVA) needing peripheral access.
Insertion should be ultrasound guided by
an experienced operator to ensure large
calibre basilic or brachial veins are
selected to avoid thrombosis

IT does not
need to be
confirmed with
X-Ray or ECG as
it is not placed
near the heart.

CENTRAL VENOUS CATHETERS

CVC is a thin, flexible tube TIP of a (CVC) within the superior vena
That is inserted into a vein, below cava (SVC) at or just above the level of
the right collarbone, the carina is generally considered
acceptable for most short-term uses
Guided (threaded) into a large vein
above the right side of the heart Such as fluid administration
called the superior vena cava. Monitoring of central venous pressure.

Is used to give intravenous fluids, blood Includes all types of central lines; the difference is
transfusions, chemotherapy, and other drugs. the type of catheter & how it's inserted

Some medications require a central

line as they can cause extravasation if infiltrated
 Fundamentals

IV Line Management

PICC catheter CORDIS catheter Port-a-Cath catheter

Peripherally Inserted It is a short, wide,

Central Catheter Combination of a portal
Single-lumen central
venous catheter and a catheter .
Inserted through a
through basilic, brachial, That is perfect for rapid Used to give chemotherapy
cephalic, or medial large-volume infusions. or medicine into a vein To
cubital vein in your arm. take blood samples

And passed through to It is inserted percutaneously Thin, soft, flexible tube

the larger veins near your
Allows rapid and efficient Easier for healthcare
heart.
catheterization for professionals
hemodynamic monitoring,
USES More comfortable
Infusion of multiple solutions for patients.
Used to give medications
or liquid nutrition. Cordis catheter for trauma
patients who are unstable High risk
Cancer treatments.
with lower GI bleeding.
(long-term intravenous) Skin infections at
the puncture site.
High risk
High risk
Pneumothorax.(air leaks
into the space between Swollen and bruised
your lung ) for a few days
Hematoma (clotted
blood)
Bleeding,
Non-Tunneled Central Catheter
Infection,
Extravasation. (leakage
of vesicant fluids) HOW TO USE
A fine tube which is put directly into your
child's large vein, usually in the neck or groin.
The CTC is removed by simply pulling
NURSING CARE
Used for blood collection

Proper hand hygiene Why use?

Focus on dressing Easy access to your bloodstream
management every 7 days
Medicine may work faster.
Change your dressings in a
sterile (very clean) way. High risk
Access of intravenous Bloodstream infection(Bacteria or viruses
infusion sets, blood draws enter TO bloodstream through central line)
Management of port line Risk of phlebitis.
occlusions
Central Line Associated Bloodstream Infection
BIOPATCH Protective Disk
with CHG is a polyurethane
foam disk proved to reduce Short term use ONLY! HItGH RISK for infection
local infections.
One of the most effective ways to reduce CLABSIs
is to remove central venous catheters
 Fundamentals

IV Therapy Basics

Intravenous (abbreviated as IV therapy) is a medical technique that

administers fluids, medications and nutrients directly into
therapy a person's vein.

Remember

Objective data CHARGE

The ECF would be at +1 and

ICF ECF the ICF at -1.
(Intracellular (Extracellular
fluid ) fluid ) Extracellular fluid
(ECF) (Fluid OUTSIDE
the cell)
Intracellular fluid Extracellular fluid
(ICF) is the cytosol (ECF) surrounds the
Intracellular fluid
within the cell. cells serves as a
(ICF) (Fluid INSIDE
circulating reservoir.
the cell)

Found inside the cell Found outside Intervascular

the cell fluid (Plasma/
fluid in blood
Comprises Comprises plasma,
vessels)
the cytosol tissue fluid, and
transcellular fluid

Conc sodium ions is Conc sodium ions is

low Conc of High Conc of
potassium ions is potassium ions is
high low

Comprises 55% of Comprises about

body 45% of body water

Comprises 33% of Comprises 27% of

total body weight total body weight
Interstitial fluid
Comprises 19 L of Comprises 32 L of (Fluid that surrounds
total body fluids total body fluids the cell (in between cells)
 Fundamentals

IV Therapy Basics

DIFFUSION Vs OSMOSIS

Diffusion Osmosis

Occurs in liquid, gas and even solids. It is limited only to the liquid medium.
Does not require a semipermeable Requires a semipermeable membrane.
membrane. Depends on the number of solute
Depends on the presence of other particles dissolved in the solvent.
particles. Requires water for the movement of
Does not require water for the particles.
movement of particles. Only the solvent molecules can diffuse.
Both the molecules of solute and The flow of particles occurs only in one
solvent can diffuse. direction.
The flow of particles occurs in all the The entire process can either be
directions. stopped or reversed by applying
This process can neither be stopped nor additional pressure on the solution side.
reversed. Occurs only between similar types of
Occurs between the similar and solutions.
dissimilar types of solutions. It involves the movement of only solvent
It involves the movement of all the molecules from one side to the other.
particles from one region to the other. The concentration of the solvent does
The concentration of the diffusion not become equal on both sides of the
substance equalizes to fill the available membrane.
space. Depends on solute potential.
Does not depend on solute potential, Only water or another solvent moves
pressure potential, or water potential. from a region of its high concentration
Any type of substance moves from area to a region of its lower concentration.
of highest energy or concentration to Not associated with uptake of minerals
region of lowest energy or and nutrients.
concentration.
It helps in the uptake of minerals and
nutrients.

Diffusion Osmosis

Solution Pure Water

High Concentration Low Concentration
Semipermeable Membrane
 Fundamentals

IV Therapy Basics

DIFFUSION OSMOSIS

Diffusion refers to the movement Osmosis is a type of diffusion

of molecules from an area of specifically for water molecules
high concentration to an area of moving across a
lower concentration. semi-permeable membrane.

Solute Solvent Water follows salt

A substance that is A substance with the When sodium enters the

dissolved in a solution. The ability to dissolve other cell, water will follow,
amount of solute present substances to form a causing it to exit the
is less than the amount of solution. The amount of extracellular space.
solvent. solvent present is greater
than the amount of solute.

Water “universal solvent".

Both solute Only SOLVENT MOVES

& solvent move
Semipermeable
Membrance
Solute Solvent
molecules molecules

High Solute Diffused evenly Low High Same

Concentration ( Equilibrium ) Solute Solute Concentration
Concent Concent ( Equilibrium )
ration ration

Diffusion Osmosis
 Fundamentals

Colloids VS Crystalloids

Colloids Crystalloids

A colloid is a mixture in which one A substance that, when dissolved,

substance consisting of forms a true solution and is able to
microscopically dispersed insoluble pass through a semipermeable
particles is suspended throughout membrane.

VS
another substance.
Consist of isotonic saline or balanced
Contain high-molecular-weight electrolyte solutions and widely
molecules suspended in crystalloid distribute across extracellular fluid
carrier solution and do not freely compartments,
distribute across the extracellular fluid
Have small molecules, are cheap, easy
compartments.
to use
Have larger molecules, cost more

Classification of colloids

Dispersed phase
Medium/phase
Gas Liquid Solid

No such colloids are Liquid aerosol

Examples: fog, Solid aerosol Examples:
known. Helium and
Dispersion smoke, ice cloud,
Gas xenon are known to be clouds,
atmospheric
medium immiscible under condensation, mist, particulate matter
certain conditions. steam, hair sprays

Emulsion or Liquid
crystal Examples: milk,
Sol Examples:
Liquid Foam Example: mayonnaise, hand
pigmented ink,
whipped cream, cream, latex, biological
sediment, precipitates,
shaving cream membranes, liquid
solid bimolecular
bimolecular
Light condensate
condensate

Gel Examples: agar,

Solid foam Examples:
gelatin, jelly, gel-like Solid sol Example:
Solid aerogel, floating soap,
bimolecular cranberry glass
Solution Coloid
Styrofoam, pumice
condensate

Classification of Crystalloids Hypertonic Isotonic Hypotonic

Crystalloids are classified into three types:

Hypotonic
H2O H2O
Isotonic
Hypertonic
Outside Inside
the cell the cell
 Fundamentals

Colloids VS Crystalloids

Colloids Plasma Crystalloids

expandars
Large molecules Small molecules
Efficiently boosts blood fluid volume Offer prompt fluid resuscitation
The large insoluble molecules do not easily Maintains osmotic pressure, preventing
cross the endothelial glycocalyx and fluid shifts between compartments.
membrane
Rapidly excreted in urine
Acts to retain current fluid
Remain in the intravascular compartment
Promotes fluid movement into for less than an hour
intravascular space

Example Example

Immunoglobulins (IgG, IgA, IgM) Lactated Ringer's solution

Albumin & Plasma NS & D5W

RISK: Harsher on kidneys RISK: Can cause edema

Example of a Example of an Crystalloids

stable colloid unstable colloid

Aggregation

Sedimentation

MEMORY TRICK-
Crystalloids are
small like
CRYSTALS
MEMORY TRICK-
Colloids are
COOL, LARGE &
handsome!
 Fundamentals

IV Fuid Therapy

#1 HYPERTONIC

HYPERTONIC
Hyper: excessive The cell shink
Tonic: concentration of a solution
Water is transported
A hypertonic solution is one where the out from the cell
concentration of solutes is greater outside
the cell than inside it. H2O
More solute; less water (in solution).
Solute concentration
inside the cell is LOWER

PATHO

Cell is placed in a hypertonic solution

Uses

Greater salt concentration than water in Rapidly expands volume in

the solution. dehydration or shock.
Replenishes electrolytes in salt loss.
Manages intracranial pressure in
neurological conditions.
Have a higher solute concentration than
Treats hyponatremia by raising blood
that of the cell.
sodium levels.
Induces diuresis to remove excess
fluids.

water will leave the cell, and the cell Reduces cellular swelling.
Cells SHRINK Addresses pulmonary edema by
mobilizing lung fluids.

Rises in tonicity result from changes in VOLUME EXPANDERS

body water, body solute, or both water Draws fluid out of cells into
and solute the EXTRACELLULAR SPACE
 Fundamentals

IV Fuid Therapy

Anything ABOVE
0.9% is HYPERTONIC

Example Solute molecules

3% Saline

5% Saline

5% Dextrose in 0.9% Saline (D5NS)

5% Dextrose in LR (DSLR)

10% Dextrose (D10W)

3% Dextrose in 0.45% Saline (D3½NS)

5% Dextrose in Water (D5W)

5% Dextrose in 0.45% Saline (D5½NS)

5% Dextrose in Lactated Ringer's (DLR)

10% Dextrose in 0.9% Saline (D10NS)

Nursing considerations

Record baseline data and monitor

vital signs.
Watch for hypervolemia signs during
infusion.
Administer in high-acuity areas with
constant monitoring.
Confirm specific details in the
prescription.
Avoid for kidney, heart issues, or Water molecules
dehydration.
Administer carefully to prevent fluid
overload.
Use central administration to prevent
Hypertonic Solution
vessel irritation. (Osmotic Flow out of Cell)
Monitor blood glucose closely,
especially in diabetics.
 Fundamentals

IV Fuid Therapy

#2 ISOTONIC

ISOTONIC
Amount of water
Iso : same/equal transported into the
cell equal to the amount
Tonic: concentration of a solution of water transported
out from the cell
An isotonic solution is one in which the
concentration of solutes is same both
inside and outside of the cell.
H2O
Solute concentration
inside the cell is equal
to the solution outside
the cell
PATHO

Cell is placed in an isotonic solution

Uses

Hyponatremia (low blood sodium

Solution with an equal ratio of water and levels)
solute, possessing the same
concentration as blood plasma. Hypovolemia (low blood volume)
Intravenous medication
administration

there will be no net flow of water into or Postoperative recovery

out of the cell
Heat-related illnesses (heatstroke)
Treatment of certain kidney disorders
Rehydration in athletes after intense
the cell's volume will remain stable
physical activity
Do not shrink or swell
Correction of electrolyte imbalances
Management of certain
gastrointestinal conditions causing
If the solute concentration outside the fluid loss.
cell is the same as inside the cell

NORMAL SALINE ONLY fluid

Solutes cannot cross the membrane, used when giving BLOOD
then that solution is isotonic to the cell. PRODUCTS
 Fundamentals

IV Fuid Therapy

Example

1.0 M glucose solution is isotonic with

Solute molecules
1.0 M fructose solution

0.9% NaCl (Normal Saline Solution,

NSS)

Dextrose 5% in Water (D5W)

Lactated Ringer’s 5% Dextrose in

Water (D5LRS)

D5W starts ISOTONIC and becomes

HYPOTONIC when metabolized

Nursing considerations

Monitor vital signs before, during, and

after infusion.
Watch for fluid overload:
hypertension, dyspnea, edema.
Check for ongoing hypovolemia:
decreased urine output, tachycardia.
Prevent hypervolemia with cautious
isotonic IV infusion.
Elevate head and consider
semi-Fowler's position.
Elevate legs for edema, aid venous
return.
Educate on fluid overload signs, Water molecules
prompt reporting.
Closely monitor heart failure patients
for potential fluid overload. Isotonic Solution
(No OSmotic Flow)
 Fundamentals

IV Fuid Therapy

#3 HYPOTONIC

HYPOTONIC
Hypo: "under/beneath" The cell inflate and
eventually burst
Tonic: concentration of a solution
Water is transported
A hypotonic solution is one in which the
into the cell
concentration of solutes is greater inside
the cell than outside of it.
less solute; more water (in solution) H2 O
The normal range for blood sodium levels
is 135 to 145 mEq/L
Solute concentration
inside the cell is HIGHER

PATHO Uses

When a cell is placed in a hypotonic solution Diabetic ketoacidosis (DKA)

Promoting urine output in renal
conditions
Greater water content than salt in the Hypovolemia with hypernatremia
solution.
Rehydration in mild dehydration
Treatment for hypertonic dehydration
Reducing cerebral edema
The concentration of the vessel
decreases compared to the cell. Aid kidney excretion of excess fluids
and electrolytes
Intracellular dehydration prevention
water will flow into the cell, causing it to swell. Hyponatremia treatment
Perioperative hydration
Dilution of extracellular electrolytes
will swell and expand until it eventually burst
through a process known as cytolysis.
DRAWS FLUID INTO CELLS
Can lead to HYPONATREMIA
or HEMOLYSIS (cells swell
& burst)
In an animal cell that lacks a cell wall,
the cell can lyse, or burst, from too much
water influx. Anything BELOW 0.9 % is HYPOTONIC
 Fundamentals

IV Fuid Therapy

Solute molecules
Example 0.25 and 0.45% saline

2.5% glucose water (2.5 grams of

sugar in 100 mL of water),
0.45% Sodium Chloride (0.45% NaCl)
0.33% Sodium Chloride (0.33% NaCl)
0.225% Sodium Chloride (0.225%
NaCl)
2.5% Dextrose in Water (D2.5W)

D5W starts ISOTONIC and becomes

HYPOTONIC when metabolized

Nursing considerations

Document and monitor vital signs.

Avoid in hypovolemia, hypotension,
liver disease, trauma, or burns.
Caution with increased intracranial
pressure (IICP) risk.
Watch for signs of fluid deficit; report
dizziness.
Avoid excessive infusion to prevent Water molecules
fluid depletion and cell damage.
Do not administer with blood Hypotonic Solution
products to prevent hemolysis.
(Osmotic Flow into Cell)

Never give if.... cerebral edema can cause

dysfunction of the edematous
Increased intracranial pressure (ICP) brain and include weakness, visual
Hypoxia disturbances, seizures.
Infection,
Metabolic derangements,
The patient has liver disease
In cases of trauma or burns
 Fundamentals

IV Therapy Complications

IV THERAPY Complications

Phlebitis

Phlebitis is the inflammation of a vein, often characterized by redness,

swelling, and pain.
It can occur in both superficial and deep veins, with deep vein
phlebitis posing a risk of blood clot formation.

Can lead to THROMBOPHLEBITIS (blood clot)

Symptoms Pain relief (anti-inflammatory medications).

Compression stockings
Redness and warmth Elevation of affected limb.
Swelling and pain Remove IV
Hard or lumpy veins Improve circulation (compression stockings).
Skin discoloration Modify activities.
Fever and general malaise Blood-thinning medicine to reduce the risk of blood
clots
Blood clot prevention (anticoagulant medication).
May have decrease iv
Address underlying causes.
flow due to occlusion
 Fundamentals

IV Therapy Complications

Infection
If the IV line, port, or skin on the site of injection are not properly
cleaned prior to inserting the IV, the likelihood of infection increases.
This can be prevented with proper sterilization and hygiene.

Symptoms Treatment

Localized redness Antibiotics(For bacterial infections )

Swelling Wound care
Pain or tenderness Antifungal may be used to treat fungal infections
Discharge or drainage Anthelminthics may be used to treat parasitic infections.
Fever IV fluids
Chills Pain management
Warm compresses
Follow-up care

Hematoma
A hematoma happens when blood leaks into surrounding tissue, often due to an IV catheter
passing through vessel walls or inadequate pressure during catheter removal.
Applying direct pressure can control it, and it typically resolves within two weeks.

Symptoms Treatment

Localized swelling. No specific medication is

Discoloration or available
bruising at the site. Hematoma Cold compresses to reduce
Pain or tenderness. swelling.
Restricted Assess the patient and be Elevating the affected area.
movement or sure they are medically Rest and avoiding further injury.
stiffness in the stable Some patients may be
Pain relief with OTC
affected area. more prone to hematomas if
medications.
they have abnormal coags
People taking blood-thinning Allow time for natural healing.
medications,
 Fundamentals

IV Therapy Complications

Infiltration
IV infiltrations and extravasations occur when fluid
leaks out of the vein into surrounding soft tissue.

Symptoms Treatment

Stop the infusion.

Swelling
Remove the IV.
Blanching
Mark the outline affected area with a marker.
Cool skin temperature around the IV site
Photograph the affected area.
Puffy or hard skin
Apply a hot or cold compress based on the
IV not working. type of IV fluid infiltrated.
Pain Elevate the extremity.
Slowed infusion Inject medication into the subcutaneous
Tenderness tissue.

Extravasation occurs when a vesicant

drug leaks out of the vein and into the
surrounding tissue.

Can Lead to
to injury or friction(Blisters)
Peeling
mucosal damage.
Necrosis

Vesicant examples
Vasopressors
Dopamine (vasopressor)
High concentration IV fluids (D10)
Chemo agents
Epinephrine (vasopressor)
 Fundamentals

IV Therapy Complications

Maintaining IV lines
Ensuring that the proper fluid is infusing at the appropriate rate as prescribed by the physician.

Assess insertion site regularly.

Secure catheter and dressing.
Flush with saline for patency.
Change dressings as needed.
Monitor for complications (phlebitis, clot).
Use aseptic techniques.
Follow schedule for tubing and solution changes.
Educate patients on reporting complications promptly.

Discontinuing IV lines Notify the MD if a portion of

the catheter tip is missing.
Confirm need per medical orders.
Gather supplies (dressing, tape).
Wash hands, use aseptic technique.
Remove catheter smoothly.
Apply pressure or sterile dressing.
Check for bleeding or infection.
Document the procedure and patient's
response.
 Fundamentals

Pressure Injuries

What is it?
Pressure injuries are ulcers that happen on areas of the skin that are
under pressure from lying in bed, sitting in a wheelchair, or wearing
a cast for a long period.

Risk Factors Branded Scale Scale Interpretation

Nutrition Identification of patients at Mild risk: 15-18

Urinary incontinence risk for forming pressure
sores. The Braden scale
Immobility (bedridden uses six areas to rate the Moderate risk: 13-14
patients) risk for pressure ulcers:
Malnutrition (Albumin
Sensory Perception High risk: 10-12
<3.5)
Moisture
Mental status
Activity
Moisture Severe risk: less than 9
Mobility
Shear
Nutrition
Age No risk: 19-23
Friction and Shear
Compromised blood flow
Diagnosis
Turning and
repositioning

Sensory/Mental Moisture Activity Mobility Nutrition Friction / Shear

Total limited Constantly Moist Bedfast 100% immobile Very poor Frequent sliding

Veri limited Very moist Chairfast Very limited < 1/2 portion Feeble Corrections

Occasionally Walks w/ Idependent

Slightly limited moist assistance Slightly limited Most of portion Corrections

Walks w/
No Impairment Dry Full mobility Eats everything
assistance
 Fundamentals

Pressure Injury Stages

Stage 1 Stage 2 Stage 3

Not an open wound. Open wound. Extends through skin into

Skin is painful with no Skin breaks, wears away, deeper tissue and fat.
breaks or tears. or forms an ulcer. Subcutaneous fat is
Reddened appearance, Tender and painful. visible just under the
does not blanch. skin.
Expands into deeper
Different color in dark layers. Does not reach muscle,
skin, not necessarily red. tendon, or bone.
Resembles a scrape,
Skin temperature may blister, or shallow crater.
be warmer. May appear as a blister
Area may be swollen & with clear fluid.
irritated NO exposed fat
Texture can feel firmer or Some skin may be
softer than surrounding irreparably damaged or
area. die.

Stage 1 Stage 2 Stage 3 Stage 4

Skin
Fat

Muscle

Bone

DTI Risk of evolving

into stage 3 or 4

Stage 4 No open wound, but

Unstageable damage to tissues
Full-thickness skin loss. beneath the surface.
Pressure injuries extend An unclear stage. Skin may appear purple
to muscle, tendon, or Base covered by dead or dark red.
bone. tissue, which can be Blood-filled blister might
Reddish crater on the yellow, grey, green, be present.
skin brown, or black.
Non-blanchable, often
Severe tissue damage, . Doctor unable to see the looks bruise-like
wound base to
May involve tunneling or determine the stage. Treated as a suspected
pockets. pressure injury.
 Fundamentals

Pressure Injury Assessment

Initial Assessment Reassessment

Identify the type and stage of the Periodically reassess injury for changes.
pressure injury. Document improvements or deterioration.
Note the location and size of the injury. Check for signs of infection or
Assess surrounding skin for signs of complications.
inflammation or damage. Modify treatment plan accordingly.
Check for signs of infection, such as Reevaluate contributing factors.
redness, warmth, or discharge.
Communicate with healthcare team.
Evaluate the presence of pain or
tenderness. Re measure wound dimensions once a
week or per hospital policy
Document any factors contributing to the
injury, such as moisture or friction. Provide ongoing patient education.

Consider the patient's overall health and

nutritional status.
Consult wound care nurse if within
hospital policy
Initiate appropriate interventions based
on the assessment findings.

Wound Descriptions

Dehiscence: Separation of wound edges. Types of Drainage

Puncture wound : Deep wound
Abscess: Areas of infection Serous: Clear, thin, watery fluid.

Lacerations: Cuts, slices, or tears in the Hemorrhagic: Active bleeding or large

skin amounts of blood.
Desiccated: Dry and dehydrated. Seropurulent: Clear and blood-tinged with
pus.
Edema: Swelling of the skin.
Fibrinous: Thick and sticky, containing fibrin
Traumatic wounds: Burns, and penetra- strands.
ting trauma wounds.
Serosanguineous: Pale pink to light red,
Erythema: Redness of the skin. watery fluid.
Eviscerated: Internal organ protruding Sanguineous: Bloody or blood-tinged fluid.
through an incision. Biliary: Drainage from the bile ducts, often
Indurated: Firm or hard skin around the seen post-surgery.
wound. Purulent: Thick, yellow, green, or brown pus.
Macerated: Moist, soggy, and soft. Chylous: Milky and opaque, containing
lymphatic fluid.
Periwound: Skin surrounding the wound.
 Fundamentals

Pressure Injury Prevention

Skin Hygiene Adequate Nutrition

Keep skin clean, dry, and moisturized. Promote a well-balanced and nutritious
Use gentle cleansers and barrier creams. diet.
Regularly inspect for redness or irritation. Monitor protein intake for tissue repair.
Educate on proper skin hygiene. Ensure sufficient vitamins and minerals for
skin health.
Implement measures for high-risk areas.
Collaborate with a dietitian for personalized
nutrition plans.
Encourage hydration to maintain skin
integrity.
Relieve Pressure Educate on the importance of nutrition in
preventing pressure injuries.
Change positions at least every 2 hours if
you are confined to a bed.
Avoid sliding, slipping, or slumping, or
being in positions that put pressure
directly on an existing pressure injury. (if
approved by HCP)
Apply prevention devices to bony
prominences.
Use special support surfaces.
 Fundamentals

Skin Overview

It is made up of three layers, the epidermis, dermis, and the hypodermis,

All three of which vary significantly in their anatomy and function.
The skin's structure is made up of an intricate network which serves as the body's initial barrier
against pathogens, UV light, and chemicals, and mechanical injury

Epidermis
Epidermis
The outermost layer of skin, provides a
waterproof barrier and contributes to
skin tone.
Protecting your body from the outside Dermis
world, keeping your skin hydrated,
producing new skin cells and
determining your skin color.

Hypodermis
Dermis
found beneath the epidermis, contains
connective tissue, hair follicles, blood
vessels, lymphatic vessels, and sweat
glands. Functions
The layer of skin that lies beneath the
epidermis and above the subcutaneous Provides a protective barrier against
layer. mechanical, thermal and physical injury
and hazardous substances.
Thickest layer of the skin, and is made up
of fibrous and elastic tissue Prevents loss of moisture.
Reduces harmful effects of UV radiation.
Provides strength and flexibility to the skin.
Acts as a sensory organ (touch, detects
temperature).
Helps regulate temperature.
Hypodermis
An immune organ to detect infections etc.
The lowest layer of skin that connects the Production of vitamin D.
upper layers to the muscles and bones
below and supports them.
Including storing energy, connecting the
dermis layer of your skin to your muscles
and bones,
Insulating your body and protecting body
from harm.
 Fundamentals

Types of Skin Lesions

Primary SKIN LESIONS

Treatment

A macule is a discolored spot on the skin; freckle

Flat, distinct, discolored area of skin less than 1 centimeter (cm) wide.

Papule

A papule is a solid, circumscribed, elevated area on the skin; pimple

Elevated solid lesion up to 1 cm in size

Vesicle

A vesicle is a small fluid filled sac; blister. A bulla is a large vesicle:

varicella (chickenpox)
These vesicles will break, crust over, scab, and finally heal.
Early appearance of a poison ivy rash, located on the knee.

Nodule

A nodule is a larger papule; acne vulgaris

Elevated solid lesion with depth up to 2 cm
Growth of abnormal tissue.
Develop in deeper skin tissues or internal organs.

Pustule

skin lesions formed by a collection of leukocytes (predominantly

neutrophils) within the Epidermis or superficial dermis.
Can be infectious or inflammatory and should be differentiated from
vesicular eruptions

Plaque

Elevated, plateaulike, solid lesion greater than 1 cm in size.

Elevated lesion filled with purulent fluid.
Plaques are raised red patches covered with a whitish buildup of dead
skins cells called scale
 Fundamentals

Types of Skin Lesions

Secondary SKIN LESIONS

Fissure

A fissure is a crack-like sore or slit that extends through the epidermis

into the dermis; athlete's foot.
Painful breaks within the skin surface, as a result of excessive xerosis
(dryness of skin)

Scales

A scale is a thin, dry flake of cornified epithelial cells such as psoriasis.

Caused by dry skin, certain inflammatory skin conditions, or infections.

Scar

Permanent fibrotic skin changes that develop as a consequence of

tissue injury
In which normal tissue is replaced by fibrous connective tissue at the
site of injury to the dermis

Ulcer

Open sores caused by poor blood circulation.

Sores and ulcers often become infected if not properly treated.
Full thickness loss of epidermis with damage into dermis
 Fundamentals

Types of Skin Lesions

Edema
Edema results from excess fluid trapped
SKIN COLOR ABNORMALITIES
in body tissues.
Can affect any part of the body but Pallor (Pale): Skin looks lighter than usual.
commonly occurs in legs and feet.
Causes: Emotions, reduced blood flow,
Medications and pregnancy are common
low red blood cell count.
causes of edema.
Can signal underlying medical conditions

Cyanosis (blue): Bluish or grayish skin tone.

Peripheral cyanosis affects hands and feet.
Cold temperatures may contribute to
blue-tinged skin.
Make sure to check
Grading for Pitting mucous membranes!

Grade Difinition
Jaundice: Yellowish skin and eyes due to
1+ 2mm or less disappear immediately
excess bilirubin. Bilirubin dissolves in
subcutaneous fat, causing the discoloration
2+ 2-4mm few second rebound

3+ 4-6 mm 12-12 second rebound

Hyperpigmentation: Darkening of skin in
certain areas. Appears as brown, black, gray,
4+ 6-8 >20 second rebound
red, or pink spots. Commonly known as age
spots, sun spots, or liver spots.

Pitting edema Erythema: Red, pink, or purple skin mark

from acne.
Pitting edema occurs when excess fluid
builds up in the body, causing swelling; Persistent spots are post-inflammatory
when pressure is applied to the swollen erythema (PIE).
area, a “pit”, or indentation, will remain. Treatable with home and medical methods.

Pitting edema
Most common areas:
Legs
Ankles
Feet
 Fundamentals

Types of Skin Lesions

Skin turgor
Skin turgor is a sign of fluid loss
(dehydration).
Measure of skin elasticity

Skin turgor test

The skin is held for a few seconds then
released.
Skin with normal turgor snaps rapidly
back to its normal position.
Skin with poor turgor takes time to return
to its normal position.
Lack of skin turgor occurs with moderate
to severe fluid loss.

Normal: : < 2 seconds

Decreased: >2 seconds

Measurement
Using 2 fingers to gently grasp the skin over
the antecubital fossa and dorsum of the
hand. Turgor was considered normal if the
time for the skin to return to the hand was
less than 2 seconds and considered
decreased if > 2 seconds.

NOT a reliable test in the elderly

With age, your skin loses elasticity,
causing poor skin turgor.

Need to include other assessments to

test for dehydration
 Fundamentals

Ambulation Devices

Assessing mobility status

Functional mobility is a person's physiological ability to move independently and safely in a
variety of environments in order to accomplish functional activities or tasks and to participate
in the activities of daily living, at home, work and in the community.

Main areas of functional mobility

Bed Mobility: The ability to move around in bed, including actions like scooting, rolling, or
moving from lying to sitting and sitting to lying.
Transfers: The action of moving from one surface to another. This includes moving from a
bed into a chair or moving from one chair to another.
Ambulation: The ability to walk. This includes assistance from another person or an assistive
device, such as a cane or a walker.

Assistance requirements

Dependent Healthcare provider performs all mobility tasks. A mechanical lift and
assistance by other personnel are required to perform tasks.

Maximal Assist Therapist does 75%, you do 25% of the work.

Moderate Assist Equal sharing, 50% each.

Minimal Assist You do 75%, therapist does 25% of the work.

The caregiver places one or two hands on the patient’s body to help
Contact Guard Assist with balance but provides no other assistance to perform the
functional mobility task.

The caregiver does not touch the patient or provide assistance, but
Stand-by Assist remains close to the patient for safety in case they lose their balance
or need help to maintain safety during the task being performed.

Independent Can perform task without assistance, ensuring safety.

 Fundamentals

Types of Assistive Devices

Assistive devices for ambulation, or just ambulation devices, are tools used
to aid in walking.
That serve to increase the size of an individual's base of support

Crutches

Crutches are the last kind of

common ambulation device. They A
are either single or paired and are
used by people who cannot bear
B
weight on one or both legs.
Finger
Width

Ensure crutches fit by

Cuff
Aligning top below armpits.
Adjusting handgrips to wrist
height. Hand
Allowing 1-2 inches clearance Grip
under armpits.
Confirming stability and secure
adjustments.
Checking for comfort in armpits
and hands.
Practicing a smooth walking
pattern.

Going upstairs Going downstairs

When going upstairs with crutches: When going downstairs with crutches:

Positioning: Approach the stairs and Positioning: Stand close to the edge of the
stand close. stairs.
Grip Adjustment: Hold both crutches in Grip Adjustment: Hold both crutches in one
one hand on the side opposite the railing. hand on the side opposite the railing.
Railing Utilization: Hold the railing with the Railing Utilization: Hold the railing with the
free hand for support. free hand for support.
Ascending: Lift the good leg first, followed Descending: Lower the injured leg and
by the crutches and the injured leg. crutches first, followed by the good leg.
Safety: Take one step at a time, ensuring Safety: Descend one step at a time, ensuring
stability before moving to the next step. stability before moving to the next step.
 Fundamentals

Types of Gaits

Two-Point gait Three-Point gait

Sequence: Move the crutch on the injured Movement: The injured leg does not touch
side simultaneously with the non-injured the ground.
leg, then move the crutch on the Pattern: Both crutches and the injured leg
non-injured side simultaneously with the move forward together, followed by
injured leg. moving the non-injured leg.
Pattern: Mimics a more natural walking Steps:
motion by coordinating movements on
both sides. Simultaneously move both crutches and
the injured leg.
Steps:
Move the non-injured leg.
Move the right crutch with the left leg.
Move the left crutch with the right leg.

Swing through gait

Four-Point gait
The gait of choice for those crutch walkers
Sequence: Move the crutch on the injured
who can perform it
side, then move the non-injured leg;
followed by moving the crutch on the Move both crutches forward.
non-injured side and moving the injured Swing both legs forward past the crutches.
leg.
60% of the gait cycle
Pattern: Provides a more stable and
controlled walking pattern.
Steps:
Move the right crutch.
Move the left leg.
Move the left crutch.
Move the right leg.

Swing to gait
Simultaneously move both crutches
forward.
Both legs follow forward to a height
parallel with the crutches ("swing-to") to
complete the cycle..
 Fundamentals

Walker

Infiltration
These are movable, lightweight devices that consist of a metal frame, two hand grips, and
four legs.
Walkers provide great stability due to their wide base,
They are great for people who can bear weight on their feet but have trouble walking due to
weakness of the legs or balance issues.

GAIT How to know it fits

Lift and move the walker forward. If your balance is poor, or if you have
Move the weaker leg forward. weakness or arthritic pain in both legs or hips
the patient can bear full weight with one Your elbows should be relaxed and held
lower extremity close to the side of the body,
Put weight on hand grips with hands. The walker height should be at the crease
of your wrist when your arm is extended
Only allowed to touch the involved lower
extremity to the floor Elbows should be bent at 30 degrees when
hands are on grips.
Move the stronger side forward.

Getting Up with a Walker:

To start with stand in the walker with your
hands on the hand grips.
Elbows should be bent comfortably.
First, lift the walker and move it forward
about an arm's length.
Be sure that all four legs contact the floor
at the same time to avoid tipping the
walker

Sitting Down with a Walker:

To sit down using a walker:
Back up until you feel the chair
behind you.
If you have an injured leg, knee, or
hip, extend that leg a little bit out in
front of you.
Bend forward at your hips.
 Fundamentals

Cane

A cane can be used for support. It may be a good choice if you only need a little help with
balance and stability, or if your leg is only a little weak or painful.

GAIT How to know it fits

Place the cane in the Ensure that the cane is

hand opposite to your the correct height for the
weakest leg. patient.
Stand with your weight Cane should extend from
evenly distributed on the patient's greater
each leg, using the cane trochanter to the floor
for balance. The patient's elbow
Move the cane forward. should be able to flex 15
Place most of your to 30 degrees
weight on your good leg. The cane's handle should
Place the cane 6-10 fit comfortably in the
inches forward. patient's hand..

Move the cane and the

weak side forward. Nurse should stand on patient's
weak side during ambulation

Going Upstairs: Going Downstairs:

Move good leg first Then move bad leg Move bad leg first Then move good leg

Place your cane in the hand Grasp the handrail with the hand
opposite your injured leg. opposite the cane.
With your free hand, grasp the Place the cane on the next lower step.
handrail. Lower the weaker leg to the same step as
Step up on your good leg first, thn the cane.
step up on the injured leg. Shift weight to the cane, weaker leg, and
handrail before bringing the remaining
leg down to the lower step.

Using a four-pronged cane:

Hold the cane in one hand. If one leg is weak, hold the cane in the hand opposite the weak
leg.
Advance the quad cane forward about one arm's length.
Step forward with the weak leg.
Gently press down into the handle of the quad cane with your hand to help with stability. ...
Repeat this cycle.
 Fundamentals

Patient Positioning

ANATOMICAL PLANES Anatomical Body Planes and Directional Terms

Transverse plane
The transverse plane, or the axial plane,
divides the body into upper (superior)
and lower (inferior) halves.
Coronal Plane
The coronal plane is a vertical plane
which also passes through the body
longitudinally – but perpendicular
Sagittal plane
The sagittal plane (lateral or Y-Z plane)
divides the body into sinister and dexter Transverse Frontal/Coronal Sagital/
(left and right) sides. Plane Plane Lateral Plane
Superior inferior Medial Lateral Anterior Posterior

Directional Terms

Directional terms describe the positions of structures relative to other structures or locations
in the body.

Directional terms
Superior or cranial - toward the head end of the body; upper (example, the hand is part
of the superior extremity).
Inferior or caudal - away from the head; lower (example, the foot is part of the inferior
extremity).
Anterior or ventral - front (example, the kneecap is located on the anterior side of the
leg).
Posterior or dorsal - back (example, the shoulder blades are located on the posterior
side of the body).
Medial - toward the midline of the body (example, the middle toe is located at the
medial side of the foot).
Lateral - away from the midline of the body (example, the little toe is located at the
lateral side of the foot).
Proximal - toward or nearest the trunk or the point of origin of a part (example, the
proximal end of the femur joins with the pelvic bone).
Distal - away from or farthest from the trunk or the point or origin of a part (example, the
hand is located at the distal end of the forearm).
 Fundamentals

Patient Positioning

"Supine" means lying flat on the back with arms at the sides. It is a common medical position
for procedures, allowing access to the chest and abdomen while minimizing nerve damage
and pressure ulcers.

Supine Uses : Supine

Medical Procedures: Enables access to chest and abdomen.

Prevention: Minimizes nerve damage and pressure ulcers.
Examinations: Standard for clinical assessments.
Versatility: Common in various medical procedures.
Comfort: Provides a neutral and comfortable position.

The prone position is when a patient lies face-down on their stomach with arms outstretched
or tucked underneath.

Prone Uses : Prone

Medical Procedures: For interventions requiring back access.

Diagnostic Imaging: Beneficial in certain imaging studies.
Pain Management: Relieves musculoskeletal back pain.
Respiratory Support: Improves ventilation in specific cases.
Pressure Relief: Reduces the risk of pressure ulcers during extended
prone positioning. Monitor for skin breakdown

The lateral position is when a patient lies on the non-operative side of their body with one arm
bent towards their head and the other extended towards their feet.

Lateral Uses : Right Lateral Recumbet

Medical Procedures: Ideal for X-rays and blood drawing.

Surgical Interventions: Ensures total lateral stability.
Patient Comfort: Enhances comfort during exams.
Anatomical Accessibility: Facilitates access to specific body areas.
Versatility: Adaptable for various medical contexts.

Left Lateral Recumbet

 Fundamentals

Patient Positioning

Fowler Semi-sitting

A position in which the individual lies

on their back on a bed with the head
of the bed elevated at 15-60 degrees Fowler’s

Fowler's position requires the patient to

be in a semi-sitting position, typically Uses
between 30 and 90 degrees. to prevent
aspiration Respiratory Support: Improves lung
expansion for better breathing.
1
Digestive Comfort: Enhances stomach
Low Fowler's Position (15-30 degrees) Uses:
expansion for improved digestion.
Lower Back Pain: Eases discomfort for Cardiovascular Benefits: Reduces heart
patients with lower back pain. workload and venous pressure.
Post-Procedure Comfort: Provides a Post-Surgical Care: Promotes comfort and
balanced recovery position after certain aids in recovery.
procedures. Patient Observation: Facilitates monitoring
Blood Drawing: Facilitates blood drawing in a semi-upright position.
with a slight upper body elevation. Procedures and Exams: Commonly used
2 for various medical interventions requiring
Semi Fowler's Position (30-45 degrees) Uses:
a semi-sitting position.

Aspiration Prevention: Reduces the risk of

aspiration with a moderate upper body
elevation.
Lung Expansion: Facilitates improved
lung expansion for respiratory support.
Nausea Reduction: Helps alleviate
nausea by maintaining a moderate angle.
3
High Fowler's Position (45-60 degrees) Uses: Pillow Placement

Eating & Drinking: Facilitates comfortable Place small pillow under the head and neck.
ingestion. Place a pillow under the flexed upper arm,
Oral Medication: Optimal angle for supporting arm level with the shoulder.
swallowing medications. Place a pillow under the flexed upper leg,
Bedside Chest X-rays: Ideal for supporting leg level with the hip.
convenient chest x-ray examinations.

Sims (Semi-Prone)
A medical posture where the patient lies on the left side, with the left hip straight and the
right hip and knee bent. Commonly used for perineal exams, enemas, and in pregnancy,
providing visualization and pressure reduction.
 Fundamentals

Patient Positioning

Patient lies flat on their back with flexed knees and thighs apart, commonly used in childbirth or
pelvic exams for enhanced access.

Lithotomy Uses :

Childbirth: Optimal for labor and delivery.

Pelvic Exams: Facilitates thorough examinations.
Gynecological Procedures: Enhances access.
Surgeries: Access to pelvic area in surgical procedures.

Patient's head lower than feet by tilting the table. Enhances visualization for lower abdomen
and pelvis, commonly used in robotic procedures. Caution for gradual changes to
accommodate heart adaptation.

Trendelenburg Uses :

Enhanced Visibility: Improves view for lower abdomen

and pelvis.
Robotic Procedures: Commonly used in robotic
interventions.
Medical Imaging: Facilitates specific imaging studies.
Used for lower abdominal surgeries

Lying on the back at a 15-30° angle reduces leg venous pooling, aiding blood flow to the heart.
Post-surgery, promoting circulatory benefits in recovery.

Reverse Trendelenburg Uses :

Post-Surgery Recovery: Applied for circulatory benefits in the

recovery phase.
Circulation Aid: Aids in facilitating blood flow from lower
extremities to the heart.
Venous Pooling Prevention: Helps reduce pooling of blood in
the legs.
Used for neck and head surgery and gynecological
procedures
 Fundamentals

Urinary Elimination

Factors Affecting urinary Elimination

What is it?
URINARY ELIMINATION is the removal of waste products
Fluid from the body through the urinary system(urine)
Diet
Response to urge
Urinary Incontinence(UI) the involuntary leakage of
Stress Urine, is a common clinical condition that occurs
Cognition frequently in older adults.
Psychosocial factors
Activity
Types of Urinary Incontinence
Pathological Conditions
Body positioning
Leaking urine during activities like
Medications Stress coughing, sneezing, or exercising due
Developmental level Incontinence to high pressure on the bladder and
weak pelvic floor muscles
Environmental factors
Medical Diagnosis or surgery Sudden, intense urges to urinate,
Can be temporary or permanent
Urge leading to involuntary urine loss.
Incontinence Causes can range from infections to
neurological disorders.

Urinary Incontinence is not a

normal part of aging. It is a loss of Overflow Constant dribbling of urine due to an
urine control due to a Incontinence incompletely emptying bladder
combination of:
Age related changes
Genitourinary pathology Physical or mental impairments
Functional
hindering timely toilet access, such as
Comorbid conditions and Incontinence in severe arthritis.
medications
Environmental Obstacles
Mixed Experiencing a combination of stress
Incontinence and urge incontinence.

Reflex Bladder contracting without warning

 Fundamentals

Urine Elimination & Collection

NON-INVASIVE
Always attempt
first before moving
to more invasive
“NON-INVASIVE" refers to methods that don't involve measures
inserting any instruments or devices into the body.

Bedpan / Urinal

A bedpan is normally used in a sitting or lying position, whilst a urinal can be used
sitting or standing. Generally men prefer to use a bedpan for bowel movements
and a urinal bottle to collect urine.

Purewick
condom catheter (cause fewer
urinary tract infections)

Bedpan / Urinal

A category of devices that adhere to the external genitalia or pubic area and
collect urinary output.
Used to treat conditions like urinary incontinence

Invasive (Catheters)

Medical device introduced into the body. Enter either through a break in the skin
or an opening in the body. For example; Urinary catheters:

Intermittent Straight Catheterization Procedure must be done sterile.

Involves inserting a thin, hollow tube called a catheter into the bladder through
the urethra (the tube from which the urine exits your body).
 Fundamentals

Urine Elimination & Collection

Ndwelling foley catheter Coude catheter

Inserted in the same way as an Curved tip or slightly angled catheter that is
intermittent catheter sometimes needed when a straight tip
The catheter is left in place. catheter is not easily inserted. USED FOR?

The catheter is held in the bladder by a Obstructions or blockages in the

water-filled balloon, urethra.
Which prevents it falling out. Ideal for patients with enlarged
prostates (BPH), urethral narrowing,
Used on average up to two weeks.
blockages, or scar tissue.
Helps drain urine from your bladder
Insert a coude up or down
Prolonged catheter use increases
risk of infection the tip of the catheter should be facing
pointed towards the ceiling or patient's face,
assuming the patient is laying down.

Often used in
patients with
enlarged prostate
Two types of Foley catheters

Urethral indwelling catheter is a

catheter inserted through the urethra
into the bladder. Suprapubic catheter
Suprapubic indwelling catheter is
inserted through the stomach directly A suprapubic catheter is a type of catheter
into the bladder. that is left in place
The catheter is inserted through a hole in your
tummy (abdomen) and then directly into
your bladder.
Three-way catheter catheter stay in?
Have three channels: Will need to be changed every 4 to 6 weeks.
USED FOR:
One for inflation of the balloon,
To manage bladder dysfunction and urinary
One for urine drainage
retention not amenable to urethral
One for connection of irrigation fluid. catheterization
These are used primarily after
surgery on the bladder or prostate, to
wash away blood and blood clots.

Often used in
patients after
bladder sx
 Fundamentals

Urine Elimination & Collection

Catheter care Catheter care management

Wash your hands Making Sure Your Catheter is Working
Remove the stopper or open the clamp Always keep your bag below your waist.
that keeps your collection bag shut.
Try not to disconnect the catheter more
Ensure the tubing is not coiled, kinked, or than you need to.
compressed so that urine can flow
unobstructed into the bag. Keeping it connected to the bag will make it
work better.
Catheter insertion is always a sterile
procedure Check for kinks, and move the tubing
around if it is not draining.
Slack should be maintained in the tubing
to prevent injury to the patient's urethra. Drink plenty of water during the day to keep
urine flowing.
Empty the collection bag into a toilet. ...
Clean the drainage port with soap and
water. ...
Pat the drainage port dry. Nurses responsibility
Replace the stopper or clamp.
of catheter care
Remove catheter as soon as possible to Nurse must be vigilant in assessing the
reduce risk of infection patient for proper catheter placement.
Wash your hands again. If the PA waveform suddenly looks like the
Ensure date & time of insertion is properly RV or PCWP waveform, the catheter may
documented have become misplaced.
The nurse must implement the proper
procedures for correcting the situation.
 Fundamentals

Bowel Elimination

Bowel elimination is the way your It is also known

body rids itself of solid wastes as Defecation

Physiology of Bowl Elimination Factors Affecting Bowel Elimination

Digestive Process: Food is broken down Fluid Intake.

in the digestive system, leaving waste
Physical Activity.
material.
Psychological factors.
Large Intestine's Role: The colon absorbs
water, forming solid stool. Age
Peristalsis: Muscle contractions move Personal Habits:
waste towards the rectum. Busy schedual, postpone BM ,
Defecation RefPositionlex: Rectum Constipation
stretching triggers the urge to defecate. Activity & Exercise:
Voluntary Control: We can delay or Immobile , Activity in colon
initiate bowel movements.
Medications:
Factors Affecting Bowel: Diet, fluids,
Laxatives, Narcotics with codiene
activity, meds, stress, and health
conditions. Diet and Fluids
Normal Patterns: Vary from several times Privacy
a day to a few times a week. Drugs
Disorders: Diarrhea, constipation, Squatting Position
incontinence, obstructions disrupt bowel
function.
 Fundamentals

Bowel Elimination

Developmental Considerations Constipation

Infancy: Bowel movements irregular, Constipation is infrequent bowel

influenced by feeding. movements or difficulty passing stools,
Toddlerhood: Toilet training starts, often with hard, dry stools and
awareness of bowel sensations develops. abdominal discomfort.
(between 1.5-3 years old)
Preschool: Further toilet training,
If Left Untreated, Constipation Can Lead to:
achieving daytime control.
School Age: Established bowel habits, Hemorrhoids: Straining during bowel
occasional disruptions due to stress or movements can lead to swollen and
routine changes. inflamed veins around the anus.
Adolescence: Similar to adults, Anal Fissures: Hard stools can cause small
influenced by diet, stress, and hormones. tears in the lining of the anus, resulting in
pain and bleeding.
Adulthood: Generally stable bowel
patterns, affected by lifestyle and health Fecal Impaction: Severe constipation may
factors. lead to a large, hardened mass of stool that
gets stuck in the rectum, making it difficult
Older Adults: Changes due to aging,
to pass any stool
including constipation and incontinence.
Rectal Prolapse: Chronic straining during
bowel movements can weaken the rectal
muscles, causing the rectum to protrude
from the anus.
Promotion for Healthy
Bowel Obstruction: In rare cases,
Bowel Elimination constipation can lead to a partial or
complete blockage of the intestines,
Eat Fiber: Load up on fruits, Vegetables, requiring immediate medical attention.
and whole grains for digestion.
Drink Water: Stay hydrated to prevent
constipation.
Stay Active: Exercise for a happier gut.

"Bowel Frequency Varies:

From 3 Times Daily to Weekly"
 Fundamentals

Bowel Elimination

Risk Factors for Constipation:

Dietary Factors
Low fiber intake,
inadequate fluid intake,
Diet high in processed foods can contribute
to constipation.
Lifestyle Factors:
Lack of physical activity,
Ignoring the urge to defecate,
Stressful living conditions can increase the
risk.
Medical Conditions:
Certain medical conditions
Irritable bowel syndrome (IBS),
Hypothyroidism,
Diabetes,
Neurological disorders can cause
Exacerbate constipation.
Medications: Some medications,
Including certain painkillers,
Antidepressants,
iron supplements,
Age:
Older adults are more prone to constipation
due to decreased mobility,
changes in diet, and medication use.
Pregnancy
Hormonal changes
Pressure on the intestines from the growing
uterus can lead to constipation during
pregnancy.
Psychological Factors: Stress
Anxiety,
Depression can affect bowel function and
contribute to constipation
 Fundamentals

Bowel Elimination

Diagnostics Valsalva maneuver

Act of holding breath & bearing down:

Colonoscopy:
The process of forcefully exhaling while
Visual examination of the colon using a closing the mouth and nose,
flexible tube with a camera.
which increases pressure in the chest and
Stool Tests: abdomen.
Analyzing stool samples for bleeding, Stimulates vagus nerve & slows heart rate:
infection, or abnormal substances.
The Valsalva Maneuver can stimulate the
Imaging Studies: vagus nerve, leading to a decrease in heart
Techniques like CT scans, rate (bradycardia).
MRIs, barium enemas, Caused by straining from constipation
abdominal ultrasounds to visualize the Straining during constipation can trigger the
gastrointestinal tract. Valsalva Maneuver.
Blood Tests: Increases intrathoracic pressure & ICP
overall health and detect conditions (Intracranial Pressure)
affecting the gastrointestinal tract. This refers to the rise in pressure within the
Biopsy: chest and skull cavity during the maneuver.
Taking tissue samples for microscopic High risk of complications:
examination during procedures like In individuals at high risk, such as those with
colonoscopy or endoscopy cardiovascular issues or brain injury,
Sigmoidoscopy: Can lead to severe complications like brain
Similar to colonoscopy but examines injury, bradycardia, or cardiac arrest.
only the lower part of the colon. Should be avoided:
Endoscopy Due to the potential risks, it's advised to avoid
Visual examination of the upper or excessive or prolonged use of the Valsalva
lower gastrointestinal tract using a Maneuver, especially in high-risk individuals.
flexible tube with a camera.
SMALL BOWEl Series
X-ray examination of the small
intestine that uses a special form of
x-ray called fluoroscopy
Esophagogastroduodenoscopy (EGD)
Test to examine the lining of the
esophagus, stomach, and first part of
the small intestine
 Fundamentals

Diarrhea

Diarrhea is characterized by loose, watery, and possibly more-frequent bowel movements

than usual.

Complications of Risk Factor

Untreated Diarrhea for Diarrhea
Dehydration: Contaminated Food and Water:
Loss of fluids can lead to dehydration, Consuming tainted food or water raises the
especially dangerous for vulnerable risk of diarrhea.
groups. Poor Hygiene Practices:
Electrolyte Imbalance: Inadequate handwashing spreads
Diarrhea disrupts electrolyte balance, diarrhea-causing pathogens.
causing weakness and heart rhythm Travel to High-Risk Areas
issues.
: Visiting regions with poor sanitation
Nutritional Deficiencies: heightens the risk of diarrhea.
Chronic diarrhea can lead to Immunocompromised Status:
malnutrition due to poor nutrient
Weakened immune systems increase
absorption.
susceptibility to diarrhea-causing infections.
Worsening Underlying Conditions:
Age:
Untreated infections or conditions like
IBD can worsen and lead to serious Infants, young children, and older adults are
complications. more prone to diarrhea.
Weakened Immune System: Underlying Health Condition
Chronic diarrhea weakens immunity, : Certain medical conditions increase the
increasing susceptibility to other likelihood of diarrhea.
illnesses. Medications:
Decreased Quality of Life: Some drugs can disrupt gut bacteria and
Severe or prolonged diarrhea can cause diarrhea.
greatly impact daily life, causing Antibiotics Chemo Antidepressants
discomfort and social isolation.
Most common cause of c.diff

Dietary Factors:
Certain foods or beverages may trigger
diarrhea.
Stress:
Psychological stress can contribute to
diarrhea.
Contact with Infected Individuals:
Close contact with infected individuals raises
the risk of transmission
 Fundamentals

Nutrition Basics

Nutrition:
Nutrition is the process of obtaining and utilizing nutrients from food for growth, energy, and
bodily functions, crucial for overall health and well-being.

Types of nutrients

Macronutrients Micronutrients

Macronutrients are nutrients required by Micronutrients are nutrients required by the

the body in relatively large amounts to body in smaller amounts to support various
provide energy and support various physiological processes and biochemical
physiological functions. reactions.

Types and Examples: Types and Examples:

Carbohydrates: Found in foods like bread, Vitamins: Essential for various bodily
rice, pasta, fruits, and vegetables. They functions, including metabolism, immune
are the body's primary source of energy. function, and vision.
Proteins: Found in sources such as meat, Examples: include vitamin A, vitamin C,
fish, eggs, dairy, legumes, and nuts. vitamin D, and the B vitamins (such as B12,
Proteins are crucial for building and folate, and riboflavin).
repairing tissues and enzymes. Minerals: Important for bone health, fluid
Fats: Found in oils, butter, nuts, seeds, and balance, nerve function, and other
fatty fish. Fats provide energy, support cell physiological processes.
structure, and aid in nutrient absorption Examples: include calcium, iron,
potassium, magnesium, zinc, and
selenium.

Includes electrolytes
 Fundamentals

Nutrition Basics

BMI BMI CHART

The Body Mass Index is a measure

Underweight less than 18.5
used to assess an individual's body
weight relative to their height.
It's calculated by dividing a person's Normal weight 18.5 to 24.9
weight in kilograms by the square of
their height in meters Overweight 25 to 29.9

(BMI = weight / height^2) Obesity (Class 1) 30 to 34.9

Obesity (Class 2) 35 to 39.9

Extreme obesity (Class 3) 40 or higher

Body mass index

Underweight Normal Underweight Underweight Underweight

<18,5 18,5-24,9 25-29,9 30-34,9 35<

 Fundamentals

Nutrient Functions

Macro nutrients
Carbohydrates, often labeled as the body’s energy powerhouse
Carbohydrates

Provide fuel for brain function and physical activity.

Kcal= Kilocalorie
Aid in digestion and fiber-rich carbohydrates promote (calorie) Kcal=
gastrointestinal health. Kilocalorie
(calorie)
Intake should be: 45%-65% of total daily calories. The quantity of
heat needed to
increase the
Provides 4 kilocalories (kcal) of energy per gram. temperature of 1
kilogram of water
by 1 degree Celsius.

Essential for building and repairing tissues, including muscles,

organs, and skin.
Serve as enzymes, hormones, and antibodies, facilitating
Proteins

biochemical reactions and immune function.

Act as a secondary source of energy when carbohydrates are
insufficient.

Intake should be: 10%-35% of total daily calories.

Provides 4 kilocalories (kcal) of energy per gram.

Provide a concentrated source of energy.

Essential for cell structure and function, including the formation
of cell membranes.
Aid in the absorption of fat-soluble vitamins (A, D, E, K) and
Fats

support hormone production.

Intake Should be: 20%-35% of total daily calories.

Provides 9 kcal of energy per gram..

 Fundamentals

Micronutrients

Vitamins Minerals

Vitamins
Vitamins are essential micronutrients that our bodies don't produce.
Helping to fight infection, wound healing, making our bones strong and regulating hormones..

Water-soluble vitamins Fat-soluble vitamins

Water-soluble vitamins are organic they are soluble in organic solvents and are
compounds that dissolve in water and are not absorbed and transported in a manner similar
stored in the body for long periods to that of fats.

Characteristics Characteristics

Dissolved in water and readily absorbed into Fat-soluble vitamins, stored in fatty tissues
tissues for immediate use. and the liver for extended periods, can
Excess is quickly passed in urine, Because accumulate in the body gradually, serving
they are not stored in the body as a reserve during periods of insufficient
intake.
Water-soluble vitamins need to be
replenished regularly through your diet. Fat-soluble vitamins require the presence of
dietary fats for absorption in the digestive
Water-soluble vitamins generally have a tract.
lower risk of toxicity
Fat-soluble vitamins pose a higher risk of
toxicity compared to water-soluble
The water-soluble vitamins include:
vitamins.
Vitamin C
The water-soluble vitamins include:
Vitamin B complex
The four fat-soluble vitamins are:
Thiamine,
Vitamin A: Essential for vision, immune
Riboflavin, function, and skin health.
Niacin, Vitamin D: Important for calcium
Pantothenic acid, absorption, bone health, and immune
Pyridoxine, function.

Biotin, Vitamin E: Acts as an antioxidant, protecting

cells from damage caused by free radicals.
Folate,
Vitamin K: Necessary for blood clotting and
cobalamin bone metabolism.

Think a Fat DECK of cards

 Fundamentals

Micronutrients

Vitamins Minerals

Minerals
Minerals are inorganic substances that play crucial roles in various physiological functions,
including hormone and enzyme production, as well as supporting cardiac, neurological, bone, and
muscle functioning

Also Known As
Macrominerals Electrolytes Trace minerals
Macrominerals, are essential minerals required Trace Minerals are minerals present in living
in relatively large amounts for maintaining tissues in small amounts (typically less than
100 milligrams per day) Trace minerals serve
Fluid balance, as catalysts for enzymes, supporting and
Nerve function, regulating metabolic functions within the body.

Muscle contraction, Include:

Overall physiological balance in the body.
Iron Nickel
Include: Zinc Vanadium
Calcium (Ca) (Bones and teeth ) Copper Silicon
Phosphorus (P) (Bones and teeth ) Manganese Boron
Magnesium (Mg)(Bones and teeth ) Iodine Arsenic
Sulfur (S) (Hormone and enzyme synthesis) Selenium Tin
Sodium (Na)(Fluid balance ,Muscle function) Chromium Cadmium
Potassium (K)(Muscle function) Fluoride Lead
Chloride(Hormone and enzyme synthesis) Molybdenum Lithium
Cobalt Rubidium
Aluminum Bismuth
Beryllium Germanium
Palladium Many More!
 Fundamentals

Nutrition Basics

Macronutrients

Macronutrients are the nutritive components of food that the body needs for energy and to maintain the
body’s structure and systems.

Carbohydrates Functions

Carbohydrates are sugar molecules, along nergy production

with proteins and fats, they are one of the Storage
three main nutrients in foods and drinks.
Structural support
The body breaks down carbohydrates into
glucose. Dietary fiber
Glucose, also known as blood sugar, serves Glycoprotein and glycolipid formation
as the primary source of energy for the
body's cells, tissues, and organs.

Simple carbs
Sugars composed of one or two sugar Disaccharides
molecules. They're quickly digest. They
provide rapid energy, overconsumption can Double sugar molecules made up of two
lead to health issues. monosaccharide units They are joined by
glycosidic linkage.
(Di Means two)
Act as an energy source for the
Found in Monosaccharides body,

Candies,
Examples
The simplest form of carbohydrates,
Sugary snacks, consisting of single sugar molecules. Sucrose (table sugar)
Refined grains. Lactose (milk sugar)
(Mono means one)
Fruits Maltose (malt sugar)
They are the building blocks of more
Milk
complex carbohydrates Primary source of
Milk products. energy for living organisms. Source
Examples Sugar cane,
Glucose ( Dates, apricots, raisins,) sugar beets,
Sources Fructose(fruit ,juices, vegetables and sweet fruits for sucrose
Fruits honey.)
Milk and dairy products for
Vegetables Galactose ( fruits and vegetables) lactose
Honey Xylose (rice straw) Germinating grains
Dairy products Pentose's ,( Beef and poultry) Malted beverages for maltose
Some grains Ribose, ( Beef and poultry)
 Fundamentals

Nutrition Basics

Complex carbs Polysaccharides Fiber

They are long chains of sugar They are complex Fiber, also known as dietary
molecules They provide sustained carbohydrates made of long fiber or roughage,
energy and numerous health chains of sugar molecules Type of carbohydrate found in
benefits like improved digestion They serve as energy storage plant-based foods that
and weight management. (like starch and glycogen) The body can't digest or
Provide structural support (like absorb.
cellulose and chitin).
Found in It Contain multiple sugar
It passes through the
digestive system mostly
molecules unchanged and plays a
Whole grains
crucial
Vegetables
(Poly means many) Role in maintaining
Legumes
Peas Digestive health
Examples
Beans Regulating bowel
Starch: Found in grains, movements
legumes, and tubers, it
Lowering the risk of various
serves as a storage form of
chronic diseases.
energy in plants.
Glycogen: Stored in the liver
and muscles of animals, it
serves as a short-term
Soluble
energy reserve. Soluble fiber dissolves in water to
Cellulose: Found in the cell form a gel-like substance in the
walls of plants, it provides digestive tract. It's found in oats,
structural support and beans, fruits, and vegetables,
dietary fiber. and helps lower cholesterol,
Macronutrients Chitin: Found in the regulate blood sugar, and
exoskeletons of arthropods promote fullness.
Stored in Skeletal
muscles (~500 g) and
the liver (~100 g) (the the process by which glycogen is
muscles attached to Insoluble
converted to glucose-1-phosphate (G1P)
your bones and and then to glucose-6-phosphate (G6P)
tendons),released into Insoluble fiber doesn't dissolve in
to enter the glycolytic pathway, water and adds bulk to stool,
bloodstream through
glycogenolysis promoting regular bowel
movements. It's found in whole
Glyco=Sugar Sources grains, nuts, seeds, and
vegetables.
Lysis= Breakdown
Starch: Grains, legumes, and
Glucagon, in part, tubers.
triggers glycogen in Glycogen: Animal tissues,
your liver to convert especially liver and muscles.
back to glucose so it
Cellulose: Plant cell walls in
can enter your
fruits, vegetables, and grains.
bloodstream.
Chitin: Exoskeletons of
arthropods and cell walls of
fungi.
 Fundamentals

Protein

Protein is essential for tissue growth and repair, made of amino acids.

Complete proteins Function Incomplete proteins

Complete proteins contain all Structural support for cells, Incomplete proteins lack one or
9 essential amino acids tissues, and organs. more essential amino acids and
They provide the full spectrum Enzymes facilitate are commonly found in
of amino acids needed for biochemical reactions. plant-based foods like legumes,
various bodily functions. grains, nuts, seeds, and
Transport molecules like vegetables.
oxygen and nutrients.
Hormones regulate
Found in physiological processes. Found in:
Antibodies defend against
Meat: Such as beef, pork, pathogens. Legumes: Beans (such as
lamb, and venison. black beans, kidney beans,
Serve as a source of energy
Poultry: Such as chicken, when needed. and chickpeas) and lentils.
turkey, and duck. Grains: Rice, wheat, oats,
Fish: Such as salmon, tuna, barley, quinoa, and corn.
and cod. Complementary Nuts and seeds: Almonds,
Eggs: Both the egg white and protein peanuts, sunflower seeds, chia
yolk contain complete seeds, and pumpkin seeds.
Two incomplete sets of proteins
proteins. that are consumed at the same Vegetables: Broccoli, spinach,
Dairy products: Such as milk, time in order to fulfil the amino kale, Brussels sprouts, and
cheese, yogurt, and whey acid deficiency in the other meal peas.
protein. These animal-based
foods provide all essential
amino acids required by the
body.
Example
Rice paired with beans
Peanut butter spread on
wheat toast
Hummus served with pita
bread These combinations
offer a complete set of
essential amino acids when
consumed together,
contributing to a
well-rounded and nutritious
diet.
 Fundamentals

Fats (LIPIDS)

Unsaturated fat (Good Fat)

Unsaturated fat is a type of dietary fat that remains liquid at room temperature and is considered
healthier than saturated and trans fats. .

Monounsaturated Polyunsaturated

Monounsaturated fats are a type of Polyunsaturated fats are essential for health.
unsaturated fat. Found in foods like fatty fish, seeds, and
Consumption of monounsaturated fats vegetable oils.
is associated with heart-healthy Include omega-3 and omega-6 fatty acids.
benefits.
Lower LDL cholesterol and reduce heart
They can help lower LDL cholesterol disease risk.
levels.
Crucial for brain function and overall health.
Monounsaturated fats may reduce the
risk of heart disease when included in a
balanced diet.
Found in
Found in Fatty fish (salmon, trout, mackerel,
sardines)
Olive oil Seeds (flaxseeds, chia seeds,
Avocados pumpkin seeds, sunflower seeds)
Nuts (such as almonds, cashews, Nuts (walnuts, almonds)
and peanuts) Vegetable oils (soybean oil, corn
Seeds (such as sesame seeds and oil, sunflower oil, safflower oil)
pumpkin seeds) Avocado
Peanut butter Tofu
Sunflower oil Edamame
Canola oil Hemp seeds
Almond butter
Incorporating these foods into your diet
These foods are rich in can help ensure an adequate intake of
monounsaturated fats and can be polyunsaturated fats for overall health and
incorporated into a balanced diet to well-being.
promote heart health.
 Fundamentals

Fats (LIPIDS)

Monounsaturated
Saturated fat (Bad Fat) Trans (Worst Fat)

Saturated fat is considered "bad" fat. Trans fat is considered the "worst" type of fat.
Consuming too much saturated fat It is created through the hydrogenation
can raise LDL cholesterol levels. process.
High LDL cholesterol increases the risk Found in processed and fried foods, baked
of heart disease and stroke. goods, and margarine.
It is recommended to limit intake of Consumption raises LDL cholesterol and
saturated fats for better heart health.. lowers HDL cholesterol levels.
Increases the risk of heart disease, stroke, and
other health issues.
It is advised to minimize intake of trans fats
Found in for better health.

Fatty cuts of meat (beef, pork, lamb)

Poultry with skin (chicken, turkey) Found in
Processed meats (sausage, bacon, hot
dogs) Processed foods such as packaged snacks
Full-fat dairy products (whole milk, (chips, crackers, cookies)
cheese, butter) Fried foods like French fries and fried chicken
Tropical oils (coconut oil, palm oil) Baked goods such as cakes, pastries, and
Processed and fried foods doughnuts
Baked goods (cakes, cookies, pastries) Margarine and shortening
Fast food and fried snacks Fast food items like burgers and fried chicken
sandwiches
Reducing intake of these foods can help
lower saturated fat consumption and Reading food labels and choosing products
promote better heart health. with minimal or no trans fats can help reduce
intake and promote better health.
It is recommended to limit saturated
fat intake to no more than 6% of total It is advised to restrict trans fat intake to
daily calorie consumption. no more than 1% of total daily calorie
consumption.

Restrict the consumption of high-fat Steer clear of processed foods.

dairy products and tropical oils and
opt for leaner cuts of meat.
 Fundamentals

Fats (LIPIDS)

Cholesterol
Cholesterol is a waxy, fat-like
substance found in the body's cells.
Essential for hormone production,
vitamin D synthesis, and bile acid
formation.
Produced naturally by the body and
obtained from certain foods.
High levels of LDL cholesterol can
increase the risk of heart disease and
stroke.
It is important to maintain healthy
cholesterol levels through diet and
lifestyle choices.

LDL HDL
LDL stands for low-density lipoprotein. HDL stands for high-density lipoprotein.
Often referred to as "bad" cholesterol. Often referred to as "good" cholesterol.
Carries cholesterol from the liver to Waxy-like substance produced by the liver
cells in the body. Removes excess cholesterol from the
Excess LDL cholesterol can accumulate bloodstream.
in artery walls. Transports cholesterol to the liver for
Contributes to atherosclerosis, excretion.
increasing heart disease and stroke High levels of HDL are associated with
risk. reduced heart disease risk.
Maintaining healthy LDL levels is crucial Maintaining high HDL levels is beneficial for
for heart health. heart health.

Think L for Lousy Want lousy Think H for Happy Want

Levels low lousy levels high

The recommended daily intake should be

less than 300mg.

For individuals at high risk of heart disease, the

recommended intake should be less than 200mg
per day.
 Fundamentals

Nutrition Basics

Micronutrients

Micronutrients are the elements required by us in small quantities.

Deficiency of any of the nutrients affects growth and development.
Micronutrients in plants are beneficial for balanced nutrition of crops.
These support all the biological functions of a plant.
Their deficiency leads to stunted growth, chlorosis, necrosis, delayed maturity, and senescence.

Vitamins
Water soluble

Thiamin, or vitamin B1 Riboflavin, or vitamin B2

It is crucial for carbohydrate It is crucial for energy production and

metabolism and nerve function. metabolism.
It acts as a coenzyme in energy It's found in dairy, meat, fish, eggs, and leafy
production. greens.
Deficiency can lead to skin and mucous
membrane problems.

Deficiency can cause:

Beriberi: Weakness, nerve damage. Deficiency can cause:

Wernicke- Korsakoff syndrome: Memory
Skin disorders and cracks at mouth
problems, confusion.
corners.(cheilosis)
Peripheral neuropathy: Numbness,
Mouth and throat inflammation.
tingling.
Sore throat and glossitis.
Cardiovascular issues: Enlarged heart,
heart failure. Eye problems like light sensitivity.
Mental confusion, fatigue. Anemia, fatigue, and weakened immunity.
Muscle weakness.
Gastrointestinal symptoms like nausea.
 Fundamentals

Nutrition Basics

Niacin, or vitamin B3 Pyridoxine, or vitamin B6

It is a vital water-soluble vitamin It is essential for metabolism and

essential for energy metabolism. immune function.
It's found in foods like meat, fish, nuts, and It's found in poultry, fish, beans, nuts,
grains and is crucial for skin, nerve, and and grains.
digestive health.

Deficiency can cause: 4’D’S Deficiency can cause

Pellagra: Dermatitis, Diarrhea, Dementia, Neurological issues: Such as numbness,

Death. tingling, and nerve damage.
Skin disorders: Dry, scaly skin, rash in Anemia: Due to impaired red blood cell
sunlight. production.
Digestive issues: Nausea, vomiting, Weakened immunity: Increasing
diarrhea. susceptibility to infections.
Cognitive impairment: Confusion,
memory loss.
Cobalamin, or vitamin B12
Fatigue and weakness: Decreased energy
metabolism It is vital for DNA synthesis, red blood cell
formation, and neurological function. Found
in animal products.
Folic acid, or vitamin B9

It is essential for DNA synthesis, red blood cell

formation, and preventing birth defects. It's Deficiency can cause: Vitamin C,
found in leafy greens, legumes, and citrus or ascorbic acid
fruits, and often added to fortified foods. Anemia
It is a water-soluble
Deficiency can lead to anemia and birth Neurological vitamin found in fruits
defects. problems and vegetables. It's
Fatigue crucial for collagen
synthesis, immune
Deficiency can cause: Digestive issues
function, and wound
Mood changes healing. Acting as an
Anemia: Due to impaired red blood cell antioxidant, it
Elevated
production. protects cells from
homocysteine levels
Neural tube defects: Birth defects damage.
Pernicious anemia
affecting the brain and spine in infants.
Fatigue and weakness: Resulting from
decreased red blood cell function. Deficiency can cause:
Digestive issues: Such as diarrhea and Scurvy: Weakness, bleeding gums.
loss of appetite.
Weakened immunity.
Poor growth: In children and adolescents.
Dry skin, impaired wound healing.
Increased risk of complications
Anemia.
During pregnancy: Including preterm
birth and low birth weight.
 Fundamentals

Nutrition Basics

Fat-Soluble

Vitamin A Vitamin D

It is crucial for vision and mucous It is essential for calcium absorption and
membrane health. bone health.
It's found in animal-based foods and It comes in two forms, D2 and D3, and is
certain plant sources like dark-green synthesized in the skin upon sunlight
vegetables. exposure.

Function Function

Maintaining vision
Calcium absorption for bone health.
Supporting immune function
Immune system support.
Promoting healthy skin
Cell growth regulation.
Supporting growth and development
Mood modulation.
Acting as an antioxidant

Sources Sources

Animal-based: Liver, fish liver oil, egg Sunlight: Exposure to sunlight triggers
yolks. Vitamin D synthesis in the skin.
Plant-based: Dark-green vegetables, Fatty fish: Such as salmon, mackerel, and
yellow/orange fruits. tuna.
Fortified foods: Skim milk, margarine, Egg yolks.
cereals. Fortified foods: Including milk, orange juice,
and cereals.

Deficiency can cause

Deficiency can cause:
Night blindness
Dry skin Weak bones
Weakened immunity Muscle weakness
Delayed growth Increased falls risk
Corneal ulcers Weakened immunity
Mood changes
 Fundamentals

Nutrition Basics

Vitamin E Vitamin K

It is an antioxidant that protects cell Vitamin K is essential for blood clotting.

membranes from damage.
It comes in two forms: K1 from plants and K2
It's primarily found in vegetable oils, nuts, from bacteria.
seeds, and whole grains.

Function Function

Antioxidant activity Blood clotting

Maintaining healthy skin Bone health
Supporting immune function Cardiovascular health
Protecting against heart disease Cell growth regulation
Supporting eye health
Sources
Sources
Green leafy vegetables (such as kale,
Vegetable oils spinach, and broccoli)

Nuts Vegetable oils (such as soybean and

canola oil)
Seeds
Fish (such as salmon and tuna)
Whole grains
Meat
Wheat germ
Eggs

Deficiency can cause:

Deficiency can cause:
Muscle weakness
Vision problems Bleeding risk
Weakened immune function Poor bone health
Nerve damage Cardiovascular issues
Impaired cell regulation

Require Fats to be absorbed higher risk of toxicity because stored in fat

 Fundamentals

Minerals

Macrominerals

Sodium Potassium

It is an electrolyte vital for fluid balance, It is a vital electrolyte essential for fluid
nerve, and muscle function. balance, nerve, muscle, and heart function.
It's found in table salt, processed foods, It's found in fruits, vegetables, and legumes.
and vegetables.
Excess intake can lead to health issues
like high blood pressure.
Function

Function Regulating fluid balance

Transmitting nerve impulses
Regulating fluid balance
Muscle contraction
Transmitting nerve impulses
Blood pressure regulation
Muscle contraction

Sources Sources

Fruits: Bananas, oranges, and avocados.

Table salt (sodium chloride)
Vegetables: Potatoes, spinach, and
Processed foods
tomatoes.
Canned soups and vegetables
Legumes: Beans, lentils, and peas.
Snack foods like chips and pretzels
Dairy: Milk and yogurt.
Condiments such as soy sauce and salad
Nuts and seeds: Almonds, peanuts, and
dressings
sunflower seeds.
 Fundamentals

Minerals

Calcium Magnesium

It is a vital mineral for bone health, muscle Magnesium is a vital mineral for muscle,
function, and nerve transmission. It's nerve, and bone health, as well as energy
abundant in dairy, leafy greens, and production and blood sugar regulation.
fortified foods.
It's found in nuts, seeds, leafy greens, and
whole grains.
Function

Bone and teeth health

Function
Muscle contraction Muscle and nerve function
Nerve transmission Energy production
Blood clotting Protein synthesis
Cell signaling Bone health
Blood pressure regulation
Sources Blood sugar control
Heart health
Dairy products
Leafy greens
Fortified foods Sources
Tofu
Nuts and seeds: Almonds, cashews, and
Fish pumpkin seeds.
Whole grains: Brown rice, quinoa, and oats.
Leafy greens: Spinach, kale, and Swiss
chard.
Legumes: Black beans, chickpeas, and
lentils.
Avocados
Bananas
Dark chocolate
 Fundamentals

Minerals

Function Sources
Energy production Dairy products: Milk, cheese, and
Bone and teeth health yogurt.
Cell signaling Meat: Beef, pork, and chicken.
DNA and RNA synthesis Fish: Salmon, tuna, and sardines.
pH buffering Nuts and seeds: Almonds, walnuts, and
sunflower seeds.
Whole grains: Brown rice, quinoa, and
whole wheat bread.
Phosphate Legumes: Lentils, beans, and peas.
Eggs
Phosphate is a mineral crucial for
Some processed foods may also
energy production, bone health, and
contain phosphate additives.
cell signaling.
It's found in dairy, meat, fish, nuts, and
whole grains.
 Fundamentals

Trace Minerals

ZINC Iron (Fe)

It is a vital trace mineral essential for enzyme It is vital for energy transfer, nitrogen
function, immune health, and DNA synthesis. reduction, and enzymatic reactions in plants.
Function Deficiency leads to chlorosis, characterized
Enzyme activity by yellowing leaves.
Immune function Function
Wound healing Oxygen transport
Growth and development Energy production
Taste and smell perception DNA synthesis
Sources Immune function
Meat: Beef, pork, and lamb. Neurotransmitter synthesis
Seafood: Oysters, crab, and lobster. Sources
Nuts and seeds: Pumpkin seeds, cashews, Red meat: Beef, lamb, and pork.
and almonds. Poultry: Chicken and turkey.
Legumes: Chickpeas, lentils, and beans. Fish: Tuna, salmon, and sardines.
Dairy: Milk, cheese, and yogurt. Shellfish: Oysters, clams, and mussels.
Whole grains: Wheat germ, quinoa, and oats. Legumes: Lentils, beans, and chickpeas.
Tofu
Fortified foods: Certain cereals and nutritional
supplements. Seeds: Pumpkin seeds, sesame seeds, and
hemp seeds.
Dark leafy greens: Spinach, kale, and Swiss
chard.
Iodine Fortified cereals and grains.

It is a vital trace mineral crucial for thyroid

function and overall health. Chloride
It's primarily found in iodized salt, seafood,
dairy, and select fruits and vegetables. It is an essential mineral that helps regulate
fluid balance, blood pressure, and nerve
Function
function in the body.
Thyroid Hormone Production It's primarily obtained from salt and plays a
Metabolism Regulation crucial role in overall health.
Growth and Development Function
Cellular Metabolism and Energy Production Regulates fluid balance
Cognitive Function and Brain Development Supports nerve function
Immune Function and Disease Protection Maintains blood pressure
Sources Aids digestion
Iodized Salt Maintains acid-base balance
Seafood (e.g., fish, shellfish, seaweed) Sources
Dairy Products (e.g., milk, cheese, yogurt) Salt (sodium chloride)
Eggs Processed foods
Certain Fruits and Vegetables (e.g., Seafood
strawberries, potatoes) Dairy products
Iodine Supplements (under medical Vegetables
supervision) Drinking water
 Fundamentals

Trace Minerals

Fluoride Copper (Cu)

It is a mineral essential for dental health, It is a vital trace mineral essential for enzyme
strengthening tooth enamel and preventing function, energy production, and immune
decay. system health.
t's found in fluoridated water, toothpaste, and Deficiency can lead to anemia and impaired
some foods. immune function, while excess intake can
Excessive intake can lead to dental and cause toxicity.
skeletal issues. Function
Function Enzyme activation
Strengthens tooth enamel Iron metabolism
Prevents tooth decay Connective tissue formation
Neurological function
Remineralizes and hardens teeth
Immune system support
Inhibits growth of harmful bacteria in the mouth Antioxidant activity
Reduces risk of cavities
Sources
Sources
Shellfish: Oysters, crab, lobster
Fluoridated Water: Many public water
Nuts and seeds: Cashews, almonds, pumpkin
supplies contain fluoride.
seeds
Toothpaste: Most toothpaste contains
Whole grains: Wheat bran, barley, oats
fluoride as an active ingredient.
Legumes: Lentils, chickpeas, beans
Mouthwash: Some mouthwashes contain
Organ meats: Liver, kidney
fluoride.
Dark leafy greens: Spinach, kale, Swiss chard
Certain Foods and Beverages: Some foods
and beverages naturally contain fluoride or Chocolate: Dark chocolate, cocoa powder
are fortified with it. Mushrooms: Shiitake, morel
Professional Dental Treatments: Fluoride Avocado
treatments provided by dentists or dental Copper water pipes (can contribute trace
hygienists. amounts)

Selenium

It is a vital trace mineral essential for Sources

antioxidant function, immune support, and Seafood: Fish, shellfish (e.g., tuna, shrimp, oysters)
thyroid regulation. Meats: Beef, pork, chicken, turkey
It's found in seafood, meats, nuts, seeds, and Nuts and seeds: Brazil nuts, sunflower seeds
grains. Maintaining optimal levels is crucial Grains: Wheat, rice, oats
for overall health.
Dairy products: Milk, cheese, yogurt
Function Eggs
Antioxidant activity Legumes: Lentils, chickpeas
Thyroid hormone metabolism Vegetables: Spinach, broccoli
Immune system support Mushrooms
DNA synthesis and repair Selenium supplements (under medical
Reproductive health supervision)
 Fundamentals

Parenteral Nutrition vs Enteral

NUTRITION
Parenteral nutrition Nasogastric
Tube

Parenteral nutrition is a method of

feeding in which nutrition goes IV
directly to the bloodstream.
Intravenous administration of nutrition
outside of the gastrointestinal tract
Used to manage and treat
malnourishment
The ability to deliver a precise dose of a Nasoduodenal
medication rapidly Tube Gastrostomy
Tube
Total parenteral nutrition (TPN): Sole
source of nutrition via IV.
Indications: Impaired GI function, enteral
nutrition contraindicated.
Nasojejunal
Conditions: Severe pancreatitis, bowel Tube
obstruction, malabsorption. Jejunostomy
Tube
Components: Carbs, proteins, fats,
vitamins, minerals.
Monitoring: Electrolytes, glucose,
nutritional status.
Formulation: Tailored to patient's needs.
Administration: Specialized equipment,
trained staff.
Complications: Infection risk, electrolyte
imbalances, hyperglycemia.

Used for patients with various conditions

Impaired gastrointestinal function

Inability to tolerate enteral nutrition (nutrition through the digestive tract)
Severe pancreatitis
Higher risk of sepsis
Bowel obstruction
than enteral feeding
Malabsorption disorders
greater hunger, thirst, tiredness(NPO status)
 Fundamentals

Types of Parenteral Nutrition

Central parenteral Peripheral central

1. Partial parenteral nutrition (PPN) nutrition parenteral nutrition

Given for short periods of time,

TPN
The delivery of artificial nutrition via a
peripheral intravenous cannula. Clavicle
To replace some of the nutrients required Heart
daily and only supplements a normal diet.
Subclavian
Only provides partial nutrient needs vein

At risk for thrombophlebitis

PICC PICC line enters
Superior body here
Causes a blood clot to form and block vena cava PICC=peripherally inserted
one or more veins, often in the legs central catheter

Nursing Care, Skills

2. Total parenteral nutrition (TPN)
Daily Weight.
Given to patients who can't eat anything
Prevent infection, air embolism.
For more long-term use
Monitor and assess the patient's
The IV administered nutrition is the only nutritional status and response
source of nutrition the patient is receiving. to TPN
Must receive all nutrients required daily Maintain fluid & electrolyte
through an intravenous line. balance.
Change bag & IV tubing every
At risk for central line infection(bloodstream infection)
24 hours
Encourage ambulation, ADL's &
comfort.
3. Home parenteral nutrition (HPN)
Educate patient & family.

Usually requires a CVC (central venous catheter), Monitor site for infiltration or
which must first be inserted in a fully equipped leakage
Cannot administer
medical facility. After it is inserted, therapy can NPO stress.
other fluids or
continue at home.
Dressing change. meds in same line
as TPN or ppn

Problems Alternative Methods

w/ Eating or
Drinking Chewing, Parental
Nutrition
Swallowing,
Digestion) Medical
Trauma Surgery
Condition
 Fundamentals

Enteral Nutrition

Enteral nutrition involves administering

nutrients directly into the gastrointestinal tract,
bypassing the oral cavity. Feeding
tube
Esophagus
Purpose: Helps maintain gastric motility
and gut integrity.
Nasogastric feeding
tibe (NG)

Indications: For patients requiring

nutritional supplementation with a
functioning GI tract, but unable to eat
normally due to conditions like dysphagia Stomach
or neurological disorders.
Nasojejunal feeding
tube (NJ)

Used for patients with various conditions

Have swallowing difficulties (dysphagia).
Need long-term nutritional support with a functional GI tract.
Experience malnutrition but can digest and absorb nutrients.
Higher risk of aspiration
Severe burns
than parenteral feeding
Stroke
Have conditions like Crohn's disease or short bowel syndrome.
Require nutritional support post-surgery or during critical illness.

Routes

Nasogastric tube (NGT): Jejunostomy tube (J-tube):

Inserted through the nose and passes through the Surgically inserted through the
esophagus into the stomach. abdominal wall into the jejunum
(part of the small intestine).
Nasoenteric tube (NET):
Gastrostomy-jejunostomy
Similar to an NGT but extends beyond the stomach
tube (GJ-tube):
into the small intestine.
Surgically inserted into both the
Percutaneous endoscopic gastrostomy tubes(PEG-tube): stomach and the jejunum, allowing
Surgically inserted through the abdominal wall for feeding into either or both
directly into the stomach. sections of the GI tract.
 Fundamentals

Enteral Nutrition

Nasogastric Nasointestinal
Tube Tube
Nursing Care, Skills

Assess patient's nutritional status and GI function.

Verify correct tube placement to prevent complications.
Check tube administration residual every 4 hours (or per
hospital policy
Administer enteral feeds as prescribed, monitoring for
intolerance.
Discarding residual gastric aspirates may result in
insufficient nutritional supplement for the patient and
Formulas
higher risk of fluid and electrolyte imbalance.
Measured gastric residual volume>400 (GRV) is most Polymetric
commonly used as a marker to guide enteral feeding
rate and prevention of pulmonary aspiration in Polymeric formulas are a type of
gastric-fed, enteral nutrition containing
Flush tube with 20-60 mL of water to prevent clogging intact proteins, carbohydrates,
Continuously monitor patient's clinical status and vital fats, vitamins, and minerals.
signs.
Provide oral hygiene and suctioning as needed. They offer complete nutrition
and are suitable for patients
Care for skin around tube insertion site to prevent with normal digestion who
complications. require tube feeding or oral
Educate patients and caregivers about enteral feeding supplementation.
and care.
Collaborate with healthcare team for optimal patient care. These formulas come in different
varieties to meet diverse
nutritional needs and tastes.

Elemental

Elemental formulas are

predigested enteral nutrition
Prevent Aspiration designed for patients with
compromised digestion.
Avoid distractions during meals (e.g., phone, TV). They contain easily absorbable
Cut food into small, bite-sized pieces. nutrients like amino acids and
Use x-ray to verify initial placement simple sugars,
Monitor bowel sounds Ideal for those with
Chew food thoroughly before swallowing. malabsorption disorders or
Eat and drink slowly. severe gastrointestinal conditions.
Sit upright while eating, if possible.
Use a wedge pillow when eating in bed.
Monitor external length of NG & OG tube
For patients who have a harder
Maintain an upright position (at least 45 degrees) time digesting & absorbing nutrients
for 1 hour after eating or drinking.
 Fundamentals

Ostomies

An ostomy is a surgery that creates an opening in the abdomen, changing the way that waste exits your
body. This procedure is used to treat various diseases of the urinary or digestive systems.

Waste is collected in a removable bag, called

Possible causes a pouch. The pouch is on the outside of the
body and can be emptied as needed.

Birth defects,
Bladder cancer
Can be temporary or permanent
Inflammatory bowel disease,
Diverticulitis,
Severe abdominal or pelvic trauma
Colon cancer
Trauma to bowel
Trauma to rectum
Obstruction
Trauma to bladder or ureters
Chronic infections
Renal calculi
Hemorrhagic cystitis
Incontinence and many other medical
conditions
 Fundamentals

Stool Diversions

Transverse
Fecal diversion by the creation of an ostomy,
colostomy
Which is a purposeful anastomosis between a
segment of the gastrointestinal tract and the
skin of the anterior abdominal wall, is indicated
when restoration of intestinal continuity is Ascending
contraindicated or not immediately feasible Colostomy
given the patient's clinical condition.

Descending
Illeostomy & Sigmoid
Colostomies
Diverts the ileum to a stoma Opening between the
surface of the skin and the small intestine
Semisolid waste flows out of

the stoma and collects in an ostomy pouch,

Which must be emptied several times a day.
An ileostomy bypasses the colon, rectum, and
anus and has the fewest complications.
Colostomy Ileostomy Urostomy

Liquid output:
Elimination occurs before fluid Ascending (Right)
reaches colon to mix into stool Near the beginning of the large intestine
The stool is usually liquid, because very little
water has been absorbed in the colon.
Education Transverse
Performed on the middle section of the colon,
Low fiber diet first 6-8 weeks (fiber-rich foods The stoma will be somewhere across the
such as legumes, vegetables, and grains) upper abdomen.
can reduce symptoms such as gas, odor, and Stool is usually Semi-liquid
stools that are too loose or too firm. Typically performed for diverticulitis,
Certain foods make ileostomy output more inflammatory bowel disease, cancer,
liquid especially if eaten in large quantities. blockage, injury or a birth defect.
Chew foods to the consistency of applesauce Descending
to avoid blockages and better absorb nutrients Made from the descending part of the colon.
Located on the lower left-hand side of the
abdomen

Colostomy Stool is usually solid & formed stool

Sigmoid
Opening between the surface of the skin Is made from the sigmoid colon.
and the colon Waste is moved to the rectum.
 Fundamentals

Urine Diversions

Surgical procedure that creates a new way for urine to exit your body when urine flow is blocked
Need to bypass a diseased area in the urinary tract

Urostomy Education Nephrostomy

This procedure is performed to Check the tubing regularly for A nephrostomy is a procedure
redirect urine away from a any signs of sediment or to drain urine from your
defective or diseased bladder. cloudiness. kidney using a catheter
Following surgery, there may (tube).
During the surgery, a section
from the beginning of the large be a slight reddish hue in the Urine normally drains from
intestine or the end of the small urine. your kidneys into your bladder
bowel is removed and Periodically examine the through small muscular tubes
relocated. pouch for emptying since you (ureters).

Once in its new location, this might not sense the need to Tests have shown that one or
portion of the small bowel urinate. both of your ureters has
creates a passageway that Ensure consumption of eight become blocked.
allows urine to pass through glasses, each containing
the kidneys and exit the body eight ounces of water, daily.
through your stoma.

bypasses
bypasses thebladder
thebladder Allows urine to bypass an
injured or impaired bladder and
Allows urine to exit the body.
bypass an injured
Stoma or impaired
bladder and exit
the body.

Do not have
stoma sites
Drainage tube goes directly
into kidney
Collection Urustomy
bag
 Fundamentals

Urine Diversions

Stoma care Pouch care

Wash your skin with warm water and dry it well Change the pouch system every 3-5 days to
before you attach the pouch. maintain hygiene.
Avoid skin care products that contain alcohol. Completely clean the skin around the stoma
These can make your skin too dry. prior to placing a new pouch to achieve a
tight seal.
Do not use products that contain oil on the skin
around your stoma. Doing so can make it hard Empty the ostomy pouch when it's one-third
to attach the pouch to your skin. to one-half full to minimize leaks and odors.
Use special skin care products to make skin Try to avoid unnecessary bag changes as
problems less likely. they can irritate the surrounding skin.
The skin in this area may become red or
irritated. the wound-ostomy nurses may
Stoma Color recommend special skin wipes
If the bag fills with gas, release air slowly to
Red or pink: Normal "burp" the bag.
Indicates healthy blood flow.
Pale pink: Anemia Alert MD if any blood seen in pouch
Suggests potential anemia, a condition of low
red blood cells.
Purple or blue: Ischemia
Signals possible ischemia, a lack of blood supply
to the stoma area.

Provide
Stoma necrosis emotionalsup
port to
Early postoperative complication
patient
resulting from inadequate
stomal blood supply.
contact PCP immediately!

Stoma
(Moist, red, and
painless)

Umbilicus
 Fundamentals

Oxygenation

What is it?
Several body systems work collaboratively during the oxygenation process to take in oxygen from the air,
carry it through the bloodstream, and adequately oxygenate tissues. It is important that all parts of the
system work together to ensure that oxygen is delivered appropriately to tissues within each system.

NORMAL BREATHING BRADYPNEA BREATHING TACHYPNEA BREATHING

Slow and regular, breathing in Bradypnea is when a person's Tachypnea breathing more
and out through the nose only. breathing is slower than usual than 20 breaths per minute.
for their age and activity 12-20 breaths per minute is a
levels. For an adult, this will be normal range.
under 12 breaths per minute.

CHEYNE-STOKES KUSSMAUL BREATHING BIOT BREATHING

Cheyne-Stokes respiration is a Kussmaul respirations are Biot's breathing' is a term rarely

specific form of periodic characterized by rapid, deep used today that describes an
breathing characterized by a breathing at a consistent abnormal respiration pattern.
crescendo-decrescendo pace. They are indicative of Biot's breathing occurs when
pattern of respiration between metabolic acidosis, or when periods of apnoea alternate
central apneas or central the body accumulates too irregularly with series of
hypopneas much acid. breaths of equal depth that
terminate abruptly.

APNEA BREATHING SIGHING BREATHING ATAXIC BREATHING

The pattern involves a period of Sighing is a type of long, deep Ataxic respiration is an
fast, shallow breathing followed breath. It begins with a normal abnormal pattern of breathing
by slow, heavier breathing and breath, then you take a characterized by complete
moments without any breath second breath before you irregularity of breathing.
at all, called apneas. Instead of exhale.
an apnea.

Some people have periods of We often associate sighs with

with irregular pauses and
extremely shallow breathing, feelings such as relief,
increasing periods of Apnea
called hypopneas. sadness, or exhaustion
 Fundamentals

Oxygenation

Dyspnea Orthopnea Dyspnea on exertion Accessory Muscle Use

Shortness of Orthopnea is a Dyspnea on exertion is Accessory muscle

breath — known medical term to the sensation of running breathing means using
medically as describe out of the air and of not muscles other than those
dyspnea — is shortness of being able to breathe typically used for
often described breath that occurs fast or deeply enough breathing to take in and
as an intense while lying flat and during physical activity. expel air.
tightening in the is relieved by
chest, air hunger, sitting or standing.
difficulty
Example is the
breathing,
subclavius between the
breathlessness
collarbone and the top
or a feeling of
rib which usually
suffocation.
stabilizes the rib cage.

LUNG SOUNDS
TYPES SOUNDS LIKE CAUSED BY: CONDITIONS

Crackling(Rales): Rales occur when you Pneumonia

There are three different types; inhale, causing a Atelectasis
fine, medium and coarse. low-pitched or Acute Respiratory Distress
high-pitched Syndrome (ARDS)
Fine are typically late inspiratory and crackling noise. It is acute bronchitis
coarse are usually early inspiratory. caused when
collapsed alveoli
Medium crackles are high pitched, suddenly snap open
very brief and soft. It sounds like
rolling a strand of hair between two
fingers. ...

Coarse crackles are louder, more

low pitched and longer lasting.

Rhonchi Ronchi caused by Asthma

These low-pitched wheezing sounds movement of fluid Viral Upper Respiratory
sound like snoring and usually and secretions in Infection [URI])
happen when you breathe out. They larger airways COPD(Chronic Obstructive
can be a sign that your bronchial Pulmonary Disease)
tubes (the tubes that connect your cystic fibrosis
trachea to your lungs) are thickening
because of mucus
 Fundamentals

Oxygenation

Stridor Stridor is an Laryngomalacia

Wheeze-like abnormal, Croup
sound heard high-pitched Epiglottitis
when a person respiratory sound Craniofacial Malformations
breathes. ... produced by irregular
airflow in a narrowed
airway during the
inspiration phase. A
stridor is an indicator
of partial obstruction
in the upper airways

Wheezing Wheezing is usually Bronchitis

High-pitched caused by an COPD(Chronic Obstructive
sounds produced by obstruction Pulmonary Disease)
narrowed airways. (blockage) or Asthma
narrowing of the Pneumonia
small bronchial tubes
in the chest. It can
also be caused by an
obstruction in the
larger airways or
vocal cords.

Whooping Whooping cough Contagious Respiratory Illness

This high-pitched gasp typically (pertussis) is a highly Sneezing
follows a long bout of coughing. If you contagious Fever
hear a “whoop” when you breathe in, respiratory tract Nasal discharge
it may be a symptom of whooping infection.
cough (pertussis), a contagious
infection in your respiratory system.

Pleural Friction Rub The pleural rub sound Pulmonary Embolism

results from the Pleurisy
A pleural friction rub
movement of
is an adventitious Pneumonia
inflamed and
breath sound heard
roughened pleural
on auscultation of
surfaces against one
the lung.
another during
movement of the
chest wall.
 Fundamentals

Hypoxia

Hypoxia is a state in which oxygen is not available in sufficient amounts at the tissue level to maintain
adequate homeostasis; this can result from inadequate oxygen delivery to the tissues either due to low
blood supply or low oxygen content in the blood (hypoxemia)

Early Signs Late Signs

Dyspnea On Exertion Cyanosis

Difficulty with breathing when the body is This is a bluish discoloration of the skin,
exercising is one of the first signs of hypoxia Caused by a decreased amount of
because the demand of tissues exceed the oxygenated hemoglobin on red blood cells.
supply available.
Cool, Clammy Skin
Tachycardia Also commonly called “diaphoretic,”
Tachycardia manifests as the body compensatory responses release
attempts to increase cardiac output to catecholamines like epinephrine and
circulate oxygenated blood more frequently. norepinephrine into the bloodstream,
which cause increased perspiration.
Tachypnea Use of Accessory Muscles
As cells are deprived of oxygen they Accessory muscles are additional
stimulate the respiratory center to increase muscles that can help increase the
respiratory rate and depth. Depending on amount of air that is inspired.
the mechanism of decreased oxygenation
other mechanisms like peripheral These muscles are used to increase the
chemoreceptors can detect low oxygen volume and rate of respiration
levels in the blood and trigger this response.
Retractions
Restlessness
Visualization of muscles pulling into the
Some initial responses include releasing body cavity in the neck and intercostals can
catecholamines like epinephrine and be seen during inspiration..
norepinephrine which stimulate an
unexplained apprehension, restlessness and Hypotension
even irritability in some patients. In the early stages of hypoxia, blood
pressure is typically increased as a
Diaphoresis compensatory mechanism, but with
Compensatory release of catecholamines sustained or severe hypoxia,
like epinephrine and norepinephrine can
cause excessive perspiration, termed The body can no longer meet the
diaphoresis. demands for oxygen and tissues are
unable to compensate, resulting in low
Anxiety blood pressure.
Anxiety disorders are a type of mental
health condition. Blood pressure changes are not a good
indicator of hypoxia.
Symptoms include feelings of
Arrhythmias
nervousness, panic and fear as well as
sweating and a rapid heartbeat. The heart is very sensitive to low oxygen
levels because it has a high extraction
percentage of oxygen from the blood.
 Fundamentals

Oxygen Delivery Devices

NASAL CANNULA

A nasal cannula is the most FIO2 % Flow L·min−1

common oxygen delivery
system, used for Mild Hypoxia.
24–28 1–2
It delivers oxygen into the
30–35 3–4
nasopharyngeal space and
can be set to deliver between
38–44 5–6
1 and 6

SIMPLE FACEMASK

Simple face masks (also called Hudson masks) are typically used to
treat Mild To Moderate hypoxia
Moderate oygen requirement ..

Flow rate: 6-10 L/min

Fraction Of Inspired Oxygen (FiO2)
FiO2: 28% to 50%

NON-INVASIVE VENTILATION CPAP/ BIPAP

Continuous Positive Airway Pressure (CPAP) devices or modes apply

constant pressure throughout the respiratory cycle via face mask or
other interface to splint open the upper airway, increase lung volume,
and increase intrathoracic pressure.

Flow rate: 20-100 LPM

Fully controlled oxygen delivery up to 100%
FiO2: 0.21-1.0

VENTILATOR

A ventilator that assists or replaces breathing in patients who can't

breathe on their own.
It delivers a controlled mixture of oxygen and air to the lungs.

The Flow Rate required for life support on a ventilator varies

depending on the individual patient's needs. FiO2 setting can typically
be adjusted up to 100%
 Fundamentals

Oxygen Delivery Devices

VENTURI MASK

Venturi masks are low-flow masks

that use the Bernoulli principle to Colour Required FIO2
entrain room air when pure oxygen flow rate*
is delivered through a small orifice,
Blue 2–4L/minute 24%
Resulting in a large total flow at
predictable Fio2. Venturi masks are White 4–6L/minute 28%
often used in COPD, where it is
important not to over-oxygenate Yellow 8–10L/minute 35%
the patient.
Red 10–12L/minute 40%
Venturi face-mask receives
oxygen at a specific rate Green 12–15L/minute 60%

Venturi masks deliver Fio2

between 24% and 60%

NON-REBREATHER MASK

A non-rebreather mask (NRM) is a device that gives you oxygen, usually

in an emergency.
It’s a face mask that fits over your mouth and nose.
The mask connects to a small bag filled with oxygen (reservoir bag),
and the bag is attached to an oxygen tank.
It provides a high concentration of oxygen quickly,.

Flow rate: 10 to 15 L/min Safety Note: The reservoir bag should

FiO2: 60-80% always be partially inflated.

HIGH FLOW NASAL CANNULA

High-flow nasal cannula (HFNC) therapy is an oxygen supply

system capable of delivering up to 100% humidified and heated
oxygen at a flow rate of up to 60 liters per minute.

Flow Up of up to 60 liters FIO2 ranging from 21 to 100%,

per minute. independent of flow.
 Fundamentals

Pain Management

Pain management is an aspect of medicine and health care involving relief of pain (pain relief, analgesia,
pain control) in various dimensions, from acute and simple to chronic and challenging.

Types of Pain

Acute Pain Chronic Pain

Duration: Short-term, lasting from minutes Duration: Longer-term, can be constant or
to about three to 6 months. intermittent.
Cause: Often related to soft-tissue injury or Impact: Can affect daily life and activities over
temporary illness. an extended period, longer than 6 month.
Resolution: Typically subsides as the injury Parasympathetic nervous system
heals or the illness resolves. predominates
Potential Transition: May evolve into chronic Management: Requires ongoing treatment
pain if the underlying issue persists. and coping strategies.

Examples Examples
Sprained Ankle: Pain that occurs immediately Headaches over many months, pain related
after twisting or injuring the ankle. to health conditions like arthritis or
Burns: Pain experienced after touching a hot fibromyalgia.
surface or getting scalded. Back pain
Surgical Pain: Pain following a surgical Endometriosis
procedure, such as after getting your Chronic fatigue syndrome
wisdom teeth removed.
Breaking a bone;
Appendicitis; inflammation of the appendix 4’S’ Shooting. Squeezing. Stiffness. Stinging.
Labor contractions; the muscles of your
uterus tighten up like a fist and then relax

Nociceptive Pain Examples

Cause: Caused by damage to body tissue, Injuries like hitting your elbow, stubbing your
often external injuries. toe, or falling.
Characteristics: Sharp, achy, or throbbing Pain in the musculoskeletal system, which
pain, commonly felt in joints, muscles, skin, includes the joints, muscles, skin, tendons,
tendons, and bones. and bone.
Duration: Can be both acute and chronic. Aching, or throbbing.
 Fundamentals

Pain Management

Radicular Pain Neuropathic Pain

Cause: Compression or inflammation of Cause: Result of nerve or nervous system
spinal nerves, often associated with sciatica. damage.
Radiation: Pain radiates from the back and Characteristics: Described as shooting,
hip into the leg(s) through the spine and stabbing, burning, or like pins and needles.
spinal nerve root.
Symptoms: May affect touch sensitivity and
Symptoms: Tingling, numbness, and muscle cause difficulty with temperature
weakness may accompany the pain. sensations.
Aggravating Factors: Certain activities like Impact: Can make everyday tasks
walking or sitting can worsen radicular pain. challenging and lead to mobility issues.

Examples Examples
Lumbar Radiculopathy: Compression or Diabetic Neuropathy: Nerve damage due to
irritation of nerves in the lower back, diabetes, leading to tingling, burning, or
resulting in pain radiating down the leg. shooting pain, typically in the feet and
Herniated Disc: When the gel-like center of a hands.
spinal disc pushes through a tear in the Nerve compression
outer layer, it can compress nerves and
Nerve trauma,
cause radicular pain.
Autoimmune disease
Sciatica: Compression of the sciatic nerve,
causing pain that radiates down the leg, often
accompanied by numbness and tingling.

Idiopathic Pain
Pain that has no specific or determinable
cause or which has multiple etiologies

Idiopathic Pain
Biological,
Physiological,
Psychological,
Psycho-social

Examples
Persistent idiopathic facial pain.
Stabbing or burning pain in the face
Migraines
Fibromyalgia
Temporomandibular joint pain TMJ
 Fundamentals

Pain Locations

Referred pain Radiating pain Nociceptive

Referred pain is when you have an There are many causes of

injury in one area of your body but radiating pain, all of which are Somatic pain
feel pain somewhere else. This located either in the legs, back,
happens because all the nerves in chest, ribs, or arms.
Somatic pain is the type
your body are part of a huge, if the pain becomes more severe,
of pain you feel in your
connected network. Referred pain lasts longer than a week, came
skin, muscles, joints, and
can occur anywhere, but it's most after an injury or accident, or if
bones. It can feel like a
common in your neck, shoulders, you have difficulty controlling
gnawing, aching, or
back, teeth and jaws your bladder or bowels.
cramping. Some people
describe somatic pain
as "sharp."

Use the OPQRST mnemonic to assess a patient in pain.

Onset Radiation Visceral pain
When did the pain start? Does the pain radiate to other
areas?
What was the patient doing when the Visceral pain originates
pain began? Severity in the internal organs of
Palliation/Provocation Rate the intensity of pain on a the chest, belly, or pelvis.
scale from 0-10.
Does anything increase or release the
pain? Time
Is the pain the same intensity as PAIN ASSESSMENT
Quality
when it started or has it
How does the patient describe the
decreased/increased?
pain: sharp, dull, aching, burning,
tearing etc.
Is the pain constant, intermittent or Patient's self
pulsating? report is the most
reliable indicator!

Lung and Diaphgram

Thymus Spleen Thymus

Heart
Liver and Liver and
Stomach
Gall Bladder Gall Bladder
Pancreas
Small
Intestine
Appendix
Ovary
Colon

Kidney
Urinary
Bladder
Ureter
 Fundamentals

Pain Management Methods

1. Non-Pharmacological
Non-pharmacological is any intervention intended to
improve the health or the well-being of individuals that
do not involve the use of any drugs or medicine.
Relaxation techniques Guided imagery
Aromatherapy Companionship
Deep breathing Music
Tense your muscles and then Biofeedback
relax them Distraction
Meditation Self-hypnosis
Yoga Physical Therapy
Tai Chi Acupuncture therapy

2. Pharmacological
Pharmacologic pain management is one of many
Presription Opioids
treatment options available to provide pain relief
and a better quality of life. Over-the-counter NSAIDS
and acetaminophen
Depending on your acute or chronic pain condition,
our professional pain management physicians Antidepressants
may decide that pain medications are ideal or
they may suggest other interventional procedures. Anticonvulsants

Non-opioid Topical Analgesics

Topical NSAIDs
Oral NSAIDs
Acetaminophen Adjuvant
Tricyclic and tetracyclic antidepressants
Serotonin and norepinephrine reuptake inhibitor Antidepressants
(SNRI) antidepressants Anticonvulsants
Anticonvulsants (e.g., pregabalin /gabapentin) Neuroleptics.
Capsaicin and lidocaine patches Local anesthetics
Corticosteroids
Bisphosphonates
Opioid

Codeine Oxycodone
Drugs with primary use
Fentanyl Oxymorphone other than pain but also
Hydrocodone Morphine have analgesic properties
 Fundamentals

Pain Management Methods

Pain Intensity

Mild Pain Moderate Pain Severe Pain

WHO Ladder 1-3 4-6 7-10

Step 1
Non-opioid plus optional
adjuvant analgesics for mild Moderate to Severe Ex: Ibuprofen + Lidocaine Gel
pain Step

Step 2
Weak opioid plus non-opioid
and adjuvant analgesics for
Mild to Moderate Ex: Tramadol+ Ibuprofen + Lidocaine Gel
mild to moderate pain

Step 3
Strong opioid plus non-opioid
and adjuvant analgesics for
Mild pain Ex: Morphine+ Ibuprofen + Lidocaine Gel
moderate to severe pain.

Severe
ses
ea Pain
cr
y In
sit The World Health
te Moderate
In Organization (WHO)
Pain
Initially crafted a strategy
Strong Opioids focused on alleviating
± Non-opioid Analgesics
pain among cancer
± Adjuvant Analgesics
patients. However, its
profound efficacy
Mild
Weak Opioids prompted a broader
Pain
± Non-opioid Analgesics embrace, extending its
± Adjuvant Analgesics application to cater to the
diverse spectrum of
Pain patients grappling with
Non-opioid Analgesics various ailments.
Analgesic ± Adjuvant Analgesics
Ladder
 Fundamentals

Therapeutic Communication

A collection of techniques that prioritize the physical, mental, and emotional well-being of patients. An
exchange between the patient and provider using verbal and non-verbal methods.

Communication styles
Communication styles refer to how individuals express themselves and respond to others in everyday
conversations and interactions. It encompasses a person's tone, language choice, nonverbal behavior,
and overall approach to communication.

Passive Lose-win Assertive Win-win

Someone avoids expressing their opinions, needs, Clear expression of values and needs while
or values. Often, the person prioritizes the needs, respecting others, fostering open dialogue without
values, and opinions of others over their own. expecting constant agreement.

Avoids expressing personal opinions, needs, or Involves expressing values, needs, and desires.
values. Respects the values and needs of others.
Prioritizes others' feelings and opinions. Calmly communicates feelings and
May refrain from sharing emotions or concerns. expectations.

Frustrations build over time. Open to hearing others' perspectives.

Occasional explosive outbursts may occur. Does not expect always getting what one
wants.
Feelings of guilt often follow, perpetuating a
cycle of avoidance. Emphasizes clear expression of needs while
respecting input from others.

Example of Passive Communication: Example of

Situation: Partner broke a Assertive Communication:
promise. Situation: Partner broke a
Passive Response: Silence and promise.
internalizing feelings. Assertive Response: "I felt hurt
Resulting Behavior: Frustration when you broke your promise,
builds over time without and I would appreciate it if you
expressing hurt or expectations. could keep promises in the
May lead to eventual explosive future. I'm open to hearing your
outbursts or feelings of guilt. perspective and having a
conversation about it.“

"Whatever you want" "I'd really like to do..."

"That's fine" "I respect your opinion, but I disagree
 Fundamentals

Therapeutic Communication

Passive aggressive Lose-lose Aggressive Win-lose

A blend of passivity and aggression, expressing Expressing needs, values, and opinions assertively
anger indirectly through subtle means like but often at the expense of others, involving
sarcasm or neglect, often reflecting discomfort in behaviors like yelling, blaming, and criticism, and
direct emotional expression. may extend to various forms of abuse.

Combines passive and aggressive traits. Assertive expression of personal needs and
opinions.
Appears passive but expresses anger subtly.
Tends to overlook others' perspectives.
Conveys resentment or discomfort indirectly.
Involves yelling, blaming, and criticism.
Result of discomfort expressing feelings
directly. May include various forms of abuse.
Resembles a spreading fire, potentially causing
harm without regard for others.

Example

Situation: A colleague takes credit for your idea in Example of

a meeting. Passive-Aggressive Response: Smiling Aggressive Communication:
and saying, "Great job on presenting that
fantastic idea," while avoiding direct Situation: A colleague disagrees with your
confrontation, but expressing resentment proposal in a team meeting.
indirectly through tone and body language.
Aggressive Response: Yelling, interrupting, and
criticizing the colleague's opinion without
acknowledging or considering their
I guess I'll just do it myself" perspective.

"Like I just said..."

"If you don't like it,

too bad"
"Can you do
anything right?"
 Fundamentals

Non-verbal Communication

The transfer of information through body language, facial expressions, gestures, created space and more.

Types of Nonverbal 90% of 8. Eye Contact

Communication: communication Definition: Using eye contact to
is non-verbal! communicate attention and interest.
1. Body Language:
Example: Avoiding eye contact may convey
Definition: The way someone positions their
disinterest or disrespect.
body to express feelings in a given situation.
Example: Crossing arms may indicate anger 9. Pace of speech.
or nervousness. 10. Pitch and tone
2. Movement 11. Pronunciation
Definition: The way arms and legs move, 12. Touch
conveying different messages to onlookers.
Example: Stillness in a meeting conveys Definition: Using physical contact to
respect and attention. communicate support or comfort, used
sparingly and with consent.
3. Posture
Example: Placing a hand on a shoulder may
Definition: The way one sits or stands, express support or empathy
communicating comfort level,
professionalism, and disposition.
Example: Slouching shoulders may signal & 7% of WHAT you say
tiredness or frustration. Avoid false reassurance
4. Gestures "Don't worry, everything is going to be okay"
Avoid leading questions
Definition: Intentional or unintentional hand
"You don't smoke, right?"
movements conveying information.
Avoid "Why" questions
Example: "Thumbs up" signifies confirmation "Why didn't you follow the treatment plan?"
or positivity. Avoid giving advice
5. Space "You should" or "you shouldn't" statements

Definition: Creating or closing distance to

convey messages about comfort,
importance, or connection.
Example: Standing at a respectful distance hello!
shows consideration.
6. Paralanguage
Definition: Non-language elements of
speech, including speed, pitch, intonation,
and volume.
Example: Speaking quickly conveys
excitement.
7. Facial Expressions:
Definition: Using facial features to express
emotion or convey information.
Example: Raised eyebrows and wide eyes
indicate surprise.
 Fundamentals

Therapeutic
Communication Techniques

Technique Definition Example

Paraphrasing The client’s words and key ideas to

clarify their message and encourage
additional communication. Example
Client: “I’ve been way too
busy today.”
Nurse: “Participating in the
support groups today has
kept you busy.”

Open-ended Open-ended questions are ones that

allow you to provide whatever
questions amount of detail you want, rather Example
than simply answering "yes" or "no."
Open-ended questions encourage “Can you share your thoughts
you to share relevant material about on the project?"
your life, your way of thinking, and "How do you envision solving this
your beliefs. challenge?"
"What are your main goals for
the upcoming year?“

Reflecting Reflecting asks clients what they think

they should do, encourages them to
be accountable for their own actions, Example
and helps them come up with
solutions. Client: “Do you think I should do
this new treatment or not?”
Nurse: “What do you think the
pros and cons are for the new
treatment plan?”

Restating Restating uses different word choices

for the same content stated by the
client to encourage elaboration. Example
Client: “The nurses hate
me here.”
Nurse: “You feel as though
the nurses dislike you?”
 Fundamentals

Thermoregulation

Thermoregulation is a homeostatic process that maintains a steady internal body temperature despite
changes in external conditions. Maintaining a body temperature within a tight range (between 36.5 to
37.5°C) allows for the enzymes and immune responses of the body to maintain proper functionality

Pyrexia

Hyperthermia Hypertermia
Hypothermia
What is hyperthermia? Hyperthermia is an Death
Fº
abnormally high body temperature or 93.2 95.0 96.6 98.6 100.4 102.2 104 105.6 107.6 109.4 111.2

overheating. It's the opposite of hypothermia,

34 35 36 37 38 39 40 41 42 43 44
when your body is too cold. Hyperthermia occurs
when your body absorbs or generates more heat Cº
than it can release. Average
Normal Range

Risk Factors Types of hyperthermia

Age-related changes to the skin such as poor Heat Cramps:

blood circulation and inefficient sweat glands Result from electrolyte loss through sweating.
Alcohol use Causes muscle cramps in arms, hands, lower
Endocrine disorders legs, and feet.
Heat Exhaustion:
Addison's disease.
More serious than heat cramps.
Adrenal fatigue.
Body temperature may reach 104°F.
Congenital adrenal hyperplasia. Can progress to heatstroke if not addressed.
Cushing's syndrome. Heat Rash:
Diabetes. Skin irritation in hot, humid weather.
Being substantially overweight or underweight Appears as small red pimples or blisters.

Dehydration Common in elbow crease, under breasts, near

groin, chest, and neck.
Taking diuretics
Heat Stress:
Heart, lung and kidney diseases, as well as any Occurs in occupations with hot conditions
illness that causes general weakness or fever (firefighters, miners, construction workers).
High blood pressure or other health conditions Can lead to heat exhaustion or heatstroke.
that require changes in diet. Heatstroke:
Reduced perspiration, caused by medications Most severe hyperthermia form.
such as diuretics, sedatives, tranquilizers and
Life-threatening with body temperature above
certain heart and blood pressure drugs
104°F.
Use of multiple medications. It is important, Causes organ and brain dysfunction.
however, to continue to take prescribed
Extremely dangerous if temperature exceeds
medication and discuss possible problems
106°F.
with a physician.
 Fundamentals

Heat Exhaustion vs Heat Stroke

Heat exhaustion Treatment VS Heat stroke Treatment

Take a cool shower or

Elevated body
General weakness use a cold compress
temperature above Do not give fluids
Nausea or vomiting to decrease body
104°f (40°c)
temperature

Increased heavy Hydrate with water or Rapid and strong Move to a shaded or
sweating sports drinks pulse or heart rate cool area

A weak but faster Move to a shaded or Loss or change of Circulate air to speed
pulse or heart rate cool area consciousness up cooling

Use a cold compress

Seek medical
Fatigue/ dizziness/ Hot, red, dry, or moist or cold, wet cloth to
treatment if vomiting
fainting skin help lower body
continues
temperature

Possible fainting, Possible fainting,

Pulsating sensation
lightheadedness, lightheadedness,
within your brain
dizziness dizziness

for
l l 911 cy
Ca rgen t
e n
Em atme
Remove any extra
tr e
Pale, cold, clammy layers or unnecessary
Rapid, strong pulse
skin clothing, like shoes or
socks
 Fundamentals

Malignant Hyperthermia

Malignant hyperthermia is a severe reaction to certain drugs used for anesthesia.

This severe reaction typically includes a dangerously high body temperature.

Causes
Malignant Hyperthermia Susceptibility (MHS):
40ºC
Genetic Mutation: Caused by
at HIGH RISK
gene change.
Inheritance: Often inherited or
occurs randomly.

Anesthesia Trigger:
Drug Reaction: Triggered by specific Treatment
anesthesia drugs.
Genetic Link: Risk increased by MHS gene Medication: DANTROLENE stops calcium
(RYR1, CACNA1S, STAC3). release, addresses metabolic imbalances,
and manages complications.
Associated Genes: Oxygen Therapy: Administered via face
RYR1: Most common gene. mask or tracheal tube for sufficient oxygen
supply.
Others: Less common genes like CACNA1S
and STAC3. Body Cooling: Utilizes ice packs, cooling
blankets, fan with cool mist, and chilled IV
fluids to reduce body temperature.
Fluid Administration: Extra fluids provided
through an intravenous (IV) line.
Symptoms
Supportive Care: Hospital stay in intensive
Severe muscle rigidity or spasms care for monitoring vital signs, frequent lab
tests to check muscle breakdown and
Rapid, shallow breathing and problems with kidney damage.
low oxygen and high carbon dioxide
Electrolytes
Rapid heart rate
Sodium
Irregular heart rhythm
Potassium
Abnormal or irregular heartbeat.
Calcium
Dangerously high body temperature
Magnesium
Excessive sweating
ECG is more accurate than an optical heart
Patchy, irregular skin color (mottled skin) rate monitor.
 Fundamentals

Hypothermia

Hypothermia is a medical emergency that occurs when your body loses heat faster than it can produce
heat, causing a dangerously low body temperature.

Normal body temperature is around 98.6 F (37 C).

Hypothermia (hi-poe-THUR-me-uh) occurs when body temperature falls below 95 F (35 C).

Risk Factors Symptoms

Exhaustion The following are warnings signs of
Older age hypothermia:
Very young age Idiopathic Pain
Mental problems Shivering Memory loss
Alcohol and drug use Exhaustion or feeling Slurred speech
very tired
Surgical patients receiving Drowsiness
anesthesia Confusion
Low body fat % Fumbling hands
Certain medical conditions Examples
Medications Bright red, cold skin
Very low energy

Stages of Hypothermia

Swiss system Symptoms By degree Temperature

Stage 1 Awake and shivering Mild 32–35 °C (89.6–95.0 °F)

Stage 2 Drowsy and not shivering Moderate 28–32 °C (82.4–89.6 °F)

Stage 3 Unconscious, not shivering Severe 20–28 °C (68.0–82.4 °F)

Stage 4 No vital signs Profound <20 °C (68.0 °F)

 Fundamentals

Hypothermia

Mild Mild Hypothermia

effects on the body
Shivering
Tiredness
High Blood Pressure Memory loss,
Unlear Speech lack of judgement.
Fast Heart Rate inability to think
Body Temperature
Rapid Respiratory Rate 90-95’F (32-35’C)
Rapid breathing rate

Blood Vessel Contraction Faster heart rate

Pale & Dry Skin
Increased blood pressure
Without Coordination (Ataxia)
Constricted Hunger/nausea
Blood Vessels
Increased Uriantion

Loss of Control of
Body Movement

Increased
Moderate Muscle Tone
Shivering

Shivering
High Blood Pressure
Fast Heart Rate
Moderate Hypothermia
Rapid Respiratory Rate
effects on the body
Blood Vessel Contraction
Slow Reflexes
Without Coordination (Ataxia)
Lethargy
Continued decline in
thinking ability
Enlarged pupils
Slow hearth beat
Less Responsive
Abnormal heart rhythms
Slow Breathing Rate Lower blood pressure

Severe Body Temprature

82-90’F (28-32’C)

Cold, inflamed skin.

Hallucinations.
Lack of reflexes. Servere Hypothermia
Fixed dilated pupils.
effects on the body
Low blood pressure.
Pulmonary edema.

Nonreactive pupils Heart Failure

No Responsive
Pulmonary edema
Labored Breathing Pulmonary edema
No Pulse! start cpr Fluid Buildup in The Lungs

Body Temprature
Less Than 82,4’F (28’C)
 Fundamentals

Cold Injuries

Cold injury occurs when the core body temperature has decreased to 35 degrees C (95 degrees F) or less.

Frostnip VS Frostbite
Frostnip is a mild cold-related injury affecting Frostbite occurs when your skin
extremities like cheeks, ears, nose, fingers, and toes. freezes during exposure to freezing
temperatures.
It causes reddened skin, numbness, and tingling.
Treatable at home by warming the affected areas,
Frostbite is skin damage caused by
avoiding rubbing. Seek medical help if symptoms
freezing temperatures below 32
persist or worsen.
degrees Fahrenheit (0 degrees
Reddened skin Celsius):

Numbness During the winter.

Tingling In windy weather conditions.
At high altitudes.
If you don’t have shelter from
the cold weather.

Treatment
Remove from cold Remove wet clothing to
environment and move prevent further heat loss.
to a warm area. Avoid rubbing or
Place chilled body parts massaging the affected
in warm water. areas.
Immerse for 20-30 Seek medical attention if
minutes until sensation symptoms persist or
returns. worsen.
 Fundamentals

Cold Injuries

Frostbite

Superficial Frostbite Deep Frostbite

Second stage, requires medical treatment. Third stage, requires immediate medical
attention.
Skin feels warm, but water freezes into ice
crystals. Subcutaneous tissue freezes, causing total
numbness.
"Pins and needles" sensation, stinging,
swelling. Difficulty or inability to move the affected
area.
After rewarming, may have painful, spotty
patches or purple/blue areas. Loss of sensation; muscles or joints may no
longer work
Skin peels, resembling a sunburn.
Formation of big blisters within a day or two.
Fluid-filled blisters may develop after a day.
Blood filled blisters may form after
rewarming
Frostbitten skin turns black as cells die.
Treatment of Superficial Frostbite:
Skin white or bluish-gray

Seek medical attention. Potential for a hard, black covering (carapace)

that may require surgical removal.
Move to a warm environment.
Remove wet clothing. Can lead to gangrene
Gradually rewarm affected areas using
warm water.
Avoid direct heat sources. Treatment of Severe Frostbite (Deep):
Take pain relievers if needed.
Do not pop blisters; let them heal naturally. Seek emergency medical attention
Follow medical advice for recovery. immediately.
Move to a warm environment to prevent
further cold exposure.
Thaw only if there is no risk of refreezing.
Frostbite
Avoid direct heat sources.
1st Degree 2nd Degree 3rd Degree 4th Degree Do not pop blisters; leave them intact.
Escharotomy or fasciotomy(depending on
severity)
Keep the affected area elevated and
protected.
Pain relievers may be administered.
Professional assessment for potential
surgical removal of dead tissue.
 Fundamentals

Perioperative Care

The practice of patient-centered, multidisciplinary, and integrated medical care of patients from the
moment of contemplation of surgery until full recovery.

Perioperative Phases

Preoperative

Denoting, administered in, or occurring in the period before a surgical operation.

Critical time for the collection and collation of pertinent patient information that is relevant and
necessary for any patient scheduled for surgery.

Identify, communicate, and minimize the Nurse's Focus:

patient-specific, attendant risks of surgery and
anesthesia Apply evidence-informed, standardized
Surgery-related anxiety.
clinical protocols for further preoperative diagnostic
testing and goal-directed medical optimization Risky management due
to lack of knowledge.
Implement individualized perioperative care plan,
including additional preoperative medications and the Fear of surgery and
perioperative maintenance of the patient's indicated separation.
chronic medications
Insufficient knowledge
Makes decision to have procedure about the surgical
process.
Confirm and remediate the patient's surgical consent

Postoperative

During, relating to, or denoting the period OF surgical operation

The postoperative phase of the surgical experience
extends from the time the client is transferred to the
recovery room .
Patient waking up from anesthesia
Close 1:1 monitoring in immediate phase
Transported back to the surgical unit, discharged from
the hospital until the follow-up care.

Nurse's Focus:

Maintain until fully awake, suction secretions as needed.

Ensure a secure environment post-surgery.
Administer prescribed pain medications as directed.
 Fundamentals

Perioperative Care

Intraoperative

Performed during the course of a surgical operation. The intraoperative phase extends from the
time the client is admitted to the operating room, to the time of anesthesia administration,
performance of the surgical procedure and until the client is transported to the recovery room or
postanesthesia care unit (PACU).

Period of time during which a surgical procedure takes place.

Valuable in the detection and prevention of neurological insult.
Monitored anesthesia care (MAC) is a sedation protocol in which the patient is sedated
Time out is performed
After receiving anesthesia for a surgery or procedure, a patient is sent to the PACU to recover
and wake up.

Nurse's Focus: Intraoperative symptoms

Prioritize safety. Hypertension (high blood pressure)

Simultaneously place feet to Tachycardia (high heart rate)
prevent hip dislocation. Patient movement.
Prepare and apply cautery pad Tachypnea.
for bleeding control.
 Fundamentals

Perioperative Care

NURSE RESPONSIBILITIES

Preoperative

Obtaining the patient’s medical history

Past and current medical conditions, surgeries, family history, social aspects, allergies,
complications with anesthesia, and current medications.
History of falls and incontinence, including any relevant lifestyle factors.

Performing a physical examination

Assess nutrition, dental, respiratory, cardiovascular, hepatic/renal, and endocrine/immune status.
Evaluate overall health including dental, respiratory, cardiovascular, hepatic/renal, and
endocrine/immune function.

Evaluating the patient’s psychosocial factors

Holistic nursing: Assess patient's surgery understanding, support network, and potential
post-discharge needs.
Inquire about next of kin, support, and consider spiritual/cultural beliefs for patient-centered care.

Get all the required medical tests

Conduct essential blood tests, including CBC, blood typing, cross-match, INR, APTT, electrolytes,
and creatinine.
Consider fasting glucose for diabetics and include ECG for comprehensive patient assessment.

Ensure all pre-operative documentation is in order

Ensure informed consent is obtained.
Confirm completion of pre-operative nursing checklist; assessments are documented in the
patient's file

Patients without catheter must void before surgery

 Fundamentals

Perioperative Care

Intraoperative

Circulating Nurse Scrub Nurse

Assures cleanliness in the OR. Scrubbing for surgery. Roles

Guarantees the proper room Setting up sterile tables.
temperature, humidity and lighting Circulating nurse
Preparing sutures and special
in OR. equipment's. Scrub nurse/ tech
Make certain that equipment's are Assists the surgeon and assistant Surgeon
safely functioning. during the surgical procedure by Surgical Assistant
Ensure that supplies and materials anticipating the required Anesthesiologist
are available for use during surgical instruments, sponges, drains and
procedures. other equipment.
Monitors aseptic technique while Keeps track of the time the patient
coordinating the movement of is under anesthesia and the time
related personnel. the wound is open.
Monitors the patient throughout the Checks equipment's and materials
operative procedure to ensure the such as needles, sponges and
person’s safety and well being. instruments as the surgical incision
is closed.
NOT Sterile Sterile

Must be done before

every procedure
Postoperative

Circulating Nurse Time out

Maintain airway until fully awake; suction secretions as needed. Brief pause with
Bilateral lung auscultation, lateral positioning for ventilation entire surgical team
to clarify correct
Encourage deep breaths; assess orientation for oxygen delivery. information to avoid
Turn the patient every 1-2 hours for breathing support. harm to patient
Administer humidified oxygen to prevent respiratory irritation. Right patient
Monitor vital signs, intake/output; recognize shock symptoms. Right procedure
Hourly temperature assessment; report abnormalities promptly. Right site
Prevent nerve damage, support pressure areas, raise side rails. Right markings

Monitor GI function; maintain nasogastric tube if in place.

Observe, assess pain manifestations; administer and document pain medications
Educate patients being discharged home.
 Fundamentals

Types Of Surgery

Type Urgency Example

Elective Surgical procedure planned or booked in Cystoscopy

advance of routine admission to hospital.
Tonsillectomy
It occurs within a planned time that suits
patient, hospital and staff.
Expected Location: Elective theatre list
(after being booked and planned prior to
admission)

Urgent Intervention for acute onset or clinical Debridement plus fixation of

deterioration of life, limb or organ survival; for fracture; Laparotomy for
fixation of multiple fractures; and for relief of perforation
pain or other distressing symptoms.
Appendectomy
Normally it occurs within hours of decision
to operate and once resuscitation is
completed
Expected location: day time “emergency”
list or Out-of-hours emergency theatre

Required/ When a patient is stable but requires early Retinal detachment; Excision of
Expedited intervention for a condition that is not an tumor with potential to bleed or
immediate threat to life, limb or organ survival. obstruct
Normally it occurs within days of decision Kidney stone removal
to operate
Expected Location: Elective list with “spare”
capacity or Day time “emergency” list
(except at night)

Emergent Urgent/emergent cases were defined as Acute appendicitis and trauma

patients requiring access to the operating room
(OR) within 24 hours of the decision to operate. Gunshot wound
 Fundamentals

Surgery Classes

Minor Minor
Minor surgical procedures are minimally Major surgery normally involves opening
invasive. the body, allowing the surgeon access to
the area where the work needs to be
These are performed laparoscopically or completed and require overnight or
arthroscopically. extended stay in hospital
Small incisions are made that allow It involves major trauma to the tissues.
surgical tools and a small camera to be
inserted into the body. High risk of infection

The risk of infection is greatly reduced Extended recovery period.

and the patient's recovery time is much Involves major body organs
shorter.
Most major surgeries will leave a large
No anesthesia or assisted breathing scar.
involved
Intraoperative mechanical ventilation is
There are also surgical procedures that mandatory during many surgical
are superficial, only affecting the procedures
outermost portions of the body.

Minor Surgeries? Major Surgeries?

Cataract surgery Cesarean section
Dental restorations Organ replacement
Circumcision Joint replacement
Breast biopsy Full hysterectomy
Arthroscopy Heart surgeries
Laparoscopy Bariatric surgeries, including the gastric
bypass
Burn excision and debridement
procedures
 fundamentals

Dosage Calculation

RULES

1 Show ALL your work Instead of .5 mg, write 0.5 mg

2 Calculate your answer for atleast two times to .5 could be mistaken as 5

reach the accuracy of the resulting quantity
3 Leading zeroes MUST be placed before decimals
Leading zeros can be ignored if they are in front Instead of 5.0 mg, write 5 m
of or to the left of a decimal point.
5.0 could be mistaken as 50
4 No trailing zeroes
Decimal points can be missed & mistaken for a larger
whole number
Rounding Reference
5 No rounding until you have the final answer
Round only the final answer to the correct number of
significant digits. Make sure to use exact calculations. 1 thousands
2 hundreds
3 tens
Rounding Rules
4 one
If number > 1: round to the nearest tenth
Rounding
Example: 1.234 rounds to 1.2
Any Number 5 tenths
(unless
otherwise If number < 1: round to the nearest hundredth 6 hundredths
instructed) Example: 0.567 rounds to 0.57 7 thousandths

Calculations Concepts Some tips for correct calculations

Mix in
In some cases it is better to convert
Example a larger unit into smaller unit, which
If 10 ml of solution is mixed in
500 ml of water, how many 10 ml + 500 ml= uses multiplication and most often
ml is the resulting solution? 510 ml solution keep the calculation in whole
numbers. E.g, convert grams to
milligrams
Mix with Make sure that all measurements
are in same units. If necessary
Example
If 10 ml of solution is mixed with convert between units.
500 ml of water, how many ml 10 ml + 500 ml=
Always try to think by urself that
is the resulting solution? 510 ml Solution
either drug dosage make the sense?
For example amount less than half a
tablet or greater than 3 tablets are
Mix up to not common but still possible.
Example Calculate your answer for atleast
If 10 ml of solution is mixed
with water up to 500 ml, how 10 ml solution – 500 ml water two times to reach the accuracy of
many ml of water is used? =490 ml water the resulting quantity
 fundamentals

Dosage Calculation

Some other Rounding rules for drops and tablets Abbreviation Term

1 Rounding should not be done during the calculation po By mouth

process, but only in the final answer.
2 Use 2 decimal places in the final answer for adults. susp suspension
3 Use 3 decimal places in the final answer for children.
4 Percentages are not rounded. qid Four times a day
5 Drops are rounded to the nearest whole drop. Follow
the rounding rules. tid Three times a day
6 Do not round during the calculation process.
bid Twice a day
7 Look at the nearest digit to the right for the number of
decimal places you are rounding to; if this digit is 5, 6,
7, 8, or 9, round up the preceding digit by 1. q every
8 If the digit is 0, 1, 2, 3, or 4, keep the preceding digit.
pm As needed

Rounding to the Nearest Tenth IV Calculation

If the hundreds digit If the hundreds digit is Total volume (in mL) divided by time (in
minutes), multiplied by the drop factor
is less than 5, round equal or greater then
(in gtt/mL), which equals the IV drip rate
down to the 5 round up to the
in gtt/min
previous 1000 previous 1000
gtt MUST be rounded to a whole number
Example Example
1.54 rounds to 1.5 1.57 rounds to 1.6 Example 25.3 rounds to 25 gtt/ min

Rounding to the Nearest Hundredth Capsules & Tablets

The digit in the thousandth place is 5 or more than 5, we Capsules should not be split,
add 1 to the digit in the hundredth place, that is, we crushed or opened , Capsules must
increase the hundredth place by 1 and remove all the be rounded to a whole number.
digits to the right. Round unscored tablets to the
nearest whole number.
Example Example
Example: for capsule
2.995 is rounded to 3 2.975 is rounded to 2.98
1.7 rounds to 2 capsules
If the number in the
thousands place is 4 or less, Example Example: for tablet
then the number is dropped 0.993 is rounded to 0.99 1.4 rounds to 1.5 tablets
 fundamentals

Dosage Calculation

CONVERSIONS
Weight Conversion between units:
1000 mcg= 1 mg 1 kg= 2.2 lbs
When converting from grams to micrograms, you
1000 mg= 1 g 1 lb= 16 oz
multiply by 1000, and from micrograms to grams, you
1000 g= 1 kg 2,000 lbs= 1 ton divide by 1000.
1kg=1000g 1mg=.001g Prefixes like micro-, milli-, centi-, Deci- are examples
1g=0.001kg and can be applied to all units, not just grams.
1cg=0.1g For substances that are difficult to measure in terms of
mass or volume due to purity, International Units (IU) or
Volume International Units (IU) as established by the WHO are used

1 tsp= 5 mL 4 quarts= 1 gallon To convert time:

1 tbsp= 15 mL 8 pints= 1 gallon
min hr (divided by 60) min hr (multiply by 60)
1 tbsp= 3 tsp 8 fl oz= 1 cup
2 tbsp= 1 fl oz 1 mL= 1 cc To convert mass:
1,000 mL= 1 L 1 cup= 240 mL
30 mL= 1 fl oz 1 mL= 20 gtt x 1000 Gram (g) ÷ 1000
16 fl oz= 1 pint 60 gtt= 1 tsp x 1000 Milligram (mg) ÷ 1000
2 pints= 1 quart 1 dram= 5 mL x 1000 Mikrogram (µg) ÷ 1000
1kl= 1000l 1L= 0.001kL
x 1000 Nanogram (ng) ÷ 1000
1L= 100cL 1Cl= .01L
1ml= 0.001L

TYPES OF DOSAGE FORMS

1 (based on physical rate) Solid:
Tablet, capsules
Oral Powder, tablets, capsules, suspension , solution, syrups etc
Semisolid:
Parentral Suspension, emulsion, solutions cream , paste, gel, suppositories
Vaginal Suppositories, ointments, tablets liquids:
solution, emulsion, suspension
Intranasal Sprays, solutions, aerosol
Gases :
Rectal Enemas, ointments, solutions, suppositories Aerosol, inhalers
Conjuntival ointment
Transdermal Creams, pastes, plasters, lotions Based on route
3 of administration
Sublingual Lozenges, tablets

2 Based on Sites of application 4 Based on Uses:

Skin Eye Nasal Hair Foot Hand Tooth External:
Creams, powders, paste, creams,
Ointment, Ointment, Sprays, Shampo, Cream, Lotion, hand Tooth liniment etc
cream, cream, inhalation, hair lotion ointment wash, hand paste Internal:
liniment, solutions solutions cream All preprations except external
lotion
 fundamentals

Dosage Calculation

CALCULATION EXAMPLES
Percentage Calculation
IV Flow Rate With Pump
Percentage is a part of a hundred. Formula: 120
V (mL of solution) 80
typically representing the ratio between the mass of mL/ hour
the active ingredient and the volume of the solution it's T (Time)
dissolved in.
Example
The mass of 100 ml of water is approximately 100g. The Phycian orders NS 2000 mL to be given
over 16 hours. What rate do you need to set
Types: the pump to?
Three forms of percentage representation for active V 2000 mL
ingredients in medications are: = = 125 Ml/hr
T 16 hours
1 Mass percentage 3 Mass/volume percentage
Remember: Remember:
1%=1g per 100 g 1 % =1 g/100 ml IV Flow Rate With Drops
1 %=1000 mg/100 ml Formula:
2 Volume percentage
Remember: 1 %=100 mg/10 ml V mL of solution Drop
X = gtt/
1%=1 ml per 100 ml 1 %=10 mg/ml T (Time) factor min

Formula: Example
Example:
The Phycian orders D5W 2000 mL to be
value/total value×100%. Eye drops Livostin are infused over 16 hours. The tubing you're
or inverse proportion available in a strength of using has a drop factor of 10 gtt/mL. What
do you need to set the gtt/min to?
0.5 mg/ml. What is the
strength expressed as a Step 1 Convert hours to minutes
Calculate: percentage? 8 hours 60 mins
X = 480 minutes
If 1 %=10 mg/ml x mins 1 hour
Then 0.5 mg/ml have strength in percentage=
Step 2 Plug in & solve the formula
0.5 mg/ml x 1 %: 10 mg/ml = 0.05 %
V 1000 mL
X X 10 gtt/M L= 20.83 21 gtt/ min
T 480 mins

For Time Calculation Injectable Doses

Example: Formula:
A patient has received intravenously 0.5 ml/min from 09:43 to
D (Dose Ordered) Volume
13:19. How many milliliters have they received? x V = A
Calculate:
H (Amount on Hand) Amount
Needed
The time is 09:43. There are 17 minutes until 10:00.
Example
Then there are 3 full hours until 13:00, and 19 minutes until 13:19.
That adds up to 3 hours + 19 minutes + 17 minutes = 3 hours An order for Furosemide 20 mg is placed. The
and 36 minutes. pharmacy stocks Furosemide 100 mg/10 mL.
How many mL will you need to administer a
Three hours correspond to 180 minutes, so the total is 180 +
20 mg dose?
36 = 216 minutes.
The total number of milliliters would be=216min × 0, 5 ml/min D 20 mg
= X 10 ml (v) = 2 Ml
= 108ml H 100 mg
 fundamentals

Dosage Calculation

CALCULATION EXAMPLES
Dilution and Concentration of Liquids

Formulas
1 Inverse proportion.
2 The equation: (1st quantity) X (1st concentration) = (2nd quantity) X (2nd concentration)
Or Q1 X C1 = Q2 X C2.

2 By determining the quantity of active ingredient (solute) present or required and relating that
quantity to the known or desired quantity of the preparation.

Task
If 500 mL of a 15% v/v solution are diluted to 1500 mL, what will be the percentage strength (v/v)?

1500 (mL) 15 (%) Or, 50 mL of 15% v/v solution 1500 (mL) 100 (%)
contains 75 mL of solute
500 (mL) x (%) 75 (mL) x (%)
x 5%, answer. x 5%, answer.

Or, Q1 (Quantity) X C1 (Concentration) Q2 (Quantity) X C2 (Concentration) 500

500 (mL) X 15 (%) 1500 (mL) X x(%)

x 5%, answer.

Weight-base Dose Tablet Doses

Formula: Formula:
D (Dose orderd) D (Dose orderd)
× Kg(pt WEIGHT) × Quantity(Q) = (A)Amount needed
H (Amount on hand) H (Amount on hand)
= (A)Amount needed Example
Example Motrin 200 mg PO is ordered every 6
hours. The pharmacy stocks 100 mg
The doctor orders Amoxicillin at 2 mg/ kg/ dose. The
tablets. How many tablets should be
patient weighs 130 lbs. How many mg per dose will
administered per dose?
you administer?
D 200mg
Step 1 Convert patient's weight from lbs to kg = × 1 TABLET = 2 TABLET
130 lbs H 100mg
X 59.09 = 59.1 kg
2.2 kg

Step 2 Plug in & solve the formula

D 4 mg
= X 59.1 kg = 236.4 Mg/ dose
H 1 kg
MENTAL HEALTH
 Mental health

Mental Health Overview

Mental health continuum

a scale which represents the spectrum of
mental health
a range of wellbeing having mental health
and mental illness at the two extreme ends

HEALTHY REACTING INJURED ILL

(anger + negative attitude) (abnormal functioning + aggressive)
(normal functioning + active ) (confused + low energy )

Normal fluctuations in mood Sadness and overwhelmed Anxiety and anger Inability to make decisions
Physically and socially active Nervousness and irritability Decreased workaholic Panic attacks and excessive
tendencies anxiety
Normal sleep patterns Intrusive thoughts and
disturbed sleeping patterns Avoidance and withdrawal Suicidal thoughts and intentions
Behaving ethically and morally
Decreased social activity Hopelessness and Unable to perform assigned
worthlessness duties

MENTAL HEALTH MENTALL ILLNESS

Mental health is a state of well-being where each person fulfills A mental illness is a diagnosable health condition characterized by
their maximum potential. a set of signs and symptoms.
Represents overall psychological well-being. Refers to specific diagnosable conditions.
Characteristics: Characteristics:
Encompasses emotional balance, resilience, and life satisfaction. Involves disorders like depression, anxiety, and schizophrenia.
Reflects positive mental functioning. Manifests through symptoms and dysfunctions.
Exists on a well-being continuum. Requires medical diagnosis and treatment.
Promotes a sense of fulfillment and contentment. Exists alongside mental health on the well-being spectrum
For example: For example:
optimism schizophrenia
Emotional stability Sleep disorders
Positive attitude Depression
Self esteem Anxiety

Diagnostic and Statistical Manual of mental disorders ( DSM-5)

What is Diagnostic and statistical Who published DSM? Some disorders and mental illnesses
manual of mental disorders? which can be diagnosed by DSM include
The American Psychiatric
Association (APA) is depression schizophrenia
The Diagnostic and Statistical Manual of Mental Disorders, Bipolar disorder anxiety
responsible for the writing,
often known as the “DSM,” is a reference book on editing, reviewing and dementia
mental health and brain-related conditions and disorders. publishing of this book

The DSM-5 maladaptive trait dimensional model proposal How DSM can be useful?
included 25 traits organized within five broad domains :
The first step in treating any health condition — physical or mental —
negative affectivity
is accurately diagnosing the condition.
detachment
antagonism DSM-5 provides clear, highly detailed definitions of mental health and
disinhibition brain-related conditions. It also provides details and examples
psychoticis of the signs and symptoms of those conditions.
 Mental health

Mental Health Overview

Factors affecting mental health

Condifence Breakup behaviour
Abuse Physical Illness Self-esteem

Biological factors Social and environmental Psychological factor

Physical health Socio-economic status Attitude

Neurochemistry culture Beliefs
Metabolic disorder Family circumstances emotions
immune/stress response Peer group Self esteem
Genetic vulnerability Diet/ lifestyle Response to reward
Response to outer Interpersonal relationships Perceptions
environmental conditions
Unemployment Temperament
Discrimination Social skills
Coping skills

Cultural competency
WHAT IS IT? Mental health symptoms looks
Cultural competence included a set of skills or processes that enable mental health different across different cultures
professionals to provide services that are culturally appropriate for the diverse populations
that they serve.
OR
The ability to interact effectively with patients of different cultures, beliefs and behaviors.
ASK YOURSELF:

Awareness In your family who is supposed

to make healthcare decisions?

Cultural competency emphasizes the need for health care systems

Does illness is to be concerned
providers to be aware of,
in your cultures?
and responsive to, patients' cultural perspectives and backgrounds .
Patient and family preferences, What type of end-of-life customs
values, cultural traditions, do you have?
language, and socioeconomic conditions are respected.

Knowledge Skills Encounter Desire

for better understanding of ability to gathered relevant Interaction with different Requires a strong motivation
patient enough information data cultures,
about their culture can be to learn about other cultures
more effective making it useful to engage in backgrounds and ethnicities
effective cross-cultural as well as being open and
interactions competences to grow more accepting to different beliefs
efficiently and effectively in and perspective
concerning with cultural treatments
competency
 Mental health

Mental State Examination (MSE)

Key factors should be considered along with the MSE include

Appearance Thoughts
Mental state examination is a structure to evaluate,
Behavior Perceptions
quantitatively and qualitatively, a range of mental functions
Speech Cognition
and behaviors at a specific point in time
Mood Insight
Affect Judgement

COMPONENTS OF MSE

APPEARANCE BEHAVIOR SPEECH

(evaluation based on physical outlook) ( evaluation based on way of behaving) ( evaluation based on verbal
communication)

Demographics Attitude Quality

Age, sex, race, ethnicity cooperative or not? talkative or not?
suspicious or not? to the point answer?
Clothing guarded or not clear words or not?
neat/clean or dirty ? articulate?
well dressed or not? Facial expressions aphasic?
according to weather or not? slurred
in accordance with statement or not?
according to occasion or not
Eye contact Rate
Clothing
avoided eye contact? speaking speed ?
neat/clean or dirty ?
intense or normal? fast or slow?
well dressed or not?
according to weather or not? Psychomotor Volume
according to occasion or not signs of agitation or not ? low volume or high?
Posture Motor activity depressive or manic?
closed or open? Retardation
Spontaneity
Gait agitation
roaming ?
hemiplegic Parkinsonian abnormal movements
staying on topic?
spastic diplegic choreiform gait
neuropathic ataxic (cerebellar) catatonia
myopathic sensory

MOOD AFFECT

( evaluation based on emotional ( evaluation based on expressions)

state/feelings)

Consistency Totally observational

mood swings ? Stability
range
1.Objective appropriateness
observance and description Either
assess intensity and expressions moment
anxious ? to moment
elated?
mood (long term duration)
irritable?
postures and gestures
sad?
voice tonality
2.Subjective Mood and affect both are related to
how’s feeling? emotion BUT are not the same thing
how’s mood? affect (expressed immediately)

Do consider if affect is Labile as well as

the Range and Intensity
 Mental health

Mental State Examination (MSE)

THOUGHTS PERCEPTIONS COGNITION

( evaluation based on thoughts process ( evaluation based on overall sympathetic ( evaluation based on attention,
and thought content) discernment as of shades of feeling) orientation and memory)

FORM Illusions Alert

organized or linear thinking? yes or not? Yes or not?
STREAM Depersonalization Oriented
state of thinking yes or not? Yes or not?
ongoing or blocking ?
Derealization Memory loss
POSSESSION yes or not?
long term or short term
insertion or broadcasting?
Hallucinations Attention
CONTENT manifests as five senses attentive or not?
suicidal ideation paranoid ideation Sight
death wishes magical ideation
Visual spatial
hearing read or write?
homicidal ideation depressive cognitions taste
ruminations delusions touch
obsessions overvalued ideas smell
ideas of reference

INSIGHT JUDGEMENT

( evaluation based on recognition and ( evaluation based on patient’s

appraises of patient’s experiences) decision making power)

Awareness of illness Assess Decision making power

Aware or denied? Decision making on behalf of kinship
Proper communication to patient
Understanding of illness ensured, about illness
Well aware or not?

Case study
A 27-year-old man presented to the psychiatric emergency department with somewhat
grandiose behavior, pressured speech, irritability, and psychomotor agitation

The initial diagnostic impression was bipolar disorder, manic or drug induced mania.
The patient denied drug abuse. However, questioning his wife uncovered a history of
substance abuse, and laboratory evaluation revealed the presence of amphetamine
metabolites.

The correct diagnosis was amphetamine-induced mood disorder

 Mental health

Attention Deficit Hyperactivity Disorder (ADHD)

What is it
Attention deficit/hyperactivity disorder (ADHD
is a common neurodevelopmental disorder known by a pattern
of diminished sustained attention and increased impulsivity or
hyperactivity

Risk factors
The cause(s) and risk factors for ADHD are unknown, but current
research shows that genetics plays an important role
In addition to genetics, scientists are studying other possible
causes and risk factors including:
Brain injury
Exposure to environmental risks (e.g., lead)
during pregnancy or at a young age
Alcohol and tobacco use during pregnancy
Premature delivery
Low birth weight

Signs and symptoms

Inattentiveness Impulsivity Hyperactivity

Have difficulty getting along with others Have a hard time resisting temptation Squirm or fidget
Can be distracted easily Make careless mistakes or take Talk too much
Unnecessary risks
Daydream a lot Restlessness
Have trouble taking turn
Forget or lose things a lot Unable to sit calmly

Diagnostics Treatment
According to DSM-5 criteria Medications:
U.S. FDA has approved two different stimulant drugs
Age group (up to 16 years old):
methylphenidate and amphetamine
experiencing 6 symptoms or more for at least
6 months(≥ 6 months) U.S. FDA has approved four non-stimulants :
Atomoxetine (Strattera)
Adults :
Clonidine (Kapvay)
experiencing 5 symptoms or more for at least 6 months
Guanfacine (Intuniv)
(≥ 6 months)
Viloxazine (Qelbree)

non pharmacological therapy:

Nursing interventions Behavior therapies(Psychotherapies)

behavior-changing strategies
Cognitive behavior therapy (a talking therapy)
Based on activity
help you manage your problems by changing the way you
Implement scheduled routine every day think and behave.
Encourage physical activity And aims to help the child to better manage 'thinking
skills', such as problem solving and self-control
Avoid stimulating or distracting settings
Social trainings or social skills sessions
Allow some short breaktimes during activitie
Psychoeducation
Based on communication Regular exercises and physical activities
Accept the child or individual as what he is Avoid certain foods containing
Approach the child at his current level of functioning
Preservatives, food colours and simple sugar
Use simple and direct instructions
Give positive reinforcements
Complex tasks should be divided into simple step
 Mental health

Aggression & Abuse

Aggression
What is it?
A way of behaving in which the person tries to express
his or her rights and feelings by dominating and
usually getting his or her way at the
expense of others

Different types of aggression

Symptoms Physical aggression:

Each form of aggression
Hitting, biting, kicking
Agitation. can occur directly, with the person present, or indirectly
Verbal aggression: by doing something to hurt thei
Hyperarousal and hypervigilance.
Paranoia. Screaming or name-calling property,
Dramatic mood swings. Relational aggression: feelings,
Argumentativeness. reputations,
Aggressive behavior with the intent of
Delusions. manipulating or damaging other or relationships without them being there
Poor judgment. people's relationships,
Impaired coping skills

Treatment of aggression IF NOT SUCCESSFUL

Monitor EKG
DE-ESCALATION TECHNIQUES (ECG or EKG records the Must get
(techniques Which are used to decrease or lower the intensity of aggression) Haloperidol
electrical signal from the order within 1
Know your triggers Redirection heart to check for different Lorazepam hour of
heart conditions.) applying
Set boundaries Do something physically active Restraints
restraints
Keep calm Meditations or relaxing techniques HALDOL prolongs QTC
Give them personal space

Abuse
What is it?
According to the Gale Encyclopedia of Medicine,
abuse is defined as any action that intentionally The injuries can be inflicted by
harms or injures another person. In short, punching, beating,
Different types of abuse
someone who purposefully kicking, or use of a weapon such as
harms another biting, a baseball bat or knife
in any way is burning,
committing abuse. Physical abuse Physical abuse can result in
Abuse is also Physical abuse is deliberately bruises, burns, poisoning, broken bones,
defined as any aggressive or violent behavior by and internal hemorrhages
action that one person toward another that Physical abuse can happen to both children and
intentionally results in bodily injury. adults of either gender and of any sexual orientation..
harms or injures
another person

It includes An emotional abuser

uses the following tactics
threatening the victim with violence
Psychological or
emotional abuse harassing them when the are outside the home Humiliation
(e.g., at school or work) Harassment
What is it? denying the victim access to others Rejection
when one person purposely harms the (e.g., refusing to allow the victim to see friends Isolation from other
mental well-being of another person in preventing use of the telephone) people in your life
a non-physical way, sometimes referred confining the victim to home Control of where you
to as nonphysical abuse. destroying the victim's property go and what you do
Withholding affection
 Mental health

Aggression & Abuse

Sexual abuse Neglect abuse Financial or Economical Abuse

What is it Neglect is the failure of a caregiver to Financial or material abuse is the misuse
It involves sexual violence or exploitation, meet a dependent person’s basic physical or stealing of money, assets, or belongings
or forcing someone to engage in and emotional needs, including the need of another person for personal gain,
sexual activity against their will for shelter, food, clothing, medical care, sometimes by coercion, threats,
and emotional support or deception.

Forms of sexual abuse include These are some of the common sign
of neglect You may be experiencing financial
Rape abuse if your partner or caregiver
Forcing someone to watch Dehydration does the following:
pornography or taking pictures of Malnutrition
them in sexual poses Poor personal hygiene Controls your money
Forcing someone to dress in a Untreated wounds, sores, or injuries Steals from you
suggestive manner Unattended medical problems Refuses to contribute to
Threatening to withhold something Unsanitary living conditions household expense
if someone does not have sex with yo (including dirt, insect or animal
infestation, or soiled clothes or bedding)
Hazardous living conditions
(including improper wiring, lack of heat,
or no running water)

Risk factors YCLE of ABUS

C E
Abuser Phase 1

Tension Building
Lack of mental capacity
Increasing age Abuser
Being physically dependent on others Irritable provoking
Low self-esteem Frustrated Bullying
Previous history of abuse Judgmental unpredictable
Negative experiences of disclosing abuse.
Social isolation
Victim
Lack of access to health and social services or Agreeable
high-quality information Nurturing
Blind trust
Failed to convince
abuser

Victim
Routines
Lifestyle choices
Phase 3 Phase 2
Demographics
Economic status
Social activities
Honeymoon Explosive
Substance abuse Abuser Abuser
Community also contribute to victimization risk Abuse starts (Physical , Emotional, Loving and Good future plans
Sexual, neglect etc. kind behavior Fake Promises
Enraged Full of negative energy Apologizes not to do abuse
Nurses are to be required by law to report again
Violent Gift
suspected abuse
Victim Victim
Try to avoid situations Believes everything will be
Protective behavior fine now
towards family Accept apologizes
Usually bot registered
any complains Again trust
injuries
 Mental health

Anxiety

What is it? Levels of anxiety

Anxiety is an emotion characterized by feeling 1.Mild anxiety
of tension, worried thoughts, and physical 2.Moderate anxiety
changes like increased blood pressure. 3.Severe anxiety

Levels of anxiety
4.Panic

Mild Anxiety Moderate Anxiety Severe Anxiety Panic

Description Description Description Description
as a vague sense of unease the symptoms become more things get really tough face sudden episode of intense fear
feeling nervous or worrying noticeable. Constant worry, debilitating fear and constant triggers severe physical
about potential problems that difficulty concentrating worry, making day-to-day life reactions when there is no
may never happen Interferes with daily activities difficult to navigate. real danger or apparent cause
Symptoms Symptoms Symptoms Symptoms
Nervousness, heightened Increased heart rate Fearfulness in social settings – Numbness or tingling sensation
alertness Rapid breathing avoidant behavior Obsessive thoughts
Nail biting Dry mouth Shortness of breath hallucinations
Clenching jaws insomnia Chest tightness Fear of loss of control or death
sighing Digestive issue

Types of anxiety Causes of anxiety

stress
Generalized Anxiety Disorder (GAD):
medical issues such as depression or diabetes
a generalized condition of being uncontrolled, excessive worrying
first degree relatives with generalized anxiety disorder
unproportional to situation
environmental concerns, such as child abuse
Substance(drug or alcohol) use
Social anxiety disorder : situations such as surgery or occupational hazard
This is an extreme fear of being judged by others in Physical and mental health problems
social situations. trauma

Treatment
Panic Disorder :
experience recurring panic attacks at unexpected times. Treatment for anxiety falls into three categories:
Medication
Doctors prescribe antianxiety and antidepressant drugs.
Agoraphobia: Benzodiazepines:
using for short time period not more than 3-4 months
This is an excessive fear of a specific places where the person Buspirone:
feels unsafe takes almost 15 days for the therapeutic effects to take place
SSRI’s:
management of panic disorders
Phobias :
Complemental health technniques:
sudden and intense sense of fear of specific object or situation Mindfulness self-management strategies such as stress management
yoga are ways to treat your anxiety using alternative methodsyoga

Separation anxiety: Psychotherapy

his means you have a fear of being away from home or you Therapy can include cognitive behavioral therapy and exposure
loved ones. response prevention.
counselling

Nursing interventions
Stay calm and be non-threatening.
Assure the patient of safety.
Be clear and concise with words.
Administer medications as prescribed.
Recognize precipitating factors.
Help patient to focus on reality
Encourage patient to verbalize feelings.
Recognize awareness of the patient’s anxiety
Interact with the in a peaceful manner.
Accept the defenses; do not dare, argue, or debate
Reinforce the personal reaction to or expression of pain, discomfort, or threats
to well-being (e.g., talking, crying, walking, and other physical or nonverbal expressions).
Allow the patient to talk about anxious feelings and examine anxiety-provoking
situations if they are identifiable
 Mental health

Autism Spectrum Disorder

characterized by
What is it? differences in communication and social ASD is found in people around the world,
Autism spectrum disorder (ASD), or autism, interaction. regardless of race and ethnicity, culture,
is a broad term used to describe a group People with ASD often demonstrate restricted or economic background.
of neurodevelopmental conditions and repetitive interests or patterns of behavior

Causes Early symptoms of ASD

Autism spectrum disorder has Both genetics and environment Some of the early signs of ASD in Autism spectrum disorder
no single known cause.. may play a role. children include things like: affects children of all races
and nationalities, but certain
Genetics Environmental factors problems making or maintaining eye
factors increase a child's risk.
Researchers are currently contact
Several different genes appear These may include:
exploring whether factors not responding when their name is called
to be involved in autism spectrum Your child's sex.
such as viral infections, trouble utilizing nonverbal forms of
disorder. Family history.
communication, such as pointing or waving
For some children, autism spectrum medications or complications Other disorders.
during pregnancy, or air difficulties with verbal communication,
disorder can be associated with a Extremely preterm babies.
pollutants play a role in such as cooing or babbling in very young
genetic disorder, such as Rett Parents' ages
triggering autism spectrum children and use of single words or two-word
syndrome or fragile X syndrome.
phrases in older children
For other children, genetic changes disorder.
trouble with play, including disinterest in
(mutations) may increase the risk
other children or difficulty imitating another person
of autism spectrum disorder.
Hyperactivity or hypoactivity
No or decreased level of facial expressions

Level 1 Level 2 Level 3

(Require support) (Require substantial support) (Requires very substantial support
Or Full support)

may have difficulty understanding speak in short sentences avoid or limit interaction with others
social cues only discuss very specific topics find it difficult to join in imaginative play
may struggle to form and maintain have difficulty understanding or using with peers
personal relationships. nonverbal communication, including show limited interest in friends
may understand and speak in facial expression have difficulty forming friendships
complete sentences, but have difficulty engage in repetitive behaviors face extreme difficulty in changing their
engaging in back-and-forth conversation. neurotypical behaviors or that appear daily activities or routine
feel a need to follow rigid behavioral in spaces neurotypical people view as follow repetitive behavioral patterns, such
patterns incongruous as flipping objects, to the point that it
feel uncomfortable with changing Impairments noticeable even with affects their ability to function
situations, such as a new environment support experience a high level of distress if a
need help with organization an situation requires them to alter their focus
planning or task

EARLY SCREENINGS Some screening tools that are specific for ASD are:
Developmental screenings can help identify ASD early. Modified Checklist for Autism in Toddlers (MCHAT).
During a developmental screening, your child’s doctor will evaluate This is a parent-completed
things like your child’s behavior, movements, and speech to see if questionnaire that’s used for identifying children at risk for ASD.
they meet typical milestones AASQ (autism spectrum screening questionnaire
Duration
9 months
18 months
24 or 30 months
 Mental health

Autism Spectrum Disorder

Possible Treatment
Treatment options also include:
Medication: Other therapies to treat ASD
Antipsychotic medications : Speech and language therapy. This type of therapy can help a
The atypical antipsychotics risperidone (Risperdal) and aripiprazole child improve their speech and verbal communication skills.
(Abilify) are the only two medications approved by the FDA to help Occupational therapy. A therapist will help your child gain
reduce irritability in autistic children and teens. everyday living skills.
Treating other health conditions. Children with ASD may also have
Tricyclic antidepressants other health conditions, such as epilepsy. Your doctor will work to
oldest of the antidepressants, manage these conditions as well.
work by reducing the reuptake, or absorption, of two Alternative therapy. Many parents consider alternative therapy to
eurotransmitters. complement other support options. In some cases, risks may
Common tricyclics used include outweigh the benefits. Discuss alternative therapies with your
child’s pediatrician.
Stimulants
Psychological therapy.
Methylphenidate (Ritalin) is the stimulant most commonly
prescribed to autistic children with ADHD. This can include a myriad of different therapy types, including thing
like various types of
SSRIs behavioral therapy
that might be prescribed include: educational therapy
fluoxetine (Prozac) paroxetine (Paxil) social skills training
sertraline (Zoloft) citalopram (Celexa)
escitalopram (Lexapro) fluvoxamine (Luvox)

NURSING INTERVENTIONS

Ensure patient safety

Assess mood and behavior
Check for physical and sexual abuse
Avoid fast movements as they may causes anxiety to patient
Remove all sources of distractions such as television or tape recorder during
assessment procedures
Remove all the things from nearby surroundings that can causes injuries
Use simple and clear language
Dimming the lights
Remove the source of loud noise
 Mental health

Bipolar Disorder

Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental illness that causes unusual shifts in a person’s
mood, energy, activity levels, and concentration. These shifts can make it difficult to carry out day-to-day tasks

TYPES OF
BIPOLAR DISORDER
Hypomania refers to less severe manic
symptoms that lasts for usually 4 days
Bipolar I disorder (FULL MANIA) Bipolar II disorder (HYPOMANIA)
is defined by manic episodes that last for at least 7 days is defined by a pattern of depressive episodes and hypomanic
(nearly every day for most of the day) or by manic symptoms episodes. The hypomanic episodes are less severe than the manic
that are so severe that the person needs immediate medical care episodes in bipolar I disorder

Symptoms
SYMPTOMS OF DEPRESSIVE Episode SYMPTOMS OF MANIC Episode
Having a lack of interest in almost all activities
Feeling very up, high, elated, or extremely irritable or touchy
Having trouble concentrating or making decision
Talking fast about a lot of different things (“flight of ideas”)
Having trouble falling asleep, waking up too early, or Having excessive appetite for food, drinking, sex, or
sleeping too much other pleasurable activities
Feeling slowed down or restless Delusions, hallucinations or unrealistic thought
Feeling hopeless or worthless, or thinking about
death or suicide

Depression Mania

Patterns of Bipolar Disorders

There are two patterns of bipolar disorders
Rapid cycle of Depression Mixed state of Mania
When Rapid Cycling occurs, it means that four Mixed episodes are defined by symptoms of
or more manic, hypomanic, or depressive episodes mania and depression
have taken place within a twelvemonth period.
occur at the same time or in rapid sequence
Changes in mood here can happen quickly and without recovery in between.
occur over a few days or even over a few hours.
Mania with mixed features usually involves:
If there are four mood changes within a month, Irritability racing thoughts and speech,
it is called ultra-rapid cycling high energy overactivity or agitation.

Risk factor for Bipolar Disorders Evaluation of Bipolar Disorders MDQ ( Mood disorder Questionnaire)
Genetics Evaluation or diagnosis is done through two ways The Mood Disorder Questionnaire is a
Some research suggests that people with certain genes are more self-report questionnaire designed to
likely to develop bipolar disorder. MSE ( mental state Examination) help detect bipolar disorder.
The Mental Status Exam is a “snapshot” It focuses on symptoms of hypomania
Research also shows that people who have a parent or sibling with bipolar of a patient, that describes their behaviors and mania, which are the mood states
disorder have an increased chance of having the disorder themselves. and thoughts at the time you interviewed them that separate bipolar disorders from other
types of depression and mood disorder.
Many genes are involved, and no one gene causes the disorder.
Brain structure and functioning (lesions etc.)
Biochemical imbalances in the brain
Nursing interventions
Promoting Safety and Preventing Injury
Observe for signs of
Assess current mood and behavior, observe for signs of a manic
lithium toxicity
Treatment (e.g., nausea, vomiting,
or depressive episode, as well as any impulsive or reckless
behavior that may increase the risk of injury.
Medications diarrhea, drowsiness,
Assess cognitive function, including attention, memory, and
mood stabilizers (Lithium or valproate) muscle weakness, tremor,
decision-making skills.
atypical antipsychotics lack of coordination,
assess use of substances, including alcohol and drugs.
Antidepressants blurred vision, or ringing
Encourage to communicate openly about their feelings and concerns
Anticonvulsants n the ears).
provide a nonjudgmental and supportive environment.
Anxiolytics (benzodiazepines)
Safe and low stimulus environment (dimming lights, turn off TV )
Therapies Redirect hyperactive or aggressive behavior (exercise, coloring ,writin)
Cognitive behavioral therapy (CBT) is an important treatment for
depression, and CBT adapted for the treatment of insomnia can be Diet plan
especially helpful as part of treatment for bipolar depression. Sodium chloride(NaCl) intake decrease
Electroconvulsive therapy (ECT) is a brain stimulation procedure that ( increased intake leads litium toxicity)
can help relieve severe symptoms of bipolar disorder. Foods containing high protein level
Repetitive transcranial magnetic stimulation (rTMS) during maniac episodes
Light therapy
 Mental health

Depression

Risk factors
What is Depression? Genetically running in family
Depression is a mood disorder that causes a persistent feeling of sadness and loss Life with continuous stressed condition
of interest in things and activities you once enjoyed. It can also cause difficulty with thinking, Hormonal imbalance
memory, eating and sleeping
Alcohol or drug abuse
it persists practically every day for at least two weeks and involves other symptoms than sadness. Chronic medical issues

Research indicated that a person with depression have very low levels of
SEROTONIN (involve mood regulations and sleep cycles)
DOPAMINE (involves in pleasures and motivation)
NOREPINEPHRINE ( involves in responses towards stress and maintaining energy levels)

Types of depression

Major Depressive Disorder It also includes

you’ve felt sad,
This is the most severe form of low or worthless most days for at least Anhedonia (inability to feel pleasure)
depression and one of the two weeks Suicidal thoughts
most common forms sleep problems, Indecisiveness
Anhedonia must be
A diagnosis of major loss of interest in activities Fatigue or low energy
present in this type
depressive disorder means change in appetite of depression

The symptoms are less severe than major

Persistent Aka "dysthymia" depressive disorder
depressive disorder
Healthcare providers used to call
Persistent depressive disorder is mild PDD- Dysthymi
or moderate depression that lasts for
at least two years in adult and 1 year in children

Seasonal affective disorder

This is a form of major depressive disorder that It arises during the fall and winter
typically associated with seasonal patterns and goes away during the spring
and summer.

Premenstrual Dysphoric PMS symptoms along with mood symptoms,

such as extreme irritability, anxiety or
Disorder
depression.
Premenstrual syndrome (PMS) refers to depression These symptoms improve within a few
associated with menstrual cycle. days after your period starts, but they
can be severe enough to interfere with
your life.

Treatment Nursing interventions

Medications
= 1 priority is SAFETY
Prescription medicine called antidepressants can
help change the brain chemistry that causes Monitor for suicidal risk.
depression. Keep the environment safe by eliminating sharp objects and items that could be used to harm self.
SSRI’s: high serotonin level Encourage patient to do as much as possible for self. The patient may need more direction with
activities of daily living if depression is severe.
SNRI’s: high serotonin availability
Use sleep hygiene to encourage sleep.
MAOI’s : last option (a lot of risks and side effects) Engage the patient in a therapeutic relationship.
Use empathy when communicating with the patien
Therapies
Following can also Reinforce elements of therapy such as challenging negative thoughts about self, the world, and the future.
Psychotherapy (talk therapy) Encourage patient to participate in activities.
help in treating
Electroconvulsive therapy depression Have patient list positive characteristics about the self.
Brain stimulatory therapy Getting Regular exercise Have patient set a realistic goal for the day and review goal attainment
Getting quality sleep Review and evaluate patient coping strategies and support systems.
Eating a health diet Monitor eating patterns and encourage nutritional intake.
Avoid alcohol Monitor medications for effectiveness and side effects.
Include family in care if the patient chooses.
 Mental health

Eating Disorders

There is a commonly held misconception that eating disorders are a lifestyle choice Common eating disorders include
Eating disorders are actually serious and often fatal illnesses that are associated with anorexia nervosa
severe disturbances in people’s eating behaviors and related thoughts and emotions bulimia nervosa
Preoccupation with food, body weight, and shape may also signal an eating disorder binge-eating disorder

Anorexia nervosa

What is it? Symptoms Nursing interventions

Anorexia nervosa is characterized by self- Dramatic weight loss Regular exercising
starvation and weight loss resulting in low Has disturbed experience of body weight or shape Counselling by a nutritionist
weight for height and age. Stomach cramps, other non- specific gastrointestinal Proper monitoring of patient during or after
Anorexia has the highest mortality of any complaints (constipation, acid reflux, etc.)
meals to prevent purging
psychiatric diagnosis other than opioid Difficulties concentrating
*CONSIDER Refeeding Syndrome
use disorder and can be a very serious Dizziness
(in malnourished patient fluids and
condition. Fainting/syncope
electrolytes shifts too quickly
Body mass index or BMI, a measure of Feeling cold all the time
weight for height, is typically under 18.5 in Sleep problems
an adult individual with anorexia nervosa Has limited social spontaneity

Bulimia nervosa

What is it? Symptoms

Nursing interventions
People diagnosed with bulimia nervosa binge Usually a normal or above average body weight.
Regular exercising
or eat, or perceive they ate, large amounts Recurrent episodes of binge eating and fear of not
Counselling by a nutritionist
of food over a short time being able to stop eating.
Monitoring meals portions with respect to time
Self-induced vomiting (usually secretive)
Afterward, they may force Gradually increase meal portion size
Excessive exercise.
themselves to purge the calories in Consider Refeeding syndrom
Excessive fasting.
some way such as vomiting, using
Peculiar eating habits or rituals.
laxatives or exercising excessively
Inappropriate use of laxatives or diuretics.
to rid their body of the food and
calories.

Binge eating Disorder

What is it? Symptoms Nursing interventions

People who have a binge eating disorder Eating unusually large amounts of food in a specific
experience compulsory eating behaviors. Psychotherapy (cognitive behavioral therapy)
amount of time, such as over a two-hour period
They eat, or perceive that they have eaten, Techniques and programs to lose weight
Feeling that eating behavior is out of control
large amounts of food in a short period of time. An anticonvulsants drug called “Topamax”
Eating even when full or not hungry
However, after binging they don’t purge to decrease binge eating
Eating rapidly during binge episodes
food or burn off calories with exercise. Frequently eating alone or in secret
Instead, they feel uncomfortably full and Feeling depressed, disgusted, ashamed, guilty or
may struggle with shame, regret, guilt or upset about eating
depression Frequently dieting, possibly without weight loss

Nursing interventions
Reinforce body image
Doing regular exercising
Practicing coping skills
(moderate exercise as intense
Choice of food should be according to patient’s preferences
exercising burns extra calories
Takings antidepressant pills
which may lead to severe condition)
Different psychotherapies
Monitoring weights Must be cleared by PCP
Maintain healthy relationships depending on clinical state
Nutritional counselling

Emphasis on liquid intake instead of solid food but don’t force if it creates negative effect on health
 Mental health

Obsessive Compulsive Disorder (OCD)

What is it?
a mental health condition where an individual has intrusive thoughts
(an obsession)
feels the need to perform certain routines (compulsions) repeatedly to
relieve the distress caused by the obsession, to the extent where it
impairs general function.
(Excessive orderliness, perfectionism and great attention to detail)

Causes/ risk factors

Genetic factors been bullied, abused or neglected
Biological/neurological factors history of child abuse or other
Life changes stress-inducing events during the
Behavioral factors postpartum period or after
streptococcal infections
Personal experience
family history .

SYMPTOMS

Obsessions Compulsions
an unwanted, intrusive and often distressing thought repetitive behaviors or mental acts that a person with OCD feels
image or urge repeatedly enters your mind driven to perform as a result of the anxiety and distress caused
by the obsession
Strong thoughts to hurt oneself or others
Washing and cleaning.
Fear of contamination or dirt Emotion
Checking.
Doubting and having a hard time dealing with uncertainty.
Counting. a feeling of intense
Needing things to be orderly and balanced.
Ordering. anxiety or distres
Aggressive or horrific thoughts about losing control and harming
yourself or others. Following a strict routine.
Unwanted thoughts, including aggression, or sexual or religious Demanding reassurance.
subjects

Treatment

Medications NON PHARMACOLOGICAL THERAPY

Antidepressant called selective serotonin Cognitive behavioral therapy (CBT) with exposure and response prevention (ERP).
reuptake inhibitors (SSRIs). Exposure and Response Prevention (ERP)
An SSRI can help improve OCD symptoms ERP therapy is a behavioral therapy that gradually exposes people to situations
by increasing the levels of a chemical called
designed to provoke a person's obsessions in a safe environment.
serotonin in brain.
Psychothera
Anxiolytics

Nursing interventions

Provide safety If OCD is uncontrolled by psychotherapy

Reinforce Good behavior or medications, newer treatments may be considered.
Stress management
Start cognitive-behavioral therapy Meditation
Encourage relaxation Deep Transcranial Magnetic Stimulation non-invasively Exercise
Administer SSRIs as ordered stimulates nerve cells using magnetic fields to alleviate Breathing exercises
Consider other treatment options symptoms of OCD.
 Mental health

Personality Disorder

A personality disorder is a mental health condition where people have a lifelong pattern CAUSES Not fully known
of seeing themselves and reacting to others in ways that cause problems. Genetics. Peers
A person with a personality disorder thinks, feels, behaves or relates to others very Childhood trauma chemical imbalances
differently from the average person Verbal abuse addictio
High reactivity.

Cluster A Cluster B Cluster c

Odd / eccentric Overdramatic / emotional Anxious/ insecure

PARANOID ANTISOCIAL AVOIDANT
difficulty trusting others a pattern of disregard for and the being overly sensitive to criticism and rejection
unjustified suspicion that others are being violation of rights of others. regularly feeling inferior or inadequate
disloyal without reason Deceitfulness and manipulation avoiding social activities or jobs that require
reluctance to confide in others out of fear they’ll treat other people harshly working around other people
use the information against you
likely to engage in theft holding back from personal relationships
perception of innocent remarks as threatening
or insulting
anger at perceived attacks DEPENDANT
tendency to hold a grudge lacking the confidence to take care of yourself or
unjustified fear that a spouse or romantic partner BODERLINE make small decisions
is being unfaithful feeling the need to be taken care of
impulsive behavior
chronic feelings of emptiness having frequent fears of being alone
chronic feelings of abandonment being submissive to others
SCHIZOID
intense episodes of anger having trouble disagreeing with others
preferring to be alone
reckless behavior tolerating unhealthy relationships or abusive
not wanting or enjoying close friendships treatment
feeling unable to experience pleasure from display suicidal behaviors
feeling overly upset when relationships end or
anything desperate to start a new relationship right away
having difficulty expressing emotions
having difficulty reacting to emotional situations HISTRONIC
feeling little or no desire for sexual relationship provocative interactions OBSESSIVE-COMPULSIVE
theatrical expressions being overly preoccupied with schedules, rules, or
SCHIZTYPICAL a false sense of intimacy details
increased risk for suicidal gestures working too much, often to the exclusion of other
using a peculiar style of speech or unusual
activities
speaking patterns
setting extremely strict and high standards for
lacking close friends
yourself that are often impossible to meet
dressing in unusual ways
having a hard time delegating tasks to others
believing they have unusual powers, such as the
neglecting relationships because of work or
ability to influence events with their thoughts
NARCISSISTIC projects
experiencing unusual sensations, such as hearing
extremely negative reactions to being inflexible about morality, ethics, or values
a voice that isn’t there
criticism lacking flexibility, generosity, and affection
having unusual beliefs, behaviors, or mannerisms
elevated sense of self-importance tightly controlling money or budget
being suspicious of others without reason
preoccupation with grandiose
having inappropriate reactions thoughts of success
excessive need for admiration
strong sense of entitlemen

Treatment Nursing interventions

Medication Therapies
Promoting patients' safety
Mood stabilizers Dialectical behavioral therapy (DBT),
This therapy focuses on treating Promoting therapeutic relationships
Xanax
dangerous behavior, including Establishing boundaries in relationships
Antidepressants
behavior that can lead to suicide Teaching effective communication skills
Antipsychotics
Hospital and residential treatment Helping to cope and control emotions
Fluoxetine programs Reshaping thinking patterns
Clonazepam Psychotherapy and group session Structuring the client’s daily activities
Diazepam
Monoamine oxidase inhibitors
 Mental health

Schizophrenia

What is it Schizophrenia is a serious mental disorder in which people interpret reality abnormally. May result in
some combination of hallucinations, delusions, and extremely disordered thinking and behavior that
impairs daily functioning and can be disabling

Imbalances in chemical signals your brain uses for cell-to-cell communication.

Brain development problems before birth.
Loss of connections between different areas of your brain.
Cause Having a family history of schizophrenia
Some pregnancy and birth complications, such as malnutrition or exposure to toxins or viruses that
may impact brain development
Taking mind-altering (psychoactive or psychotropic) drugs during teen years and young adulthood

Symptoms

Positive symptoms Negative symptoms

persistent delusions very limited speech,
persistent hallucinations restricted experience and expression of emotions,
experiences of influence, control or passivity inability to experience interest or pleasure, and social withdrawal
disorganized thinking extreme agitation or
slowing of movements
maintenance of unusual postures

The Positive and Negative Syndrome Scale is a medical scale used for measuring symptom severity of patients with schizophrenia.

Types of schizophrenia

Catatonic schizophrenia Paranoid schizophrenia

Delusions.
stupor (a state close to unconsciousness)
Auditory Hallucinations.
Severe form of disease
Disorganized or incoherent speech.
catalepsy (trance seizure with rigid body)
Disorganized or unusual behavior.
waxy flexibility (limbs stay in the position another person puts them in)
Negative symptoms
mutism (lack of verbal response)
Extreme negativism (lack of response stimuli or instruction)
posturing (holding a posture that fights gravity)
mannerism (odd and exaggerated movements) main priority: main priority:
stereotypy (repetitive movements for no reason) fluid & nutritional intake safety & focus on reality
agitation (not influenced by eternal stimuli) Patient will avoid eating or Never feed into patient's
grimacing (contorted facial movements) drinking & will become delusions. Always
echolalia (meaningless repetition of another person’s word) extremely malnourished acknowledge
echopraxia (meaningless repetition of another person’s movements) (may require complete patient's feelings/ thoughts
care) & reinforce reality

Treatment
Schizophrenia requires lifelong treatment, even when symptoms have subsided.
Nursing interventions
Treatment with medications and psychosocial therapy can help manage the Suicide risk
condition. In some cases, hospitalization may be needed Promoting Client Safety
Be alert for signs of increasing fear, anxiety, or agitation.
First-generation Common medications that are available as Explore how the hallucinations
Antipsychotics include: an injection include: Assess for the potential of substance abuse.
Chlorpromazine Aripiprazole (Abilify Maintena, Aristada Fluphenazine decanoate Observe for obsessive-compulsive symptoms.
Fluphenazine Haloperidol decanoate identify the needs that might underlie the hallucination
Haloperidol Paliperidone (Invega Sustenna, Invega Trinza) identify times when the hallucinations are most
Perphenazine Risperidone (Risperdal Consta, Perseris) prevalent and frightening.
Decrease environmental stimuli when possible
Establishing Therapeutic Relationships and
Second-generation Promoting Therapeutic Communication
antipsychotics include: Therapies Improving Thought Organization and Reality Orientation
These may include: Promoting Effective Coping Strategies
Aripiprazole (Abilify)
Individual therapy: may help to normalize
Asenapine (Saphris)
thought patterns. Example:
Brexpiprazole (Rexulti)
Social skills training: improving "I understand the voices are very real to you and must
Cariprazine (Vraylar)
communication and social interactions feel scary, but I do not hear them."
Clozapine (Clozaril, Versacloz)
Family therapy: This provides support and Acknowledge patient with compassion & bring them
Iloperidone (Fanapt)
education to families dealing with schizophrenia. back to reality
Brexpiprazole (Rexulti))
Vocational rehabilitation and supported
Cariprazine (Vraylar)
employment: helping people with
Clozapine (Clozaril, Versacloz)
schizophrenia prepare for, find and keep jobs.
Iloperidone (Fanapt)
 Mental health

Therapies for Treating Mental

Disorders and Illnesses

What is therapy? WHAT A THERAPY CAN PROVIDES?

Therapy is a form of treatment that aims Improve mood Coping with stress
to help resolve mental or emotional issues. Stronger relationships Counseling can reduce medical costs
Improve communication skills Developing individual coping strategies
Resolving conflict Learn healthy ways to address problems
Treat mental health conditions Therapy can make you feel happier

Psychoanalytic Therapy

What is it? Key characteristics Techniques involve For example:

form of psychotherapy is effective in helping people free-flowing conversation resolving a patient’s fear of
(talk therapy) rooted in the gain insight into the dream analysis darkness as he was got
idea that all people are subconscious freely free association locked in a dark room as
motivated by unconscious interpretation a child
desires, thoughts, emotions, transference analysis
and memories.

Psychodynamic Therapy

What is it? Key characteristics Techniques involve For example:

a form of talk therapy that Target to alter the recurring maintenance of a focus, connecting a low esteem
explores the connection thoughts patterns and much work on transference patient with high
between a patient's past earned defense a high level of activity confidence and moral
experiences – often from mechanisms
childhood – and their Try to resolve past conflicts
current mindset. that remained unresolved

Interpersonal therapy

What is it? Key characteristics Techniques involve For example:

is a form of psychotherapy Short term treatment Evidence based treatment treating a depressed
that focuses on relieving focuses on relationships, patient who got low marks
symptoms by improving life transitions and how to in his final exams
interpersonal functioning. improve the way you
communicate and relate
to others.

Rational emotive therapy

What is it? Challenging For example:

a type of therapy that helps irrational beliefs a person feels that “he is a failure and must be a
to reframe irrational developing more rational beliefs perfect one” after losing a match.
thought patterns (rational disputing) This therapy replaces above thought into that “
problem-solving strategies he must try again for better results and losing or
winning is a part of game”
 Mental health

Therapies for Treating Mental

Disorders and Illnesses

Behavioral therapy

What is it? Therapy looks OPERANT CONDITIONING:

based on the idea that all to identify and help change potentially encouraging positive side of a patient to
behaviors are learned and self-destructive or unhealthy behaviors. discourage his negative side.
that behaviors can be The focus of treatment is often on CLASSICAL CONDITIONING:
change current problems and how to
change them involving involuntary RESPONSE with a neutral
stimulus

Cognitive behavior therapy

What is it? Key characteristic : For example:

a type of psychotherapy in which Focusing on coping skills to deal with exposing someone to handle such
negative patterns of thought challenging scenarios more efficiently situations that creates anxiety and
about the self and the world are Bringing awareness to change currents focusing the full day activities to enhances
challenged in order to alter thoughts and behaviors positive behavior and awareness
unwanted behavior patterns or
treat mood disorders such as
depression.

Group therapy

What is it? Key characteristic : For example:

a small group of patients or members of group or family support Interpersonal groups
families meet regularly with each other’s feelings and emotional state Skill development groups
the therapist It is patient-centered therapy, therapist act Support groups
as a facilitator Cognitive behavioral groups
facilitates giving and receiving support Psychotherapy groups
helps to find patient’s “voice.”
 Mental health

Post Traumatic Stress Disorder

What is it? Causes

Post-traumatic stress disorder (PTSD) is a disorder that Combat exposure
develops in some people who have experienced a shocking, Childhood physical abuse
scary, or dangerous event. Sexual violence
Physical assault
or Being threatened with a weapon
An accident
Post-traumatic stress disorder (PTSD) is a mental health
Being exposed to previous traumatic experiences,
condition that’s triggered by a terrifying event —
particularly during childhood
either experiencing it or witnessing it.
Getting hurt or seeing people hurt or killed
Feeling horror, helplessness, or extreme fear
Having little or no social support after the event
Dealing with extra stress after the event, such as loss of a
loved one, pain and injury, or loss of a job or home
Having a personal or family history of mental illness or
SYMPTOMS substance use
( diagnostic criteria when symptoms occur more Stressful experiences, Inherited mental health
than 4 weeks) including the amount and risks,
PHYSICAL AND EMOTIONAL REACTIONS severity of trauma you’ve such as a family history of
Being easily startled or frightened gone through in your life anxiety and depression
Always being on guard for danger
Self-destructive behavior, such as drinking too much or
driving too fast Inherited features The way brain regulates
Trouble sleeping of your personality — often the chemicals
Trouble concentrating called your temperament and hormones your body
Irritability, angry outbursts or aggressive behavior releases in response to
Overwhelming guilt or shame stress
INTRUSIVE MEMORIES
Recurrent, unwanted distressing memories of the
traumatic event TREATMENT
Reliving the traumatic event as if it were happening again
(flashbacks) Non pharmacological therapy:
Upsetting dreams or nightmares about the traumatic
Psychotherapy
event
Several types of psychotherapy, also called talk therapy,
Severe emotional distress or physical reactions to
may be used to treat children and adults with PTSD.
something that reminds you of the traumatic even
Cognitive therapy.
AVOIDANCE
This type of talk therapy helps you recognize the ways of
Trying to avoid thinking or talking about the traumatic
thinking (cognitive patterns) that are keeping you stuck.
event
for example, negative beliefs about yourself and the risk of
Avoiding places, activities or people that remind you o
traumatic things happening again. For PTSD, cognitive
the traumatic event
therapy often is used along with exposure therapy.
NEGATIVE CHANGES IN THINKING AND MOOD
Exposure therapy.
Negative thoughts about yourself, other people or the
helps you safely face both situations and memories that
world
you find frightening so that you can learn to cope with
Hopelessness about the future
them effectively.
Memory problems, including not remembering important
Exposure therapy can be particularly helpful for
aspects of the traumatic event
flashbacks and nightmares.
Difficulty maintaining close relationships
Feeling detached from family and friends EMDR
Lack of interest in activities you once enjoyed EMDR combines exposure therapy with a series of guided
Difficulty experiencing positive emotions eye movements that help you process traumatic
Feeling emotionally numb memories and change how you react to them.
 Mental health

Post Traumatic Stress Disorder

MEDICATION NURSING INTERVENTIONS

Several types of medications can help improve symptoms Anxiety Interventions
of PTSD:
1. Encourage therapeutic communication.
Antidepressants 2. Encourage relaxation techniques.
3. Evaluate the patient’s support systems.
Help with symptoms of depression and anxiety.
4. Administer medications as ordered
improve sleep problems and concentration.
SSRI medications sertraline (Zoloft) and paroxetine (Paxil) Fear Interventions
1. Reassure safety.
are approved by FDA for PTSD treatment.
2. Discuss the reality of the situation.
Anti-anxiety medications 3. Encourage healthy coping strategies.
4. Be sensitive to the patient’s feelings
relieve severe anxiety and related problems.
Some anti-anxiety medications have the potential for Ineffective Coping Interventions
abuse, And used only for a short time 1. Empathetic listening.
2. Arrange for professional support.
Prazosin 3. Encourage positive self-talk and self-care.
While several studies indicated that prazosin (Minipress) 4. Recommend a support group
may reduce or suppress nightmares in some people
with PTSD,

BA
NG

N G
BA

G
BAN
 Mental health

Somatoform Disorders

What is it? Different somatoform disorders are distinguished by

thoughts, emotions and actions related to somatic
Somatoform disorders are characterized by physical symptoms. There are four types of somatoform disorders:
sensations and bodily pain caused by mental illness.
Somatization disorder Somatization disorder
Conversion disorder Conversion disorder

Somatic symptom disorder

Somatic symptom disorder is characterized by an extreme focus on physical symptoms
such as pain or fatigue that causes major emotional distress and problems; functioning and reaction to the symptoms is
not normal

Symptoms Risk factors Nursing interventions

Symptoms of somatic symptom Risk factors for somatic symptom Perform neurological assessment
disorder may be: disorder include: daily or per facility protocol
Specific sensations, such as pain or Having anxiety or depression Assess if patient is having suicidal or
shortness of breath, more general Having a medical condition or homicidal ideations or potential
symptoms, such as fatigue or recovering from one substance abuse
weakness Assess pain per appropriate scale
Being at risk of developing a medical
Constant worry about potential illness condition, such as having a strong Encourage behavior modification
Viewing normal physical sensations family history of a disease such as praising client and offering
as a sign of severe physical illness Experiencing stressful life events, more attention when symptoms
Fearing that symptoms are serious, trauma or violence improve
even when there is no evidence Having experienced past trauma, Provide teaching and demonstrations
Thinking that physical sensations such as childhood sexual abuse of relaxation techniques including
are threatening or harmful progressive muscle relaxation and
Having a lower level of education
deep breathing exercises
Feeling that medical evaluation and and socio-economic status
treatment have not been adequate Provide education about feared or
actual medical condition
Fearing that physical activity may
cause damage to your body Administer medications and decrease
dosage as appropriate
Repeatedly checking your body for
abnormalities Encourage patient to keep a journal of
symptoms and the events or factors
that lead up to the development of
symptoms and their resolution
 Mental health

Somatoform Disorders

Conversion disorder
What is it?
This includes neurological symptoms that can't be explained by a neurological disease or other medical condition.
However, the symptoms are real and cause significant distress or problems functioning.

Signs and symptoms Risk factors Nursing interventions

Weakness or paralysis The nursing interventions for

Having a neurological disease or
somatoform disorders are:
Abnormal movement, such as disorder
tremors or difficulty walking Recent significant stress or emotional Providing health teaching.
Loss of balance or physical trauma establish a daily routine that includes
Having a mental health condition, improved health behaviors.
Difficulty swallowing or feeling
"a lump in the throat" such as a mood or anxiety disorder, Assisting the patient to express
Seizures or episodes of shaking dissociative disorder or certain emotions.
and apparent loss of consciousness personality disorders patients may keep a detailed journal
(nonepileptic seizures having family member with a of their physical symptoms.
neurological condition or symptoms the nurse might ask them to describe
Episodes of unresponsiveness the situation at the time such as
history of physical or sexual abuse or
Numbness or loss of the touch whether they were alone or with
neglect in childhood
sensation others,
Females may be more likely than
Speech problems, such as the whether any disagreements were
males
nability to speak or slurred speech occurring, and so forth.
Vision problems, such as double Teaching coping strategies.
vision or blindness Emotion-focused strategies include
Hearing problems or deafness progressive relaxation,
Cognitive difficulties involving deep breathing, guided imagery,
memory and concentration
and distractions such as music or
other activities
 Mental health

Somatoform Disorders

Hypochondriasis
What is it?
Illness anxiety disorder, sometimes called hypochondriasis or health anxiety,
is worrying excessively that you are or may become seriously ill. Nursing interventions
You may have no physical symptoms.
you may believe that normal body sensations or minor symptoms are signs of severe Providing health teaching
illness, Assisting the client to express
even though a thorough medical exam doesn't reveal a serious medical condition. emotions.
Teaching coping strategies.
Building trust with patient
Signs and symptoms

Being preoccupied
Risk factors
Worrying that minor symptoms or body sensations mean you have a serious illness
Being easily alarmed about your health status Risk factors for illness anxiety disorder
Finding little or no reassurance from doctor visits or negative test results may include:
Worrying excessively A time of major life stress
Having so much distress about possible illnesses that it's hard for you to function Threat of a serious illness that turns
Repeatedly checking your body for signs of illness or disease out not to be serious
Frequently making medical appointments for reassurance History of abuse as a child
or avoiding medical care for fear of being diagnosed with a serious illness A serious childhood illness or a
parent with a serious illness
Avoiding people, places or activities
Personality traits, such as having
Constantly talking about your health and possible illnesses a tendency toward being a warrier
Frequently searching the internet forcauses of symptoms or possible illnesses Excessive health-related internet use

Body dysmorphic disorder

What is it?
A mental health condition in which you can't stop thinking about one or more Nursing interventions
perceived defects or flaws in your appearance
Observe the patient with their
complete attention
Signs and symptoms (notice body language,
facial expressions, does patient
Being extremely preoccupied with a perceived flaw in appearance actively cover the flaw?
Strong belief that you have a defect in your appearance Use questions effectively
Belief that others take special notice of your appearance in a negative way or mock you open ended questions
Engaging in behaviors such as frequently checking the mirror, grooming or skin picking encourage the patient to give more
Attempting to hide perceived flaws with styling, makeup or clothes detailed information regarding
Constantly comparing your appearance with others grooming rituals and habits)
Frequently seeking reassurance about your appearance from others Be an active listener
Having perfectionist tendencies (evaluate patient’s stress, paraphrase
Seeking cosmetic procedures with little satisfaction comments verbalized by the patient)
Avoiding social situations Know there is no quick fix
 Mental health

Substance Abuse Disorders

Substance use disorder (SUD) is a complex condition that involves a problematic pattern of substance use.
It can range from mild to severe (addiction).
SUD is treatable.

Alcohol Stimulants Depressants

Intoxication Intoxication Intoxication

Mental confusion, stupor.
Nasal and lung damage Insomnia
Difficulty remaining conscious,
Dental problems Weakness
or inability to wake up.
Anxiety and depression nausea
Slow breathing
Heart problems and Drug cravings Agitation
fewer than 8 breaths per
Severe itching and skin sores high body temperature
minute)
Increased appetite Delirium
Irregular breathing
Problems concentrating Hallucinations
(10 seconds or more
Suicidal thoughts and convulsions can also occur.
between breaths)
Fatigue and Paranoia
Slow heart rate.
Clammy skin
Irritability and Psychosis
Insomnia
Withdrawal S+S
Withdrawal S/S cold or flu-like symptoms
Withdrawal S/S headache
6 hours after last drink sweating
Nausea and vomiting Agitation Nightmare
aches and pains
Headache Paroxysmal sweating Mood swings and depression
difficulty sleeping
Auditory disturbances Anxiety Tiredness
nausea
Pain in body
mood swings
48-72 hrs after last drink Inability to concentrate
Visual disturbances Orientation Decreased cognitive ability
Tremor tremor and seizure
Hyperactivity
Clouding of sensorium Treatment of
Required Medical emergency
Treatment of depressants abuse
Treatment of alcohol abuse stimulants abuse Detoxing from the drug in
a brief intervention Community reinforcement approach a medically controlled climate is essential.
individual or group counseling Motivational interviewing Inpatient care
an outpatient program Cognitive behavioral therapy (CBT) Outpatient Care
residential inpatient stay. Antidepressants and antipsychotics Methadone
benzodiazepines benzodiazepines buprenorphine
( used for withdrawal as it reduces the risk of
seizures as well as lower the delirium) Examples include caffeine, nicotine, amphetamines FOR EXAMPLE CANNABIS. HEROIN ETCand cocaine.
Delirium refers to episodes of confusions and cocaine.

DSM-5 criteria for substances abuse disorder Terms need to understand

1. Taking the substance in larger amounts or for longer than you're meant to Dependance
2. Wanting to cut down or stop using the substance but not managing to psychic and physical state of the person
3. Spending a lot of time getting, using, or recovering from use of the characterized by behavioral and other
substance responses resulting in compulsions to take
a drug.
4. Cravings and urges to use the substance
Tolerance
5. Not managing to do what you should at work, home, or school because of
substance use a decrease in response to a drug that is used
repeatedly.
6. Continuing to use, even when it causes problems in relationships
Addiction
7. Giving up important social, occupational, or recreational activities a chronic, relapsing disorder characterized by
because of substance use compulsive drug seeking and use despite
8. Using substances again and again, even when it puts you in danger adverse consequences.
9. Continuing to use, even when you know you have a physical or Withdrawal
psychological problem that could have been caused or made worse by A term used to describe the physical and
the substance mental symptoms that a person has when
they suddenly stop or cut back the use of an
10. Needing more of the substance to get the effect you want (tolerance) addictive substance, such as opiates and
11. Development of withdrawal symptoms, which can be relieved by taking opioids, nicotine products, or alcohol.
more of the substance
MOTHER & BABY
 Mother & baby

GTPAL & Maternity Terms

What is it?
The GTPAL system provides a comprehensive overview of a woman’s reproductive history, including the number of times she
has been pregnant and the outcome of each pregnancy.

GRAVIDA TERM PRETERM ABORTION LIVING CHILDREN

The total number of The number of The number of The number of The number of living
pregnancies a pregnancies carried pregnancies ending pregnancies ending children a woman has.
woman has had. to 37 weeks or beyond. before 37 weeks. before 20 weeks. The term is typically
"Gravida 1" A pregnancy is Preterm births can Often happen in the used in contrast to
representing the first considered full-term occur at various early stages of the total number of
pregnancy, when it has stages, with pregnancy pregnancies or births
"Gravida 2" for the completed 37 to classifications. a person may have
For example:
second, and so on. 42 weeks Extremely preterm experienced.
Termination of
For example: For example: (less than 28 weeks) For example:
pregnancy at six
A female who has A pregnant female Very preterm weeks and an Each living child is
had a miscarriage at who carried one (28 to less than unexpected stop counted individually.
8 weeks of pregnancy, pregnancy to term 32 weeks) of a fetal heartbeat So if there has been
A birth of twins at 36 with a surviving infant. Moderate to late at 12 week a pregnancy of twins,
weeks of pregnancy, Carried one preterm that would be
A birth of a single pregnancy to 35
(32 to 37 weeks). calculated as G1.
baby at 40 weeks of weeks with surviving Because it's one
pregnancy is a twins. pregnancy, but L2 as
gravida 3 Carried one there are two living
pregnancy to 9 weeks children.
( the female has had 3
as an ectopic (tubal)
confirmed pregnancies)
pregnancy. and has
Nulligravida three living children
Never pregnant would have a TPAL
Primigravida annotation of
1st Pregnancy T1, P1, A1, L3.
Multigravida
2+ pregnancies

New Gestational Age Designations

Early Term Full Term Late Term Post Term

37 weeks - 39 weeks - 41 weeks - 42 weeks and beyond

38 weeks & 6 days 40 weeks & 6 days 41 weeks & 6 days

37 38 39 40 41 42 43

Old Gestational
Age Designations
“Term” birth

gestation between
37 weeks and 42 weeks
 Mother & baby

GTPAL

Positive Terms
GRAVIDA: Is a female who is pregnant for the first time or
Parity, in the context of obstetrics and maternity care,
has been pregnant once
refers to the number of times a woman has given birth to
infants who reached the stage of viability, typically 20
GESTATIONAL AGE: The age of the baby in the womb
weeks of gestation or more, regardless of whether the
infants were born alive or stillborn.
ABORTION: Spontaneous or intentional termination of
pregnancy

MISCARRIAGE: Spontaneous loss of pregnancy <20 weeks

Nullipara Primipara Multipara

0 births > 20 weeks 1 birth > 20 weeks 2+ births > 20 weeks

Nulligravida Primigravida Multigravida

A female who has never carried a A multiple pregnancy (e.g., twins, A multigravida woman who has
pregnancy beyond 20 weeks is triplets, etc.) is counted as 1. undergone two viable pregnancies
nulliparous and is called a Parity, or "para", indicates the and birthed two children would be
nullipara or para 0. number of births (including live considered gravidity 2 parity 2.
births and stillbirths) where Similarly, a woman who has
pregnancies reached viable experienced four pregnancies
gestational age. resulting in four viable births.
A multiple pregnancy (e.g., twins, And one miscarriage in early
triplets, etc.) carried to viable pregnancy would be noted as
gestational age is still counted as 1. "gravidity 5 parity 4.

Example

A 28-year-old woman is currently pregnant with her second child. Her first child was born prematurely at 34 weeks, and she had a
miscarriage in her third pregnancy at 10 weeks gestation.

G ->3 T->0 P ->1 A ->1 L ->0

Currently pregnant No full-term The first child was One miscarriage at No living children yet
for the third time births yet born prematurely at 10 weeks gestation
34 weeks

Answer 3-0-1-1-0.
 Mother & baby

GTPAL & Maternity Terms

Maternity Terminology
Abprtion; miscarriage or "spontaneous abortion Egg cell; female reproductive cell,
Fetus: Unborn baby (embryo) Endometriosis: the lining of the uterus grows outside the uterus.
Amniotic fluid:Fluid that surrounds your baby during pregnancy. Fetal Heart Tones: Baby's heartbeat
Effacement: Thinning of the cervix during labor Fertility: Person's ability to conceive children.
Amniotic sac: Sac that surrounds baby & amniotic fluid . Embryo: Fertilized egg, developmental stage
Endometritis: Inflammation of uterine lining Engagement: Labor stage when baby's head in pelvis
Braxton Hicks Contractions: False contractions Cervix: Canal between the uterus & vagina
Colostrum: First breast milk produced Contraception: Measures used to prevent pregnancy
Dilation: Cervix opening during labor Conception: Fertilization of egg & sperm
Fibroids: Non-cancerous growths in uterus Labor: Stages of active childbirth
Involution: Shrinking of uterus to original size Fundus: Rounded top part of the uterus
Meconium: Baby's first bowel movement when first born Lochia: Vaginal discharge after giving birth
Gestation: Time between conception & birth Menopause: Time when period stops indefinitely
Oligohydramnios: Lack of amniotic fluids Os: Opening of cervix
Preterm birth: Baby born before 37 weeks Prom: Water breaking <37 weeks
Post-Term: Pregnancy lasting >42 weeks Rupture of membranes: Water breaking

Example Answer
A 28-year-old woman is currently pregnant 3-0-1-1-0.
with her second child. Her first child was born
prematurely at 34 weeks, and she had a G ->3 T->0 P ->1 A ->1 L ->0
miscarriage in her third pregnancy at
10 weeks gestation. Currently No full-term The first child One No living
pregnant births yet was born miscarriage children yet
for the prematurely at 10 weeks
third time at 34 weeks gestation

Antepartum Intrapartum

Antepartum refers The period of

to the period of time during
time before childbirth;
childbirth or labor and delivery.
delivery. Essential Maternity Term

Neonate Postpartum

A newborn baby, The period of time

typically in the first after childbirth;
28 days of life. typically the
first six weeks
following delivery
 Mother & baby

Contraception Methods

What is it?
CONTRACEPTION (also known as family planning or birth control) protects you from pregnancy. Contraception works so that
an egg can’t be fertilized by sperm to conceive a baby.

Types of contraception

Abstinence Oral Spermicide

Restraining from having
contraceptives
Oral contraceptives, Using a product before
sexual intercourse
commonly known as sex to kill sperm inside the
Abstinence is often
birth control pills vagina before reaching the cervix.
influenced by cultural
A pill with hormones to prevent the It is available in various forms,
and religious practice
release of eggs from the ovaries. including creams, gels, foams, films,
and suppositorie
Most effective method TUBAL LIGATION
DOES NOT PROTECT AGAINST STD'S
INCREASED RISK FOR BLOOD CLOTS

Coitus Condoms Calendar

Interruptus Condoms are used to Rhythm
Coitus Interruptus, also prevent unintended Tracking ovulation to
known as the withdrawal method pregnancies know when to avoid sex.
Withdrawal of penis before Wearing a condom during sex to also known as the calendar
ejaculation prevent ejaculating inside the uterus. method or fertility awareness
method
NOT EFFECTIVE & ONLY METHOD PROTECTIVE
DOESN'T PROTECT AGAINST STD'S AGAINST STD'S (besides abstinence) NOT USEFUL FOR IRREGULAR PERIODS

OTHER METHODS

Vaginal Ring IUD Tubal Ligation Patch

A vaginal ring is a An intrauterine device (IUD) A surgical method for A small patch that
hormonal is a small T-shaped device female sterilization by releases hormones in
contraceptive device placed inside the uterus to tying the fallopian tubes, the body to prevent
designed for women. prevent pregnancy. carries a increased risk pregnancy.
There are two main types of blood clots.
A soft plastic ring inside Similar to birth control
of IUDs:
the vagina that Tubal ligation is usually pills, the patch uses
Hormonal and copper.
releases hormones to irreversible, reversal is hormones to prevent
Hormonal IUDs release
prevent pregnancy. uncertain, emphasizing ovulation
progestin,
its permanent
while copper IUDs have
contraceptive nature.
copper wire coiled around
the device
 Mother & baby

Contraception Methods

INFERTILITY What is it? Infertility is defined as not being able to get pregnant (conceive)
after one year (or longer) of unprotected sex

OVULATORY DYSFUNCTION; ANATOMICAL DYSFUNCTION

Irregular, infrequent (less than nine per year) Develops when the nerves of the ANS are damaged
menstrual periods or does not ovulate at all,
Parkinson's disease,
Endocrine disorders Cancer,
PCOS (testosterone production) Autoimmune diseases, alcohol abuse,
Addison's disease. ... Diabetes.
Adrenal fatigue. Tumors Fallopian tubes are
Cushing's syndrome. Endometriosis blocked by small
Fallopian tube adhesions amounts of scar tissue
Diabetes.
STD's
Hypo/hyperthyroidism
Radiation exposure (damages eggs)
produces too much thyroid hormone Pelvic Inflammatory Disease
Functional Hypothalamic Amenorrhea
Inflammation of organs affecting the female
The Hypothalamus doesn't stimulate pituitary to release reproductive system
FSH & LH
Extreme exercising
AFFECTED BY Stress
BMI <18.5 or >25

Modern Contraceptive methods

ALTERNATIVE CONCEPTION METHODS
100 97.3 98.9
Sperm donation, surrogacy, in vitro fertilization with 87.8
preimplantation genetic diagnosis (IVF with PGD), and 80 63.1 74.8
embryo adoption 60
40 31.7 36.2
IN VITRO FERTILIZATION (IVF): 25.5 23.9
mature eggs are collected from ovaries and fertilized by 20
sperm in a lab. 0
Client's egg fertilized with sperm in lab, then embryo Pil
ls e CD t y
bl IU an om om ion m Pil
ls
implanted into uterus. ta pl at to
jec Im nd nd ig ec cy
In co co -L s n
le e al Va ge
INTRAUTERINE INSEMINATION: Ma al b er
m Tu Em
Fe
Sperm is directly placed into uterus using a small catheter.
SURROGATE:
Surrogate mothers are impregnated through the use of in Permanent methods of contraception
vitro fertilization (IVF).
Someone agrees to carry and deliver a baby for you or Tubal sterilization.
another person/couple. Is a surgical and more than 99% effective permanent
contraception method.
TUBAL LIGATION:
This involves blocking or sealing the fallopian tubes in
women to prevent the egg from reaching the uterus.
MALE-INFERTILITY CAUSES
Contraceptive pill
Testicular tumors 85% effective in preventing pregnancy.
Germ cell tumour VASECTOMY:
Cryptorchidism (testes don't ascend In men, this procedure involves cutting or sealing the vas
absence of at least one testicle from the scrotum. deferens, preventing the release of sperm during
ejaculation.
Genetic disorders Varicocele
Permanent contraception by hysteroscopy.
Charcot-Marie-Tooth disease. . (enlarged veins
Congenital adrenal hyperplasia. compress testes) Both methods are considered permanent and highly
Cystic fibrosis (CF) effective in preventing pregnancy.
 Mother & baby

Signs of Pregnancy

Presumptive signs( subjective) of pregnancy:

Ectopic
The signs of early pregnancy can include: pregnancy must be
considered as a
Breast changes Food cravings Cramp possibility.
Fatigue Backache Headaches Symptoms could be
Nausea Bloating Heartburn from other
Amenorrhea Constipation Quickening underlying
conditions
Frequent urination Spotting Vaginitis
Mood swings Dizziness Nasal congestion

Probable signs( objective) of pregnancy: Positive

They are more reliable than the presumptive A confirmed, clear, and definite pregnancy is indicated when :
signs, but they still are not positive or true
The fetus is seen on an The baby is delivered.
diagnostic findings.
ultrasound. The provider feels
Hegar's sign; Non-specific indication of The fetal heart rate is detected. fetal movement.
pregnancy characterized by the
compressibility and softening of the Still not
definitive Positive sign of pregnancy
cervical isthmus.. 6-8 weeks
Missed period
Goodell's sign ; Probable sign of Mood swings
pregnancy, characterized by softening of
Breast tenderness
the cervix. 4-8 weeks
Breast changes
Ballottement. dropping and rebounding of Food aversions
symptoms that can only be
the fetus in its surrounding amniotic fluid in Bloating attributed to pregnancy
response to a sudden tap on the uterus
Positive pregnancy test.
Braxton hicks contractions, more Naegle's Rule
frequently felt after 28 weeks. They usually
disappear with walking or exercise. A tool used to estimate a pregnant woman's due date by
calculating from her last menstrual period.
It involves adding nine months and seven days
to the first day of her Last Menstrual Period (LMP).
Warning Signs in Early Pregnancy: The calculation assumes a
Abdominal Pain:
May

Aug

Dec
Oct
Mar

standard 28-day menstrual cycle.

Jul
Jan

Report severe abdominal pain promptly.

Jun

The gestation period considered

Sept
Apr

Nov
Feb

Vaginal Bleeding:
Any bleeding should be communicated to is 280 days or 40 weeks.
a healthcare professional. Leap years are not taken
Nausea and Vomiting: into account in this
Excessive nausea needs medical attention to
estimation method. Knuckle trick
prevent dehydration. 31 days 30 days 29 days
Dizziness or Fainting:
Persistent spells require investigation by ahealthcare
provider.
Headache or Vision Changes: Formula for Naegle's Rule
Seek immediate attention for severe headaches or FIRST DAY OF LAST MENSTRUAL PERIOD – 3 MONTHS+ 7 DAYS + 1 YEAR
vision changes.
Severe Back Pain: Example:
Intense back pain, especially with other symptoms, First day of Last Menstrual Plus 7 days:
needs medical assessment. Period (LMP): May 4, 2022 February 4, 2022 + 7 days =
Decreased Fetal Movement: Minus 3 months: February 11, 2022
Report any significant decrease in fetal movement. Plus 1 year:
May 4, 2022 - 3 months =
Fluid Leakage: February 11, 2022 + 1 year =
February 4, 2022
Any fluid leakage should be addressed promptly.
February 11, 2023
 Mother & baby

Trimesters & Fetal Development

1st trimester Weeks 0-12 2nd trimester Weeks 13-26 3rd trimester Weeks 27-40

Embryo looks like a tadpole. Assess fetal heart rate. Weekly prenatal visits after 36 weeks.
Obtain obstetric history, Gently press two fingers Provide tDaP vaccine.
including GTPAL. (don't use your thumb) Administer Rhogam to Rh-negative
Calculate the Estimated Due Date on the spot until feel a beat. patients.
(EDD) using Naegle's Rule. Perform abdominal ultrasound Given to pregnant people whose
Conduct an ultrasound, either blood is negative for Rhesus factor
MATERNAL SERUM ALPHA-FETOPROTEIN
abdominal or transvaginal (Rh) protein
The MSAFP screens for
“open neural tube” defects Perform Group-B Strep test.
LaBS ;
Conduct non-stress tests
Complete blood test Screen for gestational
for high-risk pregnancie
urinalysis is a test of urine. diabetes.
Sexually transmitted Assess fundal height. Baby responds
infections (STIs)HIV normally to stimulation
Blood type & Rh factory and is getting enough
Hepatitus B oxygen.
Rubella Titer;
Baby has an 8 to 9 in 10
chance (85 percent)
of getting infected

WHAT TO AVOID DURING PREGNANCY

Food Medications Activities

Alcohol Isotretinoin (Acne Medicine): Contact sports

Caffeine Highly likely to cause birth defects. Scuba diving
Unpasteurized milk Avoid during pregnancy or potential Exercising in high altitudes
Fish high in mercury pregnancy. Weightlifting
Raw eggs ACE Inhibitors Activities with a fall risk
Raw sprouts (e.g., Benazepril, Lisinopril): Alcohol
Soft cheeses Used for high blood pressure and Hot tubs
Raw meat heart conditions Bouncing while stretching
Raw or undercooked meat Food
Seizure Control Medicines
Raw shellfish Hot yoga
(e.g., Valproic Acid):
Certain fish Bicycling
Some medications used for seizure
Deli meat Caffeine
control may pose risks during
Unwashed produce Downhill skiing
pregnancy.
Food Holding your breath
Smoked seafood Methotrexate: Horseback riding
Unpasteurized juice Occasionally used for arthritis Weight lifting and pregnancy
D/R/U/G/S treatment. Amusement parks
Marlin Warfarin (Coumadin): Changing a litter box
Bigeye tuna Prevents blood clots. Exercise
Deli meats and prepared salads Gymnastics
Lithium:
Exercise High impact aerobics and pregnancy
Treats bipolar depression.
Fruit and vegetables Running
Herbal tea Anxiolytics Sit-ups
(e.g., Alprazolam, Diazepam): Smoking
Medications for anxiety.
Over-the-Counter Pain Medicines
(e.g., Ibuprofen, Naproxen):
Low risk of birth defects, but
acetaminophen is a safer option
during pregnancy.
 Mother & baby

Trimesters & Fetal Development

FETAL DEVELOPMENT
1st month 2nd month 3rd month 4th month 5th month

Fertilization of egg Embryo becomes Organs, muscles, Rapid growth. Hair and nails begin
by sperm. fetus. and nervous system Facial expressions to form.
Formation of Heart begins beating. develop. develop. Fetal movements
blastocyst. Limb buds form. Fingers and toes Bone development felt by the mother.
Implantation in form. starts. External genitalia
Eyes, ears, and
the uterus. facial features start Embryo is now Movement of limbs distinguishable.
Basic structures of to develop. officially a fetus becomes noticeable. Development of
brain and spinal US will show Sex organs begin taste buds.
cord begin to gestational sac to differentiate.
develop 4 weeks and 1 day
from the last
menstrual period 4
weeks and 1 day
from the last
menstrual period
Confirms pregnancy

6th month 7th month 8th month 9th month

Eyes open for the Eyes sensitive to Rapid weight gain. Final weeks of
first time. light. Continued lung preparation for birth.
Lung development Fat layers develop. development. Fetal immune
begins. Ability to hiccup. Immune system system matures.
Brain grows rapidly. Increased brain strengthens. Continued growth
and development
Fetus can respond activity. Fetus assumes of organs.
to sounds. head-down position.
Ready for the
transition to the
outside world.

Developing eye Basic facial features

Visible earlobe are in place

Week 5 Week 7 Week 9 Week 13

 Mother & baby

Pregnancy Physiology

RESPIRATORY
HORMONES
Larger uterus may cause shortness of
breath. PROGESTERONE and ESTROGEN
Breathing pattern (tidal volume, RR) levels rise significantly.
adjusts. Progesterone thickens the uterine lining
Some may have mild respiratory and aids in milk duct development.
acidosis. It inhibits oxytocin during pregnancy.
Estrogen supports fetal development
and helps maintain.
CIRCULATORY
HCG AND HPL are produced by the
increased vascular volume placenta.
cardiac output
heart rate HCG stimulates the corpus luteum to
with a marked fall in vascular resistance produce estrogen and progesterone,
maintaining pregnancy.
HPL provides nutrition to the fetus and
regulates metabolism.
HEMATOLOGICAL
Increased fibrinogen levels. PROLACTIN readies the breasts for milk
Elevated white blood cell count (WBC). production.
Expanded blood volume OXYTOCIN stimulates contractions at the
Increased Clotting Risk: beginning of labor.
Hypercoagulable state in pregnancy.
Raises the risk of blood clot formation.
GASTROINTESTINAL
Progesterone relaxes GI muscles.
SKIN
Causes heartburn.
Stretch marks (Striae) can appear on Results in constipation due to reduced
the skin. motility
Linea nigra is a dark line across the belly.
Melasma causes brown patches on Increased HCG leads to nausea and
the face. vomiting.

MUSCULOSKELETAL RENAL/URINARY
Relaxin hormone increases, making Glomerular filtration rate (GFR) increases
ligaments and joints more flexible. by up to 50% due to expanded plasma
Caution: Increased risk of injury. volume.
Smooth muscle relaxation in the bladder.
Lordosis occurs, shifting the center of
gravity forward. Raises the risk of urinary tract infections
(UTIs).
Results in an arch in the lower back.
Can lead to low back pain and calf Uterus pressing on the bladder leads to
cramping urgency and frequency.
Protein may be excreted in urine.
 Mother & baby

Pregnancy Physiology

NUTRITIONAL NEEDS

Balanced diet vital in pregnancy for baby's nutrients. Increase intake of iron, folate, calcium, vitamin D, and protein-rich foods.

WEIGHT GAIN VITAMIN Carbohydrates

Crucial for both mom and baby's Vitamin D pregnant and breastfeeding women
health. Supports calcium absorption. need about 175-210 grams of
Managing it carefully is essential Excess Vitamin A increases the risk carbohydrates per day.
to avoid complications of Birth defects.
First trimester goal: Too little= Decreased Night vision
2 to 4 pounds of weight gain vitamin C. CAFFEINE
2ND-3RD TRIMESTER TARGET: 80mg -85mg of vitamin C per day.
Limit caffeine to <200 mg/day.
1 pound per week weight gain Excessive intake hampers fetal
A-During pregnancy you need
blood supply and growth.
CALORIES 770 micrograms daily
C-During pregnancy you need
Additional 300-500 cals/day needd 85 mg daily.
during pregnancy. IRON
D-During pregnancy you need
Opt for complex carbs to manage 600 international units (IUs) daily.
glucose and insulin. Iron aids oxygen delivery to the
baby via red blood cells.
Dieting could be harmful for unborn PROTEINE Sources: lean red meat, beans,
baby. peas, iron-fortified cereals.
Aim for 60g protein/day during
pregnancy. Pregnancy daily requirement: 27 mg.
Calcium Complete proteins:
Contain all 9 amino acids
Calcium essential for strong bones meat, FOLIC ACID
and teeth. eggs,
Sources: milk, cheese, yogurt, poultry, Folate vital for blood and protein
sardines. dairy. production, reducing neural tube
defect risk.
Incomplete proteins:
Daily requirement during Sources: green, leafy vegetables,
Does not contain all 9 amino acids
pregnancy: 1,000 mg. liver, orange juice, legumes, nuts
nuts, grains,
legumes, veggies.
PICA Pre-pregnancy and first 12 weeks:
400 mcg daily; during pregnancy:
Cravings for non-food items Vitamin B12 (cobalamin) , found in 600 mcg daily.
(salt, ice, clay) linked to possible animal food product
vitamin deficiency (fish, eggs, milk)
B12 Lack of energy ,weight loss
Associated with risks like preterm
delivery and low birth weight.
 Mother & baby

RH Incompatibility

Normal Partial Total

What is it?
Mother-to-be and father-to-be are not both positive or
negative for Rh factor
Incompatibility occurs when a Father has Rh-positive
blood, a Mother has Rh-negative blood, and their
baby inherits Rh-positive blood
Baby could have problems, but Mother is completely fine Placenta Cervical opening Placenta
Placenta attached near/on cervical
opening causes BLEEDING

Rh Negative:
PATHOLOGY Rh Positive
Rh- Rh- Woman No Rh factor on red blood cells (RBC).
Rh Positive:
When the blood of the mother and the Presence of Rh factor protein on RBC.
baby mixes, it makes the mother's body No Rh Factor:
Rh+ Rh+ foetus
produce Antibodies against Absence of Rh factor protein on RBC.
the baby's Rh-positive blood.
Called Sensitization Rh Negative

The mixing of the mother and baby's

blood most commonly occurs after
the birth of their first child when Other Ways Blood Mixing May
the placenta detaches.
Impact First Child:

include:
During Pregnancy Complications:
SYMPTOMS Certain pregnancy complications, such as PLACENTAL
SSUES or bleeding, can lead to blood mixing.
Mother passes antibodies to baby through passive Invasive Medical Procedures:
immunity & attack baby's RBC's Certain medical procedures, like AMNIOCENTESIS or chorionic
villus sampling, can carry a risk of blood mixing.
Injuries or Trauma:
Transfer of Antibodies to Baby: In cases of injury or trauma during pregnancy, there may
Mother provides antibodies through passive immunity, be a risk of blood mixing.
targeting the baby's red blood cells (RBCs).
RBC Hemolysis and Fetal Anemia: Rh Incompatibility in Second Pregnancy:
Hemolysis happens in the baby's red blood cells (RBCs),
Rh incompatibility may arise during the second
potentially resulting in severe fetal anemia.
pregnancy if the baby has Rh-positive blood.
Hypoxia:
No issues are expected if the baby has Rh-negative
Reduced oxygen supply as hemoglobin (Hb) carries
blood
oxygen.
Heart Compensatory Response:
Heart failure occurs as the heart tries to compensate. Maternal Sensitization After First Rh+ Pregnancy:
Enlarged Spleen and Liver: The mother has developed antibodies
Splenomegaly and hepatomegaly due to the body (become sensitized) from the first Rh-positive
producing more immature red blood cells. pregnancy.
Jaundice:
Jaundice results from bilirubin released during hemolysis.
Neurotoxicity and Brain Development: Condition for Sensitization:
Potential issues in brain development due to neurotoxicit This can only occur if the mother is Rh-negative and
Severe cases can lead to fetal death the father is Rh-positive.
 Mother & baby

RH Incompatibility

Diagnostics TREATMENT

Coomb's Test: Antiglobulin Treatment:

testing, also known as the
Objective: Avoid sensitization in the mother.
Coombs test, is an immunology PCR TEST

laboratory procedure used to Rh immune-globulin shots:

detect the presence of antibodies Prevent antibodies
against circulating red blood cells Blood Type Testing:
(RBCs) in the body, which then Test mother's blood type at 1st prenatal visit
induce hemolysis. Indirect Rh-Positive Mother:
Coombs Test (Mother's Blood): No additional treatment needed
Rh-Negative Mother with Rh-Positive Baby:
Negative: Indicates normal conditions. Rhogam shot at 28 weeks
Positive: Indicates abnormal conditions; may lead to issue Rhogam shot within 72 hours after delivery

Direct Coombs Test (Baby's Blood or Umbilical Cord): Stops your blood from making antibodies that attack
Rh-positive blood cells
Helps assess the baby's blood condition.
Rh-Positive Baby:
Important Note: (Direct Coombs)
Do Not Administer Rhogam if Positive: Body will recognize that the Rh-positive blood is not hers.
A positive result in the Coombs test indicates
potential issues. Fetal Blood Transfusions
Possible Outcomes: Phototherapy for Jaundice at Birth Will only be needed
Positive Result (Abnormal): for 24 hours or less, in some cases, it may be required
Baby may develop anemia and jaundice. for 5 to 7 days
Folic Acid for RBC Support Folic acid is a B vitamin that
helps body make red blood cells.

Tips
for Rhogam Administration:

Protecting the Baby, Not the Mother:

Rhogam administered to safeguard the baby, not the mother.
Ineffectiveness in Sensitized Mothers (Indirect Coombs):
If the mother is already sensitized (indirect Coombs),
Rhogam will not be effective.
Routine Rhogam for Rh-Negative Mothers with Rh+ Babies:
Every Rh-negative mother receives Rhogam after the birth of
an Rh-positive baby
 Mother & baby

Intrapartum Complications:
Bleeding, Placenta Previa

What is Placenta Previa

placenta attaches low in the uterus.
Placenta is a disc of tissue that connects a mother's Concealed Revealed
uterus to the umbilical cord,
Responsible for delivering nutrients and oxygen to a
fetus.
1.Marginal previa
Placenta is positioned at the edge of your cervix
90% of placentas identified as "low lying"

2.Partial previa Separated Separated

The cervix is partly blocked, placenta placenta
If it persists it can cause serious bleeding and other
complications later in pregnancy
Blood accumulates Blood leaks out of cervix
3.Complete or total previa behind uterine wall causing vaginal bleeding
The placenta is completely covering your cervix,
blocking your vagina.
Placenta previa is less likely to correct itself.
Diagnosis can be achieved by ultrasound in the majority
Usually diagnosed second trimester around 20 weeks of cases.
marginal or partial may correct itself
Recheck at 30-32 weeks gestation
Risk Factors
Have had a baby
SYMPTOMS Have had a previous C-section delivery
Have scars on the uterus from a previous surgery or
Soft, non-tender uterus/abdomen procedure
Spontaneous bleeding after sex Had placenta previa with a previous pregnancy
Abnormal fetal position Are pregnant after having an assisted reproductive
(placenta blocking normal position) technology (ART) procedure for treating infertility
Bright red, painless vaginal bleeding Are carrying more than one fetus
Normal fetal VS Are age 35 or older
Smoke
Use cocaine

Treatment
Pelvic Rest: Complications of Placenta Accreta
No vaginal exams
No sexual intercourse Excessive bleeding before, during, or after delivery that
Avoid abdominal manipulation may require a blood transfusion and a stay in the
If Minimal or No Bleeding: intensive care unit
Bedrest for the remainder of the pregnancy Preterm delivery
Avoid strenuous exercise A prolonged hospital stay, possibly before delivery
If Bleeding Occurs: Hysterectomy (surgical removal of the uterus) which
Continuous monitoring of: prevents future childbearing
Baby and maternal vital signs Surgical injury to organs including the intestines,
Blood loss (using pad count) bladder and ureter
Administer blood transfusion and fluids
Medical emergency
Use tocolytics to halt contractions
Positioning: treatment
Lie on the left side to maximize blood flow to the baby Hysterectomy
If Bleeding Persists: Cesarean Section
Continuous monitoring Uterine Artery Embolization
Consider C-section if bleeding doesn't stop Fetal Monitoring and Neonatal Care
Preterm Delivery Before 37 Weeks:
Administer steroids to the mother
Aids in the faster maturation of the baby's lungs
Reduces the risk of respiratory complications post-delivery
 Mother & baby

Intrapartum Complications:
Bleeding, Placenta Previa

Normal Ectopic
What is it?
Placental abruption is a serious condition in which the
placenta separates from the wall of the uterus before
birth.
The highest risk occurs in the third trimester.
JUST few weeks before the anticipated delivery date Embryo
Uterus
Risk Factors
Partial Abruption
Prior placental abruption Prolonged rupture of when the placenta does not completely detach from the
Cocaine use membranes uterine wall
Hypertension Umbilical cord
Multiple pregnancy Thrombophilia Complete Abruption
Smoking Hemorrhage when the placenta completely detaches from the
Abdominal trauma Maternal trauma uterine wall.
Advanced maternal age Perinatal consequences
Hypertension in pregnancy Trauma

Role of Placenta
Symptoms Organ formed during pregnancy with the purpose of:
Removing waste from the baby
Vaginal bleeding (Dark Red), although there might not be any
Transporting nutrients and oxygen to the baby
Abdominal pain
Back pain Typically, the placenta separates and is delivered
Uterine tenderness or rigidity within 10-20 minutes after childbirth.
Uterine contractions, often coming one right after another
Women with placental abruption may experience a sudden
increase in blood pressure TREATMENT
blood pooling inside mother
Blood products
Cryoprecipitate fibrinogen
RBC to replace blood loss & volume
Complications Fresh frozen plasma to clotting
Platelets to bleeding
(medical emergency) Heparin: stop clotting
Placenta detachment trigger clotting cascade causing IV fluids
severe abnormal clotting and bleeding Postpartum Care
Maternal Monitoring
Vaginal bleeding Fetal heart rate abnormalities
Abdominal pain Hemorrhage
Contractions Blood transfusion
Blood clotting issues Fetal death NURSING INTERVENTIONS
Uterine tenderness Hysterectomy
Back pain Stillbirth Bedrest
Blood loss Avoid vaginal exams
Monitor vital signs of mother and baby every 15 minutes
Monitor bleeding
Diagnosing Placental Abruption Count and weigh pads
Clinical Assessment: Monitor fundal height and abdominal girth
Physical exam to check for symptoms like abdominal pain. Left side lying position to enhance blood flow to the baby
Imaging: Conduct laboratory tests:
Ultrasound for visual signs of abruption. Type and crossmatch
Fetal Monitoring: Coagulation studies (coags)
Continuous monitoring of baby's heartbeat (CTG). Complete blood count (CBC)
Hospital Evaluation: Prepare mother for delivery:
Visit hospital for a comprehensive assessment if abruption Vaginal delivery if both baby and mother are stable
is suspected. C-section if signs of distress are evident
Blood Tests: Provide emotional support
Coagulation studies to assess clotting factors.
Observation: Early detection is critical;
Continuous monitoring for maternal and fetal well-being. seek prompt medical attention
if symptoms arise.
 Mother & baby

Intrapartum Complications:
Bleeding, Placenta Previa

Normal Ectopic
What is it?
The fertilized egg implants itself outside of the womb,
usually in one of the fallopian tubes.
Predominant in the Fallopian Tube.

Embryo
Uterus
Risk Factors
Diagnosis usually occurs around 6-8 weeks of gestation.
Ectopic pregnancies in roomier locations
Previous ectopic pregnancy Pelvic inflammatory (such as the abdomen) may not exhibit symptoms until
Prior fallopian tube surgery disease several weeks later.
In vitro fertilization Endometriosis
smoking
Previous pelvic or abdominal surgery
Certain sexually transmitted infections (STIs)
Causes scarring, hindering the embryo from
DIAGNOSTICS
moving into the uterus.
Diagnosis involves a combination of:
HCG BLOOD TESTS:
Measure levels of human chorionic gonadotropin (hCG)
hormone.
PATHO ULTRASOUND IMAGING:
Visualize the location of the pregnancy and assess for signs
Repeated implantation failure (RIF) the embryo of ectopic implantation.
does not Clinical Evaluation:
Consider symptoms such as abdominal pain, vaginal
bleeding, and medical history.
get attached to the uterus.

Anatomic obstruction to the passage of the zygote.

Implantation takes place anywhere outside the

Symptoms
uterine
A missed period and other signs of early pregnancy
cavity it is referred to as an ectopic pregnancy Tummy pain low down on one side
Vaginal bleeding or a brown watery discharge
Embryo starts growing. Pain in the tip of your shoulder
Discomfort when peeing or pooing
Transperitoneal migration of the zygote.

Early pregnancy loss by the spontaneous Interstıtıal Intramural Isthmıc tubal

termination of
Ampullar tubal
an intrauterine pregnancy during the first trimester.
Fallopıan tube
Caused by chromosomal abnormalities or
maternal reproductive tract abnormalities AND Infundıbular/
due to low supply of blood. fımbrıal tubal

Cervıcal Abdomınal Ovarıan

Damage to mother’s tissues.
Caesarean sectıon scar
Ectopıc pregnancy
 Mother & baby

Intrapartum Complications:
Bleeding, Placenta Previa

TREATMENT COMPLICATION

Expectant management Ectopic pregnancy can cause fallopian tube to burst

open. Without treatment, the ruptured tube can lead to
Condition is carefully monitored to see whether life-threatening bleeding
treatment is necessary. Vaginal bleeding. Vaginal bleeding tends to be a bit
Spontaneous Resolution: different to your regular period. ...
Tummy pain
Uncomplicated ectopic pregnancies may
The growing embryo runs out of space, damaging the
resolve spontaneously
fallopian tube.
Methotrexate: Considered a medical emergency that can lead to severe
Functions as a folic acid antagonist. bleeding or infection.
Terminates pregnancy by halting cell growth Symptoms
and dissolving existing cells.
light vaginal bleeding and pelvic pain.
Leucovorin: Lack of colour ,paleness
Administered to mitigate the side effects Severe, sudden abdominal/pelvic pain.
of methotrexate. Shoulder pain (referred).
Low blood pressure, paleness, and rapid heart rate.
Salpingostomy:
Laparoscopic removal of an unruptured ectopic Treatment
embryo. Administer IV fluids.
surgery is also used to remove the pregnancy, Provide a blood transfusion if necessary.
usually along with the affected fallopian tube. Using surgery (usually laparoscopy) to make a small
opening in the fallopian tube.
Perform salpingectomy: ligate bleeding vessels and
emove the damaged fallopian tube.

NURSING INTERVENTIONS

Assess and manage pain.

Medical
Offer emotional support. emergency
Monitor for bleeding.
Monitor vital signs and EKG for shock indicators.
Track strict intake and output.
 Mother & baby

Intrapartum Complications:
Bleeding, Placenta Previa

Normal Molar pregnancy

What is it?
Form of abnormal pregnancy.
Formed placental-like tissue sometimes invades the
wall of the uterus (womb). Trophoblastic
villi
Egg is fertilized abnormally.
Type of Gestational trophoblastic disease (GTD)

abnormal trophoblast cells grow inside the uterus

after conception TROPHOBLASTIC VILLI
Small finger-like parts of the placenta:
Assist the embryo in attaching to the uterine wall.
Enable the passage of nutrients to the fetus.
Symptoms Provide protection to the embryo during pregnancy

Vaginal bleeding during early

pregnancy
Risk Factors
Abnormal appearance of the
uterine cavity at the first Maternal age of less than 20 or more than 40 years
ultrasound (called a Race – Asian women are at increased risk
‘snowstorm’ pattern).
Dietary deficiencies including lack of folate,
Uterus larger than expected beta-carotene or protein
No fetal movement Prior history of gestational trophoblastic disease –
he recurrence rate is one in 100.
No fetal heartbeat
Extremely severe morning Partial Mole: Embryonic tissue is present.
sickness Complete Mole: Embryonic tissue is absent.
High blood pressure Hydatidiform Mole: A benign growth that can potentially
(hypertension) – early onset of become malignant, known as Choriocarcinoma.

gestational hypertensive
diseases.

TREATMENT

Removal of the uterus.

Pathology (Patho) (increased risk of gestational trophoblastic neoplasia
GTN) )
Replication and distribution of DNA during meiosis Dilation and curettage (D&C)
No chromosomal duplication occurs during this stage. 1st line treatment - is a procedure to remove tissue from
(Fertilization) inside your uterus..
The embryo could have reduced metabolic activity or Human chorionic gonadotropin (hCG)
slow evelopment and as a result, degenerate. is a chemical created by trophoblast tissue
Hydatiform mole is composed of abnormally proliferating Hysterectomy
syncytiotrophoblastic and cytotrophoblastic cells (the surgical removal of the uterus, and most likely,
Resulting in generalized swelling of chorionic villi. the cervix.) high risk of developing GTN (Gestational
( grape-like structures in the uterus) Trophoblastic Neoplasia)
Prevents the mother's immune system from attacking the Post-Treatment Checks:
embryo AND Prevents normal maturity.
Monitors HCG levels for six months.
Pregnancy Planning:
Molar pregnancy referring to the watery contents
Suggests waiting before attempting pregnancy again.
of the cysts, and mole
Recommends reliable birth control.
 Mother & baby

Intrapartum Complications:
Bleeding, Placenta Previa

Diagnostic Procedures NURSING INTERVENTIONS

ULTRASOUND IMAGING: Watch for Bleeding:

Transvaginal ultrasound to visualize the uterus and identify Keep an eye on any signs of bleeding.
characteristic features. Pad Count and Weight:
HCG BLOOD TESTS:( Human chorionic gonadotropin) Keep track of the number and weight of pads used.
Monitoring hCG levels, which are typically elevated in molar Monitor Belly Size:
pregnancies. Measure and monitor the height and girth of the belly.
HISTOPATHOLOGICAL EXAMINATION: Check Vital Signs and Blood Counts:
Microscopic examination of tissue from D&C procedure to Regularly assess vital signs and conduct complete blood
confirm molar tissue. count checks.
KARYOTYPING: Watch for Infection Signs:
Chromosomal analysis to determine the type of molar Be vigilant for any signs of infection.
pregnancy and genetic abnormalities. Offer Emotional Support:
IMAGING STUDIES (IF NEEDED): Provide comforting emotional support.
Chest X-ray or CT scan in cases of suspected gestational
trophoblastic neoplasia (GTN).

EDUCATION

Monitor HCG levels for 6 months after D&C.

Avoid getting pregnant for 1 year.
Be aware of the risk of choriocarcinoma ,
which is a malignant condition.
Understand why the pregnancy is not viable.
 Mother & baby

Intrapartum Complications:
Bleeding, Placenta Previa

What is it? Risk Factors

Spontaneous termination of pregnancy due to natural
Endocrine disorders Chromosome abnormality
causes occurring before 20 weeks gestation or before Previous miscarriages Ovulation induction
the baby reaches a weight of at least 500 grams. Menstrual disorders Genetics
Tobacco Infections
Uterine abnormalities Birth spacing
Alcohol Maternal age
Symptoms Aloimmune factors Obesity
Antiphospholipid antibodies Previous induced abortion
Caffeine Sexual activity
Vaginal bleeding
Ranges from light spotting to heavy bleeding with RECURRENT/HABITUAL-ABORTION-
bright-red blood or clots
Experiencing three consecutive miscarriages at the
May occur intermittently over several days
same point in the pregnancy.
Cramping and pain in your lower tummy
Discharge of fluid from your vagina Diagnostic Procedures:
Discharge of tissue from your vagina Ultrasound: Reveals no embryonic activity.
No longer experiencing the symptoms of pregnancy, Pelvic Exam: Identifies the type of abortion.
such as feeling sick and breast tenderness
Hormone Analysis:
HCG Levels:(human chorionic gonadotropin)
Measures the amount of the hormone hCG in your urine
or blood.
COMPLICATION: SEPTIC ABORTION Elevate during pregnancy and decline following abortion.

Infection caused by retained products of conception in

the uterus; can arise in missed, inevitable,
or incomplete abortion.
Types of Abortion
Symptoms Treatment Missed Abortion:
Fever Broad-spectrum Fetus doesn't develop, but loss not immediate.
Uterine pain/tenderness antibiotics (ABX) No symptoms or delayed symptoms.
Pelvic Pain Intravenous (IV) fluids Requires medical assessment.
Abnormal Bleeding Dilation and curettage Inevitable Abortion:
Hypotension (D&C) procedure Unavoidable loss with open cervix.
Elevated white blood cell Blood Transfusion Products of conception being expelled.
count (WBC) (if necessary) Medical attention needed.
Septic Abortion:
Infection from retained products.
Can occur in various abortion types.
Treatment for Complete Abortion Requires prompt medical treatment.
Threatened Abortion:
Typically, no intervention is required. Vaginal bleeding before 20 weeks.
Interventions when needed: Positive pregnancy test.
Dilatation and curettage (D&C): Removal of contents Closed cervix.
from the uterus. No passage of fetal tissue.
No evidence of fetal demise.
Misoprostol: Used to induce abortion.
Spontaneous Abortion (Miscarriage)
Mifepristone: Enhances the efficacy of Misoprostol.
Natural loss before 20 weeks or if baby weighs < 500g.
Rh-negative Patient Consideration: Vaginal bleeding, may include clots.
Rhogam administration if the patient is Rh-negative. No deliberate intervention in most cases

Induced Abortion Incomplete Abortion: Complete Abortion:

Deliberate termination through Partial expulsion of conception products. Full expulsion of conception products.
medication or surgery. Requires medical intervention. Typically requires no additional
May be done for medical, May involve symptoms like bleeding and intervention.
personal, or social reasons. cramping. Minimal to no ongoing symptoms
Should be performed in a safe
and legal environment.
 Mother & baby

Infection Pregnancy Complications

HIV / AIDS

If a mother has HIV/AIDS, Risk of transmitting Get tested as soon as possible, ideally during the first
HIV to your baby can be less than 1%. . prenatal visit, and again during the third trimester.
Infect the fetus via vertical transmission.

Symptoms (INTRAPARTUM) Symptoms (NEWBORN)

Premature birth. Fever and chills meningitis or sepsis. Lack of energy

Stillbirth. Mouth sores Low birth weight Swollen lymph nodes
Infections in the mother after birth. Sore throat Diarrhea
Heavy bleeding after birth Night sweats Skin rash
Weight loss Muscle and joint pain Persistent fever

METHODS OF TRANSMISSION TREATMENT

Transmission from mother to baby during pregnancy Antiretroviral prescribed.
through the placenta. C-section if viral load >1000.
Potential transmission during delivery after the No breastfeeding recommended.
amniotic sac ruptures. Prophylactic meds for opportunistic infections.
Risk of transmission through breastfeeding. Monitor viral load and CD4 count regularly.

STD'S
Sexually transmitted diseases (STDs),

TRICHOMONIASIS CHLAMYDIA GONORRHEA SYPHILIS

Infection caused Permanent damage Infects the mucous Cause serious health
by a parasite to a woman's membranes of the problems without treatment
reproductive system. reproductive tract,
Symptoms: Symptoms: Symptoms: Symptoms:
Redness or soreness of the Unusual vaginal discharge. Abnormal discharge fever
genitals. Pain in the tummy or pelvis. (green/yellow) swollen lymph nodes
Vaginal discharge Painful urination Painful urination sore throat
(yellow-green). unusual vaginal discharge Bleeding after sex patchy hair loss
Vaginal soreness, tummy or pelvis pain Occasional abdominal pain headaches
swelling, itching. pain during sex Rare: abnormal bleeding weight loss
Pain during urination or sex. bleeding after sex muscle aches
PROM bleeding between periods fatigue

Treatment Treatment Treatment Treatment

Metronidazole . Doxycycline Rocephin or Cipro Pencillin
500 mg 2 times/day Taken every day for a week. ceftriaxone Single injection of
for 7 days. Azithromycin – Single dose of 500 mg of long-acting Benzathine
Tinidazole . one dose of 1g, followed by intramuscular penicillin G
2 g orally in a single dose. 500mg once a day for 2 days
 Mother & baby

Infection Pregnancy Complications

GROUP B STREP

Infection in urinary, reproductive, or digestive systems, commonly found in the vagina and rectum..
Newborns who are infected with GBS can develop
Pneumonia (lung infection), Meningitis (infection of the lining of the brain and spinal cord).
Septicemia (blood infection),

Symptoms Tested at 36 weeks gestation CAUSES

Cause of infection in the mother Miscarriage

Intrapartum Symptoms: Newborn Symptoms:
Stillbirths Cause serious infections
Typically asymptomatic. Weak muscle tone.
Fetal tachycardia. Fast heart rate.
Seizures changes in skin colour,
TREATMENT
Vomiting Sepsis
Breathing problems Respiratory distress. C-section might be necessary.
Fever. Intravenous (IV) antibiotics during labor to kill the bacteria.
Usually use penicillin, but can give other medicines if a
woman is allergic to it.

Methods of Transmission
Vertical transmission from colonized mothers during passage through the vagina during labor and delivery.
Limited to newborn exposure during labor.
May be passed from person to person through direct physical contact.
It is not a sexually transmitted disease

Torch Infections

Infections passed from mother to baby that can lead to fetal abnormalities, also known as teratogenic infections.

Rubella Toxoplasmosis Cytomegalovirus HERPES SIMPLEX

Contagious disease caused sources: raw meat, garden Transmitted through Risk during delivery with
by a virus soil, cat feces. contact with body fluids active lesions.
Early pregnancy Rubella Avoid litter box cleaning. Newborn will need antiviral Consider C-section.
therapy
testing No gardening. Antivirals in pregnancy.
Practice good hand hygiene!
Postpartum vaccination Ensure thorough cooking No kissing babies.
recommended. of foods. Signs and Symptoms Signs and Symptoms
Avoid live vaccines during Signs and Symptoms Shortness of breath, Tingling, itching or burning.
labor. Muscle aches and pains. Cough, Fever, swollen lymph nodes
Signs and Symptoms Headache. Muscle aches, Weaknes or muscle aches.
Low-grade fever. Fever. Fever. Pain while urinating.
Headache. Inflammation of the lungs. Fatigue
Mild pink eye
OTHER

Can Causes Hepatitis

Low birth weight Cataracts Symptoms vary based on the Parvovirus
hepatitis B virus, "Blueberry muffin" rash underlying condition but share Varicella
herpes simplex virus (HSV), Hearing loss common nonspecific features.
Fever Congenital heart disease
 Mother & baby

Medical Pregnancy Complications

Gestational Diabetes Infections. . Preterm Labor. Pregnancy Loss/Miscarriage.

High Blood Pressure Preeclampsia. Depression & Anxiety. Stillbirth.

Hyperemesis Gravidarum
Pregnancy-induced diabetes
typically resolves post-childbirth.
Intractable vomiting during pregnancy, leading to weight loss
usually occurs during and volume depletion, resulting in ketonuria and/or ketonemia
1st trimester

Risk factors Symptoms Treatment

Having A Multiple Pregnancy Prolonged And Severe Nausea Temporary Suspension
(Twins, Triplets Or More). And Vomiting. Of Oral Intake, Followed
Losing More Than 5% Of Your By Gradual Resumption.
Motion Sickness Or Migraine
Headaches Pre-pregnancy Weight. Anti-emetics If Needed.
Previous HG. Not Being Able To Keep Highly Palatable Foods Filled With
Expecting Multiples. Food Or Liquids Down. Sugar, Salt And Unhealthy Fats,

First Pregnancy. Dehydration. Fainting. Vitamin B-6 (Pyridoxine)

Family History Of Severe Morning Feeling Dizzy Or Headaches. IV Fluid

Sickness.
Lightheaded.
Gestational Trophoblastic
Disease History. Peeing Less Than Normal.
Extreme Tiredness.

GESTATIONAL DIABETES

Develop during pregnancy in women who don't already have diabetes. Usually occurs duing 2nd-3rd trimesters

Risk factors Symptoms Treatment

prediabetes. a dry mouth. Monitor Blood Sugar
Overweight/obesity. tiredness. Monitor glucose daily.
polycystic ovary syndrome. blurred eyesight. Follow a balanced diet and
exercise.
fetal macrosomia genital itching or thrush
(newborn baby weighing 9-pounds) Polyuria: Use insulin.
Increased thirst and needing to
Higher risk races. pee more often than usual. Take oral anti-diabetic
medications
Ethnicity Polydipsia:
Excessive thirst, often associated Postpartum Monitoring.
Polycystic Ovary Syndrome (PCOS)
with increased fluid intake.
Hypertension
Polyphagia:
Increased hunger or excessive
eating
Fatigue.
Blurred vision.
 Mother & baby

Medical Pregnancy Complications

GESTATIONAL HYPERTENSION

IF UNTREATED: Increased chance of delivering a large baby with low blood sugar.(Hypoglycemia)

High blood pressure that occurs in the latter half of pregnancy but doesn't affect on kidneys.

Risk factors Type of diabetes that can develop during pregnancy in

Kidney disease Gestational diabetes women who don’t have already diabetes
Multiple pregnancy First pregnancy
Black ethnicity History of preeclampsia
Chronic hypertension Gestational age <20 or 40> 40 weeks from the first day of the last menstrual period.

Gestational htn Pre- Eclampsia Severe Pre-Eclampsia Eclampsia

A form of high blood Hypertension disorder Blood pressure ≥ 160/100. Pre-eclampsia with
pressure in pregnency seizures.
After 20 weeks without Signs of kidney or liver
Blood pressure ≥ 140/90 problems in the kidneys damage Blurry vision
or other organs (higher
after 20 weeks gestation.
than 140/90 mmHg) Severe proteinuria Convulsions.
Requires two separate (Protein +3 in urinalysis).
Gestational hypertension Onset can occur from
readings ≥ 6 hours apart
with accompanying Presence of severe either mild or severe
proteinuria. headache. pre-eclampsia.
Elevated protein
in the urine Urinalysis indicates mild

Risk factors HELLP Syndrome Severe complication

Previous pregnancy with HELLP syndrome

Hemolysis Elevated Liver enzymes Low Platelets
High blood pressure Caucasian ethnicity HELLP syndrome is a severe complication characterized by Hemolysis, Elevated
Liver enzymes, and Low Platelets. It is a variant of pre-eclampsia, leading to
Multiparous Young pregnancy severe blood and liver complications.

Symptoms Treatment
Symptoms
Edema (swelling) Magnesium sulfate
Sudden weight gain.
Nausea or vomiting. Sudden weight gain. Administration of blood
products.
Making small amounts of urine. Vision changes
Tachycardia Shortness of breath. Baby delivery.
Right upper quadrant (RUO)
Headache. Epigastric pain. pain and dyspnea. Corticosteroids for premature
delivery.
Blurry vision. Changes in urine output. Bleeding.
Use of antihypertensive
Nausea and vomiting. medications.
Neurological changes. IV hydralazine, IV dihydralazine
Magnesium toxicity signs:
Corticosteroids
Respiratory Depression, Flushing Are a medication that ma
Pulmonary Edema, Urine Output be offered to you if you are
at risk of giving birth early.
Cardiac Arrythmias RR<12
Magnesium Toxicity
Deep Tendon Reflex (DTR)

Antidote: calcium gluconate

 Mother & baby

Stages of Labor

Signs
First Stage Rectal pressure
can be a sign of constipation or
The first stage of labor involves the onset of contractions and the opening fecal impaction
(dilation) of the cervix. Mild contractions

LATENT PHASE ACTIVE PHASE TRANSITION PHASE

Cervix starts to soften and open Your cervix will dilate from Contractions will come close together
(dilate) so your baby can be born 6 centimeters (cm) to 10 cm. and can last 60 to 90 seconds.

Cervix dilation Cervix dilation Cervix dilation

the cervix dilates slowly to More rapid cervical dilation The cervix dilates from
approximately 1 to 3 centimeters. cervix typically dilates at a rate 4 to 7 8 to 10 centimeters.
centimeters per hour..

1-3 cm 4-7 cm 8-10 cm

1cm 2cm 3cm 4cm 5cm 6cm 7cm 8cm 9cm 10cm

Contractions Contractions Contractions

Irregular contractions; Moderate contractions; Strong contractions&intensive

it can take many hours, or even days. Contractions move in a wave-like contraction
Mild contractions that are motion from the top of the uterus to Very strong contractions,
15 to 20 minutes the bottom lasting 60 to 90 seconds
last about 40 to 60 seconds and occurring every 2-3 min .
Regular contractions. the cervix dilates from 8 to 10
Regular contractions.
centimeters.
thin, paper like cervix that is soft and contractions become more regular
4cm dilated 20-45 seconds each until they are lest
than 3-5 minutes apart
Mother Mother Mother
Communicative, Outspoken Fearful Lacking or denying rest
Conversational Excite Forceful Uneasy AND troubled.
Ardent &Strong Unsettled.AND anxious.
Nursing interventions Nursing interventions Nursing interventions
Putting the woman to bed Monitor maternal vital signs and the nurse assesses the woman for
Get a patient to move around as fetal heart rate every 30 minutes perineal swelling, hematoma,
soon as able Manage the labor pain. excessive bleeding, and hemorrhage.
Hot water bath or massage Encourage ambulation and changes Nurse cares for mother and baby
( improves the circulation of blood.) in position together
Breath focus technique Urinary elimination breathe in lightly, taking shallow
(regular toileting schedule) inhalation
Nurse cares for mother and baby
together
 Mother & baby

Stages of Labor

Second Stage Pushing phase

The second stage of NURSING INTERVENTIONS DURATION

laborinvolves the activ Sustained "pushing" or bearing down 20 minutes to 2 hours..
pushing and delivery of efforts with contractions. Contractions will last about 45-90 seconds at
the baby. Monitor vital signs for both mom and baby. intervals of 3-5 minutes
Commences with Perineal massage with lubricants and You will feel strong pressure at your rectum.
complete cervical warm compresses
dilation and ends with Provide encouragement to the mother. Stage 2: Placenta
the delivery of the fetus. Educate on pushing techniques and Uterine contractions
optimal positioning. increase in strength and
Record the time of delivery. the infant is delivered. Umbilical
cord

Third Stage 5-30 mins after childbirth

The third stage of labor NURSING INTERVENTIONS DELIVERY MECHANICS

involves the delivery of Administer oxytocin to prevent hemorrhaging. "Dirty Duncan“:
the placenta. uterine massage to help retraction of the Dull, rough, red maternal side presenting first
uterus
Initiates after the fetus Encourage skin-to-skin contact. "Shiny Shultz“:
is delivered and ends Assess placenta completeness. Shiny fetal side of placenta presenting first
when the placenta is
delivered.
Placenta (detaching
SIGNS OF PLACENTA DELIVERY
Stage 3: from uterus)
Gush of blood at the vagina. The placenta
Umbilical cord lengthening. is expelled.
Globular shaped uterine fundus on palpation. Umbilical cord

Fourth Stage Recovery phase

Initial 4 hours post-placental delivery.

NURSING INTERVENTIONS If fundus is:

Monitor vital signs, especially blood pressure and Fundus is not firm and feels soft (boggy)
heart rate, to identify potential hemorrhage risk. Respond to manual massage and
Track temperature to catch signs of infection. become firm.
Provide effective pain management. Feel soft or boggy,
Administer IV fluids. This may indicate uterine atony and
Utilize ice packs and witch hazel for episiotomy care. may lead to postpartum
Encourage bonding with the baby. hemorrhage
Monitor postpartum discharge (lochia):
Fundus Should be:
Solid.
Centered.
Fundus at or above the umbilicus
(corresponds to an estimated GA of ≥20 weeks gestation )
It should steadily decrease 1 centimeter every 24 hours
 Mother & baby

True vs False Labor

Regular Contractions Iregular Contractions

Do not go into remission They go away on foot
Contractions
TRUE LABOR FALSE LABOR

4 times per hour or more, and get closer together Happens in the third trimester of pregnancy and feel a
lot like real labor.

Frequency Frequency

Contractions are Regular Contractions do not increase in frequency, duration, or

30 to 70 seconds and come about 5 to 10 minutes apart. intensity
Contractions are irregular

Intensity Intensity
Occur over a prolonged period. Irregular in duration AND Intensity.
Increase in intensity and duration with walking Unpredictable and non-rhythmic,
regular intervals (every 5-20 minutes). Often stop with walking
Do NOT resolve with comfort measures

Location Location
Contractions usually start in the lower back and move In the front of your stomach
to the front of the abdomen. Contractions felt in abdomen above umbilicus.
Vaginal pressure starting at top of uterus NO radiation to other area
Radiating pain No change in cervix
Dilation and effacement Fetus is ballotable
Fetus usually engaged

Cervix
Lower, narrow end of the uterus that connects the uterus to the vagina .

Cervix Changes During Labor NO CHANGES IN CERVIX

Dilation: No dilation observed in the cervix.

Opening of the cervix. No thinning or shortening (effacement) of the cervix.
Effacement: No appearance of blood-tinged mucus (bloody show).
Thinning and shortening of the cervix. Fetal position remains unchanged.
Bloody Show: No engagement of the baby's head into the pelvic cavity
Release of blood-tinged mucus as cervix changes.
Fetal Position Change:
Baby may shift into the Left Occiput Anterior (LOA) position.
Fetal Engagement:
Baby's head descends into the pelvic cavity.
 Mother & baby

True vs False Labor

Signs of Labor False Labor Pain Care (Stay Home):

Contractions or tightening's Remain Calm:

A "show", when the plug of mucus from your cervix False labor doesn't progress into active labor, so staying
(entrance to your womb, or uterus) comes away calm is crucial.
Backache. Hydrate:
Sudden burst of energy. Drink plenty of water to stay well-hydrated.
interstitial cystitis(pressure on bladder) Change Positions:
Baby dropping Move around and try different positions to ease
An urge to go to the toilet, which is caused by your discomfort.
baby's head pressing on your bowel Take a Warm Bath:
waters breaking. Relax in a warm bath to soothe any muscle tension.
Rest:
Lie down and rest to see if the contractions subside.
Monitor:
Keep track of the contractions, noting their duration
and frequency.
No need to go to hospital unless
Distraction:
ngage in activities or distractions to shift focus from
discomfort.
Contractions are 5 minutes apart, lasting
Contact Healthcare Provider:
for 1 minute, for 1 hour or longer.
If unsure or if there are concerns, consult with the
healthcare provider before heading to the hospital.
5-1-1 Rule

5-1-1 Rule

5 Minute Intervals 1 Minute duration 1 hour period

 Mother & baby

5 P's of Labor

5 P'S OF LABOR

Passageway Passenger Position Power Psychology

Passageway BIRTH CANAL (SHAPE OF MOTHER'S PELVIS)

Gynecoid Anthropoid Platypelloid Android

Round Long & oval Flat & oval Heart shaped

Gynaecoid pelvis Anthropoid pelvis Platypelloid pelvis Android pelvis

Female pelvis Long oval pelvic inlet Uncommon in both Heart-shaped pelvic
Suitable for vaginal Anteroposterior (AP) sexes inlet with a prominent
delivery diameter > transverse Flattened sacrum
Rounded or slightly diameter (kidney-shaped) Convergent sidewalls
oval inlet Elongated and narrow pelvic inlet funneling from above
Straight pelvic sacrum Transverse diameter downwards
sidewalls with a Common in tall women > AP diameter Prominent ischial
spacious pelvic cavity Associated with fewer Forward-pushed spines
Well-defined sacral labor complications sacral promontory Forward-inclining
curve sacrum
Most Favorable Narrow subpubic arch

Most favorable 2nd Most Favorable Shallow Shape Common Male Shape

May Require C-Section

POWER PSYCHOLOGY
Refers to contractions during labor, which vary based on The psychological state of the mother during childbirth.
the stage.
Latent stage of labor feel irregular contractions, Psychological impact of giving birth?
FREQUENCY: Anxiety,
Occurrence rate of contractions. Depression
INTERVAL: Post-traumatic stress disord
Time gap between contractions. FACTORS AFFECTING PSYCHOLOGICAL STATE:
DURATION: Support system
Length of each contraction. Previous experiences
INTENSITY: Anxiety, fear, & pain
Strength of contractions, ranging from weak to strong Information from staff
Knowledge of the condition
 Mother & baby

5 P's of Labor

PASSENGER CHARACTERISTICS OF THE FETUS

Fetal Head Size Fetal Attitude Fetal Presentation

Lose joints and “holes” in a baby's Head down, face up Baby is positioned head-down,
skull help change the shape facing the mother's back with the chin
Flexed Extended
of a baby's head so they tucked to its chest and the back
don't get stuck during birth. Vertex Military Brow Face of the head ready to enter the pelvis.

Cephalic Transverse Breech

Anterior fontanel

Posterior fontanel

Most
Favorable Most
Head first Scapula first Pelvis first
Biparietal diameter at term: 9.25 cm. Favorable
C-section

Fetal Station Fetal Lie

(Measured in cm) Relationship between the long axis of the fetus
The presenting part is in pelvis and with respect to the long axis of the mother
the baby that leads the way through
the birth canal.. Longitudinal Transverse Oblique

(-)= ABOVE ischial spine

(+)= below ischial spine

+4/ +5 means baby

coming soon!

0=ischial spine Baby's back aligned Baby's back is at a Baby's back is positioned
means baby is engaged
parallel to the perpendicular angle at an angle to the
AKA Lightening (Baby
dropping into pelvis) mother's back to the mother's back. mother's back

Fetal Position
Facing rearward (toward the woman's back) with POSITION
the face and body angled to one side and the
neck flexed, and presentation is head first. Mother's position during childbirth:
Sitting, semi-lying down on the bed, or lying on your side with
1ST LETTER: L or R
Indicates whether the fetus is turned left or right. your top leg bent.
2ND LETTER: O, S, or M
UPRIGHT: Sitting or standing
Specifies which part of the fetus is presenting first
ALL FOURS: On hands and knees
O = OCCIPUT (Head first) LITHOTOMY: On the back with knees bent or feet in stirrups
S = SACRUM (Sacrum first)
LATERAL: Lying on the side
M = MENTUM (Chin first)
3RD LETTER: A, P, or T
Represents the direction the fetus is
facing.
A = ANTERIOR (Facing forward)
P = POSTERIOR (Facing backward)
T = TRANSVERSE (Lying on the side)
 Mother & baby

Fetal Positioning & Station

Leopold Maneuvers
Performed after 36 weeks
Determine baby's position and estimate their birth weight. Fetal positions
Used to palpate the gravid uterus systematically
Easy to perform, ROA ROT ROP
Non-invasive
Determine the position, presentation, and engagement of the fetus
in utero.
Will also indicate twins and their presentation.

MANEUVER 1: FUNDAL-GRIP
Right Occiput Right Occiput Right Occiput
Permits determination of the uterine fundus level as well as the fetal Anterior Transverse Posterior
presentation Most Mom may have
favorable back pain aka
The uterine fundus is palpated by flat hands, positions “Back labor”

Which are placed in such a manner on the abdomen that the LOA LOT LOP
fingers of one hand are facing the fingers of your other hand
NORMAL FINDINGS
Head feels firm, hard, and round.
Buttocks are symmetrical and soft.
Head moves independently from the trunk.
If the head of the fetus is well flexed,
it should be on the opposite side from the back of the fetus. Left Occiput Left Occiput Left Occiput
Anterior Transverse Posterior

MANEUVER 2: UMBILICAL-GRIP
Determines fetal presentation. RMA RMP LMA

Left hand is placed on the right, lateral wall of the uterus and with
the fingers of right hand to palpate fetal body parts..
Same procedure is repeated conversely.
involves palpation of the lateral uterine surfaces.
NORMAL FINDINGS
Fetal back will feel firm and smooth while fetal extremities Right Mentum Anterior Right Mentum Posterior Left Mentum Anterior
(arms, legs, etc.)
Extremities may protrude Risk of trauma: do not try to manually rotate baby

(may need c-section

MANEUVER 3: PAWLICK’S -GRIP LSA LSP

Determines fetal engagement
Fingers and thumb to feel what part of the fetus is in the lower
abdomen, just above the birth canal, they're in the right position.
Permits determination of the presenting fetal part in respect to
the true pelvis.
The inferior uterine part is compressed by hand, which is c-shaped.
Thumb is placed on one side of the pelvis while the remaining 4 other Left Sacrum Anterior Left Sacrum Posterior
fingers are placed on the other side.

MANEUVER 4: PELVIC -GRIP Fetal Station

Determines fetal attitude.

-1 to -5: Fetus head not engaged
Permits determination of the location of the presenting part in
respect to the true pelvis. 0: Fetus head engaged
Please stand at the side of patient facing towards her foot part.
The fingers of both hands are performing deep palpation between +1 to +3: Baby coming soon
the presenting fetal part and the lateral walls of the pelvis.
+5: Head is crowning
Good Attitude (Flexed):
Brow is opposite the fetal back.
0= ischial spine
Poor Attitude (Extended): Tips
Brow is on the same side as the fetal back. If the brow is easily felt, it is likely in a posterior position.
If the head cannot be felt, it is likely descended into the pelvis.
 Mother & baby

Fetal Heart Tones

Measures the Heart Rate and Rhythm of Baby (Fetus).

Remember VEAL CHOP MINE

FHR pattern (VEAL) Cause (CHOP) Management (MINE)

V ariable Decelerations C ord Compression M ove mother

E arly Decelerations H ead Compression I ntervention not needed

A ccelerations O kay! N o intervention needed

L ate Decelerations P lacental Insufficiency E mergent actions needed

Variable Decelerations
Fetal HR

What is it? Interventions

Attributable to transient compression of the Put the patient in the knee-chest position
umbilical cord. Change position, relieve cord pressure.
Fetal heart rate varies in duration & timing Primary care provider
Contractions

Administer oxygen for fetal oxygenation.

Maternal

Provide IV fluids for placental perfusion.

Cause Release cord compression if identified.
Compression of the umbilical cord. Stimulate fetal scalp for response.
Head compressions (vagal stimulation), Consider amnioinfusion if needed

Early decelerations

What is it? Do not actually come early!

Fetal HR

A symmetrical decrease and return of fetal heart rate (FHR) that is associated with a uterine
contraction.
Goes up when contraction starts & goes down when it ends
Contractions
Maternal

Cause Interventions
Head Compression Benign and Normal No need for intervention; Keep monitoring.
Vagal Response it's normal.

Accelerations Late decelerations

What is it?
Fetal HR
Fetal HR

What is it?
Gradual decrease in the fetal
Short-term rises in the heart heart rate typically following
rate of at least 15 beats per the uterine contraction.
minute, lasting at least
Contractions
Contractions

15 second
Maternal

Cause
Maternal

Caused by placental
insufficiency.
Cause
Decreased blood flow
Caused by fetal movement.
to the place
Indicates fetal wellbeing.
Fetal movement
Fetal scalp stimulatio Interventions
Change the mother's position to left side-lying to enhance oxygen to the baby.
Interventions Halt pitocin infusion (as pitocin can contribute to contractions).
JUST vaginal examinations Administer oxygen and IV fluids.
No need for intervention; it's normal. Keep monitorin Communicate with the primary care provider (PCP).
Emergent delivery may be necessary.
 Mother & baby

Labor Complications

Contractions weaken, the cervix does not dilate enough or in a timely manner,
or the infant's descent in the birth canal does not proceed smoothly.

Cord Prolapse

What is it? Risk Factors Symptoms Treatment

when the Abnormal fetal Visible cord position for childbirth
umbilical cord Breech. heart rate slows baby is positioned head-
slips down in Oblique, (bradycardia) down, facing the mother's
front of the baby presentation Palpable cord on exam back with the chin .
after the waters Prematurity. compression of the Terbutaline 0.25 mg
have broken. Fetal congenital. umbilical cord subcutaneously
Abnormality. Relieve pressure on cord
Umbilical cord Multiparity Manually lift babies head &
precedes fetus, Polyhydramnios maintain until delivery
leading to (too much amniotic Delivery of a baby after
compression. fluid) rapid labor
Wrap prolapse cord in
NS cause

DYSTOSIA
What is it? Risk Factors Symptoms Treatment

abnormal fetal Abnormal size and uncontrolled muscle Diagnosis is by

size or position position of the fetus cramps and spasms examination,
resulting in Dysfunctional uterine shaking (tremors) ultrasonography
Shoulder Dystocia
difficult delivery. action uncontrolled blinking. oxytocin is the only
Gestational diabetes "Hold the hand at available treatment of the
Labor is Small pelvic inlet about chest height" condition
challenging or Maternal fatigue Occurs when the Fundal pressure, pressure
prolonged Advanced maternal baby's shoulder gets applied to the upper
because of age Macrosomia stuck behind the abdomen, SHOULD NOT
mechanical pelvic bone, causing be used. )
issues. the head to retract Rotational maneuvers
back Drain bladder
Resulting in an Slide one half along one
unusually slow descent side of the baby's head,
during delivery. and repeat that on the
other side, so the device
cradles the baby's face
changes.
C-section if unsuccessful
 Mother & baby

Labor Complications

Meconium Stained Amniotic Fluid

What is it? Risk Factors Symptoms Treatment

Brown or green prolonged rupture of Bluish skin color in the use of a ventilator.
staining of the membranes infant. Continuous positive airway
fluid indicates the intra-amniotic Limpness in infant at pressure (CPAP).
passage of infection birth. Surfactant or antibiotics to
Meconium
meconium pre-eclampsia, Breathing problems. open their lungs and clear
diabetes mellitus. Greenish amniotic fluid any infection.
Meconium +Fetal distress +Late or variable Continuous monitoring of
(1st stool) passed Hypacks decelerations the newborn's heart rate
by the baby Cord compression +Fetal hypoxia and vital signs.
before childbirth Post-term babies Fetal cyanosis Clearing the baby's
Prolonged delivery Tachypnea airways using a bulb
(rapid breathing.) syringe suction.
Mechanical ventilation
might be necessary in
certain situations

Premature Rupture Of Membranes

What is it? Risk Factors Symptoms Treatment

rupture of Previous preterm birth abdominal pain, Corticosteroids
gestational Vaginal bleeding. fetal tachycardia, to help develop the fetus's
membranes prior Cigarette smoking Fever lungs.
to the onset of during pregnancy. intra-amniotic Antibiotics
Amniotic Fluid labor. Unknown causes. infection. to prevent infection and
Abdominal trauma Gush of clear fluids prolong the pregnancy
The amniotic sac Stress from vagina For >34 weeks
breaks Infection Can be small or Immediate delivery
("water breaking") Uterine distention large For <34 weeks
before labor begin Tobacco or drug use Can leak Steroids to + fetal lung
Low BM continuously or maturity
(BODY MASS INDEX) intermittently Tocolytics to delay
delivery
Mag Sulfate
(prevent neura defects)
Bed rest
 Mother & baby

Labor Complications

Precipitous Labor

What is it? Risk Factors Symptoms Treatment

Precipitous labor Blood pressure You feel an urge to keeping up with your
is when a baby is Induction with push. regular prenatal care
born within three prostaglandins Contractions started appointments
hours of regular Placental abruption suddenly, coming one The person is receiving
contractions Low birth weight baby after another with fluids through an IV
starting Effective uterus short breaks. Getting oxygen
Fertility treatments The pain with each Lying on their side
The baby was Heavy bleeding contraction was receiving emotional
born within three Multiparity intense. support
hours of the onset Strong contractions Continuously painful Getting ready in case a
of contractions. Young maternal age and strong cesarean section may be
Gestational contractions with little needed
hypertension to no build up in
Low birth weight intensity level.
 Mother & baby

Newborn Assessment

Normal Newborn Vital Signs

Checks A Baby's Heart Rate, Muscle Tone,
APGAR
Quick Assessment Scale For Newborns Systolic Diastolic
Score Blood Pressure
Completed At 1 Minute And 5 Minutes After Birth 60-80 mmHg 40-50 mmHg

Score 0 Points 1 Point 2 Points MAP Mean Arterial Presssure ≥ to # weeks gestation

Heart Rate 110-160 bpm

A Appearance Blue/ pale
Pink body,
Pink
blue limbs
Skin color Respiratory Rate 30-60 breaths/min

P Pulse Absent <100 bpm >100 bpm Temperature 97.7- 99.5 F (36.5-37.5 C)

G Grimace Absent
Minimal Prompt
Score Interpretation
Reflex response response response

A score of 7, 8, or 9 is normal and is a sign that the newborn is in

A Activity Absent
Flexed arms
Active
Muscle tone & legs good health
Slow &
0-3 Points Severe fetal distress, prompt resuscitation required.
R Respirations Absent
irregular
Strong cry
4-6 Points Guarded condition, needs airway suction and oxygen.
7-10 Points Baby is in good health.
Head

Caput Succedaneum Umbilical Cord

Swelling of newborn’s scalp Arteries
Swelling extends beyond suture lines. Should contain TWO arteries & ONE vein
Swelling that may extend to both sides of Absence of one artery could
the scalp. indicate congenital heart and
Possible bruising or color change on the Vein
kidney abnormalities.
scalp swelling area
Caused by pressure during labor.
Typically resolves within a few days.
Measurements
Cephalhematoma
Blood collection between scull & scalp Expected Length
Result of a traumatic birth. 17-22 inches (44-55 cm).
Cephalohematomas (blood accumulation) Measurement taken from crown to heel
feel soft and can increase in size after birth. while lying supine with straight leg
Resolution may take months.
Swelling does not cross suture lines.
Expected Weight
Fontanelles 2,500g-4,000g (5.8 lbs-8.14 lbs).
anterior
Should be between 1 and 3 cm in size Initial loss of 5-10% of birth weight in the first
the "soft spots" on an infant's head where the 2,500G-4,000G
few days, typically regained within a wee
bony plates that make up the skull have no
yet come together
Head Circumference
BULGING FONTANELLES=ICP increases Measured above eyebrows.
posterior SUNKEN FONTANELLES= DEHYDRATION Should be approximately 2 cm larger than
the chest circumference.

Anterior fontanelle closes at 6-8 weeks

Chest Circumference Approximately 2 cm smaller than head
Posterior fontanelle closes at 12-18 months circumference.

SKIN Normal DEVIATIONS Reflexes

VERNIX CASEOSA: MILLIA:

White, creamy substance covering the newborn's skin. Small, white bumps on the skin.
Skin is crucial for determining optimal thermal support
Infection control, and skin moisturization. ACROCYANOSIS:
A blue color around the lips and
Transparent skin philtrum . Rooting Palmar Moro Tonic Neck
Seeks food by turning Grasping: Startle “Fencing”
PORT WINE STAIN: toward the direction
Flat, pinkish-red markings observed on the head or MONGOLIAN SPOTS: the face is stroked,
Light touch of the Extend arms and When the baby is laid
Flat bluish- to bluish-gray skin palm causes the then flex towards the on the back and the
neck accompanied by an
baby to tightly grip body in response to head turned, the arm
markings open mouth.
an object. a loud noise or on the same side
ERYTHEMA TOXICUM: ON SACRUM OR THIGHS commonly sudden movement. extends, while the
Pink rash appearing at random and disappearing appearing at birth or shortly Blink reflex
opposite arm flexes.
within 2 weeks. thereafter Rapid eye closure
Botchy, evanescent, macular erythema, often on exhibited
the face or trunk. Sneeze reflex
Body needs more
oxygen.
 Mother & baby

Postpartum Assessment

Important aspect of care in order to identify early signs of complications in the woman who has just given birth.

Remember BUBBLEHE
Breast-feeding moms: Mastitis
B reasts
Pain, redness, and warmth. Breasts may become heavier
Check for colostrum. and fuller and feel nodular and
Signs of engorgement, including firm.
Instruct on breastfeeding positions.
fullness, around postpartum days
Colostrum: Infection of the breast
3 and 4 Evaluate Breasts for:
First milk produced by the body, containing surrounding milk ducts, leading
Size. Redness. immune globulins. to swelling and pain.
Hot & red, Shape. Bottle-Feeding Moms: Continue breastfeeding.
painful, Symmetry. Antibiotics may be prescribed.
Educate on breast engorgement.
edematous Firmness. Avoid expressing milk
(to limit milk production).

U terus
Firm or Boggy
Causes Interventions

Assessment: Residual placental Encourage the

Monitoring Fundal Height fragments. patient to empty
Make a C shape with Distended bladder. the bladder.
One hour post delivery, the fundus is your hand and push Uterine atonicity Perform fundal
firm and at the level of the umbilicus. on the lower fundus. massage.
Should align with or be near the Stabilized and firm is
umbilicus after childbirth. good. Risk of hemorrhage
Increase by 1 cm daily for the first 10 days. Moveable and boggy
is concerning(bad)

B ladder Interventions Potential Complications

of Urinary Retention
Perform straight
Urinary Retention Causes: catheterization if necessary. Increase Urinary tract
Epidural.(provides anesthesia that creates a band of Implement a voiding infection
numbness from your bellybutton to your upper legs) schedule. Bogginess of the uterus,
Progesterone increases blader capacity and improves Monitor every 180 minutes. potentially leading to
the bladder compliance by its relaxant action on the Monitoring I&O bleeding.
detrusor. Risk of urinary tract infection.
Prolonged second stage labor.
Episiotomy.
Cut (incision) through the area between your vaginal opening and your anus.
 Mother & baby

Postpartum Assessment

B owels Interventions Education

Regular assessment of vaginal bleeding, Straining can cause tearing of
Factors Contributing uterine tonus episiotomy or C-section sutures.
to Constipation: Avoid straining during bowel
Promote increased fluid intake.
Drying. hypohydration. Administer stool softeners. movements.
increased perineal pain Encourage dietary fiber intake
Reduces activity.

L ochia Lochia Colors Lochia Odor

Between day 3-4 the lochia becomes Musty, metallic,

(Vaginal Discharge after child Birth)
more pink/brown color Sour or stale.
Assessment: An unpleasant or
Saturating one pad in less than an hour, Rubra Bright red: altered odor may
persists for up to 3 days. suggest the presence
a constant trickle of lochia, or t he presence of large
Serosa Pinkish-brown: of an infection.
(i.e., golf-ball sized) blood clot
observed from 4 to 10 days Should be odorless
is indicative of more serious complications and should postpartum.
be investigated immediately
Alba Whitish-yellow:
Evaluate for:
Scant Moderate can last up to 6 weeks.
Amount.
Color.
Light Heavy
Odor.

E pisiotomy Perineal Assessment: Assessment:

Hyperaemia, Redness REEDA-RO

A cut (incision) through Oedema
Edema..
the area between your Ecchymosis
Ecchymosis
vaginal opening and Examine for hematomaformation.
Discharge.
your anus. Gently separate labia from front to back.
Approximation.
Check for the presence of hemorrhoids or tears.
Redness,
Oedema

H oman’s Sign Symptoms

Calf or thigh pain

Postpartum Risk for Deep Vein Thrombosis (DVT)
Tenderness
Homan’s Test�Mother flexes the calf at a 90-degree angle and dorsiflexes the foot. increased skin temperature
Pain indicates a positive result (further testing may be required and could Swelling
suggest DVT). superficial venous dilatation

E motional Well-being and Bonding:

Emotional Well-being and Bonding: Postpartum Blues: Postpartum Depression:

Evaluate the bonding between Emotional fluctuations, Persistent feelings of hopelessness

the mother and baby. heightened sensitivity, and and sadness to the extent that it
Provide education to the mother episodes of crying persist for affects self-care and caregiving
about the signs of postpartum up to 2 weeks after delivery. for the newborn.
blues and depression
 Mother & baby

Postpartum Hemorrhage

After delivery, the process of involution start

What Is It?
Woman has heavy Process begins after you
bleeding after giving Vaginal Birth: >500mL deliver your baby and
birth. It's a serious but Cesarean Birth: >1000mL the placenta and takes
rare condition about six weeks to
complete.

Primary PPH
The uterus shrinks back to its normal size and resumes
The loss of 500 ml or more of blood from the genital tract within its prebirth position by the sixth week.
24 hours of the birth of a baby
Minor (500–1000 ml) During this process, called involution
Major (more than 1000 ml)
The excess muscle mass of the pregnant uterus is
Secondary PPH reduced,

Uterine bleeding occurring between 24 hours and 12 weeks the lining of the uterus (endometrium) is reestablished,
postpartum usually by the third week
common causes
Retention of the placenta, If anything disrupts this process, it can result in
Endometritis and delayed placental bed involution Severe Bleeding

remember

Causes 4T's
3.Trauma
Direct effects on the reproductive organs include the
1.Tone gonads (ovaries in the female and testes in the male)
Lack of uterine tone. Genital tract trauma
Soft and weak uterus after delivery.
cause bleeding and lead to large volume PPH.
This is when your uterine muscles don't contract enough
to clamp the placental blood vessels shut. Uterus
Vagina(surgical or assisted vaginal deliveries)
Uterine fatigue Cervix
uterus is not clearing out the lining. Perineum
Prolonged labo
Repeated uterine distention
Pregnancy with more than one fetus 4.Thrombin
(twins, triplets, or more)
when the pouch that holds your pee Thrombin' refers to coagulopathies and vascular
(urine) is enlarged.(MOST COMMON CAUSE abnormalities which increase the risk of primary
post-partum hemorrhage:
The mother has a pre-existing condition that hinders
blood clotting.
2.Tissues
The placenta doesn't completely come out of the uterus Von Willebrand
after the baby is born. Blood disorder in which the blood does not clot properly.
Blood contains many proteins that help the blood
Blood clotting disorders clot when needed.
Infection
Having many previous births DIC
High blood pressure disorders of pregnancy (Disseminated intravascular coagulation )
Obesity causes abnormal blood clotting throughout the
Placenta problems body's blood vessels
Prolonged labor
Placenta Accreta
 Mother & baby

Postpartum Hemorrhage

RISK FACTORS SYMPTOMS

Uncontrolled bleeding.
Placental abruption Decreased blood pressure.
(The early detachment of the placenta from the uterus). Increased heart rate.
Decrease in the red blood cell count (hematocrit)
Placenta previa. Swelling and pain in tissues in the vaginal and
Over distended uterus. . perineal area
Multiple pregnancy. Hypovolemic shock
Gestational hypertension or preeclampsia.
Tachycardia Shortness of breath
Having many previous births.
Hypotension Cold, clammy skin
Prolonged labor.
Dizziness
Infection.
Fundus above expected level.

TREATMENT
manual removal of the placenta, uterine balloon tamponade,
manual removal of clots, uterine artery embolization

PITOCIN METHERGINE HEMABATE MISOPROSTROL

Oxytocin Methylergometrine Carboprost Cytotec
Used for labor induction. Prevent and control Due to atony Serious postpartum
Augmentation bleeding from the uterus Effective in both the first hemorrhage in the
Decrease excessive that can happen after and second trimesters of presence of uterine atony.
blood loss childbirth. pregnancy. Prostaglandin used to
Reduce the incidence Acting directly on the Prostaglandin used to induce contractions and
of PPH smooth induce contractions and control bleeding.
muscles of the uterus control bleeding.
Higher risk of side effects
OTHER INTERVENTIONS
Not recommended for Only used if neccessary
Contraindicated in patients
Fundal massage patients with high blood with asthma, Can cause
(for 15 seconds pressure.
The muscles that line your
minimum.) Vasoconstriction reduces bronchi (airways in your
Blood substitutes are a the volume or space inside lungs) tighten.
cellular fluids that can affected blood vessels
transport and deliver
oxygen to the tissues.

Postpartum Hemorrhage Interventions:

Uterine Massage: Catheter or Balloon for Uterine Pressure:

Aimed at promoting uterine muscle contraction. Applying pressure to the uterine walls
Medication for Contractions: using medical devices.
Administration to stimulate uterine contractions. Uterine Artery Embolization:
Removal of Retained Placental Tissue: Intervention to control bleeding through
Procedure to eliminate any placental fragments. arterial blockage.

Repair of Tears and Lacerations: Blood Transfusion:

Addressing damage to the vagina, cervix, and uterus. Administered when necessary to restore
blood volume.
Uterine Packing or Vessel Tying:
Utilizing sterile gauze or ligatures to manage bleeding.
 Mother & baby

Newborn Care

Immediate care at birth (delayed cord clamping, thorough drying,

assessment of breathing, skin-to-skin contact, early initiation of breastfeeding)

Top Priorities After Delivery: IMMEDIATELY AFTER DELIVERY:

Ensure clear airway for the newborn. Assess and monitor the newborn's airway.
(assessment of breathing, ) new baby is placed in Mother arms.
Prioritize Thermoregulation. Dry and wrap the newborn in a warm blanket.
delayed cord clamping, APGAR is a quick test performed on a baby
Early initiation of breastfeeding. at 1 and 5 minutes after birth..
Skin-to-skin contact, APGAR TEST
A=appearance, A=activity,
Maintains a steady internal body temperature P=pulse, R=respiration.
despite changes in external conditions. G=grimace,

Identify and register the newborn.

Encourage skin-to-skin contact.
Vitamin K injection and erythromycin
ointment to be administered within 1 hour of birth.
Airway

Clear the Airway:

Use a bulb syringe to gently clean the baby's mouth
and nose. THERMOREGULATION
airway position sniffing position”
(neck flexion with upper cervical extension)
Surgical tracheostomy The neonate must accelerate heat production via
nonshivering thermogenesis (NST),
Dry the baby right away
Encourage Breathing: Wrap in a warm blanket
If the baby isn't breathing on their own: Put on a cap
Softly rub their back Move quickly to avoid exposing the baby to the cold
Gently tap the baby's heels.
Give a light tap to their buttocks
Babies Lose Heat Rapidly! Newborns at risk include

Do not initiate crying before proceeding with Their body surface area Conduction,
the drainage of secretions. is 3x that of adults, Evaporation,
They can't regulate Radiation
Can lead to aspiration. temperature well. Convection.
 Mother & baby

Newborn Care

HOW BABIES LOST HEAT

Convection: Radiation: EVAPORATION Conduction:

The loss of heat from the Through absorption and loss of heat from a loss of heat when the
newborn's skin to the emission of infrared rays, newborn's wet skin to the newborn lies on a cold
surrounding air surrounding air surface
Heat loss to a cooler
Heat escapes to cooler Evaporation in newborns Conduction refers to
nearby object.
air currents. is the process of liquid the transfer of heat
Monitor and control
Baby's skin warms the turning into vapor. between the baby's skin
radiation dosage
immediate air. leading to heat loss. and a cooler surface in
direct contact
Examples: Examples: Examples:
Fan Air conditioner Sweating Examples:
Air conditioner Window Being wet after birth Cool examination table
Open window Refrigerator or bath Cold stethoscope
Ventilation system Cold wall Clinical Scenario Chilled hand

NUTRITION
Breast milk and formula provide everything babies
need nutritionally until they start eating solid foods.
Initial Feeding:
Breast-fed:
Start feeding immediately after birth.

Bottle-fed:
Begin feeding at 2-4 hours of age.

REMEMBER
Changing position during and after FEED can
reduce child's risk of aspirating.

UMBILICAL CORD CARE

Keep Dry: Clean Hands: Sponge Baths: Diaper Folding:
Keep the stump dry. clean Wash hands before Stick with Keep the diaper folded below the cord.
with gauze and water only touching the cord. sponge baths. Let the stump fall off on its own
 Mother & baby

Trauma During Birth

Trauma during birth includes:

Wound or damage experienced during or after childbirth. • trauma to skin and superficial tissues • nerve trauma
• muscle trauma • fractures.

1 Trauma to skin and superficial tissues

Soft tissue injuries (STI) Risk factors TREATMENT

The newborn's skin may have minor
Vaginal breech delivery. Applying a steroid cream
injuries after delivery, especially to
Abnormal or excessive traction during (like hydrocortisone
the scalp, but also to other areas
delivery. Using a gentle detergent and no
that receive pressure during
Bruising or swelling in the scalp or fabric softener in baby's laundry.
contractions or that first emerge
brain, Using skin moisturizers
from the birth canal during delivery
Bone fractures or nerve injuries

2 Muscle Trauma
Symptoms TREATMENT
Injuries to muscle result from Bruising, Paralysis, Physical therapy can help a baby
tearing or when the blood Unusual eye movements, Seizures. develop muscle strength and range
supply is disrupted. Muscle weakness of motion and reduce pain or regain
sensation

3 Nerve trauma
Stages of nerve injury TREATMENT
The nerves most commonly traumatized
are the facial and brachial plexus nerves. Contusions (neuropraxic), Medication, physical therapy or
Facial nerve is the nerve injured most Crush (axonotmesis), massage therapy.
often. Transection (neurotmesis
Forceps pressure is a common cause,
some injuries probably result from Risk factors
pressure on the nerve in utero, which
Maternal diabetes, large-for-date infants (> 4000 g)
may be due to fetal positioning
The birth is complicated by a breech (bottom-first) delivery.

4 Fractures CAUSES TREATMENT

Fractures are rare but the most Metabolic bone diseases Posterior limb splinting, Used to treat a
Increased maternal body weight Gallows traction, broken bone in
commonly affected bones are the thigh or hip
the clavicle, humerus, femur Fetal macrosomia, Bryant's traction,
and those of the skull. With all Fetus larger than 4000 to 4500 developmental dislocated hip
such fractures, a ‘crack’ may grams (or 9 to 10 pounds) Pavlik harness.
be heard during the birth Helps hold baby's legs in a position
that allows their hip joint to be
Most often breaks during birth is the
collarbone (clavicle). valigned and stable .

The affected clavicle is usually the one that Nursing intervention

was nearest the maternal symphysis pubis.
Include improvement of the
Brachial plexus and phrenic nerve injuries
neurological status.
should be excluded in the affected baby.
PEDIATRICS
 Pediatrics

Pediatrics Physiology

Definition
Pediatrics is the branch of medicine dealing with the
health and medical care of infants, children, and
adolescents from birth up to the age of 18.

The word “pediatrics” means “healer of children”; they

are derived from two Greek words: (pais = child) and
(iatros = doctor or healer).

Pediatrics physiology
Pediatrics physiology deals with the study of normal functioning of organs and disorders
in infant’s.
To understand physiological differences during the changes in the child that occur over
time periods of development and appreciate them to properly assess, plan, and deliver a
health care.

There are number of developmental Pediatrics must remember to

characteristics that distinguish pediatrics
prioritize ABCDE’s
physiology from an adult physiology and
have higher risk of disorders such as:
Use the Airway, Breathing,
Airway Obstruction(can’t move air in Circulation, Disability, Exposure
and out)
(ABCDE) approach to assess and
Infection(invasion of microorganisms treat the patient.
like bacteria, parasite)
Dehydration(excessive loss of water)
Hypothermis(cause by prolonged
exposure to cold temperature)
Hypoglycemia(blood sugar level
lower than normal)
Injury(Accidental damage to body)

Brain Heart

Lungs
 Pediatrics

Different Systems in Pediatric

Central nervous system (CNS)

The central nervous system (CNS) is incompletely developed at birth and continues to
grow and mature till second year of life.
Brain nervous system begin to develop when a female is 5 weeks pregnant ( at 6 week)
Brain myelination(development of myelin sheath around nerve fiber) is most active in
the first two years of life and subsequently decelerates and progresses at a slow rate
until adulthood (the brain is almost completely myelinated by the end of the second
year of life).
Myelination helps provide the foundation for brain connectivity and supports the
emergence of cognitive and behavioral functioning.
Infant’s vision is not fully developed until 3_5 years.
Myelinization occurs in head to tail direction(Cephalocaudal).

Brain

Ventricle

Spinal cord

Nerves Meninges

Cerebrum

Ventricle
Cerebellum
Brainstem
 Pediatrics

Different Systems in Pediatric

Respiratory system in pediatrics

Neonates (new Born) are obligate nasal breathers (breathe through their nose rather than the
mouth) until about 2_6 months
Inability to feed and can be subject to respiratory distress or even death.
Shorter diameter of airways
Infants are more susceptible to airway obstruction.
Weakly developed intercostal muscles (muscles contract and compress the thoracic cavity,
which helps expel air out during forced exhalation) that make them tired quickly.
Unlike adults, infants tongue proportion to mouth is larger, result in airway obstruction in
unconscious condition.
Oxygen requirements is high because they have high metabolic rate.

AGE Breaths/Min Anatomy of Child’s

Tongue

airway differs
1 Month 25 - 50
from adults.
3 Month 24 - 45 Pediatric airways is nasal
smaller in diameter Cavity

and shorter in length. Adult’s

6-12 Month 20 - 40 Lungs are smalle. Tongue

Heart is higher in
18 Month 20 - 30 child’s chest,

2-7 Years 30 - 30
 Pediatrics

Different Systems in Pediatrics

Cardiovascular system
Methods of investigation of
Up to six months of age, the neonate’s cardiovascular system in children:
immature myocardium can result in a
decreased ability to respond to Inspection: color of skin
hemodynamic changes
Palpation: Apical impulse, palpation of
Parasympathetic innervation is fully pulse in arteries
developed, whereas sympathetic
innervation is incomplete. Responses to Percusion: Borders of heart
stimuli are often vagal in nature resulting Auscultation: Listening to heart sound
in significant bradycardia.
Infants have comparatively larger heart
in relation to body size HR BP
Age (Breaths/Min) (mmHG)
Higher value of HR( heart rate)to CO
Higher BSA(body surface area)which
mean larger fluid loss through Preterm 120-170 40-75/30-45
evaporation
Neonate 120-160 60-45/45-55
Requires more fluid to maintain
circulatory system
1-6 Months 100-140 70-90/50-66
Small veins + SQ tissue
(IV access can be difficult) 6-12 Months 90-120 80-100/55-65
Metabolic rate = cardiac workload
 Pediatrics

Different Systems in Pediatrics

Musculoskeletal

Weak muscle tone less coordination

Serious injury can occur
Have Soft bones (which can cause serious injuries without getting any fractures) until puberty
Growth plates present between middle and end of long bones
Infants have 300 bones more than adults( 206 bones).
Bones fuse together as baby grow.
Key stages and changes that occur during musculoskeletal development.
The rib cage in infants is barrel-shaped and rigid
Infants have a kyphotic spine (exaggerated, forward rounding of the upper back) overtime
this transitions to a more “neutral” spine (as seen in adults)
Infants have a rounded pelvis with a posterior tilt

Ears

Have smaller and less mature ears Pediatric Ear Disorders

than adults
Otitis externa (swimmer’s ear) foreign
In infants and younger children, the bodies in the ear
eustachian tube is more horizontal,
narrower, less rigid, and shorter Otitis media (middle ear ınfection)

Shorter eustachian tube leads to Mastoiditis.

difficulty in fluid drainage(Fluid stay Hearing loss in babies
stagnant and promotes bacterial
Age-appropriate hearing milestones
infections)
High risk of ears infection Myringotomy tubes (ear tubes)
 Pediatrics

Different Systems in Pediatrics

Renal system
Urinary System
Fetal urine production begins at 10 to 13 Inferior Descending
Vena Cava Aorta
weeks gestation, and although urine
production increases thereafter Adrenal
throughout pregnancy, glomerular Gland
filtration rate (GFR) is always lower in
preterm infants. Right Left Kidney
Kidney
Renal function changes quickly in the Uruter
fetus and newborn with an increasing
GFR and tubular maturity leading to
Bladder
enhanced concentrating ability.
Calculation of maintenance fluid
requirements is size dependent; Urethra
however, practically, calculations are
more typically based on body weight
rather than body surface area.
Premature infant fluid requirements are
Important
different from term infant requirements laboratory test for renal function
in both total fluid volumes and Glumerular filtration rate
electrolyte content.
Urine protein
Higher risk of hyponatremia ( a serum
sodium concentration of less than 135 Plasma creatinine
mEq/L)
Urine Glucose
To avoid serious neurologic injury,
Urine urea
sodium abnormalities should not be
corrected quickly. Osmolality
 Pediatrics

Different Systems in Pediatrics

Gastrointestinal Skin

Infant skin is in a constant state of flux with

The GI tract is divided into the upper GI
changes in trans epidermal water loss,
tract, which runs from the mouth to the
hydration, lipid content and skin acidity.
stomach, and the lower GI tract, which
includes the small and large intestines Blood vessels are very closer to body surface
that can assist in losing heat easily
There is high need of glucose but have
poor storage capability which The top layer of skin (Epidermis) is 20-30%
increases risk of hypoglycemia (Blood thinner than adults
sugar level lower than normal)
Cells and collagen fibers are thinner (more
Higher loss of fluids as the size of colon chances of dry skin)
is much larger as compared to body
size Infant skin pH levels are higher than those of
adult skin, which is usually characterized by a
Have Cylindrical shaped abdomen. pH value between 5 and 5.5.
This results in poor protection for vital
organs such as the liver and spleen. Newborns have alkaline skin surfaces,
ranging from 6.34 to 7.5, depending on the
Proportionally longer intestinal length, anatomical site
resulting in greater fluid losses.
The difference between infant and adult skin
Immature lower esophageal sphincter hydration is more evident on the skin surface,
tone until 1 month but may persist until specifically between 10 and 14 μm of depth
12 months. from the skin surface.
The deficiency of the stratum corneum
function results in reduced water-holding
capacity of newborn skin compared with
adult skin.
Infant skin has a higher rate of water
absorption and desorption compared with
adults
 Pediatrics

Different Systems in Pediatrics

Immune system

Made up of special cells, tissues and organs that work together to protect them from illness or infection.
Under developed or Immature immune system leading to High risk of infection
Releases low chemicals including histamine, bradykinin, and prostaglandins that cause Low
inflammatory response
Limited exposure to disease (gain immunity from maternal antibodies)
Child’s immune system is not fully developed until they’re around 8 years old

Head
Relative to the size of a child’s body, the head is large and heavy, balanced on a neck
poorly supported by weak muscles and ligaments.

Both head and cervical spine can get injured easily.

Have thinner cranial bone as compared to adults that can leads to high risk of
hemorrhage(escape of blood from ruptured blood vessel)

Brain
At birth the brain is about 25% of the adult size even though body weight is about 5%.

Half of the postnatal growth of the brain occurs in the first year or two.

Motor activity is not fully developed that’s why increased falls can be expected

Higher risk of hypothermia as temperature regulation is not well developed.

Spinal cord
At around the age of 3 months, as the baby raises it's head, the cervical spine gains it's
"lordosis" or reversed "C" shape curve. Spinal
Cord
Around 6 months of age, the infant adopts a seated and standing posture and the lower
back - lumbar spine - also becomes lordotic or "C" shaped in nature.

Spine is highly mobile

Most spine injuries in children occur in the cervical region.

 Pediatrics

Pediatric CPR

Pediatric CPR

Pediatrics CPR
Emergency procedure performed for cardiac
or respiratory arrest

Purpose of CPR
Provide oxygenated blood to heart & brain

Most important
Basic Life supports: interventions:
Adequate oxygen
Airway Ventilation
Breath
Circulation

Primary cardiac arrest is very

rare in infants and children
Most common reason is
generally from respiratory
system cause

But only 2% to 10% of all children who develop

out-of-hospital cardiac arrest survive, and most are
neurologically devastated.
 Pediatrics

Before Giving Child or Baby CPR

#1
Ensure the safety

Check the scene for safety, form an initial impression, obtain consent from the
parent or guardian, and use Personal Protective Equipment (PPE)

#2
Check responsiveness

If the child or baby appears unresponsive, check the child or baby for
responsiveness (shout-tap-shout)
For a child, shout to get the child’s attention, using the child’s name if you
know it. If the child does not respond, tap the child’s shoulder and shout again
while checking for breathing, life-threatening bleeding or another obvious
life-threatening condition
For a baby, shout to get the baby’s attention, using the baby’s name if you
know it. If the baby does not respond, tap the bottom of the baby’s foot and
shout again while checking for breathing, life-threatening bleeding or another
obvious life-threatening condition
Check for no more than 10 seconds

#3
Call for help

If the child or baby does not respond and is not breathing or only gasping, CALL
9-1-1 and get equipment, or tell someone to do so
 Pediatrics

Performing Child & Baby CPR

#1
Place the child or baby on their back on a firm, flat surface

For a child, kneel beside the child

For a baby, stand or kneel to the side of the baby, with your hips at a slight angle

#2
Check their breathing

Look for chest movements.

Listen at the child's nose and mouth for breathing sounds.
Feel for air movement on your cheek.
Gasping breaths should not be considered to be normal breathing.

#3
Check pulse

Feel for the child’s carotid pulse (on the side of the neck) or femoral pulse (on
the inner thigh in the crease between their leg and groin) for 5 but no more than
10 seconds.
If you cannot feel a pulse (or if you are unsure), begin CPR by doing 30
compressions followed by two breaths.
 Pediatrics

Performing Child & Baby CPR

#4
Give 30 compressions

For a child, place the heel of one hand in the center of the child’s chest, with
your other hand on top and your fingers interlaced and off the child’s chest

Position your shoulders directly over your

hands and lock your elbows
Keep your arms straight
Push down hard and fast about 2 inches at
a rate of 100 to 120 per minute
Allow the chest to return to normal position
after each compression

For a small child, use a one-handed CPR technique

Place the heel of one hand in the center of

the child’s chest
Push down hard and fast about 2 inches at
a rate of 100 to 120 per minute

For a baby, place both thumbs (side-by-side) on the center of the baby’s
chest, just below the nipple line
Use the other fingers to encircle the baby’s
chest toward the back, providing support
Using both thumbs at the same time, push
hard down and fast about 1 ½ inches at a
rate of 100 to 120 per minute
Allow the chest to return to its normal
position after each compression
 Pediatrics

Performing Child & Baby CPR

#5
Alternatively, for a baby, use the two-finger technique

Use two fingers placed parallel to the chest in the center of the chest
For a baby, if you can’t reach the depth of 1 ½ inches, consider using the
one-hand technique

#6
Give 2 breaths

For a child, open the airway to a slightly

past-neutral position using the
head-tilt/chin-lift technique
For a baby, open the airway to a neutral
position using the head-tilt/chin-lift
technique
Blow into the child or baby’s mouth for about 1 second
Ensure each breath makes the chest rise
Allow the air to exit before giving the next breath

If the first breath does not cause the chest to rise, retilt the head and before
giving the second breath. If the second breath does not make the chest rise,
and ensure a proper seal object may be blocking the airway
 Pediatrics

Performing Child & Baby CPR

#7
Continue giving sets of 30 chest compressions and 2 breaths until:

You notice an obvious sign of life

An AED is ready to use
Another trained responder is available to take over compressions
EMS personnel arrive and begin their care
You are alone and too tired to continue
The scene becomes unsafe
You have performed approximately 2 minutes of CPR (5 sets of 30:2), you are
alone and caring for baby, and you need to call 9-1-1
 Pediatrics

Performing Child & Baby CPR

INFANT SMALL CHILD LARGER CHILD

Hand Picture a line connecting the

nipples, and place two
Place the heel of one hand
in the center of the child's
1 or 2 hands in the center of
the child's chest(sternum),
Placement fingers or two thumbs on the chest, with your other hand between the nipples same
baby's breastbone just below on top and your fingers as adults.
that line interlaced and off the child's
Two finger technique chest.
use a one-handed CPR
technique.

Rescue breaths for a small

Rescue Take a breath and put
and large child: Tilt the
your mouth around the
breathing baby's mouth and nose to
head and lift the chin
observe for the chest rise
make a seal, and blow
gently and steadily for up Single rescuer: 30
to one second. compressions to 2 breaths

The chest should rise. Two rescuer: 15

compressions to 2 breaths
Remove your mouth and
1 breath every 2-3 seconds, or about 20-30
watch the chest fall. That's
breaths/min.
one rescue breath, or puff.
Infants have much smaller Assess pulse rate for no more than 10 seconds.
lungs so require less than
Continue rescue breathing; check pulse about every
a full breath to fill them
2 minutes.

AED Pad Infant (<1 year old) Child (1-8 years old) Child (more than 8 years)

Placement Anterior posterior Anterior lateral placement: Placement is same as in

placement: One pad placed on the opposing adults
should be placed on the side of the chest.
infant's chest and the 1 pad high right
other pad on its back. If pediatric pads not
available: One adult pad on 1 pad low left
Manual defibrillation chest and one pad on back AED pad placement for
recommended children 8 and under
Pediatric pad used
 Pediatrics

Pediatric Milestones

Infant

FONTANELLES WEIGHT LENGTH TEETH

Born with two major Average weight of Full-term length of a The first teeth to come
soft spots on the top of a newborn is newborn measuring 19-20 in are almost always the
the head called around 7 to 7 1/2 inches or 49-50 lower front teeth (the
fontanels. pounds (3.2 to 3.4 centimeters. lower central incisors)
kg).
These soft spots are A length of around Most babies will develop
spaces between the After six months it 18.5-20.9 inches or 47-53 teeth between 6 and 12
bones of the skull get doubled from centimeters is also months.
where bone formation birth weight considered as normal birth
isn't complete. length Upper Teeth
After 12 months it Canine
This allows the skull to get tripled from Grows 0.5 to 1 inch every 16-22 mths First molar
13-19 mths
be molded during birth weight month until 6 months Lateral incisor
9-13 mths
birth. Central incisor
Grows half (50%) of birth 8-12 mths
Second molar
Anterior fontanelle is length by 12 months 25-33 mths
located near the front,
top of your baby's
head. This is the larger
of the fontanelles.
Baby
Posterior fontanelle is
located near the back Teeth
of the head.

Posterior
fontenelle

Central incisor
6-10 mths Second
molar
Lateral incisor
23-31 mths
10-16 mths
Canine
Anterior
17-23 mths
fontanelle First molar
14-24 mths

Front of head
Lower Teeth
 Pediatrics

Pediatric Milestones

INFANT 1 MONTH 2-3 MONTHS 4-5 MONTHS

Gross Raising their hands to

their face.
Raising their head and
chest when laying on
Rolling over and reaching
with both arms.
motor Moving their head from their stomach. Holding their head
side to side. Smoother movements steady.
Pushes up onto
elbows/forearms when on
tummy
Sits with the help of
support

Fine Grasping their fists tightly Unclenching

their fists
Palmar grasp reflex
develops
motor (grasp reflex) Able to reach and grasp a
and reaching small toy using both
for objects. hands
Opens hands Touches fingers together
briefly

Language Being alert to sounds Making coos and gurgling

noises.
Laughing and babbling
Cries when get hungry Makes sounds like “oooo”,
feel uncomfortable Reacts to loud sounds “aahh” (cooing)
situations Turns head towards the
sound

Social/ Recognizing different

faces and sounds (e.g.
Calms down when
spoken to or picked up
Responding to their name.
Smiles on his own to get
emotional parents or caregivers) Smiling at faces and attention
engaging with everything Chuckles in response to
around them others

Cognitive Start to focus with

both eyes
Follows moving objects,
such as rattle or toy, with
Begin to recognize objects
and people they are
eyes. familiar with
Recognizes familiar Responsive to love and
people at a distance. affection.
Cries or fusses if bored. Identifying strangers
Startles to loud noises.
 Pediatrics

Pediatric Milestones

INFANT 6-9 MONTH 10-12 MONTHS

Gross Tries hard to move

forward by
Can sit without help and pull themselves to a
standing position
motor scooting or "army Might take their first steps without support
crawling," or
rocking back and Walks, holding on to furniture
forth on all fours.
Sits without
support

Fine Babies enjoy much better control over Can stack large objects
their hands
motor They become a nonstop flurry of activity
Can intentionally let go of an object when
someone asks
Object permanence Grasping items between the thumb and
forefinger.
Poking things with a finger.

Language Using voice to express feelings of Evolve to words such as "dada" and "mama.
happiness or sadness Calls a parent another special name
Makes a lot of different sounds like Understands “no” (pauses briefly or stops
“mamamama” and “dadadada” when you say it)

Social/ Is shy, clingy, or

fearful around
Respond to simple verbal requests
Might become skilled at gestures, such as
Emotional strangers shaking the head no or waving bye-bye
Smiles or laughs Might hear certain exclamations, such as
when you play "uh-oh!"
peek-a-boo

Cognitive Distinguishing favorite toys. Try to find objects you've hidden. Try new
ways to reach the same goal, or change old
Understanding the word “no”
actions through trial and error.
Connect animals with actions and sounds,
such as meows, barks, or chirps
 Pediatrics

Pediatric Milestones

Todler to
18 MONTHS 2 YEARS
Preschooler

Gross Walks without holding on to anyone or

anything
Kicks a ball
Runs
motor Scribbles Walks (not climbs) up
Drinks from a cup without a lid and a few stairs with or
may spill sometimes without help
Eats with a spoon

Fine Feeds himself with his fingers Have better control over their hand and finger
movements
motor Tries to use a spoon
Can stack at least four blocks and put round
Climbs on and off a couch or chair
without help or square pegs into holes.

Language Tries to say three or more words besides Points to things in a book when you ask, like
“mama” or “dada” “Where is the bear?”
Follows one-step directions without any Says at least two words together, like “More
gestures, like giving you the toy when you milk.”
say, “Give it to me.” Points to at least two body parts when you ask
him to show you
Uses more gestures than just waving and
pointing, like blowing a kiss or nodding yes

Social/ Moves away from you, but looks to make

sure you are close by
Notices when others are hurt or upset, like
pausing or looking sad when someone is
Emotional Points to show you something interesting crying
Puts hands out you to wash them Looks at your face to see how to react in a
new situation
Looks at a few pages in a book with you
Parallel play
Helps you dress him by pushing arm
through sleeve or lifting up foot

Cognitive Copies you doing chores, like sweeping

with a broom
Holds something in one hand while using the
other hand; for example, holding a container
Plays with toys in a simple way, like and taking the lid off
pushing a toy car Tries to use switches, knobs, or buttons on a
toy
Plays with more than one toy at the same
time, like putting
 Pediatrics

Pediatric Milestones

3 YEARS 4 YEARS 5 YEARS

Gross Can run with ease (start,

stop, and change
Walks up and down stairs
independently, alternating
They can throw a ball at the
ground and catch it after
motor direction) while pumping feet. one bounce.
their arms Kicks ball forward. They can balance on one
Can climb, slide, and swing Pushes, pulls, steers foot for 5–10 seconds and
on different playground wheeled toys. easily hop on one foot over
structures. They can squat a short distance (3 m).
and stand back up without Jumps over 6" high object
and lands on both feet. They can pedal a bicycle
help. (usually with the help of
training wheels)

Fine Strings items together,

like large beads or
Serves herself food or pours
water, with adult
Counts to 10
Uses words about time, like
motor macaroni supervision “yesterday,” “tomorrow,”
Puts on some clothes by Unbuttons some buttons “morning,” or “night”
himself, like loose pants Holds crayon or pencil Pays attention for 5 to 10
or a jacket between fingers and thumb minutes during activities.
Uses a fork (not a fist) Writes some letters in her
Catches a large ball most name
of the time

Language Talks with you in

conversation using at
Answers simple questions
like “What is a coat for?” or
Tells a story she heard or
made up with at least two
least two back-and-forth “What is a crayon for?” events. For example, a cat
exchanges Says some words from a was stuck in a tree and a
Asks “who,” “what,” song, story, or nursery firefighter saved it
“where,” or “why” rhyme Answers simple questions
questions, like “Where is Talks about at least one about a book or story after
mommy/daddy?” thing that happened during you read or tell it to him
Says first name her day, like “I played Keeps a conversation going
soccer. with more than three
back-and-forth exchanges
Uses or recognizes simple
rhymes (bat-cat, ball-tall)

Social/ Calms down within 10

minutes after you leave
Pretends to be something
else during play (teacher,
Follows rules or takes turns
when playing games with
Emotional her, like at a childcare superhero, dog) other children
drop off Likes to be a “helper” Sings, dances, or acts for you
Notices other children Avoids danger, like not Does simple chores at home,
and joins them to play jumping from tall heights at like matching socks or
Associative play the playground clearing the table after
eating

Cognitive Draws a circle, when you

show him how
Names a few colors of
items
Know their address and
phone number
Avoids touching hot Tells what comes next in a
objects, like a stove, when well-known story
you warn Draws a person with three
Potty training or more body parts
 Pediatrics

Pediatric Safety

SAFETY

CARSEAT INFANTS TODDLERS PRESCHOOLERS

CARSEAT High risks for: High risks for: Best age for
safety education
Falling down Falls
Rear- Airway obstructions Drowning Do not talk or laugh during
facing car eating
Animal attacks (e.g. pets) Poisoning
Playing in safer
Use a Spilling of chemicals or Burns and scalds
environments
rear-facing car medicines from high racks Choking and harm caused
seat from birth Do not get frank with
Burns by swallowing objects
until ages 2–4. strangers
Loose and low blinds or
Infants and Crossing the road with
curtains cords
toddlers should great care
be buckled in a No objects should be
rear-facing car Safety measures: Safety measures: placed in nose, ear or
seat with a mouth
harness, in the Provide a safe sleeping Create safe spaces
Keep away from
back seat, until environment Keep hot liquids and food chemicals and medicines
they reach the Do not leave alone pots away
maximum
weight or height Chemicals should be Keen observance or
limit of their car placed far from infants alertness during toddler
seat. Avoid aggressive pets bath
Bath tubs and water Household things with
Front facing: should be checked sharps edges and ends
properly (temperature, should be placed in
Until children
turbidity etc.) cupboards
outgrow the top
weight and height Blinds and curtains should
recommendations be with tight holdings and
of the car seat length should not touching
manufacturer. the ground

Booster seat:
8 – 12 Years
Keep your child
in a booster seat
until he or she is
big enough to fit
in a seat belt
properly.

For a seat belt to

fit properly the
lap belt must lie
snugly across
the upper
thighs, not the
stomach.
 Pediatrics

Erikson’s Theory

ERIKSON’S THEORY

Age Conflict Important Favorable Unfavorable

Event

Infancy Trust vs. Mistrust Feeding, Hope, faith and Suspicion, fear of
Birth- 18 months abandonment trust in others future events

Early childhood Autonomy vs. Toilet training, Will Feelings of shame

2-3 years Shame/Doubt clothing themselves and self-doubt

Preschool Initiative vs. Guilt Exploring, using Purpose A sense of guilt and
3-5 years tools or making art inadequacy to be
on one’s own

School age Industry vs. School, sports Competence A sense of

6-11 years Inferiority inferiority at
understanding and
organizing

Adolescent Identity vs. Role Social relationships Fidelity Confusion over

12-18 years Confusion who and what one
really is

Young adulthood Intimacy vs. Romantic Love Inability to form

19-40 years Isolation relationships affectionate
relationship

Middle adulthood Industry vs. Work, parenthood Care Concern only for
40-60 years Inferiority self-one’s own well
being and
prosperity

Maturity Ego Integrity vs. Reflection on life Wisdom Dissatisfaction with

65 years- death Despair life, despair over
prospect of death
 Pediatrics

Piaget’s Stages of Development

PIAGET’S STAGES OF DEVELOPMENT

STAGE Sensimotor Preoperational Concrete Formal

Stage Stage Operational stage operational stage

Age Birth- 2 years old 3-6 years old 7-11 years old 12-15 years old

Goal: object Goal: symbolic thought Goal: operational Goal: abstract concepts
Description permanence ( the
concept that objects
a child continues to use
mental representations,
thought (stage continues as an
adolescent moves into
exist even if you can’t such as symbolic Concrete adulthood)
see them) thought and language. operational stage
marks the end of Adolescents
Interacting with the Develop memory egocentrism develop abstract
environment and imagination logical and moral
Child begins to
reasoning. They
Imitates activities Learn to imitate develop an
start to analyze
Object Engage in understanding of
their environment
permanence make-believe or the outside world
and move beyond
developed pretend play and others’
concrete facts.
perceptions.
A child uses Children in this Make hypotheses
sensory (sensation) stage are A child begins to
use logical Understand
and motor egocentric,
operations when theories
(movement) meaning they have
abilities to little awareness of problem-solving Grasp abstract
experience and others and think included inductive concepts like
learn about the everything is reasoning, going morality and
world around them. connected to from the specific to beauty
themselves. They the general, and For example, when
They learn about
aren’t able to grasp mastering faced with a
cause and effect.
the idea that others conservation(the problem, an
The child begins to value or mass of an
can think adolescent can
develop object doesn’t
differently. come up with
problem-solving change even if it is
For example, a child several possible
skills and uses altered in some
imagines they’re a ways to solve the
mental images to way).
character in a book problem. They can
represent objects
or pretends a stick For example, when then select the
(mental
is a magic wand). water is transferred most logical,
combination)
from a short glass probable, or
For example, a child to a tall glass, the potentially
understands that child understands successful solution.
when a parent the amount of
leaves the home, water remains the
the parent NON-COMPLIANT
same; it’s the
continues to exist container that has AND RISK TAKING
ool changed. BEHAVIOUR
3-5 years

Learn to use words Teach to think Days before doing Teach days before
Education and pictures to
represent objects
about how other
people might think
something + teach
skills with
doing something +
teach skills with
and feel. demonstration demonstration Teach
Teach to do same like an “ADULT”
as you are doing
 Pediatrics

Vaccine Schedule

Immune system
The childhood immunization schedule, or childhood vaccine schedule, is the list of common
vaccines the Centers for Disease Control and Prevention (CDC) recommends most children
should receive. Immunization is a way to protect your child from getting many different
infections and diseases.

List of diseases against which

vaccination is provided:

HBV(Hepatitis B Virus)
HAV(Hepatitis A Virus)
DTAP(Diphtheria, Tetanus and
Pertussis)
HIB(Haemophilus Influenza Type B)
MMR(Measles, Mumps and Rubella)
VAC
TDAP(Tetanus, Diphtheria, Pertussis)
C
INE

HPV(Human Papilloma Virus)

Rotavirus
Inactivated poliovirus
Baby's first immunizations
Pneumococcal
Influenza Hepatitis B is the first vaccine most babies receive. It is
given within 24 hours of birth.
Varicella
Remember B for Birth

AGE 2 months 4 months 6 months

Acronyms to Be DR. HIP DOSE DR. HIP DOSE Be DR. HIP DOSE
remember

B Hepatitis B Virus 2nd D DTAP 2nd B Hepatitis B 3rd

D DTAP 1st R Rotavirus 2nd D DTAP 3rd
R Rotavirus H HIB R Rotavirus 3rd
1st 2nd
H HIB I Inactivated H HIB
I Inactivated 1st Poliovirus 2nd I Inactivated 3rd
Poliovirus 1st P Pneumococcal Poliovirus 3rd
2nd
P Pneumococcal 1st P Pneumococcal 3rd

DTAP(Diphtheria, Tetanus and Pertussis)

HIB(Haemophilus Influenza Type B)
 Pediatrics

Vaccine Schedule

AGE 12 Months 18 Months 4-6 Years

Acronyms to HI VAMP DOSE HID DOSE VERY DIM DOSE
remember

H Hepatitis B 4th H Hepatitis A 2nd V Varicella 2nd

I Influenza yearly Hepatitis B 3rd D DTAP 5th
V Varicella 1st I Inactivated I Inactivated Polio 4th
A Hepatitis A Poliovirus 3rd M MMR
1st
M MMR D DTAP 4th 2nd
1st
P Pneumococcal 4th

AGE 11-12 YEARS MMR(Measles, Mumps and Rubella)

TDAP(Tetanus, Diphtheria, Pertussis)
HPV(Human Papilloma Virus)
Acronyms MYTH DOSE
DTAP and TDAP

M Meningococcal 4TH They are same vaccines

Yearly Difference is based on administration for

Y Yearly flu vaccine different age groups
Every 10
T TDAP years DTAP (administered to less than 7 years old)

H HPV 1st TDAP (administered to more than 7 years old)

Pediatric vital signs

Heart rate (beats/min) Respiratory rate (breaths/min)

Age Awake Asleep AGE NORMAL

Neonate(<28 100-2O5
days)
90-160 Infant(<1 year) 30-53

Infant (1-12 100-190

months)

Toddler (1-2 98-140 80-120 Toddler (1-2 years) 22-37

years)

Preschool (3-5 80-120 65-100 Preschool(3-5 years) 20-28

years)

School-age
(6-11 years) 75-118 58-90 School-age (6-11 years) 18-25

Adolescent
(12-15 years) 60-100 50-90 Adolescent(12-15 years) 12-20
 Pediatrics

Vaccine Schedule

Blood pressure (mmHg)

Systolic
AGE Systolic Diastolic hypotension

< 1 kg 30-53 16-36 <40-50

BIRTH (12 HOURS)
3 kg 60-76 31-45 <50

BIRTH (12 HOURS) 67-84 35-53 <60

INFANT (1-12 MONTHS) 72-104 37-56 <70

INFANT (1-12 MONTHS) 86-106 42-63

<70 +
PRESCHOOL (3-5 YEARS) 89-112 46-72 (age in years ×2)

SCHOOL-AGE (6-9 YEARS) 97-115 57-76

PREADOLESCENT (10-11 YEARS) 102-120 61-80

< 90
ADOLESCENT (12-15 YEARS) 110-131 64-83

Temperature (oC) Oxygen Saturation (SpO2)

Method Normal

Rectal 36.6-38.0
SpO2 is lower in the immediate newborn period. Beyond
Tympanic 35.8-38.0 this period, a Sp02 of <90-92% may suggest a
respiratory condition or cyanotic heart diseases.
Oral 35.5-37.5

Axillary 36.5-37.5

PAIN Pain scale : A pain scale is a chart that represents different levels of pain, from mild to severe.

0-10 Numeric pain rating scale

0 1 2 3 4 5 6 7 8 9 10 Numeric scale
( 5+ years old)
None Mild Moderate Moderate
0 2 4 6 8 10 Face scale
(3+ years old)

No Hurt Hurt little bit Hurts litte more Hurt even more Hurts whole lot Hurts worst
 Pediatrics

Vaccine Schedule

CRIES Scale 0 points 1 points 2 points

Crying No High pitched Inconsolable

Requires O2 for Sat>95% No < 30% >30%

HR and BP = HR or BP <20% HR or BP >20%

Increased Vital Signs or < Pre-Op of Pre-Op of Pre-Op

Expression NONE Grimace Grimace/ Grunt

Sleepless No Wakes at Constantly Awake

Frequent Intervals

Crying: The Expression: The Increased Vital Requires O2 for

characteristic cry facial expression Signs: *Note: Take Sat>95% : Look for
of pain is high most often blood pressure changes in
pitched associated with last as this may oxygenation.
pain is a grimace. wake child Babies
Sleepless: This This may be causing difficulty experiencing pain
parameter is characterized by: with other manifest
scored based brow lowering, assessments. Use decreases in
upon the infant's eyes squeezed baseline pre-op oxygenation as
state during the shut, deepening of parameters from a measured by TCo2
hour preceding the naso-labial non-stressed or oxygen
this recorded furrow, open lips period. Multiply saturation
score. and mouth. baseline HR x 0.2
then add this to
baseline HR to
determine the HR
which is 20% over
baseline. Do
likewise for BP. Use
mean BP
 Pediatrics

Vaccine Schedule

A pain scale used to assess pain in infants 2 months to 7 years of age.

FLACC Scale 0 points 1 points 2 points

No particular Occasional grimace or Frequent to constant

FACE expression or frown, withdrawn, frown, clenched jaw,
smile disinterested quivering chin

Normal position
LEGS or relaxed
Uneasy, restless, tense Kicking, or legs drawn up

Lying quietly, Squirming, shifting back

ACTIVITY normal position, and forth, tense
Arched, rigid or jerking
moves easily

No crying( Moans or whimpers; Crying steadily, screams

CRY awake or sleep) occasional complain or sobs, frequent
complaints

Reassured by occasional
touching, hugging or Difficult to console or
CONSOLABILITY Content, relaxed
being talked to, comfort
distractible
 Pediatrics

Vaccine Schedule

Communicable diseases

DISEASE VARICELLA OR CHICKEN POX RUBEOLA OR MEASLES

Airborne By direct contact with nasal or throat

Direct contact to infected person secretions of infected individuals.
Transmission
Inhalation of infected aerosols Breathing in infected droplets
Coughing and sneezing Sneeze, cough and talks of infected person

Incubation 10-12 days from exposure to prodrome and 14

14 to 16 days after exposure to a varicella
days (range 7-21) from exposure to rash onset
period

Classic rash Early symptoms usually last 4–7 days. They

include:
Symptoms
1st phase (Raised bumps called Running nose and gradually increasing fever
papules)
3 Cs hacking Cough+ Conjunctivitis + Coryza
2nd phase (Small fluid-filled blisters (rhinitis)
called vesicles)
Red and watery eyes
3rd phase (Crusts and scabs)
Small white spots with white centers (Koplik's
spots) inside the cheeks
Fever High fever (above 100C)
Headache
Sore throat, or stomachache

Antihistamines such as diphenhydramine No specific treatment

(Benadryl) for itching Bed rest
Treatment
Acetaminophen (Tylenol) A cool-mist humidifier
A cool bath with added baking soda, Drinking plenty of water (keep hydrated)
aluminum acetate or uncooked oatmeal
Acetaminophen (Tylenol) or ibuprofen (Advil,
Calamine lotion Motrin)
Varicella immune globulin (specially for Vitamin A
children at higher risk)

Infection of the lungs (pneumonia) Blindness

Complications Infection or swelling of the brain Encephalitis (an infection causing brain
(encephalitis, cerebellar ataxia) swelling and potentially brain damage)
Bleeding problems (hemorrhagic Severe diarrhea and related dehydration
complications) Ear infections
Severe breathing problems including
pneumonia
 Pediatrics

Vaccine Schedule

DISEASE Rubella or German measles Mumps

When an infected person coughs or By direct contact with nasal or throat

sneezes; an infected pregnant woman secretions of infected individuals.
can pass it to her unborn baby and cause
Breathing in infected droplets
Transmission serious harm.
Sneeze, cough and talks of infected person
Airborne route
Respiratory route

Incubation The average incubation period of rubella The average incubation period for mumps is 16
virus is 17 days, with a range of 12 to 23 to 18 days, with a range of 12 to 25 days
period days

Symptoms Prodromal phase symptoms include: Discomfort in the salivary glands (in the front of
Low-grade fever, the neck) or the parotid glands (immediately in
front of the ears). Either of these glands may
Malaise and sore throat
become swollen and tender.
Lymphadenopathy,
Difficulty chewing
Upper respiratory symptoms preceding
Pain and tenderness of the testicles
the rash
Fever
Mild pink eye (redness or swelling of the
white of the eye) Headache
A rash(maculopapular) that starts on the Muscle aches
face and spreads to the rest of the body Tiredness (malaise)
Forchheimer spots appear in about 20% Loss of appetite
of patients with rubella with enanthem as
small, red spots on the soft palate,
occasionally preceding a rash

Treatment There is no specific medicine to treat Is usually limited to medicines for pain and
rubella plenty of fluids
Can be managed with bed rest and Bed rest is necessary the first few days
medicines for fever, such as
Antipyretics
acetaminophen.
Fluids intake
Antipyretics

Complications Severe breathing problems including Meningitis or encephalitis

pneumonia.
Orchitis
Heart problems,
Mastitis
Loss of hearing and eyesight,
Parotitis
Intellectual disability, and. Oophoritis
Liver or spleen damage Pancreatitis
Deafness
 Pediatrics

Vaccine Schedule

DISEASE Pertussis or whooping cough Diptheria

Through droplets produced during From person to person, usually through

coughing or sneezing. respiratory droplets, like from coughing or
Transmission sneezing
Airborne
Airborne

Incubation The incubation period of pertussis is

commonly 7 through 10 days, with a 2 to 5 days, with a range of 1 to 10 days
period range of 4 through 21 days.

Symptoms Catarrhal stage: can last 1–2 weeks and A thick, gray membrane covering the throat
includes: A runny nose, sneezing, and tonsils (pseudo membrane) can extend to
low-grade fever, and a mild cough larynx and trachea and cause airway
(similar symptoms to the common cold) obstruction
Paroxysmal stage: usually lasts 1–6 A sore throat and hoarseness.
weeks, but can persist for up to 10 weeks.
The characteristic symptom is a burst, or Swollen glands (enlarged lymph nodes) in the
paroxysm, of numerous, rapid coughs. neck.
Convalescent stage: usually lasts 2–6 Difficulty breathing or rapid breathing.
weeks, but may last for months. Nasal discharge.
Chronic residual cough Fever and chills.
Tiredness.

Treatment Several antibiotics (Azithromycin, Antibiotics, such as penicillin or erythromycin

clarithromycin and erythromycin)
Antipyretics
Supportive care, such as plenty of rest
Antitoxins (made from equine (horse) blood)
and fluids, can ease symptoms.
Hospitalization may be needed
Hospitalization may be needed to treat
complications
Nebulizers

Complications Apnea (life-threatening pauses in Myocarditis

breathing)
Neuritis
Pneumonia
Airway obstruction
Convulsions
Encephalopathy
 Pediatrics

Spina Bifida

Normal spinal cord in infant Spinal cord with

spina bifida
Spina bifida is a condition that affects (myelomeningocele)
Vertebrae (bones) Epidural space
the spine and is usually apparent at
birth. It is a type of neural tube defect Nerve roots
Dura (Protective
covering)

(NTD). Spina bifida can happen Spinal Cord

anywhere along the spine if the neural
tube does not close all the way.

Neural tube
The neural tube forms the early brain
and spine at embryonic level. Errors in
this process can lead to congenital
Spinal cord with spina bifida
anomalies, such as neural tube defects. (myelomeningocele)

The neural tube closure is completed

28 days(four weeks) from conception

Cervical
Curve
Vertebra
(Neck)

Causes

Exact cause is UNKNOWN

Thoracic
Curve These following factors can lead to
(Middle abnormality in development of central
Back) nervous system
Disk Genetic factors

Nutritional and environmental factors (radiations etc)

Nerve A family history of neural tube defects
Lumbar Getting too little folate, also known as vitamin b-9,
curve during pregnancy.
(Lower
Back) Overweight(obesity)

Diabetes (sugar imbalance)

Drug addiction including alcohol and other drugs

 Pediatrics

Spina Bifida

Types There are several types of spina bifida, ranging from mild to severe

Occulta Closed Neural Myelomeningocele

(Most common) Tube Defects (NTDs) (Most severe)
or Meningocele
Occulta is the mildest and Closed NTDs involve a Myelomeningocele is the
most common form of spinal defect covered by a most severe form of spina
spina bifida. layer of skin. bifida.
In this type, the spinal This category includes In this type, the spinal
defect is hidden beneath lipomyelomeningocele and canal remains open along
the skin and usually does meningocele. several vertebrae in the
not cause symptoms. lower or middle back.
Lipomyelomeningocele
The spinal cord and nerves involves a fatty mass The spinal cord and nerves
are typically unaffected, (lipoma) attached to the are exposed and may
and individuals may not spinal cord, while protrude through the
even be aware they have meningocele involves a opening in the back,
this condition unless it's sac of cerebrospinal fluid covered only by a thin layer
discovered incidentally and the meninges of skin or a sac containing
during imaging tests for protruding through the cerebrospinal fluid.
unrelated issues. spine.
Myelomeningocele often
Over defect may have the These closed NTDs may or leads to significant
following symptoms due to may not cause symptoms neurological deficits,
tethering of the spinal cord, depending on the size and including paralysis, loss of
cutaneous lesions, a small location of the defect. sensation, bowel and
backmass and meningitis bladder dysfunction, and
with an unusual orthopedic complications
aetiological agent. such as scoliosis

No treatment necessary
if asymptomatic
 Pediatrics

Spina Bifida

Diagnosis Treatment (for meningocel

+ myelomeningocele)

Prenatal diagnosis :Tests before the birth of a Prenatal Care

baby, known as prenatal screening, can check
for spina bifida. Surgical Repair (correction of lesion within
24-48 hours of birth but risk for bladder and
Blood tests bowel incontinence, hydrocephalus and
paralysis increased)
Maternal serum alpha-fetoprotein (MSAFP) test.
Management of Hydrocephalus
Test to confirm high AFP levels.
Orthopedic Care
Ultrasound: An advanced ultrasound can detect
symptoms of spina bifida, such as an open Bladder and Bowel Management
spine or features in the baby's brain. Sometimes
ultrasound also can help your healthcare Physical Therapy and Rehabilitation
professional see how serious spina bifida is. Educational and Developmental Support
Amniocentesis: indicated high levels of Psychosocial Support
alphabfetoproteins leading to spina bifida
SURGERY will not help to recover damage
caused during Myelomeningocele

Nursing interventions (for meningocele + myelomeningocele)

Education and Support: Developmental Support:

Provide education, including the condition's Promote age-appropriate developmental
nature, potential complications, and activities and milestones, considering the child's
management strategies. physical limitations and cognitive abilities.

Skin Care: Family-Centered Care:

Perform regular skin assessments to identify
areas of skin breakdown or pressure injuries. Encourage family involvement in the child's care
and decision-making process.
Bowel and Bladder Management:
Transition Planning:
Which may include scheduled toileting, use of
catheterization techniques, or medications to a transition plan for adolescents with spina
promote continence. bifida as they transition from pediatric to adult
healthcare services.
Mobility and Positioning:
Assess muscle strength, range of motion, and
motor skills. Preventive measures against infections:
Can lead to inflammation of meninges

Nutritional Support:
Monitor the child's growth and nutritional status,
considering factors such as mobility limitations, energy Neurological Monitoring:
expenditure, and potential swallowing difficulties.. Monitor for signs and symptoms of hydrocephalus, such as
changes in head circumference, bulging fontanelles,
Pain Management: irritability, vomiting, and changes in consciousness.
Assess the child's pain levels regularly and implement
appropriate pain management strategies, including
pharmacological and non-pharmacological interventions.
 Pediatrics

Bronchiolitis

Bronchiolitis is lung infection causes swelling , irritation and a buildup of mucus in the small
airways of the lung. These small airways are called bronchioles.

Risk factors: Risk factors:

The factors that increase the risk of Bronchiolitis is caused by a viral infection,
bronchiolitis in infants and young children usually the respiratory syncytial virus (RSV).
include:
RSV is very common and spreads easily in
Being born too early. coughs and sneezes.
Having a heart or lung condition. Almost all children have had it by the time
Having a weakened immune system. This they're 2. In older children and adults, RSV
makes it hard to fight infections. may cause a cough or cold, but in young
children it can cause bronchiolitis.
Being around tobacco smoke.
Contact with lots of other children, such
as in a child care setting.
Spending time in crowded places.
Having siblings who go to school or get Transmission:
child care services and bring home the
infection.
Direct Contact: RSV can spread through direct
contact with respiratory secretions from
infected individuals.
Respiratory Droplets: RSV can also spread
through respiratory droplets produced when
an infected person coughs or sneezes. These
droplets can travel through the air and be
Bronchiolitis Bronchiolitis inhaled by others nearby.
Inflammation and Inflammation and Contaminated Surfaces: RSV can survive on
sweiling of the sweiling of the surfaces for several hours. Touching surfaces
bronchioles bronchioles
contaminated with the virus and then
touching the face can lead to transmission.

Incubation Period:

The incubation period for RSV typically ranges

from 2 to 8 days, During this time, an individual
who has been exposed to the virus may not
show any symptoms but can still spread the
virus to others.
 Pediatrics

Bronchiolitis

Mechanism of SYMPTOMS Progressive

action of RSV Symptoms
(lower airway)
Transmission of RSV
Trachea, bronchi,
Virus through droplets bronchioles, alveoli and
lungs are involved
Worsening Respiratory
Entry through Respiratory Tract Initial Symptoms (upper Distress: As bronchiolitis
airway) Nasal cavity, progresses, respiratory
sinuses, larynx and distress may worsen.
Attachment to Respiratory pharynx are involved Children may have difficulty
Epithelial Cells breathing, with increased
Mild Respiratory Symptoms: work of breathing, such as
Common cold, including a nasal flaring, retractions
Viral Replication in runny or stuffy nose, (visible sinking of the chest
Respiratory Tract sneezing, and mild cough. between the ribs or under
the ribs), and grunting.
Low-grade Fever:
Increased Cough Severity:
Dissemination to Lower Cough: The cough may become
Respiratory Tract more severe and frequent
Nasal Congestion: excess
as the infection progresses,
mucous blocked nose,
often becoming moist or
making breathing difficult.
Inflammation and productive with the
Cell Damage Decreased Appetite production of mucus.

Poor exchange of gas due to Wheezing: a high-pitched

Symptoms: Coughing, Wheezing, deflated alveoli whistling sound heard when
Congestion, Fever, etc. breathing out, It occurs due
to inflammation and
Excess mucous blocks narrowing of the small
Potential Progression to Severe airway & causes alveoli airways in the lungs.
Lower Respiratory Tract Infection to deflate leading to
Cyanosis: a bluish
poor gas exchange discoloration of the skin
and mucous membranes,
Possible Complications: particularly around the lips
Pneumonia, Bronchiolitis, and nail beds, indicating
Respiratory Failure inadequate oxygenation.
Lethargy and Irritability:
Recovery with Supportive due to respiratory distress
Care or Medical Intervention and reduced oxygen levels.
Dehydration: In some cases,
bronchiolitis can lead to
dehydration, particularly if
feeding is compromised
due to respiratory distress
or if there is associated
May lead to emergency sıtuatıon vomiting and diarrhea.
 Pediatrics

Bronchiolitis

Bronchiolitis Pathophysiology

Diagnostics
Smooth
muscle
lightening Normal
around Bronchial
bronchial
The diagnostic process for bronchiolitis: tubes
Tubes
Bronchiole

Medical History: a detailed medical history, including

information about the child's symptoms, the duration of
symptoms, any previous respiratory illnesses, recent
exposure to sick individuals, and any underlying medical
conditions.
Physical Examination: The healthcare provider will listen Smooth
Muscle
to the child's lungs with a stethoscope to check for
abnormal breath sounds such as wheezing, crackles, or
diminished breath sounds. Alveoli
over-inflated
Collapse
Alveoli
with trapped
Clinical Criteria: It typically include the presence of air

respiratory symptoms such as cough, nasal congestion, Mucus buildup

Bronchial Tube
wheezing, and respiratory distress. The diagnosis may be During
Inflamed tissue
Neurosis and loss
further supported by findings such as fever, decreased Bronchiolitis of epithelium
oral intake, and signs of dehydration.
Laboratory Tests: Nasal swab or nasopharyngeal
aspirate to identify the specific antigen of virus THINGS TO CONSIDER HIGHLY
responsible for the infection, such as Respiratory CONTAGIOUS (transmission by
Syncytial Virus (RSV) or other respiratory viruses. touch)
Imaging Studies: Imaging studies such as chest X-rays
A person living with the infected
Additional Evaluation : This may include monitoring person in same room can surely be
oxygen saturation levels, blood tests to assess for infected with the same disease as
dehydration or electrolyte imbalances, and other he surely come in contact with the
assessments as indicated. infected person directly or indirectly

Treatment

Bacterial infections such Oral corticosteroid medicines Lifestyle and home

as pneumonia or an ear remedies
infection can happen along Humidify the air.
Hospital care
with bronchiolitis.
Give your child liquids to
In this case, your child's A small number of children may need stay hydrated.
health care provider may a stay in the hospital. Try saline nose drops to
give an antibiotic for the ease stuffiness.
Your child may receive oxygen
bacterial infection.
through a face mask to get enough
Nebulized albuterol oxygen into the blood.
treatment to see if it helps.
Your child also may get fluids through
During this treatment, a a vein to prevent dehydration.
machine creates a fine mist
In severe cases, a tube may be
of medicine that your child
guided into the windpipe to help
breathes into the lungs
breathing.
 Pediatrics

Croup

Croup Pathophysiology
Croup is a common respiratory illness of the trachea, larynx, Viral droplets enter body
and bronchi collectively called as Laryngotracheobronchitis
that can lead to inspiratory (the act of breathing in)
Infection Spreads to Upper Respiratory
Tract(infecting nasal cavity and pharynx)
CAUSES
Viral infections
Inflammation of the Larynx and Trachea
Parainfluenza virus (most common virus causing this disease)
Influenza A and B
Measles Edema (Swelling) of the Larynx and
Subglottic Region
Adenovirus
Respiratory syncytial virus (RSV)
Narrowing of Airway Passage including
Some bacteria can also causes this disease subglottic area (trachea and vocal cords)
due to mucous production
Corynebacterium diphtheriae
Staphylococcus aureus
Streptococcus pneumonia Respiratory Distress (difficulty breathing)
Hemophilus influenzae,
Moraxella catarrhalis.

Risk factors for developing croup include:

Respiratory Distress (difficulty breathing) Narrow
Age (6 months and 3 years old) Lumen
Season ( during the fall and early winter months )
Exposure to Irritants (cigarette smoke, air pollution, or other
respiratory irritants)
Family History
Weekend Immune system

Thickened smooth

Trachealis Inflammation
Trachea
muscle
Viral infection

Lymen
Lung

Smooth
Muscle
 Pediatrics

Croup

Initial Symptoms Progressive Symptoms Severe Symptoms

Barking cough (seal bark) Worsening cough Extreme respiratory distress:

Breathing may become severely
Hoarseness (change in pitch of Increased respiratory distress:
compromised, with pronounced
voice) Breathing difficulties may
stridor and significant difficulty
worsen, with more noticeable
Mild respiratory symptoms: Mild moving air in and out of the
stridor
difficulty breathing, which may lungs.
sound like stridor (an abnormal, Labored breathing (sounds like
Cyanosis (The skin, lips, or
high-pitched respiratory sound grunting, the “Ugh” sound)
fingernails may turn blue or
produced by irregular airflow in
Agitation or anxiety grayish due to low oxygen
a narrowed airway)
Increasing fever levels)
Low-grade fever
Fatigue or lethargy
NIGHT SYMPTOMS:DURING Altered mental status (confused,
NIGHT DURATION THESE drowsy, or unresponsive)
SYMPTOMS APPEAR
Difficulty swallowing
Signs of impending respiratory
failure: These include severe
difficulty breathing, extreme
lethargy, or loss of
consciousness.

Urgent medical help can be

needed in this situation (urgent
hospitalization)

How is croup diagnosed? Medication

Oral or inhaled steroids (such as
Your child’s provider will do a complete medical dexamethasone or budesonide steroids)
history and physical examination. Other tests Epinephrine(BRONCHODILATORS)
may be needed, including: Antibiotics acetaminophen (Tylenol) or
ibuprofen (Advil, Motrin)
Neck and chest X-rays for signs(STEEPLE SIGN) of
airway narrowing or obstruction. The steeple sign Heliox
represents the glottic and subglottic narrowing of the
Home treatments:
airway typically seen in children with croup
Home treatments may include:
Blood tests for bacterial infection.
Using a cool mist humidifier
Pulse oximetry. An oximeter is a small device that
measures the amount of oxygen in the blood. Taking the child outside into cool, moist, night air
DIAGNOSIS IS USUALLY BASED OFF CURRENT Drinking lots of fluids
SYMPTOMS Treating a fever with acetaminophen or
ibuprofen, as instructed by your child's provider
(Do NOT give a child aspirin as it can cause a
condition called Reye syndrome)
Keeping your child as quiet and calm as possible
to make it easier to breathe.
Rest
 Pediatrics

Epiglottitis

Epiglottitis is an inflammatory condition of the epiglottis and/or nearby structures including the
arytenoids, aryepiglottic folds, and vallecular and may cause obstruction of airways

Function of epiglottis Affected person should not be given

anything in mouth because it can cause
blockage in airway and laryngeal spasm
The epiglottis itself is a small, leaf-shaped flap of
cartilage located at the base of the tongue, in the
throat.
Its primary function is to prevent food and liquids
from entering the airway during swallowing.
When you swallow, the epiglottis folds down over Nasal Cavity
the opening of the larynx (voice box) to cover it,
essentially acting like a lid, directing food and
liquids toward the esophagus instead of the
trachea (windpipe). This action helps prevent Oral Cavity
choking and aspiration of food or liquid into the
lungs Epiglottis

During eating epiglottis closes while during

breathing it remains open

It can be CONTAGIOUS. If epiglottitis is the result of a

bacterial, fungal or viral infection, then it can spread
from person to person through droplets of saliva or Airways
mucus.
Food pipe

Healthy Inflammed

Epiglottis

Vocal
Cords

Airway
 Pediatrics

Epiglottitis

Severe form of symptoms can lead to completely

Symptoms: airway obstruction

Agitation or Restlessness: Individuals with epiglottitis

Symptoms of epiglottitis can develop rapidly and may appear anxious, restless, or agitated due to
include: difficulty breathing and discomfort.
Cyanosis: In severe cases, lack of oxygen can cause
3 D’S ( Dysphagia, Drooling, Distress) cyanosis, a bluish discoloration of the skin and
mucous membranes, particularly around the lips
Severe Sore Throat: Epiglottitis typically causes a and nail beds, indicating inadequate oxygenation.
severe sore throat, which may worsen quickly. The
pain may be intense and may radiate to the ears. Lack of oxygen (hypoxia)

Dysphagia (Difficulty Swallowing): Swallowing may Nasal flaring

become extremely painful and difficult due to the Cough is not observed
swelling of the epiglottis.
Drooling: Difficulty swallowing saliva may lead to
excessive drooling, especially in children.
Muffled or Hoarse Voice: The voice may sound
muffled, hoarse, or raspy due to obstruction of the Causes:
airway.
High Fever: Epiglottitis is often associated with a high
The primary cause of epiglottitis is infection, most
fever, which may develop suddenly.
commonly due to bacteria.
Difficulty Breathing: As the condition progresses,
The bacterium Haemophilus influenzae type B (HIB)
difficulty breathing and shortness of breath may
used to be the leading cause of epiglottitis in
occur. In severe cases, this can lead to respiratory
children.
distress, characterized by rapid breathing, stridor (a
high-pitched sound when breathing in), and Other infectious agents that can cause epiglottitis
retractions (visible sinking of the skin between the include Streptococcus pneumoniae, Streptococcus
ribs or above the collarbone during breathing). pyogenes (group A streptococcus), and
Staphylococcus aureus.
Appearance of Red cherry colored epiglottis due to
inflammation Some viruses implicated in epiglottitis include
herpes simplex virus (HSV), varicella-zoster virus
Prefers Sitting Upright: People with epiglottitis may
(the virus that causes chickenpox and shingles),
prefer to sit upright and lean forward in an attempt
and respiratory viruses such as influenza virus.
to open the airway and ease breathing.
Other potential causes or risk factors for
epiglottitis include:
Direct trauma to the throat or neck area can cause
inflammation and swelling of the epiglottis.

Risk factor Injury or trauma

Chemical burns: Exposure to caustic substances or
Age: ( the ages of 2 and 7 years old) hot liquids
Incomplete or Unvaccinated Status. Autoimmune diseases: In rare cases, autoimmune
Weakened Immune System conditions such as Kawasaki disease or systemic
lupus erythematosus (SLE) may lead to epiglottitis.
History of Upper Respiratory Infections
Allergic reactions: Severe allergic reactions, such
Environmental Factors: Exposure to secondhand as anaphylaxis, can cause rapid swelling of the
smoke or environmental pollutants. throat tissues, including the epiglottis, leading to
Previous exposure to Epiglottitis airway obstruction.
Anatomical Abnormalities: Structural abnormalities
of the throat or airway, such as a large or floppy
epiglottis
Poor oral hygiene and dental health
Crowded living conditions (daycare , schools )
Seasonal Factors: during the fall and winter months
 Pediatrics

Epiglottitis

Diagnostics : Treatment
Urgent treatment ıs
Physical Examination: requıred to treat aırway
obstructıons
Occulta is the mildest and most common form of spina bifida.
Intravenous (IV) therapy
In this type, the spinal defect is hidden beneath the skin and usually with antibiotics will be started
does not cause symptoms. immediately. This will help
treat the infection by the
The spinal cord and nerves are typically unaffected, and individuals
bacteria.
may not even be aware they have this condition unless it's
discovered incidentally during imaging tests for unrelated issues.
Treatment may also
Over defect may have the following symptoms due to tethering of include:
the spinal cord, cutaneous lesions, a small backmass and meningitis
with an unusual aetiological agent. Steroid medication (to reduce
airway swelling)
Imaging Studies: X-rays, particularly lateral neck X-rays, may show a
Intravenous (IV) fluids, until
swollen epiglottis, though this is not always reliable, especially in
the child can swallow again
children.
Humidified oxygen
Other imaging modalities such as CT scans or MRI may also be used
in certain cases. Breathing tube
Soothe patient by creating
save and positive
Laboratory Tests: Blood tests such as a complete blood count (CBC)
environment around him
with differential may show elevated white blood cell count, indicating
an inflammatory response. Avoid things that disturbs the
patient, make him
BLOOD/ THROAT cultures may be obtained to identify any bacterial
comfortable.
infection, which can guide antibiotic therapy.

Direct Laryngoscopy: Direct visualization of the epiglottis using a

laryngoscope is the gold standard for diagnosing epiglottitis.

Here are some nursing

Nursing intervention: interventions for epiglottitis:

Assessment signs, including oxygen saturation levels, heart rate, and respiratory rate.
FIRST PRIORITY
Maintain Airway Patency: Keep the patient in a position of comfort that optimizes airway patency, such as sitting
upright and leaning forward.
Monitor vital, such as throat examination or insertion of a tongue depressor.
Oxygen Therapy: Administer supplemental oxygen and monitor oxygen saturation levels closely and titrate oxygen
flow rate accordingly.
Monitor Respiratory Status: including respiratory rate, depth, and effort, as well as the presence of stridor, wheezing,
or retractions.
Maintain NPO Status
Prepare for Intubation: Be prepared to assist with endotracheal intubation.
Administer Medications: Follow prescribed medication administration protocols and monitor for any adverse
reactions.
Provide Emotional Support & patient education
Prepare for Discharge or Transfer
Ensure that the patient and family understand follow-up care instructions and have
access to appropriate resources for ongoing support.
 Pediatrics

Otitis Media

Normal middle ear Otitis media

Otitis media
Otitis media is an infection of the middle
ear that causes inflammation (redness
and swelling) and a build-up of fluid
behind the eardrum.
Acute otitis media:
The symptoms of a middle ear infection (otitis
media) develop quickly and resolve in a few days.

Otitis media with effusion (OME):

Otitis media with effusion (OME) is a collection of
non-infected fluid in the middle ear space. It is also Ear Auditory Eustachian Infected fluid
called serous or secretory otitis media (SOM). Drum Bones tube in middle ear

Risk Factors:
Symptoms of
a middle ear infection Allergies
Lack of breastfeeding
The main symptoms include:
Poor air quality
A high temperature (fever) being sick Low socioeconomic group
Ear pain Season
Trouble sleeping Age (Higher risks for younger persons specially
Loss of appetite Childrens)

Yellow, brown or white drainage from your ear Upper respiratory tract infection

A lack of energy Passive smoke

Slight hearing loss – if the middle ear becomes Daycare attendance

filled with fluid Lower socioeconomic status
Complications can lead to perforations(holes) in Family history of recurrent AOM in parents or
ear and complete hearing loss siblings
 Pediatrics

Otitis Media

Otitis media, which is an infection or inflammation of the middle ear, can have several
potential causes of blockage, including:

Fluid accumulation: In otitis media with effusion (OME), fluid builds up in the middle ear without active
infection. This fluid can become trapped behind the eardrum, leading to a sensation of fullness or
blockage in the ear.
Mucus and inflammation: During an acute episode of otitis media (acute otitis media), the middle ear
can become inflamed due to bacterial or viral infection. This inflammation can lead to swelling of the
Eustachian tube, the passage that connects the middle ear to the back of the throat. Swelling of the
Eustachian tube can impair its function, leading to difficulty equalizing pressure in the middle ear and
causing a sensation of blockage.
Enlarged adenoids: The adenoids are glands located near the opening of the Eustachian tube in the
back of the throat. Enlarged adenoids, often due to repeated infections or allergies, can block the
Eustachian tube, leading to fluid accumulation and otitis media.
Allergies: Allergic inflammation in the nose and throat can also lead to Eustachian tube dysfunction
and contribute to otitis media by blocking the drainage of fluid from the middle ear.
Anatomical abnormalities: Structural abnormalities of the Eustachian tube or middle ear can also
contribute to blockage and predispose individuals to recurrent otitis media.
Upper respiratory infections: Infections of the upper respiratory tract, such as the common cold or
sinusitis, can lead to inflammation and congestion in the nasal passages and Eustachian tube,
contributing to otitis media.

Pathology Diagnosis
Physical Examination
Onset of Risk Factors/Triggers
Otoscopy (examination of ear)
Eustachian Tube Dysfunction Otitis media with effusion Will show fluid buildup in ear acute otitis
media
Impaired Middle Ear Ventilation Will show red & bulging tympanic membrane
Purulent drainage may be present

Accumulation of Fluid in Middle Ear Tympanometery :

This test uses air pressure to check for fluid in your child’s
Proliferation of Bacteria/Virus middle ear.

Acoustic reflectrometry :
Inflammation and Infection of Middle Ear This test uses sound waves to check for fluid in your
child’s middle ear.
Increased Pressure and Pain
Tympanocentensis :
To remove fluid from your child’s middle ear recommend.
Potential Rupture of Eardrum Tympanocentesis if other treatments haven’t cleared the
infection.
Resolution or Chronicity Hearing Test:
Hearing loss is more common in children with
Internal blockage can cause different allergies long-lasting or frequent ear infections or fluid in the
middle ear that doesn’t drain.
and upper respiratory infections

External blockage can cause tumors and trauma

 Pediatrics

Otitis Media

Treatment Nursıng ınterventıons

Medication Supportive care:

Non-steroidal anti-inflammatory Pain Management: pain relievers such as ibuprofen or acetaminophen

drugs (NSAIDs) or
acetaminophen Cholesteatoma Take Rest

Oral antibiotics can only be Hydration: Ensure adequate hydration by drinking plenty of fluids.
administered if other
medications can’t resolve the Nasal Decongestants: If congestion is present, over-the-counter nasal
symptoms after 72 hours decongestants or saline nasal spray may help relieve nasal congestion

Azithromycin Humidifier Use: Using a humidifier in the bedroom can help keep the air
moist, which can prevent nasal passages from drying out and promote
Clarithromycin easier breathing.
Amoxicillin
Avoiding Irritants: Encourage the avoidance of tobacco smoke and other
Penicillin-allergic patients are irritants, as these can exacerbate symptoms and delay healing.
cefdinir , cefpodoxime and
cefuroxime Positioning(For infants, feeding in an upright position can help prevent milk
from entering the Eustachian tube )
Surgery Follow-Up: It's important to follow to assess whether antibiotics or further
treatment are necessary.
For recurrent infections:

Myringotomy with tube

(grommet) placement

A procedure to create a hole in

the ear drum to allow fluid that is
trapped in the middle ear to
drain out.
 Pediatrics

Cystic Fibrosis (CF)

Normal airways
Cystic fibrosis (CF) is a genetic disorder that
primarily affects the exocrine glands, leading to the
production of thick, sticky mucus in various organs
throughout the body. Airwal wall
Function OF EXOCRINE GLAND : The exocrine glands
are responsible for producing and secreting fluids,
including mucus, sweat, saliva, and digestive
enzymes. A thin layer of mucus
coats the airway wall
CF is caused by mutations in the cystic fibrosis
transmembrane conductance regulator (CFTR)
gene, which regulates the movement of salt and
water across cell membranes.

It is autosomal recessive disease in terms of

genetics

Both the parents must be carrier of CF defective

gene to cause disease in offspring.

Airways affected by cystic fibrosis

Cystıc fıbrosıs symptoms:

Dilated Airways
Cystic fibrosis (CF) affects both the gastrointestinal
(GIT) and respiratory systems due to the abnormal
A thick and sticky mucu
function of the cystic fibrosis transmembrane
blocks the airways
conductance regulator (CFTR) protein.

Blood in the mucus

Gastroıntestınal symptoms: Bacterial infection

Pancreatic Insufficiency: leads to malabsorption

of nutrients, particularly fats and fat-soluble
vitamins (A, D, E, and K). Malabsorption can
result in poor growth, weight loss, and
deficiencies in essential nutrients.

Meconium Ileus: Meconium ileus is a condition

characterized by the obstruction of the intestine Others symptoms
with thick, sticky meconium (the first stool of a
newborn). It is often the first sign of CF in (excluding GIT and respiratory system)
newborns.
Trouble with bowel movements or frequent, greasy
Distal Intestinal Obstruction Syndrome (DIOS): stools
DIOS is a complication of CF that affects the
Wheezing or trouble breathing
distal part of the intestine (usually the ileum or
colon). It results from the accumulation of thick Frequent lung infections
mucus, leading to intestinal blockage, Infertility, especially in men
abdominal pain, and constipation.
Trouble growing or gaining weight
Liver Disease: CF-related liver disease can occur
Skin that tastes very salty
due to abnormal bile flow and liver damage.
This can lead to complications such as liver
cirrhosis, portal hypertension, and bile duct
obstruction.
 Pediatrics

Cystic Fibrosis (CF)

Respıratory symptoms:
Chronic Lung Infections: Thick, sticky mucus in the airways creates an ideal environment for bacterial growth,
leading to recurrent respiratory infections. Pseudomonas aeruginosa and Staphylococcus aureus are common
pathogens associated with CF lung infections.

Persistent Cough: Individuals with CF often have a persistent cough due to the presence of mucus in the airways. The
cough is typically productive and may be accompanied by sputum production.

Wheezing and Dyspnea: Airway obstruction caused by mucus accumulation can lead to wheezing (high-pitched
whistling sound during breathing) and dyspnea (difficulty breathing), especially during physical activity or
exacerbations of respiratory infections.

Bronchiectasis:

Chronic inflammation and recurrent infections can cause damage to the airway walls, leading to bronchiectasis.

Bronchiectasis is characterized by abnormal widening and scarring of the bronchi, which further impairs lung
function.

Respiratory Failure: Progressive lung damage in CF can eventually lead to respiratory failure, where the lungs cannot
provide adequate oxygen to the body or remove carbon dioxide effectively.

Other symptoms of cystıc fıbrosıs

Failure of the chloride channel to reabsorb chloride leads to a loss of sodium onto the skin surface and a
subsequent fluid loss. This causes the pathognomonic salty skin seen with cystic fibrosis.

Electrolyte imbalances. These electrolyte imbalances include hyponatremia, hypochloremia, hypokalemia, and
metabolic alkalosis.

Can cause infertility in males and females

Dıagnostıcs:

Clinical Evaluation: Sweat Test: Newborn Screening:

Physicians typically begin by taking a The sweat test is the standard Elevated levels of
detailed medical history and performing diagnostic test for cystic fibrosis. It immunoreactive trypsinogen
a physical examination include chronic measures the concentration of chloride (IRT), a protein that is often
respiratory symptoms such as coughing, in sweat, which is typically elevated in elevated in newborns with CF.
wheezing, recurrent lung infections, and individuals with CF due to impaired salt
difficulty breathing, as well as transport in sweat glands. If IRT levels are elevated, further
gastrointestinal symptoms such as poor diagnostic testing, including
weight gain, intestinal blockage, and During the test, a small electric current is genetic testing and sweat
foul-smelling, greasy stools. used to stimulate sweating, usually on testing, may be performed to
the forearm or the back. Sweat is then confirm the diagnosis.
Genetic Testing: collected on a pad or paper and
Genetic testing can identify mutations in analyzed in a laboratory to measure Imaging Studies:
the CFTR gene, which is responsible for chloride levels.
cystic fibrosis. Value less than 39 MMOL indicated Imaging studies such as chest
negative result X-rays or CT scans may be used
Value 40-59 MMOL indicates further
testing required
Value greater than 60 MMOL indicates
positive result
 Pediatrics

Cystic Fibrosis (CF)

Gastroıntestınal treatment
No cure is available but supportive treatment is given below:

Pancreatic Enzyme Replacement Therapy (PERT): Individuals with CF-related pancreatic insufficiency require
pancreatic enzyme supplements with meals and snacks to aid in digestion and nutrient absorption.

These enzymes help break down fats, proteins, and carbohydrates in the small intestine.
Nutritional Support: A high-calorie, high-protein diet is essential for individuals with CF to meet their increased
energy needs and promote growth and weight gain

Nutritional supplements may be recommended if oral intake is inadequate.

Fat-Soluble Vitamin Supplementation: Since CF can lead to malabsorption of fat-soluble vitamins (A, D, E, and K),
supplementation with these vitamins is often necessary to prevent deficiencies and maintain overall health.

Management of Intestinal Obstructions: Treatment for conditions such as meconium ileus and distal intestinal
obstruction syndrome (DIOS) may involve bowel rest, hydration, and administration of laxatives or enemas to
help clear the obstruction.
Treatment of Liver Disease: Management of CF-related liver disease may include medications to improve bile
flow, nutritional support, and monitoring for complications such as liver cirrhosis and portal hypertension.

Respıratory Treatment:
No cure is available but supportive treatment is given below:

Airway Clearance Techniques: Regular airway clearance techniques, such as chest physiotherapy (CPT), helps
prevent thick mucus buildup in your lungs.

Mucus buildup can trap bacteria, leading to infections. These infections can result in swelling that tightens your
airways and causes more mucus production and lung damage.

Postural drainage: the person lies or sits in various positions so the part of the lung to be drained is as high as
possible. That part of the lung is then drained using percussion, vibration, and gravity.

Antibiotic Therapy: Antibiotics are commonly percussion, vibration, and postural drainage, help loosen and clear
mucus from the airways, reducing the risk of infections and improving lung function.

Inhaled Medications: Inhalation of medications such as bronchodilators (e.g., albuterol) and mucolytics (e.g.,
dornase alfa) helps open the airways and thin mucus, making it easier to clear from the lungs to treat respiratory
infections in individuals with CF. They may be administered orally, intravenously, or through inhalation, depending on
the severity of the infection.

Anti-inflammatory Medications: Inhaled corticosteroids or oral anti-inflammatory medications

Lung Transplantation: In severe cases of CF-related lung disease, lung transplantation may be considered as a
treatment.

Oxygen Therapy: Supplemental oxygen may be required in cases of respiratory failure or severe hypoxemia to
ensure adequate oxygenation of tissues.

Vaccinations: Routine vaccinations, including the annual influenza vaccine and pneumococcal vaccines, are
essential for individuals with CF to prevent respiratory infections and complications

Huff coughing technique: Huffing is similar to coughing. Instead of a forceful cough effect, air is let out steadily while
whispering the word "huff,.
 Pediatrics

Kawasaki

Kawasakı
Kawasaki disease is a condition that primarily affects children and involves inflammation of the blood
vessels throughout the body. Specially CORONARY ARTERIES are affected

Risk factors Pathology:

for kawasaki disease:
Triggering Event (e.g., infectious agent, toxin)
Age:
Immune Response Activation
Children under 5 years old are predominantly affected.

Gender: Endothelial Cell Activation

Boys are more commonly affected than girls.
Leukocyte Recruitment
Ethnicity

Higher incidence among individuals of Asian descent, Leukocyte Recruitment

particularly Japanese.
Coronary Artery Involvement
Genetics:

Increased risk in individuals with a family history of Systemic Manifestations ( Fever, rash,
Kawasaki disease. conjunctivitis, lymphadenopathy, and mucosal
change )
Seasonality:

Increased incidence during winter and spring months. Resolution or Complications

Infectious Triggers:

Some evidence suggests that certain viral or bacterial

infections may trigger the disease.
Resolution or Complications
Environmental Factors:
Resolution or Complications
Exposure to toxins or pollutants may play a role in
disease development.
Coronary Artery Aneurysm Formation
Immune Dysregulation:

Underlying immune dysregulation or genetic Coronary Artery Thrombosis

predisposition may contribute to susceptibility.
Coronary Artery Thrombosis
Geographical Location:

Higher incidence in certain regions or countries. Heart Failure

Socioeconomic Status:
Arrhythmias
Some studies suggest a possible association with lower
socioeconomic status
Pericarditis

Valvular Abnormalities
 Pediatrics

Kawasaki

Symptoms of Kawasaki Disease at Different Stages:

Acute Febrile Stage Subacute Stage Convalescent Stage

High fever persisting for at (1 to 2 weeks after onset): (2 to 4 weeks after onset)
least 5 days (often > 39°C
Desquamation (peeling) of Resolution of fever and most
or 102°F).
the skin, particularly on hands acute symptoms.
Conjunctival injection (red and feet. Restoration of energy levels.
eyes) without discharge.
Joint pain or arthritis.
Possible lingering signs of
Changes in lips and oral
Continuing fever, though inflammation (e.g., elevated
cavity:
usually lower than in acute erythrocyte sedimentation
Red, cracked lips. stage. rate, C-reactive protein).
Strawberry tongue Irritability, fatigue, and Coronary artery abnormalities
(red and swollen). malaise may persist. may become apparent
through imaging studies.
Oral mucosa may be Thrombocytosis (elevated
inflamed. level of platelets) Characteristic transverse
grooves of the fingernails,
Rash
'Beau's lines', may be seen
Widespread, non-vesicular, during this phase.
often erythematous rash,
particularly on trunk and
perineum.
HIGHEST RISK OF ANEURYSM
Changes in extremities:
AND ALSO SUDDEN DEATH
Edema and erythema of
hands and feet, sometimes
with peeling skin.
Cervical lymphadenopathy:
Often unilateral, large,
tender lymph nodes.
 Pediatrics

Kawasaki

Symptoms of Kawasaki Disease at Different Stages:

Lab dıagnostıcs: Serologic Tests:

May perform tests to rule out other conditions
Complete Blood Count (CBC): with similar presentations (e.g., viral serologies,
antinuclear antibody [ANA] testing).
Elevated white blood cell count (leukocytosis).
Cardiac Biomarkers:
Thrombocytosis (elevated platelet count) in the
acute phase Brain natriuretic peptide (BNP) and troponin
levels may be elevated in cases of myocardial
Inflammatory Markers: involvement or coronary artery abnormalities.
Elevated erythrocyte sedimentation rate (ESR) Electrolytes and Renal Function:
and C-reactive protein (CRP) levels, indicating
systemic inflammation. Electrolyte abnormalities (e.g., hyponatremia,
hypoalbuminemia) may occur due to systemic
CRP typically peaks around 7-10 days after inflammation and fluid shifts.
fever onset.
Renal function tests may show abnormalities in
Liver Function Tests: severe cases with renal involvement
Transient elevation of liver enzymes (aspartate Imaging Studies:
transaminase [AST], alanine transaminase
[ALT]) may occur. Echocardiography is essential for evaluating
coronary artery abnormalities and assessing
Urinalysis: cardiac function.
Mild proteinuria and sterile pyuria may be Chest X-ray may reveal signs of cardiac
present. enlargement or pulmonary abnormalities in
severe cases.
Coagulation Studies:
Genetic Testing:
Prolonged prothrombin time (PT) and activated
partial thromboplastin time ( aPTT ) may be Not routinely performed but may be considered
seen in severe cases with liver involvement. in patients
With atypical presentations or recurrent
Kawasaki disease to
Evaluate for genetic susceptibility.

When thinking about the diagnostic criteria Warm – 5 days of fever

for Kawasaki Disease, think of the mnemonic or more Plus 4 of 5:
WARM CREAM

Normal artery Normal blood flow Artery cross-section

CREAM

Conjunctivitis – bilateral, non-purulent, peri-limbic sparing

Rash – generalized non-vesicular (commonly maculopapular, Artery with inflammation Decreased blood flow
morbilliform of the trunk but no specific rash is
pathognomonic)
Extremity changes – erythema and edema of hands and feet,
followed by desquamation
Aneurysm Abnormal blood flow
Adenopathy – anterior cervical with at least one palpable
node ≥1.5 cm
Mucous membrane changes – cracked red lips, “strawberry”
tongue
 Pediatrics

Kawasaki

Treatment of kawasakı dısease:

Supportive Care:
Intravenous
Immunoglobulin (IVIG):
Supportive care:
Administered at a high dose (2g/kg) over 10-12 hours.
Fluid and electrolyte management to
Reduces the risk of coronary artery abnormalities and fever prevent dehydration and maintain
duration when given within the first 10 days of illness onset. hydration.
Aspirin: Management of pain and discomfort.

Given in high doses (80-100 mg/kg/day) until the patient Monitoring for potential complications,
becomes afebrile, then reduced to antiplatelet doses (3-5 including myocarditis, pericarditis, and
mg/kg/day) until inflammation subsides and platelet count arrhythmias.
normalizes.
Long-term Follow-up:
Anti-inflammatory and antipyretic effects.
Patients require long-term follow-up with
Helps prevent thrombosis in coronary arteries.
pediatric cardiology.
Additional Therapies for Refractory Cases:
Parents should be educated or aware about
If fever persists despite initial IVIG treatment, a second dose of not using live vaccines. They should wait for
IVIG may be considered. 11 months. MMR and Varicella should be
considered
Corticosteroids (e.g., prednisolone) may be used as adjunctive
therapy in cases of IVIG resistance or in patients at high risk for
coronary artery complications.

Management of Coronary Artery Abnormalities:

Patients with coronary artery aneurysms or other abnormalities
require close monitoring.

Antiplatelet therapy (usually aspirin) and/or anticoagulation

may be indicated.
VAC
C

Consultation with a pediatric cardiologist for further

INE

management and follow-up.

 Pediatrics

Kawasaki

Nursıng ınterventıon:

Assessment and Monitoring:

Conduct thorough assessments of vital signs, including temperature, heart rate, respiratory rate, and blood
pressure, at regular intervals.
Monitor for signs of systemic inflammation, including fever, irritability, and malaise.
Assess for signs of cardiac involvement, such as chest pain, abnormal heart sounds, or changes in heart rate and
rhythm.
Monitor for signs of dehydration and electrolyte imbalances, such as decreased urine output, dry mucous
membranes, and altered mental status.
Supportive Care:

Provide comfort measures to alleviate fever and discomfort, such as tepid sponge baths, appropriate clothing,
and a cool environment.
Encourage adequate fluid intake to prevent dehydration and maintain hydration.
Administer antipyretic medications, such as acetaminophen, as prescribed to reduce fever and relieve
discomfort.
Provide emotional support to both the child and their family, as Kawasaki disease can be a stressful and
frightening experience.

Medication Administration:

Administer intravenous immunoglobulin (IVIG) and aspirin as prescribed, monitoring for adverse reactions and
therapeutic response.
Educate parents or caregivers on the proper administration and monitoring of medications, including dosages,
frequency, and potential side effects.
Monitor for signs of aspirin toxicity, such as tinnitus, dizziness, or gastrointestinal bleeding.

Safety Measures:

Implement fall precautions, especially in children receiving high-dose aspirin therapy, due to the risk of bleeding
and dizziness.
Ensure that the child's environment is free from potential hazards and promote a safe and supportive
atmosphere.
Patient Education:

Educate parents or caregivers about the signs and symptoms of Kawasaki disease, the importance of adherence
to treatment regimens, and the need for long-term follow-up care.
Provide information on the potential complications of Kawasaki disease, including coronary artery abnormalities,
and the importance of ongoing monitoring and management.
Collaboration and Referral:

Collaborate with other members of the healthcare team, including physicians, pediatric cardiologists, and other
specialists, to ensure comprehensive care and management of the child with Kawasaki disease.
Facilitate referrals to appropriate specialists for further evaluation and management of complications, such as
coronary artery abnormalities or myocardial involvement.
Documentation:

Maintain accurate and detailed documentation of assessments, interventions, and patient responses to
treatment in the medical record.
 Pediatrics

Reye’s Syndrome

Reye’s syndrome is a rare

Other Symptoms: Cause
form of acute
encephalopathy and fatty
infiltration of the liver that Keep being sick (vomiting) Cause not completely known
occurs almost exclusively in
Be drowsy and lack energy
children < 18 years old. Patient contracts a viral
Feel confused infection, such as influenza,
It tends to occur after certain
chickenpox, or respiratory
viral infections, especially Have changes in their behavior ,
syncytial virus (RSV).
varicella or influenza A or B, such as being irritable or
and particularly when aggressive Aspirin Exposure: Patient
salicylates are used. consumes aspirin or products
Breathe quickly and have a fast
containing aspirin during the
heart rate
viral illness.
Have fits (seizures)
Lose consciousness

Maın symptoms

Liver Dysfunction:
Aspirin triggers mitochondrial dysfunction and impairs fatty acid oxidation in the liver.

Mitochondrial Damage:
Mitochondrial dysfunction leads to the accumulation of toxic metabolites and disrupts energy production.

Hepatic Encephalopathy:
Liver dysfunction results in the accumulation of ammonia and other toxins in the blood, leading to hepatic
encephalopathy.
Brain Edema and Injury:
Increased ammonia levels and metabolic disturbances cause cerebral edema and injury, resulting in altered
mental status, seizures, and coma.
Systemic Effects:
Disruption of metabolic processes and organ dysfunction may lead to multi-organ failure, including renal and
respiratory failure.
Clinical Manifestations:
Symptoms may include vomiting, confusion, irritability, lethargy, seizures, and altered consciousness
 Pediatrics

Reye’s Syndrome

Pathology: Reye Syndrome

Triggering Event
Initial viral infection, often influenza or Encephalopathy, Papilledema
chickenpox, or the use of aspirin during the cerebral adema
infection. ( ICP )
Aspirin Ingestion
Consumption of aspirin during the viral illness.

Mitochondrial Dysfunction
Aspirin triggers mitochondrial dysfunction in
liver cells.
Impaired Fatty Acid Metabolism
Mitochondrial dysfunction leads to impaired
beta-oxidation of fatty acids.

Accumulation of Toxic Intermediates

Accumulation of toxic intermediates such as
fatty acid metabolites, particularly in liver cells. Hepatic failure,
hepatomegaly,
Liver Damage fatty degenarion
Hepatic injury occurs due to the toxic effects of
accumulated metabolites.

Encephalopathy
Toxic metabolites and liver dysfunction lead to
encephalopathy.

Cerebral Edema
Encephalopathy causes cerebral edema due to
altered metabolism and electrolyte
imbalances. Past viral
Brain Dysfunction infection (e.g.,
VZV, influenza
Cerebral edema and metabolic disturbances
3-5 days ago)
result in brain dysfunction.

Clinical Manifestations
Clinical symptoms include vomiting, confusion,
seizures, and potentially coma.

Laboratory studies

AST/ALT Hyperammonemia Hypolycemia

Prothrombin time
Seuzire Headhache Confusion Vomiting
 Pediatrics

Reye’s Syndrome

Diagnostics Tests may include: Risk factors These include:

History and physical examination consistent with Viral Infections: Reye's syndrome often occurs in
encephalopathy and hepatic dysfunction ( elevated children and teenagers recovering from a viral
levels of AST, ALT, AMMONIA and Coags) infection, especially influenza (the flu) ,chickenpox ,
respiratory syncytial virus (RSV) or adenovirus.
Blood sample for liver function, electrolytes, and
ammonia level and urine tests Salicylate Use: The use of aspirin (acetylsalicylic acid)
or products containing aspirin during a viral illness,
Head CT or MRI, sometimes cerebral spinal fluid particularly in children and teenagers, is strongly
evaluation associated with Reye's syndrome.

An electroencephalogram (EEG) Age: it affects children and teenagers under the age
of 18, with a peak incidence between 4 and 12 years
A lumbar puncture– where a thin needle is inserted old.
into their lower back to remove a small amount of
spinal fluid for testing Family History
Metabolic Disorders: such as fatty acid oxidation
a liver biopsy– where a small sample of cells from the
disorders
liver is taken for testing
Environmental Factors

Treatments :
Treatment of Reye's syndrome typically involves supportive care aimed at managing symptoms and preventing
complications. Here are some key aspects of treatment:
Vitamin k The patients who have high level of clotting factors must received vitamin k.

Fluid and electrolyte balance:

Intravenous fluids may be administered to prevent dehydration and correct any electrolyte imbalances.
Monitoring of vital signs: Vital signs such as blood pressure, heart rate, and respiratory rate are closely monitored
to detect any signs of deterioration or complications.
Medication management:
Since aspirin use is associated with Reye's syndrome, medications containing aspirin or salicylates are strictly
avoided.
Other medications may be given to manage symptoms such as fever or seizures
Lactulose should be given who have low level of ammonia.

Management of complications: Complications such as cerebral edema (swelling of the brain) or organ failure may
arise in severe cases of Reye's syndrome.
Neurological support:
Patients with Reye's syndrome may experience neurological symptoms such as altered consciousness, seizures,
or coma.
Measures to reduce intracranial pressure and prevent further neurological damage.
Nutritional support:
Since Reye's syndrome can affect liver function, patients may require specialized nutritional support, such as
intravenous glucose, to provide energy to the body while the liver heals.
Recovery and rehabilitation:
Following the acute phase of illness, patients may require ongoing medical follow-up and rehabilitation
Osmotic diuretics (mannitol , hypertonic saline etc) should be given priority in case of lower ICP

DIALYSIS CAN ALSO BE DONE IN SEVERE CASES

 Pediatrics

Reye’s Syndrome

Education

medications containing aspirin or salicylates are strictly avoided.

Not recommended medicines include Alka-seltzer, kaopectate and pepto-Bismol

Labels of the medications should be read and understand keenly

ASPIRIN

Using such medications can cause long term neurological damage

 Pediatrics

Reye’s Syndrome

Nursıng ınterventıon Nutritional Support:

Provide nutritional support as tolerated, considering

the patient's metabolic needs and gastrointestinal
Assessment and Monitoring: function.
Perform frequent assessments of the patient's vital In severe cases, enteral or parenteral nutrition may be
signs, neurological status, and level of consciousness. necessary.
Monitor for signs of increased intracranial pressure Seizure Management:
(ICP), such as changes in mental status, headache,
vomiting, and alterations in pupillary response. Implement seizure precautions, including padding
the bed rails and maintaining a safe environment.
Assess liver function tests, electrolyte levels, blood
glucose, and coagulation parameters regularly. Administer anticonvulsant medications as prescribed.
ELECTROCARDIOGRAM(EKG): heart monitoring test Monitor for seizure activity and assess the patient's
response to treatment.
Fluid and Electrolyte Management:
Respiratory Support:
Administer intravenous fluids to maintain hydration
and electrolyte balance. Monitor respiratory status closely, including respiratory
rate, oxygen saturation, and breath sounds.
Monitor fluid intake and output closely.
Assist with positioning to optimize ventilation and
Adjust fluid therapy based on the patient's clinical prevent aspiration.
status and laboratory values.
Administer supplemental oxygen as needed.

Nursıng ınterventıon Collaboration with Interdisciplinary Team:

Collaborate with physicians, pharmacists, dietitians,

and other members of the healthcare team to ensure
Neurological Support: comprehensive care.
Provide a quiet and calm environment to minimize Participate in care planning and decision-making to
stimulation. optimize patient outcomes.
Implement measures to reduce ICP, such as elevating Patient and Family Education:
the head of the bed and avoiding activities that
increase intrathoracic pressure. Educate the patient and family about the importance
of avoiding aspirin and aspirin-containing products in
Administer medications as prescribed to manage
the setting of viral illnesses.
cerebral edema and intracranial hypertension.

Skin Care:

Provide meticulous skin care to maintain skin integrity.

Skin Care:

Provide emotional support to the patient and family

members.
Offer information and education about Reye's
syndrome, including its prognosis and potential
complications.
Encourage open communication
 Pediatrics

Scarlet Fever

Scarlet fever is a bacterial infection

caused by group A Streptococcus Rısk factors:
bacteria.

This disease is transmitted by droplet Age:

source
Children between the ages of 5 and 15.

Close Contact:
Being in close contact with someone who has scarlet fever or
strep throat

The bacteria responsible for scarlet fever, group A

Streptococcus, are highly contagious and can spread through
respiratory droplets from coughing or sneezing.

Crowded Environments:
Such as schools, daycare centers, or households with multiple
people

Poor Hygiene:
Inadequate handwashing and poor hygiene practices
Touching contaminated surfaces or objects and then
1 White patches on tonsils 3 Red throat
touching the mouth, nose, or eyes.

2 Swollen tonsils Compromised Immune System:

3 Red and
bumpy
Individuals with weakened immune systems due to conditions
tongue
such as HIV/AIDS, cancer

Recent Illness:
Having recently experienced a respiratory infection or another
illness can weaken the immune system

Untreated Strep Throat:

Scarlet fever can develop as a complication of untreated
strep throat.
5 Swollen lymp nodes
 Pediatrics

Scarlet Fever

Symptoms: Pathology:
The symptoms commonly associated with scarlet Group A Streptococcus (Strep pyogenes) Infection
fever are:

Sore throat Exotoxin Production (Pyrogenic Exotoxins A, B, and C)

Fever typically above 101°F (38.3°C)

Systemic Spread
Enlarged Lymph Nodes:, particularly those in the
neck (cervical lymphadenopathy)
Erythrogenic Toxin Production
Exudative Tonsillitis: The tonsils may become red,
swollen, and covered with white or yellow patches of
Skin Involvement
pus, resembling strep throat or tonsillitis.
Headache Mucous Membrane Involvement
Nausea and Vomiting
Body Aches: known as myalgia Systemic Symptoms (Fever, Malaise, Headache)

Flushed Face: The face may appear flushed or

reddened, particularly around the cheeks. Pharyngitis

HALLMARK SIGNS
Scarlet Fever Rash
Rash: This rash appears as small, red papules
that feel like sandpaper to the touch.
Complications (e.g., Rheumatic Fever,
Strawberry Tongue: The tongue may become Glomerulonephritis)
swollen and red, with enlarged taste buds

Diagnostics:

Throat culture: This test helps confirm the diagnosis of streptococcal pharyngitis (strep throat), which is
commonly associated with scarlet fever.

Rapid antigen detection test (RADT): RADT is a rapid diagnostic test used to detect specific proteins (antigens)
produced by group a streptococcus bacteria.

Complete blood count (CBC):

The white blood cell count may be elevated, indicating an increased immune response to the bacterial infection.

Additionally, the CBC may reveal other abnormalities, such as an elevated neutrophil count (neutrophilia) or
anemia.

C-reactive protein (CRP) test: A CRP test can help assess the severity of inflammation and monitor the patient's
response to treatment.

Erythrocyte sedimentation rate (ESR) test:

An elevated ESR can indicate the presence of an underlying inflammatory process, such as scarlet fever.

Blood culture: For culturing of microorganism

 Pediatrics

Diagnostic

Respıratory symptoms:
No cure is available but supportive treatment is given below:

Throat culture: This test helps confirm the diagnosis of streptococcal pharyngitis (strep throat), which is commonly
associated with scarlet fever.
Rapid antigen detection test (RADT): RADT is a rapid diagnostic test used to detect specific proteins (antigens)
produced by group a streptococcus bacteria.
Complete blood count (CBC):
the white blood cell count may be elevated, indicating an increased immune response to the bacterial infection.
Additionally, the CBC may reveal other abnormalities, such as an elevated neutrophil count (neutrophilia) or
anemia.
C-reactive protein (CRP) test: A CRP test can help assess the severity of inflammation and monitor the patient's
response to treatment.

Erythrocyte sedimentation rate (ESR) test:

An elevated ESR can indicate the presence of an underlying inflammatory process, such as scarlet fever.

Blood culture: For culturing of microorganism

 Pediatrics

Scarlet Fever

Complication: Treatment
Some potential complications of scarlet fever include: Urgent treatment ıs
requıred to treat aırway
Rheumatic Fever: obstructıons
Rheumatic fever is an inflammatory condition that can affect the
heart, joints, skin, and brain. Antibiotics:
Rheumatic fever can cause permanent damage to the heart valves, Oral medication (penicillin,
leading to amoxicillin, or erythromycin)
Post-Streptococcal Glomerulonephritis (PSGN) Antipyretics for feve

PSGN is an inflammatory condition that affects the kidneys. It can The complete course of
cause blood in the urine (hematuria), proteinuria (protein in the urine), medications specially
swelling (edema), high blood pressure, and decreased urine output. antibiotics should be
Scarlet Fever Recurrence: followed strictly to avoid
complications
Due to persistent colonization of group A Streptococcus bacteria in the
throat or exposure to new strains of the bacteria. Home remedies:

Invasive Infections(Sepsis): These measures may include:

untreated scarlet fever can lead to more severe invasive infections, Over-the-counter pain
such as cellulitis (skin infection), pneumonia (lung infection), or relievers such as
bacteremia (bloodstream infection). acetaminophen (Tylenol) or
ibuprofen (Advil, Motrin) to
reduce fever and relieve pain.

Gargling with warm salt water

or using throat lozenges toso
 Pediatrics

Scarlet Fever

Nursing intervention:
Here are some nursing interventions for scarlet fever:

Monitor Vital Signs:

Regularly assess the child's temperature, pulse rate, respiratory rate, and blood pressure to monitor for any signs of
deterioration or complications.
Provide Comfort Measures:
This may include providing acetaminophen or ibuprofen for fever and pain relief,
Offering cool fluids or ice chips to soothe a sore throat.
Encourage Fluid Intake:
Offer cool, clear liquids such as water, diluted fruit juices, broth, or oral rehydration solutions.
Promote Rest:
Encourage quiet activities and limit strenuous physical activity until the child is feeling better.
Monitor and Manage Rash:
MONITOR and Provide gentle skincare, including cool compresses or oatmeal baths to soothe itching and irritation.
Isolation Precautions:
include isolating the child in a separate room and minimizing contact with other household members until the child is
no longer contagious.
Educate Parents/Caregivers

Follow-up and Monitoring

Promote Good Hygiene Practices:

Such as regular handwashing with soap and water, covering coughs and sneezes, and avoiding close contact with
individuals who are sick.

Foods should be avoided having scarlet fever

Here are some nursing interventions for scarlet fever:

Acidic foods: Foods like oranges, vinegar, lemon, lime,

tomatoes
Spicy food: cause a burning sensation in the throat.
Alcoholic drinks: It may cause dry throat and it
becomes more painful.
 Pediatrics

SIDS (Sudden Infant Death Syndrome)

Sudden Infant Death Syndrome (SIDS) Risk Factors

The symptoms commonly associated with scarlet The symptoms commonly associated with scarlet
fever are: fever are:
Sudden Infant Death Syndrome (SIDS) is the sudden, Age: Infants are most at risk for SIDS between the
unexplained death of an otherwise healthy infant ages of one and four months, with the peak incidence
(<1year), typically occurring during sleep. occurring around two to three months of age.
Most of the deaths in infants is due to SIDS Sleeping Position: Infants who are placed on their
stomachs or sides to sleep have a higher risk of SIDS
Autopsies and keen examinations still not indicated
compared to those placed on their backs.
the CAUSE of this syndrome.
Sleeping Environment: Factors such as soft bedding,
The exact cause of SIDS is unknown, there are several
loose bedding, overheating, and sleeping on soft
risk factors and preventive measures associated
surfaces (e.g., couches, armchairs) increase the risk
with the condition.
of SIDS.
NO SIGNS AND SYMPTOMS ARE OBSERVED
Maternal Factors: as smoking during pregnancy,
smoking exposure after birth, and maternal
substance abuse
Prematurity and Low Birth Weight
Family History
Overheating
Low socioeconomic status , family history and gender
(specially males) can also be included in risk factors

Baby in the back sleeping position Baby in the back sleeping position
Trachea (tube to lungs) Trachea (tube to stomach)

Esophagus (tube to stomach) Esophagus (tube to lungs)

Preventive Measures: Breastfeeding: Breastfeeding has been

associated with a reduced risk of SIDS
Back to Sleep: Placing infants on their backs to sleep is
Routine Immunizations
the most effective way to reduce the risk of SIDS.
Safe Sleep Environment: Monitoring and Awareness:
Infants should sleep on a firm mattress in a
Parents and caregivers should be educated
safety-approved crib or bassinet, without soft bedding,
about the risk factors for SIDS and the
pillows, stuffed animals, or crib bumpers.
importance of safe sleep practices.
Room-sharing with the infant in a separate sleep area
(e.g., a crib or bassinet) is recommended for the first six Research and Awareness Efforts:
to twelve months of life.
Public health campaigns and awareness
Don’t overdress baby efforts aim to educate parents, caregivers,
Avoidance of Smoking and Substance Exposure and healthcare providers about safe sleep
practices and SIDS risk reduction strategies.
 Pediatrics

SIDS (Sudden Infant Death Syndrome)

Babies younger than 1 year old should be

Sleeping positions
placed on their backs to sleep — never on
to avoid
their stomachs or on their sides.

Safe sleeping

Back to Sleep: Always place your baby on their back to sleep, for naps and at night.
Firm Sleep Surface:
Use a firm mattress in a safety-approved crib or bassinet with a fitted sheet.
Avoid placing your baby to sleep on soft surfaces like sofas, waterbeds, or pillows.
No Loose Bedding: Keep soft objects, loose bedding, toys, and bumper pads out of the crib.
Room Sharing: Share a room with your baby, but not the same sleeping surface, for at least the first six months to a year
Avoid Overheating: Dress your baby in lightweight clothing and keep the room at a comfortable temperature.
Pacifiers: Consider offering a pacifier at naptime and bedtime.
Breastfeeding: Breastfeeding is associated with a reduced risk of SIDS.
Avoid Smoke Exposure:
Regular Prenatal Care.
Immunizations: Ensure your baby receives all recommended vaccinations..
 Pediatrics

Febrile Seizures

Definition:

A febrile seizure is a convulsion in a child that's caused

by a fever. The fever is often from an infection.

Symptoms:
A child having a febrile seizure may:
Have a fever higher than 100.4 F (38.0 C)
Lose consciousness, confused thinking and dizziness
(POSTICTAL PERIOD)
Shake or jerk the arms and legs.
Clonic seizures(again and again experiencing jerking
or shaking movements of the parts of body)
Tonic-clonic seizures previously also known as
“grand mal”(jerking movements with muscle
stiffness)

Postical Period:
The period following a seizure is called the postictal
state.
During this time, the child may be confused and
tired, and may develop a throbbing headache.
This period usually lasts several minutes, although it
can last for hours or even days.

Pathology is unknown but certain theories are present

Causes of febrile seizures
Increased neuron excitability can be induced by
Infection: The fevers that trigger febrile seizures very high core temperature
are usually caused by a viral infection, and less Cytokines are produced in response of high
commonly by a bacterial infection. The flu temperature causing neuron dysfunction
(influenza) virus appear to be most frequently
Respiratory alkalosis results as high fever cause
associated with febrile seizures.
hyperventilation
Post-vaccination seizures:
The risk of febrile seizures may increase after
some childhood vaccinations.
These include the diphtheria, tetanus and
pertussis vaccine and the Classification of febrile seizure:
measles-mumps-rubella vaccine.
A child can develop a low-grade fever after a Simple febrile seizures: This most common type lasts
vaccination. The fever, not the vaccine, causes from a few seconds to 15 minutes. Simple febrile
the seizure. seizures do not recur within a 24-hour period and are
not specific to one part of the body.
2- Complex febrile seizures: This type lasts longer than
15 minutes, occurs more than once within 24 hours or is
confined to one side of body
 Pediatrics

Febrile Seizures

Risk factors: The Recovery Position

Steps to take while waiting
Young age. Most febrile seizures occur in
children between 6 months and 5 years for medical attention.
of age, with the greatest risk between 12
and 18 months of age. Move the arm closest to Support the head as you
Family history. Some children inherit a 1 you in a 90 degree angle 3 pull the knee furthest from
with the palm facing up you across the body to
family's tendency to have seizures with a
adjusacent to the head. turn on the persons side
fever.
Having high temperature or rapidly
Take the opposite arm and Lift the chin to clear the
developing fever
2 move it across the chest, 4 airway. Continue to
Some vaccinations can also contribute placing the palm of the monitor breathing until
in this condition hand against the cheek. medical help arrives.

Prevention:

No one knows why febrile seizures happen,

so they usually can't be prevented. Treatment:
If your child is uncomfortable due to the
fever, give acetaminophen or ibuprofen as Most febrile seizures stop on their own within a couple of minutes. If your
directed by your doctor. child has a febrile seizure, stay calm and follow these steps:
Place your child on his or her side on a soft, flat surface where he or
she won't fall.
Start timing the seizure.
Seizures precautions
Stay close to watch and comfort your child.
Remove hard or sharp objects near your child.
Gently place your child on the floor or
the ground. Loosen tight or restrictive clothing.
Remove any nearby objects. Don't restrain your child or interfere with your child's movements.
Place your child on their side to prevent Don't put anything in your child's mouth
choking.
Loosen any clothing around their head Medical attention is needed if seizures occur again and again and lasts
and neck. for more than 5 minutes

Watch for signs of breathing problems,

including a bluish color in the face.
Try to keep track of how long the seizure
lasts.

Fever management

Encourage fluid intake ( Pedialyte 2-5 mL q 5 minutes)

Lowering temperature by placing cold water pads on forehead
Having bath
Don’t do extra clothing
 Pediatrics

Cerebral Palsy

Definition:

Cerebral palsy is a group of conditions that affect

movement and posture. It's caused by damage that
occurs to the developing brain, most often before birth.

Risk Factors:
Maternal health
Cytomegalovirus.
German measles, known as rubella.
Herpes.
Syphilis.
Toxoplasmosis.
Causes:
Zika virus infection.
Intrauterine infections. Gene changes that result in genetic conditions or
Exposure to toxins. One example is exposure to differences in brain development.
methyl mercury. Maternal infections that affect an unborn baby.
Infant illness Stroke, which interrupts blood supply to the developing
brain.
Bacterial meningitis.
Bleeding into the brain in the womb or as a newborn.
Viral encephalitis.
Infant infections that cause swelling in or around the
Severe or untreated jaundice.
brain.
Bleeding into the brain.
Traumatic head injury to an infant, such as from a motor
Birth before time vehicle accident, fall or physical trauma.
Disruption and complicated placenta issues during Lack of oxygen to the brain related to a hard labor or
delivery delivery

Speech and eating

Symptoms
Delays in speech development.
Movement and coordination Trouble speaking.
Stiff muscles and exaggerated reflexes, known as Trouble with sucking, chewing or eating.
spasticity.
Drooling or trouble with swallowing.
Variations in muscle tone, such as being either too stiff
or too floppy. Development
Stiff muscles with regular reflexes, known as rigidity.
Delays in reaching motor
Lack of balance and muscle coordination, known as skills milestones, such as
ataxia. sitting up or crawling.
Jerky movements that can't be controlled, known as Learning disabilities.
tremors.
Intellectual disabilities.
Slow, writhing movements.
Delayed growth, resulting
Trouble walking in smaller size than would
Trouble with fine motor skills, such as buttoning clothes be expected.
or picking up utensils.
Experiencing sign of Hemiplegia (paralysis that affects
only one side of body) = failure to show hand
preference because cerebral palsy cause weakness or
abnormal muscle tone
 Pediatrics

Cerebral Palsy

Type

Spastic Cerebral Palsy Dyskinetic Cerebral Palsy Ataxic Cerebral Palsy

most common type of CP is Problems controlling the (least common type)

spastic CP which affects about movement of hands, arms, feet,
80% of people. and legs, making it difficult to sit Problems with balance and
and walk. (worm like movements) coordination.
Spastic diplegia/diparesis:
The movements are They might be unsteady when
Stiffness is mainly in the legs, with
uncontrollable and can be slow they walk.
the arms less affected or not
affected at all. and writhing or rapid and jerky. They might have a hard time with
Sometimes face and tongue are quick movements or movements
Spastic hemiplegia/ hemiparesis:
affected and the person has a that need a lot of control, like
Affects only one side of a person’s
hard time sucking, swallowing, writing.
body; usually the arm is more
affected than the leg. and talking. They might have a hard time
Damage of basal ganglia is controlling their hands or arms
Spastic quadriplegia /
involved when they reach for something.
quadriparesis most severe form
of spastic CP and affects all four Damage of cerebellum is involved
limbs, the trunk, and the face.
Damage of motor cortex is
involved

Medication Orthotics
Treatment
No cure but early ınterventıons
can ıncreases qualıty of lıfe Medications

Muscle or nerve injections: Injections of Nonsurgical

onabotulinumtoxinA (Botox) to treat tightening of a
Options for
specific muscle
Cerebral palsy
Oral muscle relaxants: Medicines such as baclofen Physical Injections
(Fleqsuvy, Ozobax, Lyvispah), tizanidine (Zanaflex), Therapy
diazepam (Valium,Diazepam Intensol) or dantrolene
(Dantrium) are often used to relax muscles.
Medicines to reduce drooling: Botox injections into the
salivary glands.

Interventions Feeding Walking & Gait

Therapies

Physical therapy. Muscle training and exercises can

help in building strength, flexibility, balance, motor
development and mobility.
Occupational therapy to help gain independence in Spine Book Review Editorial
daily activities at home and in the community.
Speech and language therapy.
Recreational therapy such as therapeutic horseback
riding or skiing.
 Pediatrics

Phenylketonuria

Treatment For Cerebral Palsy

Surgical procedures:
Surgery Medications
Orthopedic surgery to place arms, spine, hips or legs in
the correct positions and also to lengthen muscles and
lengthen or reposition tendons that are shortened.
Cutting nerve fibers or selective dorsal rhizotomy may
be done when walking or moving is hard and painful
and other treatments haven't helped.
Still no specific treatment
Phy Therapy Deep Brain Stimulation

Nursing interventions:

Ensure therapeutic communication.

Enhance self-esteem.
Provide emotional support.
Strengthen family support. Occupational Therapy Speech Therapy
Prevent injury.
Prevent deformity.
Encourage mobility.
Increase oral fluid intake.

Phenylketonuria

Definition Symptoms Pregnancy and PKU

Phenylketonuria is a rare inherited
A musty odor in the breath, skin or Women who have PKU and
disorder that causes an amino
urine, caused by too much become pregnant are at risk of
acid called phenylalanine to build
phenylalanine in the body another form of the condition
up in the body.
Nervous system (neurological) called maternal PKU.
PKU is caused by a change in the
problems that may include If women don't follow the special
phenylalanine hydroxylase (PAH)
seizures PKU diet before and during
gene. This gene helps create the
Skin rashes, such as eczema pregnancy, blood phenylalanine
enzyme needed to break down
levels can become high and
phenylalanine. Lighter skin, hair and eye color harm the developing baby.
Without the enzyme, a dangerous than family members, because
phenylalanine can't transform Babies born to women with high
buildup can develop when a
into melanin phenylalanine levels don't often
person with PKU eats foods that
inherit PKU.
contain protein or eats Unusually small head size
aspartame, an artificial (microcephaly) But a child can have serious
sweetener. problems if the level of
Hyperactivity phenylalanine is high in the
Genetically, it is AUTOSOMAL
Intellectual disability mother's blood during pregnancy.
RECCESSIVE DISORDER (both the
parents must have one gene of Delayed development At birth, the baby may have:
this disorder ) Low birth weight
Behavioral, emotional and social
problems Unusually small head
Mental health disorders Problems with the heart
 Pediatrics

Phenylketonuria

Causes Risk factors Diagnosis

A gene change (genetic
Risk factors for inheriting PKU PKU screening is a blood test to
mutation) causes PKU, which can
include: screen newborns for
be mild, moderate or severe.
Having both parents with a gene phenylketonuria (PKU)
In a person with PKU, a change in
change that causes PKU. Two Babies are often screened for PKU
the phenylalanine hydroxylase
parents must pass along a copy with a heel-prick test. This is done
(PAH) gene causes a lack of or
of the changed gene for their by getting a few drops of blood
reduced amount of the enzyme
child to develop the condition. from the infant's heel.
that's needed to process
phenylalanine, an amino acid. Being of a certain racial or ethnic A urine test is an alternative to
descent. PKU affects people from the heel prick.
For a child to inherit PKU, both the
most ethnic backgrounds
mother and father must have and People with PKU also release a
worldwide. But in the United
pass on the changed gene. This substance called phenylacetic
States, it's most common in
pattern of inheritance is called acid in their urine and sweat.
people of European ancestry.
autosomal recessive. Gunthrie inhibition assay (for 24
hours baby or protein ingested by
baby)
Plasma phenylalanine( value
Phenylalanine ? more than >4MG/DL indicated
positive result)
Phenylalanine is involved in the production of the neurotransmitters
norepinephrine and dopamine, which are essential for the proper
functioning of the brain and nervous system.
In PKU there is Phenylalanine
In PKU, phenylalanine hydroxylase fails to converts the amino acid Hydroxylase
phenylalanine to tyrosine, another amino acid.
= impaired ability to use
TYROSINE involves in the different functioning of the brain and nerves Phenylalanine which leads to
in the body and also converted into different other products for
proper functioning of brain( dopamine, serotonin, norepinephrine, Buildup of Phenylalanine in
epinephrine etc.) tissues + blood

Treatment The main treatments for PKU include:

A lifetime diet with very limited intake of foods with

phenylalanine
Taking a PKU formula — a special nutritional supplement to
make sure that you get enough essential protein (without
The need of
phenylalanine) and nutrients that are essential for growth and
lipidomics Change in
studies general health
fatty acids
profile Medications, for certain people with PKU

a
enyl linine
Ph
Which foods and products to avoid:
Change in
Because the amount of phenylalanine that a person with PKU
Inflamm-
ation
PKU lipoprotein
profile can safely eat is so low, it's important to avoid all high-protein
foods, such as:
Milk
Di

nt

ta e
e

ry T
re at m Eggs
Cheese
Lipid Oxidative Nuts
Peroxidation Stress
Soy products, such as soybeans, tofu, tempeh and milk
Beans and peas
Poultry, beef, pork and any other meat
Fish
 Pediatrics

Muscular Dystrophy

(Duchenne and becker)

Definition Causes Risk factors

Muscular dystrophy is a group Certain genes are involved in Muscular dystrophy occurs in
of diseases that cause making proteins that protect both sexes and in all ages and
progressive weakness and loss muscle fibers. races.
of muscle mass. Muscular dystrophy occurs However, the most common
In muscular dystrophy, when one of these genes is variety, Duchenne, usually
abnormal genes (mutations) defective. occurs in young boys.
interfere with the production of Each form of muscular People with a family history of
proteins needed to form dystrophy is caused by a muscular dystrophy are at
healthy muscle. genetic mutation particular to higher risk of developing the
Many types of this disease are that type of the disease. disease or passing it on to their
present: children.
Most of these mutations are
inherited. Both are X-linked recessive
Duchenne
genetic disorders
Facioscapulohumeral
Almost exclusively in males
Becker
Females can be
Congenital asymptomatic carriers
Mytonic
Limb-girdle

Types (most common types are as following)

Duchenne Muscular Becter Muscular
Dystrophy (DMD) Dystrophy (BMD)
Often apprearing before age six, Duchenne Muscular Dystrophy Common symptoms include:
common symptoms include: (15-20 years life expectancy)
It is most common type of muscular
dystrophy diagnosed in childhood. It first
appears in very early childhood and
progresses rapidly. Arm weakness Difficulty walking Arm weakness
Progressive that gets worse
Most children are unable to walk by age over time
muscle
weakness and Calf muscle Fatigue
12 and later need a respirator to breathe.
atrophy Hypertrophy
The disease weakens the muscles of the
body, which can lead to frequent falls,
difficulty walking, and wheelchair
dependence.
Gower’s sign + waddling gait Hard getting Muscle pain Frequent falls
out of chair and/or spasms
Toe walking Difficulty Frequent falls
climbing up
stairs
Other symptoms of BMD may include:
Becker Muscular Dystrophy(10-12
years life expectancy)
It is very similar to Duchenne muscular
dystrophy, but it progresses much more
Developmental Breathing Learning slowly and is less common.
Cordiomyopathy Breathing problems
delay problems differences
It affects boys and usually is diagnosed
between the ages of 11 and 25.
Boys and men with Becker muscular
dystrophy develop progressive
weakness in the muscles of the hips,
Delayed
speech and thighs, pelvis, and shoulders. Learning differences Fatigue
language Scoliosis Short stature
development (height)
 Pediatrics

Muscular Dystrophy

Symptoms Weak or Cant close eyes

crooked smile all the way
Duchenne muscular dystrophy

Frequent falls
Difficulty rising from a lying or sitting position
Trouble running and jumping
Weak bicep Shoulder blade
Waddling gait sticks out
Walking on the toes
Large calf muscles
Muscle pain and stiffness
Weak core
Learning disabilities
Delayed growth
Weak hip
Becker muscular dystrophy girdle
Similar to those of Duchenne, but tend to be milder and
progress more slowly.
Generally begin in the teens but might not occur until
the mid-20s or later.
Weak thigh
leading to falls

Complications for both

Duchenne muscular dystrophy

Trouble walking.
Trouble using arms. Foot drop can’t
Shortening of muscles or tendons around joints lift foot, causing
(contractures). tripping

Breathing problems.
Curved spine (scoliosis).
Heart problems.
Swallowing problems.

Diagnosis
NO CURE
Enzyme tests: Damaged muscles release enzymes, such as creatine kinase
(CK), into blood. MAIN GOAL is to maintain
the ability to walk without
Genetic testing. the need for any kind of
Muscle biopsy. assistance (ambulation)
and enhancing quality of
Heart-monitoring tests (electrocardiography and echocardiogram).
life of patient
Lung-monitoring tests.
Electromyography.
 Pediatrics

Muscular Dystrophy

Treatment/ Nursing interventions

Medications:
Corticosteroids, such as prednisone and deflazacort (Emflaza)
Newer drugs include eteplirsen (Exondys 51)
Heart medications, such as angiotensin-converting enzyme (ACE) inhibitors or beta blockers, if muscular dystrophy
damages the heart.

Therapy:
Range-of-motion and stretching exercises.
Low-impact aerobic exercise, such as walking and swimming
Braces can help keep muscles and tendons stretched and flexible, slowing the progression of contractures.
Mobility aids. Canes, walkers and wheelchairs
Breathing assistance
Healthy diet plans to follow including foods with high fiber and fluids to avoid constipation
Ambulation must be encourage by using different strategies

Connective Tissue

Nuclei

Myocyte
 Pediatrics

Developmental Hip Dysplasia

Head of femur Head of femur

Definition

Hip dysplasia is the medical term for a hip socket that

doesn't fully cover the ball portion of the upper thigh bone.
This allows the hip joint to become partially or completely
dislocated.
Most people with hip dysplasia are born with the condition.

Symptoms

Vary by age group.

In infants, one leg is longer than the other.
Once a child begins walking, a limp may develop.
In teenagers and young adults, hip dysplasia can cause
painful complications such as osteoarthritis or a hip
labral tear.
Hip socket Hip socket
This may cause activity-related groin pain.

Hip Joint Developmental Dysplasia of the hip

Pelvis Acetabulum

Femoral head

Femur
Dislocation Subluxation

Dysplasia: physical examination

shows dislocation + the head of
femur in shallow acetabulum
Subluxation: physical
examination does not show
dislocation + the head of femur
loose in acetabulum
Dislocation: the head of femur
is not connected with
acetabulum
Figure 1 Appropriately Figure 2 Hip with Figure 3 Dislocated hip.
located hip. Femoral significant subluxation. Femoral head is not
head is well positioned in The femiral head is not positioned in the pelvis
the pelvis correctly positioned in
the pelcis
 Pediatrics

Developmental Hip Dysplasia

Risk factors

Hip dysplasia tends to run in families and

is more common in girls.
The risk of hip dysplasia is also higher in
babies born in the breech position and in
babies who are swaddled tightly with the
hips and knees straight oligohydramnios,
macrosomic newborn)

Nursing Interventions

Enhancing Physical Mobility

Preventing Trauma and Injury Risk
Managing Constipation
Enhancing Social Interaction
Monitoring Laboratory and Diagnostic
Procedures

Causes:
Pelvis
Hip dysplasia happens when femur doesn’t fit
into the socket in pelvis correctly.
Femoral
Dysplasia may occur if hip socket is too Head
shallow or the top (head) of femur is shaped
differently than usual.

Most people with hip dysplasia are born with it.

It can develop during pregnancy if the fetus’s

position puts pressure on its hips.
Femur Acetabulum
It can also be a genetic condition that Dislocation Subluxation
biological parents pass on to their children.

Diagnosis:
All newborn babies are examined for hip dysplasia in their first few
days of life.

These tests are repeated again at 6 weeks. If a problem is detected,

an ultrasound may be ordered.

This can also be done for babies at high risk of hip dysplasia.

In older children and adults, a physical examination, and an x-ray

are used to diagnose the condition.

A MRI or CT scan may be necessary to have a closer look at the

acetabulum and assess any damage.
 Pediatrics

Developmental Hip Dysplasia

Under 6 months: Ortolani test

Ortolani maneuver: gently adduct the hip
while palpating for the head falling out
the back of the acetabulum
Barlow maneuver: gently abduct the hip
with flexed hips at 90 degrees.
If the tests are positive (clunks
formation), ultrasonography or Xray is
recommended.

Above 6 months:
Hip Abduction test: Thighs are slowly
Barlow test
abducted while hips are flexed at 90
degrees.
Trendelenburg test: Patient is said to
stand on one foot for 30 seconds without
leaning.
Tests are positive if pelvis of the lifted leg
drops.

Treatment:

Depends on the age of the affected person and the extent of the hip damage.
Infants are usually treated with a soft brace, such as a Pavlik harness, that holds the ball portion of the joint firmly in its
socket for several months.
If the dysplasia is more severe, the position of the hip socket can also be corrected.
In a periacetabular osteotomy, the socket is cut free from the pelvis and then repositioned so that it matches up better
with the ball.
Hip replacement surgery might be an option for older people whose dysplasia has severely damaged their hips over
time, resulting in debilitating arthritis.

Pavlik Short Leg Hip

Harness Spica Cast
 Pediatrics

Developmental Hip Dysplasia

6 months old:
Nursing interventions
A soft positioning device, called a Pavlik harness is used
to keep the thighbone in the socket. It helps tighten the
PAVLIK HARNESS: The child will maintain his or her
ligaments around the hip joint and promotes normal hip
traction; the Pavlik harness is applied properly; the
socket formation.
skin is free of irritation in the spica cast. The child will
6 months - 2 years: maintain passage of soft, formed stool every 1 to 3
days without straining.
Closed reduction surgery:
SPICA CAST: Children in hip spicas cannot move
The femur head is moved into acetabulum under themselves easily. The child should be repositioned
anesthesia, then a spica cast is applied to hold the bones 2-4 hourly, during the day and night. The child can be
in place. After the cast, brace is used till full recovery. placed supine, prone or on their side if comfortable,
and must be supported with pillows and/or towels to
Above 2 years: alleviate any pressure from the plaster, and to
provide support.
Open reduction surgery is necessary to realign the hip. An
incision is made at the baby's hip that allows the surgeon
to clearly see the bones and soft tissues.
 Pediatrics

Cleft Lip and Cleft Palate

Definition: Symptoms:

Cleft lip and cleft palate are openings or splits in the A split in the lip and roof of the mouth (palate) that
upper lip, the roof of the mouth (palate) or both. affects one or both sides of the face
Cleft lip and cleft palate result when facial structures A split in the roof of the mouth that doesn't affect the
that are developing in an unborn baby don't close appearance of the face
completely. Difficulty with feedings
Cleft lip and cleft palate are among the most common Difficulty swallowing, with potential for liquids or foods
birth defects. to come out the nose
They most commonly occur as isolated birth defects Nasal speaking voice
but are also associated with many inherited genetic
conditions or syndromes. Chronic ear infections

Cleft Lip and Plate

Normal Lip Unileteral Unilateral Bilateral

Incomplete Complete Complete

Risk factors Complications

Family history / genetic factors
Difficulty in feeding
Having diabetes before pregnancy
Ear infections and hearing loss
Being obese during pregnancy
Dental problems: If the cleft extends
Environmental factors through the upper gum, tooth development
Certain medications usage may be affected.
Alcohol and drug usage. cigarette smoking. certain vitamin Speech difficulties: Speech may sound too
deficiencies, especially during early pregnancy. nasal.
Deficiencies of specific vitamins like folic acid Social, emotional and behavioral problems
due to differences in appearance and the
stress of intensive medical care.
Health Problems Related
to Cleft Lip and Palate
Feeding
Tooth Development
Orthodontics
Hearing
Speech
Social and Emotional Impacts
 Pediatrics

Cleft Lip and Cleft Palate

Types of Cleft Lip

Forme fruste unilateral cleft lip

A subtle cleft on one side of the upper lip,
which may appear as a small indentation.

Incomplete unilateral cleft lip

A cleft on one side of the upper lip, which Normal Lip Unilateral cleft lip and
does not extend into the nose. palate incomplete

Complete unilateral cleft lip

A cleft on one side of the upper lip, which
extends into the nose.

Incomplete bilateral cleft lip

Clefts on both sides of the upper lip, not
extending to the nose.

Complete bilateral cleft lip

Clefts on both sides of the upper lip, Bilateral cleft lip and Unilateral incomplete
extending into the nose. palate incomplete

Types of Cleft Palate

Complete bilateral cleft lip

A cleft in the back of the mouth in the
soft palate.
Complete cleft palate Normal Palate Cleft Lip Bilateral Cleft Lip
A cleft affecting the hard and soft parts
of the palate. The mouth and nose
cavities are exposed to each other.

Submucous cleft palate

A cleft involving the hard and/or soft
palate, covered by the mucous
membrane lining the roof of the mouth.
May be difficult to visualize.
Normal Palate Cleft Lip Bilateral Cleft Lip
Lip and Palate With full Palate
 Pediatrics

Cleft Lip and Cleft Palate

Treatment

Surgeries typically are performed in this order:

Cleft lip repair — within the first 3 to 6 months of age

Cleft palate repair — by the age of 12 months, or earlier if possible
Follow-up surgeries — between age 2 and late teen years

In general, procedures may include:

Cleft lip repair: The surgeon makes incisions on both sides of the cleft and creates flaps of tissue. The flaps are then
stitched together, including the lip muscles.
Cleft palate repair: The surgeon makes incisions on both sides of the cleft and repositions the tissue and muscles.
The repair is then stitched closed.
Ear tube surgery involves placing tiny bobbin-shaped tubes in the eardrum to create an opening to prevent fluid
buildup to reduce the risk of chronic ear fluid, which can lead to hearing loss.
Surgery to reconstruct appearance: Additional surgeries may be needed to improve the appearance of the mouth,
lip and nose.

A B

C D

E F

G H
 Pediatrics

Congenital Heart Defects

Maintaining Airway Clearance and Preventing

Approach to the Cleft Patient
Aspiration
Prenatal Prental Consult Genetic Diagnosis
Improving Nutritional Status and Teaching Feeding
Methods
Birth-3 Months Lip Taping NAM
Reducing Anxiety and Enhancing Coping
Preventing Injury and Infections Lip Adhesion Lip Repair
3-4 Months
Initiating Patient Education and Health Teachings

1 Years Palate Repair

EDUCATION REGARDING FEEDING STRATEGIES

Assess the newborn’s respiratory rate, depth, and 2-5-5 Years Speech Therapy VPI Surgery
effort.
Assess skin color and capillary refill. Othodontic Treatment Alveolar
6-9 Years
bone grafting
Assess for abdominal distention.
16-18 Years Orthognathic Surgery
Place the infant in an infant seat at 30° to 45°.
Position the infant in an upright position greater than
60° during feeding and elevate the head of the crib to
30° after.
GENERAL EDUCATION
Allow the infant time to swallow during feedings and
provide oral care as appropriate.
Give your child over-the-counter and prescription
Provide oral and nasal suctioning as needed. medicines only as told by your child's health care
Feed the infant slowly and burp frequently. provider.
Position the infant appropriately after surgery. Work closely with your child's team of health care
providers.
Provide special nipples or feeding devices such as
pigeon feeders with a one-way valve or Lamb’s nipple Keep all follow-up visits. This is important. Babies with
cleft lip or cleft palate must be monitored to make sure
Coordinate with other healthcare teams for the they are drinking enough fluid and gaining weight.
holistic care and management of the infant.

Oxygen
Congenital Heart Defects Poor Blood

Oxygen
Rich Blood
AO
A congenital heart defect is a problem with the
structure of the heart that a child is born with. PA
Some congenital heart defects in children are simple LA
and don't need treatment. RA
Other congenital heart defects in children are more
complex and may require several surgeries performed
over a period of several years. LV

RV

Some common congenital heart defects

Increased pulmonary blood flow
Decreased pulmonary blood flow RA : Aorta LV : Left Ventricle
Obstruction of blood flow PA : Pulmonary Artery RV : Right Ventricle
LA : Left Atrium
Mixed blood flow
RA : Right Atrium
 Pediatrics

Congenital Heart Defects

Increased Pulmonary Blood Flow

The diseases that cause too much blood

flow through the lungs include: Backflow of blood:
Atrial septal defect
Ventricular septal defect There exists a possibility that already oxygenated blood might flow back
into the circulation and is oxygenated again.
Patent ductus arteriosus
This causes increased blood volume which ultimately leads to increased
This occurs from the left to the right side workload on the heart.
of the heart. There is no hypoxia present.

Different types of Increased Pulmonary Blood Flow

Atrial septal defect Ventricular septal defect Patent ductus arteriosis

1- Atrial Septal Defect (ASD)

An atrial septal defect is a birth defect of the heart in Atzial septal

which there is a hole in the wall (septum) that divides defect
the upper chambers (atria) of the heart. A hole can vary
in size and may close on its own or may require surgery Right atrium

Pathophysiology:
ASD occurs when the hole between right and left atria Left atrium
allows the blood to flow from left to right atrium.
In this way, there is too much blood flow towards the a hole in the
right side of heart which causes increased blood flow septum allows too
to the lungs. much blood to flow
into the right atrum

Symptoms:

Often shows no symptoms but with the passage of Right atrium

time becomes symptomatic

Shortness of breath, especially when exercising. Atrial sptal

Tiredness, especially with activity. defect (ASD)
Swelling of the legs, feet or belly area.
Irregular heartbeats, also called arrhythmias.
Left atrium
Skipped heartbeats or feelings of a quick, pounding or
fluttering heartbeat, called palpitations.
 Pediatrics

Congenital Heart Defects

Causes: Diagnosis:

Changes in genes Echocardiogram

Some medical conditions Chest X-ray
Certain medicines Electrocardiogram (ECG
Smoking or EKG)

Alcohol misuse Cardiac magnetic

resonance imaging (MRI)
scan
Computerized
tomography (CT) scan

Treatment:

Treatment:
Beta blockers to control the heartbeat.
Blood thinners, called anticoagulants, to lower the risk of blood clots.
Diuretics to reduce fluid buildup in the lungs and other parts of the body.

Catheter-based repair is done to fix the secundum type of atrial septal defects. A thin, flexible tube called a catheter is
put into a blood vessel which is then guided to the heart.
Open-heart surgery involves making a cut through the chest wall to get to the heart. The surgeons use patches to
close the hole.

Atrial
Septum
RA LA

LA

RA
Secundum
ASD 1 2

IVC

Device passed up inferior vena

cava, into the right atrium and
into septal defect 3 4
 Pediatrics

Congenital Heart Defects

2- Ventricular Septal Defect (VSD)

a birth defect of the heart in which there is a hole in the wall (septum) that separates the two lower chambers
(ventricles) of the heart. This wall also is called the ventricular septum.

Venticular Septal Defect

Pathophysiology:
Defect
VSD occurs when the hole between right and left
ventricles allows the blood to flow from left to right
ventricle.
In this way, there is too much blood flow towards the
right side of heart which causes increased blood flow to
the lungs.

Symptoms:

Often shows no symptoms but with the passage of

time becomes symptomatic
Poor eating
Slow or no physical growth (failure to thrive)
Fast breathing or breathlessness
Easy tiring
Whooshing sound when listening to the heart with a
stethoscope (heart murmur)

Treatment

Medications
May be given to treat symptoms or complications. Open-heart surgery: a patch or stitch is used to close
the hole between the lower heart chambers.
Water pills (diuretics) are used to decrease the amount
of fluid in the body and reduce the strain on the heart. Catheter procedure: a catheter is inserted into a blood
vessel, usually in the groin, and guides it to the heart. A
Oxygen may be given. small device is inserted through the catheter to close
the hole.
 Pediatrics

Congenital Heart Defects

3- Patent Ductus Arteriosus (PDA)

A persistent opening between the two major blood vessels leading from the heart.

Pathophysiology: Symptoms

PDA occurs when the hole between pulmonary Poor eating, which leads to poor growth.
artery and aorta allows the blood to flow from aorta Sweating with crying or eating.
into pulmonary artery.
Persistent fast breathing or breathlessness.
In this way, blood from pulmonary artery flows into
the lungs which causes increased blood flow to the Easy tiring.
lungs. Rapid heart rate.

Patent Ductus Arteriosus

Aorta

Left Pulmonary
Artery

Treatment
Using a thin tube called a catheter and a plug or coil
Medications to close the opening. This treatment is called a
Medicines called nonsteroidal anti-inflammatory drugs catheter procedure. It allows a repair to be done
(NSAIDs) may be given to premature babies to treat a without open-heart surgery.
PDA. Open-heart surgery to close the PDA. This treatment
These medicines block certain body chemicals that is called surgical closure. Heart surgery may be
keep a PDA open. However, these medicines won't close needed if medicine doesn't work or the PDA is large or
a PDA in full-term babies, children or adults. causing complications.

Devices Coil
Device closure of PDA Coil closure of PDA
 Pediatrics

Congenital Heart Defects

Decreased Pulmonary Blood Flow

The diseases that cause decreased blood flow

through the lungs include:
Tetralogy of Fallot
Tricuspid Atresia
This occurs from the right to the left side of the heart
and blood is not oxygenated before going to the rest
of the body.
Decreased blood flow to the lungs leads to hypoxia
and this condition is also called Blue Babies.
In normal conditions, the deoxygenated blood flows
from right to left side of heart and into the lungs to
become oxygenated, and then flows through aorta to
the rest of the body.

The diseases that cause decreased blood flow through the lungs include:

bluish skin (cyanosis) Shortness of breath, Lethargy, Seizures

Rapid heartbeat Nausea, diarrhea Loss of consciousness

1- Tetralogy of Fallot

Definition: Tetralogy of Fallot

It is a rare heart condition in which a

Stenotic Ventricular
baby has four different heart problems
pulmonary septal defect
that affect the structure of the heart:
valve
Pulmonary stenosis, which is narrowing of the exit from the right
ventricle Thickened
A ventricular septal defect, which is a hole allowing blood to flow Muscle
between the two ventricles
Right ventricular hypertrophy, which is thickening of the right
ventricular muscle Some babies with tetralogy of Fallot have
episodes called TET SPELL, when they
An overriding aorta, which is where the aorta expands to allow suddenly turn bluish and may faint. These
blood from both ventricles to enter. spells are serious.

Symptoms:
Knee chest position for a tet spell
Solution for TET SPELL
Blue or gray skin color. Place your child in a
Shortness of breath and rapid breathing, especially during knees-to-chest
position. This adjusts
feeding or exercise.
the pressure and blood
Trouble gaining weight. flow in their heart.

Getting tired easily during play or exercise. If tet spells happen

often, typically this
Irritability. means it is important
Crying for long periods of time. for your child to have
surgery
Fainting.
 Pediatrics

Congenital Heart Defects

Treatment: Pulmonary artery

widened with patch
Temporary surgery, also called temporary repair

This type of treatment is called palliative surgery.

A surgeon places a tube called a shunt between a
large artery that comes off from the aorta and the lung Area below valve widened
artery.
VSD repaired with patch
The tube creates a new path for blood to go to the
lungs.
The shunt is removed during open-heart surgery to
treat tetralogy of Fallot.

Open-heart surgery, called complete repair.

People with tetralogy of Fallot need open-heart

surgery to completely fix the heart.
A complete repair is usually done in the first year of life.
The surgeon patches the hole between the lower heart
chambers and repairs or replaces the pulmonary
valve.
The surgeon may remove thickened muscle below the
pulmonary valve or widen the smaller lung arteries

2- Tricuspid Atresia

Definition:

Tricuspid atresia is a heart problem in which

tricuspid valve isn't formed between the two right
heart chambers.
Instead, a solid sheet of tissue blocks the blood flow
between the right heart chambers which limits
blood flow through the heart.
Tricuspid atresia causes the right lower heart to be
underdeveloped.
Three defects together

No tricuspid valve: no blood can go from the right atrium

through the right ventricle to the lungs for oxygen.
Hypoplastic right ventricle: a primary congenital
abnormality with the underdeveloped trabeculated
sinus of the ventricle.
Atrial septal defect: defects located between the heart's
upper chambers (atria), which receive blood from the
body. OR
Ventricular septal defect: defects located between the Absent tricuspid valve
lower chambers (ventricles), which pump blood to the
body.
 Pediatrics

Congenital Heart Defects

Symptoms:
Normal Heart Tricuspid atresia
Blue or gray skin and lips due to
low blood oxygen levels

Difficulty breathing

Tiring easily, especially during

feedings
AO
Slow growth and poor weight gain
PA
Fatigue and weakness LA

Shortness of breath RA

Swelling in the legs, ankles and feet

LV
Swelling of the belly area, a
condition called ascites RV

Sudden weight gain from a buildup

of fluid
Tricuspid valve
(not developed)

Vetricular
OTHER DEFECTS ARE RESULT OF Atrial septal defect septal defect
MISSING TRICUSPID VALVE

Shunt operation
Treatment
A
Medications may be given to:
Strengthen the heart muscle
Lower blood pressure
Remove excess fluid from the body
Multiple surgeries are required.

Stages of surgeries:
STAGE 1- Shunting creates a new pathway (shunt) for blood to flow.
The shunt redirects blood from a main blood vessel leading out of
the heart to the lungs.
Shunting increases the amount of blood flow to the lungs. It helps
improves oxygen levels.
For 2 weeks old infant
STAGE 2- In the Glenn procedure, the surgeon removes the first STAGE 3- Fontan procedure is typically done when a
shunt. Then one of the large veins that typically returns blood to the child is 2 to 5 years old. It creates a pathway so that
heart is connected directly to the lung artery instead which reduces most, if not all, of the blood that would have gone to
the strain on the heart's lower left chamber, decreasing the risk of the right heart can instead flow directly into the
damage to it. FOR 2-4 months old infant. pulmonary artery.
 Pediatrics

Congenital Heart Defects

Mixed Blood Flow

The diseases that cause oxygenated Pulmonary

and deoxygenated blood to mix and Artery
then flow through the body include: Orta

Hypoplastic left heart syndrome

Transposition of great arteries LA

RA Oxygen poor
Truncus arteriosus
Co2 Rich blood
The underdeveloped or abnormally
developed heart anatomy leads to heart LV Oxygen poor
Open ductus arteriosus
dysfunction and poor blood CO2 Poor blood
oxygenation & circulation. RV

1- Hypoplastic left heart syndrome Atrial

Septal
Defect Mitra
valve
Definition Symptoms
Aortic Pulmonary
It is a rare congenital heart defect Valve artery
in which the left side of the heart Grayish-blue color of the lips and
is severely underdeveloped and gums (cyanosis)
Underdeveloped
incapable of supporting the Rapid, difficult breathing left ventricle
systemic circulation.
Poor feeding
Several structures can be Cold hands and feet
affected including the left
ventricle, aorta, aortic valve, or Weak pulse
mitral valve all resulting in Being unusually drowsy or inactive
decreased systemic blood flow.
Life threatening stage

Treatment

Medication: alprostadil helps widen the blood vessels

and keeps the ductus arteriosus open.
Breathing assistance
Intravenous fluids
Feeding tube
Atrial septostomy. This procedure creates or enlarges
the opening between the heart's upper chambers to
allow more blood flow from the right atrium to the left
atrium.
Heart transplant: the number of hearts for transplant is
limited, so this option is not used as often. Children
who have heart transplants need medications
throughout life to prevent rejection of the donor heart.
 Pediatrics

Congenital Heart Defects

Patent Ductus Arteriosus (PDA)

Stages of surgery: lets blood reach the aorta and go out

the body

Norwood procedure: Surgeons reconstruct the aorta

and connect it to the heart's lower right chamber. This
allows the right ventricle to pump blood to both the Atrial Septal Defect (ASD)
lungs and the body. For 2 weeks old infant lets blood reach the right
ventricle
Bidirectional Glenn procedure: It involves removing the
first shunt and connecting one of the large veins that
returns blood to the heart (the superior vena cava) to
the pulmonary artery. FOR 2-4 months old infant.
Fontan procedure: The surgeon creates a path for the
oxygen-poor blood in one of the blood vessels that
returns blood to the heart (the inferior vena cava) to
flow directly into the pulmonary arteries. The
pulmonary arteries then send the blood into the lungs.
This is typically done when a child is 2 to 5 years old.

2- Transposition of Great Arteries

Definition:

Transposition of the great arteries (TGA) is a serious, rare heart problem in which the two main arteries leaving the heart
are reversed.

Types
Complete transposition of the great arteries
the two arteries leaving the heart switch positions. Pulmonary artery connects to the left lower heart chamber and aorta
connects to the right lower heart chamber.
Congenitally corrected transposition,
also called (L-TGA) is a less common type. The lower left heart chamber, called the left ventricle, is on the heart's right
side and lower right heart chamber is on the heart's left side.
Life threatning

Right & left side of the heart

Not communicating
Transposition of
Deoxygenated blood is being the great arteries Aorta
Pumped to rest of body

Atrial septal defect

Symptoms

Blue or gray skin. Depending on the Pulmonary

baby's skin color, these color changes Artery
may be harder or easier to see.
Weak pulse.
Lack of appetite.
Poor weight gain.
 Pediatrics

Congenital Heart Defects

Treatment

In most cases, corrective surgery is done in the first week of life.

Prostaglandin to keep PDA open until surgery

Atrial septostomy. It uses thin tubes and small cuts to widen a natural connection between the heart's upper
chambers and helps mix oxygen-rich and oxygen-poor blood, improving oxygen levels in the baby's body.
Arterial switch operation. most common surgery. The two main arteries leaving the heart are moved to their correct
positions.
Atrial switch operation. The surgeon splits blood flow between the heart's two upper chambers. After this surgery, the
right lower heart chamber must pump blood to the body, instead of just to the lungs.
Rastelli procedure. This surgery may be done for ventricular septal defect. The surgeon patches the hole and
redirects blood flow from the left lower heart chamber to the aorta. This lets oxygen-rich blood go to the body.
Double switch procedure. This complex surgery is used to treat congenitally corrected transposition. It redirects
blood flow coming into the heart. It switches the great artery connections so the left lower heart chamber can pump
oxygen-rich blood to the aorta.

1
PA 1 Pulmonary artery
switched to root of
PA 1 Ductus arteriosus 1 2 original aorta
Ao divided
2 Ao
2 3 2 Aorta switched to root of
2 Aorta and pulmonary original pumonary
artery divided artery

3 Coronary areries
reattached to neo-aorta

1
1 Ductus arteriosus Aorta
divided
PA
Ao 2 Pericardial patch LA
2
used to reconstruct RA
base of new
pulmonary artery
LV
where the coronary
arteries used to be RV

Sometimes VSD, ASD OR PDA are also

present at the time of birth that may allow
enough mixing to prevent severe cyanosis.
 Pediatrics

Congenital Heart Defects

3- Truncus Arteriosus

Definition Truncus Arteriosus

Truncus arteriosus is a rare heart problem in which one large blood

vessel leads out of the heart, instead of two.
Having only one large blood vessel means that oxygen-poor and
oxygen-rich blood mix.
This mixing reduces the amount of oxygen delivered to the body.
It usually increases the amount of blood flow into the lungs too. AO
The heart has to work harder to adjust for the changes in blood flow.
Pulmonary artery and aorta are replaced by one artery PA
LA
Ventricular septal defect can also be suspected
RA

Symptoms LV

Blue or gray skin due to low oxygen levels.

RV
Excessive sleepiness.
Poor feeding.
Poor growth.
Pounding heartbeat.
Common ‘trunk’ Large
Fast breathing.
gives rise to VSD
Shortness of breath. pulmonary artery

Medications:

Water pills (diuretics): these medicines help the kidneys remove extra fluid from the body. Fluid buildup is a common
symptom of heart failure.
Positive inotropes: These medicines help the heart pump stronger, which improves blood flow. They also help control
blood pressure. Positive inotropes may be given by IV to treat severe heart failure symptoms.

Surgery: Usually, the surgeon:

Rastelli repair with
patched septum
Rebuilds the single large vessel and aorta to create a new, and new
complete aorta. pulmonary
Separates the upper part of the pulmonary artery from the 2 valve/artery
single large vessel.
Uses a patch to close the hole between the two lower heart
1 Patch
chambers. 1 2 New valve and
Places a tube and valve to connect the right lower heart artery
chamber with the upper pulmonary artery. This creates a new,
complete pulmonary artery.
 Pediatrics

Congenital Heart Defects

Obstruction of Blood Flow

The congenital defects that can The area of blood flow before
cause blood leaving the heart to be stenosis has increased pressure.
obstructed due to stenosis However, after stenosis, the area has
(narrowing of vessels) include: decreased pressure and this
Aortic stenosis Causes decreased cardiac output.
Pulmonary stenosis
Coarctation of aorta

Limited
outflow/inflow

Dilated atrium or Artificial

ventricle Valves

Thrombogenic

Blood flow Thrombosis foreign materials

such as sutures
disturbances
In chd and stents

Coagulation Central
derangement venous catheter use
associated
with the use
of CPB Inherited
thrombophilia
 Pediatrics

Congenital Heart Defects

Obstruction of Blood Flow

1- Aortic Stenosis
Definition:

Aortic stenosis is the narrowing of aortic Aortic valve Normal aortic valve
valve, which functions to connect left
ventricle and aorta.
This results in reduced blood flow to the
body which can be a life threatening
condition.

Symptoms:

An irregular heart sound (heart murmur) Closed Open

heard through a stethoscope
Chest pain (angina) or tightness with
activity
Feeling faint or dizzy or fainting with
activity
Shortness of breath, especially with
activity
Fatigue, especially during times of
increased activity Aortic stenosis Aortic stenosis

Rapid, fluttering heartbeat (palpitations)

Not eating enough
Not gaining enough weight

Nursing interventions

Heart valve disease is staged into four basic groups:

Stage A: At risk. Risk factors for heart valve disease are
present.
Stage B: Progressive. Valve disease is mild or moderate.
There are no heart valve symptoms.
Stage C: Asymptomatic severe. There are no heart valve
symptoms but the valve disease is severe.
Stage D: Symptomatic severe. Heart valve disease is
severe and is causing symptoms.
 Pediatrics

Congenital Heart Defects

Balloon valvuloplasty: a long, thin tube (catheter) with Aortic valve repair: To repair an aortic valve, surgeons
a balloon on the tip is inserted into an artery in the arm separate valve flaps (cusps) that have fused. However,
or groin. Once in place, the balloon is inflated, which valve repair is rarely used to treat aortic valve stenosis.
widens the valve opening. The balloon is then deflated, Generally aortic valve stenosis requires aortic valve
and the catheter and balloon are removed. replacement.

2- Pulmonary Stenosis

Definition: Stenotic
Pulmonary
Pulmonary valve stenosis is a narrowing of the valve Valve
between the lower right heart chamber and the lung
arteries.
Pulmonary
In a narrowed heart valve, the valve flaps may become valve
thick or stiff.

Narrowing of pulmonary valve

pulmonary Valve function
Valve connecting right
ventricle and pulmonary artery
Reduces blood flow to lungs

Balloon
Angioplasty Balloon
Symptoms:

A whooshing sound called a heart murmur that can be

heard with a stethoscope(systolic ejection muemur)
Fatigue.
Shortness of breath, especially during activity. Catheter
Chest pain.
Fainting.

Treatment:

Treatment
A flexible tube with a balloon on the tip is inserted into an
artery, usually in the groin.
X-rays help guide the tube, called a catheter, to the Pulmonary valve replacement:
narrowed valve in the heart.
If balloon valvuloplasty isn't an option, open-heart
The balloon inflates, making the valve opening larger. The surgery or a catheter procedure may be done to
balloon is deflated. The catheter and balloon are replace the pulmonary valve.
removed.
People who have had pulmonary valve
Valvuloplasty may improve blood flow through the heart replacement need to take antibiotics before
and reduce pulmonary valve stenosis symptoms but the certain dental procedures or surgeries to prevent
valve may narrow again. endocarditis
 Pediatrics

Congenital Heart Defects

3- Coarctation of Aorta

Definition: Coarctation of the Aorta

Aortic coarctation is a narrowing of main body of the Defect

aorta.
It forces the heart to pump harder to move blood
through the aorta.
Coarctation of the aorta can affect any part of the
aorta, but it's most often located near a blood vessel
called the ductus arteriosus that connects the left
pulmonary artery to the aorta.

Aorta function
Supplies blood to body
Narrowing occurs after blood
Symptoms: supplied to upper body
Reduces blood flow to
In infants After infancy
lower portion of body
Difficulty breathing Chest pain
Difficulty feeding Headaches
Heavy sweating High blood pressure
Irritability Leg cramps or cold feet
Pale skin Muscle weakness
Nosebleeds

Treatment:
Constricted section
Antihypertensive of aorta removed

Balloon angioplasty and stenting:

Angioplasty is often combined with the
placement of a small wire mesh tube called a
stent. Resection and
end-to-end
The stent helps keep the artery open, decreasing anastamosis
the chance of narrowing again.

Resection with end-to-end anastomosis involves

removing the narrowed area of the aorta
(resection) and then connecting the two healthy Using a guidewire a
parts of the aorta (anastomosis). ballon is passed up
the aorta
Subclavian flap aortoplasty

Bypass graft repair :a tube called a graft is used

to reroute blood around the narrowed area of the
aorta.

Patch aortoplasty. The surgeon cuts across the Balloon

narrowed area of the aorta and then attaches a angioplasty
patch of synthetic material to widen the blood
vessel.
 Pediatrics

Hypertrophic Pyloric Stenosis

HYPERTROPHIC PYLORIC STENOSIS

What is it? Risk Factors Symptoms

Pyloric stenosis, also known as Sex: Pyloric stenosis is seen more There are following symptoms:
infantile hypertrophic pyloric often in boys
stenosis (IHPS), is an uncommon Dehydration
Race and ethnicity
condition in infants characterized Vomiting after feeding(projectile
by abnormal thickening of the Premature birth vomiting)
pylorus muscles in the stomach Early antibiotic use Stomach contractions
leading to gastric outlet
obstruction Smoking during pregnancy Weight problems
Blocks food from reaching Small Family history Changes in bowel movements
intestine Bottle-feeding. Increased appetite

Complications Diagnosis Treatment

Pyloric stenosis can lead to: Blood tests to check for Surgery is needed to treat
Dehydration: Frequent vomiting dehydration or electrolyte pyloric stenosis. The procedure,
can cause dehydration and a imbalance or both. called a pyloromyotomy, is often
mineral imbalance. These scheduled on the same day as
Ultrasound to view the pylorus
minerals are called electrolytes. the diagnosis
and confirm a diagnosis of
Stomach irritation: Repeated pyloric stenosis. Pyloromyotomy is often done
vomiting can irritate your baby’s using minimally invasive surgery
X-rays of your baby’s digestive
stomach and may cause mild system, if results of the A slender viewing instrument,
bleeding. ultrasound aren’t clear called a laparoscope, is inserted
Metabolic alkalosis through a small incision near the
baby’s navel.
Frequent vomiting depletes acid
in stomach ELECTROLYTE IMBALANCES TEST Recovery from a laparoscopic
SHOWS: procedure is usually quicker than
Jaundice: Rarely, a substance
If Increased level of HCT, recovery from traditional surgery.
secreted by the liver can build
BUN,HCO3, blood pH and This method also leaves a smaller
up, causing a yellowing of the
decreased level of potassium is scar.
skin and eyes. This substance is
known as bilirubin. detected then it indicates the
presence of disease
hypokalemia
Frequent vomiting leads to
excess loss of
Potassium which can cause
arrythmias
MALNUtrition
Inadequate absorption &
frequent vomiting
Lead to dehydration &
inadequate nutrition
Which can lead to failure to
thrive
 Pediatrics

Intussuscption

HPS Nursing Interventions Intussuscption

Maintain adequate nutrition and fluid intake. Risk Factors Cause unknown
If the infant is severely dehydrated and There are following risk Factors:
malnourished, rehydration with intravenous Family history
fluid and electrolytes are necessary;
Age ( more common in Infants and young children) 3
Feedings of formula thickened with infant months_24 Months
cereal and fed through a large-holed nipple
may be given to improve nutrition; Certain infection ( viral or bacterial)
Medical condition ( cystic fibrosis or tumors)
Provide mouth care.
Constipation
The infant needs good mouth care as the
mucous membranes of the mouth may be Meckel's Diverticulum
dry because of dehydration and the omission Celiac Disease
of oral fluids before surgery;
A pacifier can satisfy the baby’s need for
sucking What is it?
Promote skin integrity
The infant is repositioned, the diaper is Risk Factors Cause unknown
changed, and lanolin or A and D ointment is
A serious condition is which part of the intestine slides into
applied to dry skin areas.
an adjacent part of the intestine. This Telescoping action
Promote family coping. often blocks food or fluid from passing through.

Include the caregivers in the preparation for Intussuscption also cuts off blood supply to the part of
surgery and explain the importance of added intestine that’s affected.
IV fluids Mostly occurs in: Junction of Ileum and cecum .
Monitor
Electrolytes
Symptoms
Vital signs & EKG
Daily weights Risk Factors Cause unknown
Episodes of vomiting + stools
Nausea
Change in bowel movements
Vomiting

POST-OP Severe abdominal pain

Blood in the stool(red currant jelly stool)
After the procedure, small feeds should be Diarrhea
frequently started within 24 hours. Severe, colicky, intermittent
Within 2 days of procedure, the small feed Child will draw up legs towards abdomen
should be converted into normal feeds
During episode
During feed, infant position should be in
upright position Sausage shaped mass in upper abdomen
 Pediatrics

Hirschsprung's disease

Pathogenesis

As the intussusception develops, Diagnosis Treatment

the mesentery is dragged into
the bowel. There are following ways for The treatment includes:
diagnosis:
Enema: A doctor may attempt an
Physical examination: air or liquid enema to gently push
This leads to the development of examination of abdomen for the intestine back into place.
venous and lymphatic congestion signs of tenderness
with resulting intestinal edema. Surgery: If the enema doesn’t
Medical history work or if there are complications,
Imaging tests ( Ultrasound or surgery may be necessary to
X-ray) “Bullseye sign” correct the condition.
If untreated, the process can
Contrast enema(Air or barium Surgical reduction
ultimately lead to ischemia,
perforation, and peritonitis. enema): A liquid is inserted into Resect or manually reduce area
rectum to help diagnose
Only done if other methods are
ineffective
Antibiotics are also used for
Monitor vital signs: Keep a close eye on the patient’s heart rate, blood infection
pressure, and temperature. Monitor following

I&O
Also known as Congenital
Pain Ganglionic megacolon
Stool consistency and color
Signs of perforation or shock
The ganglion cells form the
Assess pain: Regularly assess the patient’s pain level and provide
network of nerves called the
appropriate pain management as prescribed by the healthcare provider.
myenteric plexus (Auerbach's
Administer fluids: Ensure the patient is adequately hydrated by plexus) that are located in
administering fluids as ordered by the healthcare provider. between the circular
Monitor bowel movements: Keep track of the patient’s bowel movements And the longitudinal muscle
and report any changes or abnormalities to the healthcare team. layers of the gastrointestinal (GI)
tract wall They make the colon
contract so stool can move
easily through the digestive
Hirschsprung's disease system
Normal colon and rectum
In children with Hirschsprung's
What is it? disease, ganglion cells fail to
Larte Colon
form completely or partially.
Hirschsprung's (HIRSH- sproongz) intestine
disease is a condition that affects the Nerves Completely missing or
large intestine (colon) and causes inadequate cells fail to make
problems with passing stool. Small
the colon contract so stool can’t
intestine move easily through the
The condition is present at birth Rectum digestive system leading to
(congenital) as a result of missing
persistent constipation
nerve cells(ganglion cells) in the
muscles of the baby's colon. Hischsprung’s disease
In children with Hirschsprung's disease,
Larte Colon
nerves fail to form in all or part of the intestine
large intestine (colon). Waste from
Nerves
digestion cannot pass through the part
of the colon lacking nerve tissue. The
normal colon swells with blocked stool. Small
intestine
Smaller Rectum
 Pediatrics

Hirschsprung's disease

Symptoms Risk factors

Factors that may increase the risk
Each child may experience symptoms differently, but
of Hirschsprung's disease include:
common symptoms in infants include:
Having a sibling who has Hirschsprung's disease.
Failure to have a bowel movement in the first 48 hours Hirschsprung's disease can be inherited. If you have
of life one child who has the condition, future biological
siblings could be at risk.
Abdominal distention (stomach bloating)
Being male. Hirschsprung's disease is more common in
Gradual onset of vomiting
males.
Fever
Having other inherited conditions. Hirschsprung's
Constipation or failure to pass regular bowel disease is associated with certain inherited conditions,
movements
Such as Down syndrome and other abnormalities
Squirt sign present at birth, such as congenital heart disease.

Digital rectal exam leads to explosive passage of gas &

watery stool

Trouble feeding
Children who don’t have early symptoms may
experience the following signs of Hirschsprung’s
disease as they get older:

Constipation that becomes worse with time

Loss of appetite Complications can lead to:
Delayed growth Swelling and inflammation spread into the deeper
Passing small, watery stools layers of your colon(Mega colon)

Abdominal distention A hole in the wall of the small intestine or the colon
(bowel perforation)

Complication: enterocolitis

The most common complication of Hirschsprung disease

is Hirschsprung-associated enterocolitis, a condition in
which the intestines become inflamed.
Typical symptoms of enterocolitis include:
Abdominal pain and cramping.
Treatment
Diarrhea, sometimes bloody.
Loss of appetite. Antibiotics, antivirals or antiparasitic drugs to target
infections.
Nausea and vomiting.
IV fluids and electrolytes to treat dehydration from
Fever. diarrhea and vomiting.
Fatigue. Corticosteroids to reduce inflammation.
Swollen, distended abdomen. Gastric compression
 Pediatrics

Hirschsprung's disease

Diagnosing Hirschsprung Disease Treatment

Abdominal X-ray: An X-ray of the belly may show a Hirschsprung Disease Treatment
bowel obstruction. This test is a first step. It cannot
give an exact diagnosis of Hirschsprung disease. Each child with Hirschsprung disease has unique needs.
The multidisciplinary care team will make a treatment plan
Contrast enema: This test uses X-ray images and an suited for your child’s condition and overall health.
enema solution with a contrast solution. The solution
makes the features of the colon show up better on an IV Fluids & electrolytes
X-ray. This is the most helpful imaging study to assist Stool softeners
in finding out if a child has Hirschsprung disease.
Enemas for constipation
Rectal biopsy: This test gives the definitive diagnosis.
It involves taking a sample of the cells in the rectum Antibiotics for infection
for a pathologist to view under a microscope. Surgery;
Anal manometry: This test measures anal pressure. Temporary colostomy to rest bowel
It also checks if normal reflexes of the rectum and the
anus are present. It can be done at the bedside in the Definitive surgery to remove a ganglionic portion of
hospital room. bowel

Based on your child’s needs and stage of

treatment, the care team may include:
Nursing Intervention
Specialized pediatric colorectal surgeon

The major nursing care planning goals for patients Dedicated nurse
with Hirschsprung Disease are: Pediatric gastroenterologist specializing in motility
(motion of the digestive system)
Provide health promotion, counseling and education.
Registered dietician
Administer medications and other personalized
interventions. Pelvic floor physical therapist
Maintaining skin integrity Psychologist
NGT placement (low intermittent suction) Social worker
Strict I &O Child life specialist
Promoting comfort Other experts as needed
Monitor bowel sounds.
Provide emotional support
Monitor fluid & electrolyte
Maintaining fluid balance.
PHARMACOLOGY
 Pharmacology

Prefixes & Suffixes

IMMUNE MEDS CARDİAC MEDS

Drug type Prefix/ Suffix Examples Drug type Prefix/ Suffix Examples

Fluoroquinolone -FLOXACIN Ciprofloxacin, Antithrombotics -parin Heparin,

s Moxifloxacin, Enoxaparin
Gemifloxacin
ACE Inhibitors -pril Moexipril.Perind
Sulfonamides SULF- Sulfadiazine,Sulfadoxine opril.Quinapril.
,Sulfisoxazole
Calcium Channel -dipine Felodipine.Isra
Tetracyclines -cycline Doxycycline,Minocycline Blockers dipine.Nicardi
,Eravacycline pine.

Antiviral/ Antiflu vir Oseltamivir,Adefovir, Angiotensin II sartan Losartan,

Cidofovir Receptor Blocker valsartan

Antiherpes -clovir acyclovir ,penciclovir Beta Blockers -olol Atenolol,bisop

rolo,carvedilol

Penicillins -cillin Amoxicillin,Dicloxacillin, HMG-CoA -statin Pitavastatin,pr

Piperacillin Reductase avastatin.rosuv
Inhibitor astatin

Cephalosporins cef- or Cefadroxil,Cefazolin, Alpha-1 Blockers -osin doxazosin,

ceph- Cefepime terazosin,
tamsulosin
Aminoglycosides -mycin azithromycin,clarithro
+ Macrolides mycin,erythromycin Aminoglycosides -mycin azithromycin,cl
+ Macrolides arithromycin,er
Tetracyclines -CYCLINE Doxycycline,Eravacycline, ythromycin
Eravacycline
Thiazide thiazide Hydrachlorothi
Monoclonal -mab Rituximab,Trastuzumab Diuretics azide
Antibodies
Loop Diuretics -semide or Bumetanide ,
rotease Inhibitors -navir Indinavir,Ritonavir, -ide Furosemide
(HIV drug) Nelfinavir
PotassiumSparin -actone Amiloride,Epler
g Diuretics enone,Spironol
actone
RESPIRATORY MEDS
Cardiac -oxin Digoxin,
Drug type Prefix/ Suffix Examples Glycosides digitoxin

Beta-2 Agonists -terol albuterol l, levalbuterol, Factor Xa -xaban rivaroxaban,api

metaproterenol, Inhibitor xaban,edoxaba
n,
Xathine -phylline Moexipril.Perindopril.
Derivatives Quinapril.

Anticholinergics -tropium Felodipine.Isradipine.

Nicardipine.

Leukotriene -lukast montelukast,zafirlukast

Modifiers
 Pharmacology

Prefixes & Suffixes

GASTROİNTESTİNAL MEDS NEURO/ PSYCH MEDS

Drug type Prefix/ Suffix Examples Drug type Prefix/ Suffix Examples

H2 Blockers -tidine FamotidineCimetidine, Antypical zodone trazodone.

Ranitidine Antidepressants

Proton Pump -prazole Lansoprazole,Dexlansop Antidepressants -pramine, Clomipramine,

Inhibitors razole.Pantoprazole. -triptyline Amitriptyline

Antiemetics -setron, Promethazine, Antipsychotics --ridone Risperidone,

-azine Granisetron, Paliperidone
Ondansetron

Benzodiazepines -pam & Diazepam,halaze

-lam pam, alprazolam
PAİN & ANESTHESİA MEDS
Selective --xetine, citalopram
Drug type Prefix/ Suffix Examples Serotonin -pram dapoxetine
Reuptake escitalopram
NSAIDs -profen ibuprofen. naproxen. Inhibitors

Opioids -done & Oxycodone, Norepinephrine -xetine, atomoxetine,

-one hydrocodone Reuptake -pram reboxetine
Inhibitors
Local -caine lidocaine, mepivacaine,
Anesthetics prilocaine, Barbituates -barbital Amobarbital.Pe
ntobarbital
Inhaled -ane Halothane Butalbital
Anesthetics
Antimigraine -triptan Sumatriptan,
Neuromuscular -uronium, Vecuronium, Zolmitriptan,
Blockers -curium Cisatracurium Almotriptan

OTHER COMMON MEDS

Drug type Prefix/ Suffix Examples

Phosphodiestera -fil sildenafil,

se Inhibitors

Corticosteroids -sone prednisone,

dexamethasone,
triamcinolone,,

Antihistamines -ine Loratidine, Cetirizine

Bisphosphonates -dronate risedronate alendronate

ibandronate

Antidiabetics -gliptin & Sitagliptin, Glipizide

-ide
 Pharmacology

Therapeutic Levels & Antidotes

COMMON THERAPEUTİC LEVELS ANTİDOTES

Drug type 10-40 mcg/ml Drug type Antidote

phenobarbital 4-10 mcg/ml methanol ethanol

amitriptyline 120-150 ng/ml methotrexate l euocovorin
Amiodarone 0.5-2.5 mcg/ml tricyclics .sodium bicarbonate
digoxin 0.5-2.0 meq/l narcotics naloxone (narcan)

lithium 0.6-1.2 meq/l mag sulfate calcium gluconate

phenytoin 10-20 mcg/ml Warfarin vitamin k

theophylline 10-20 mcg/ml acetaminophen n- acetylcysteine

valproic acid 50-100 mcg/ml anticholinergics physostigmine

Salicylates 100-300 mcg/ml insulin glucose

gentamicin 5-10 mcg/ml iron deferoxamine

tobramycin 5-10 mcg/ml Aspirin sodium bicarbonate

carbamazepine 5-12 mcg/ml benzodiazepines flumazenil

vancomycin trough 10-20 mcg/ml isoniazid Pyridoxine

Acetominophen 10-20 mcg/ml lead deferoxamine

mag sulfate 4-7 mg/dl beta blockers glucagon

cholinergic atropine
cyanide hydroxocobalamine

antidote digibind or digifab

dopamine Phentolamine
Heparin protamine sulfate
mag sulfate calcium gluconate
 Pharmacology

Pharmacology

The branch of medicine concerned with the uses, effects, and modes of action of drugs.

Branches of pharmacology
Body response Drug effects
Pharmacokinetics Pharmacodynamics

(What does body do to the drugs) (what does drugs do to the body)

Absorption Efficacy
Medicine How will it get in? Toxicity

(action-effect of drugs and

Metabolism Distribution dose-effect relationship) Mechanisms
How is it Where will Drug exert their effects,
broken down? it go? both beneficial and Dose
harmful, by interacting
with receptors Activity
Liver
Transporters Drugs bind with receptors and
produced measurable response

Excretion
1. Ligand-gated ion cholinergic nicotinic
How does it leave channel receptors
2. G-protein-coupled α and β
Drug absorption; Passive diffusion receptors adrenoreceptors
Drug move from
Transfer of drug from 3. Enzyme linked Insulin receptors
high concentration
its site of receptors
to low conc.
administration to the 4. Intercellular
bloodstream receptors Steroid receptors
(absorption of drug Active diffusion
depend on the route Drug move low
of administration) conc to high conc
Receptors and other drug targets
Drug distribution; a. G-protein-coupled b. A channel-linked
receptor (GPCR) receptor
Blood flow .
A hypothetical Drug Na+ Drug
capillary volume of body
permeability. fluid into which a
binding of drug to
drug is distributed
G-protein
plasma protein. complex

G-protein activates Na+

Volume of distribution (VD) a target protein
amount of drug in the body Target protein initiates Conformational change
VD = further events leading to a in the channel increases
Plasma drug concentration biological response ion conductance
 Pharmacology

Pharmacology

Pharmacokinetics Pharmacodynamics

Drug metabolism; c. An enzyme d. A transport protein

drug target drug target
Biotransformation of pharmaceutical substances in the
body they can be eliminated more easily. Drug
Drug
Site for drug metabolism Intestine Substrate
Tissue Liver is the major Molecules Products
Kidney

Angle for administration of ınjection

Intramuscular Subcutaneous Intravenous Enzyme
Na+ K+
injection injection injection
90॰ 45॰ 25॰

Importance of pharmacodynamics
Muscle Subcutaneous Vein Exposure-response (PK/PD) relationships,
Tissue
Optimal dose and dose regimens,
Intradermal
injection Confirming safety and efficacy, which are all
Dermis critical for successful regulatory approval.
10-15 ॰

Elimination
Studies on the mode of action or effects
(removal of drug from the body)
of a substance in relation to its desired
Route of elimination through kidney , liver, GIT , Lungs. therapeutic target
Other routes Sweat , Tear , Breast milk, Salivary secretion

Routes of drug administration

Three major routes of drug administration

Enteral (oral, sublingual) Parenteral (IV, IM,SC etc ) Others ( inhalation, intranasal,
topical, rectal etc)
Administration bymouth Administration by injection
can be oral or (parenteral administration) Inhalation
sublingual.
Subcutaneous (under the skin) Intranasal
pass through the GI
Intramuscular (in a muscle) Topical
tract and are
metabolized by the liver. Intravenous (in a vein) Rectal
 Pharmacology

Emergency Meds

Lidocaine

Action Use for Side effects

Blocking voltage-gated Used for local and Dehydration
Na+ channels topic anesthesia,
Vomiting after
Regulate intracellular Antiarrhythmic, feeding(projectile
and extracellular Analgesic. vomiting)
calcium Stomach contractions
Used as an
Concentrations through adjunct to Weight problems
other ligand-gated ion tracheal
channels. Changes in bowel
intubation
movements
Temporarily relieves
pain, itching, soreness, Increased appetite
burning, Reduces Lidocaine HCL
swelling, and protects. Injection, USP
Onset of action is rapid
after an intravenous(IV)
bolus. 10 mg/mL

Epinephrine

Action Use for Side effects

Through its action on Used for Tachycardia,
alpha-1 receptors, emergency
Hypertension,
treatment of
Induces increased
severe allergic Headache,
vascular smooth muscle
reactions Anxiety
contraction
Used to treat
Pupillary dilator muscle
anaphylaxis.
contraction
Sudden asthma
Intestinal sphincter
attacks.
muscle contraction. Adrenalin
Used to treat low Epinephrine
Renin release via beta-1
blood pressure and Injection, USP
receptors.
slow heart rate.
1 mg 1:1000 1ml
 Pharmacology

Emergency Meds

Atropine

Action Use for Side effects

Atropine increases the Reduce saliva Dry mouth
heart rate and improves and fluid in the
Fast heartbeats
the atrioventricular respiratory tract
conduction by blocking during surgery. Blurred vision
the parasympathetic Used to treat
influences on the heart.. insecticide or
By blocking mushroom
acetylcholine, atropine poisoning..
speeds up the heart rate. used in an
Atropine binds and emergency to
blocks treat a slow
Atropine
heartbeat.
acetylcholine receptors. Sulfate
Salivation and Injection, USP
Inhibit salivary and
bronchial
mucus glands
secretions 20 mL

NARCAN

Action Use for Side effects

opioid antagonist that rapidly reverses Vomiting
antagonizes opioid an opioid
Agitation
effects by competing for overdose
the same receptor sites. Seizures
Narcan is also
Naloxone hydrochloride used to increase
reverses the effects of blood pressure in
opioids, including people with septic
respiratory depression, shock.
sedation, and Used to manage
hypotension. opioid overdose
in pregnant
women NARCAN
4mg
 Pharmacology

Other Emergency Drugs

Calcium Sodium
Amiodarone Adenosine gluconate bicarbonate

Antiarrhythmic that Exerts a negative Increasing the level of increasing plasma

blocks potassium chronotropic effect by calcium in the blood bicarbonate levels,
channels. suppressing the or by binding to which are known to
automaticity of excess potassium or buffer excess
Sodium channel
cardiac pacemakers, magnesium in the hydrogen ion
blocker, thereby
and a negative blood. concentration, thereby
reducing automaticity
dromotropic effect raising solution pH to
and conduction Helps to maintain
through inhibition of combat clinical
velocity in the calcium balance and
AV-nodal conduction. manifestations of
ventricles. prevent bone loss
Decreases heart rate when taken orally. acidosis..
It works directly on the
and also decreases
heart tissue and will
the speed with which
slow the nerve
impulses in the heart. impulses flow between Uses Uses
the heart muscles to
Keep heart rhythm bring about a Hypocalcemia, Is used to relieve
normal. contraction.
Cardiac arrest, heartburn, sour
stomach, or acid
Cardiotoxicity indigestion by
Uses Uses Hyperkalemia neutralizing excess
stomach acid.
Treats a fast or Diagnostic and Hypermagnesemia.
Certain drug
irregular heartbeat therapeutic agent.
overdoses.
Heart surgery to Vasodilatory effects.
prevent atrial Side effects Stomach or duodenal
Restore normal ulcers
fibrillation. heartbeats.
Ventricular Allergic reactions
Used during a stress
arrhythmias. test of the heart. High calcium level Side effects
Slow breathing
Side effects Side effects Vomiting
Weakness
Chest pain Nausea
Skin Cough
Dizziness Blurred vision
 Pharmacology

Posology

Is the branch of pharmacology , which deals with dosage of drugs)

Drug Pro Drug Placebo

Word Drug, taken from French word A drug substance that is inactive ( inactive substances )
Drogue which means Dry Herb, in the intended pharmacological Preparation given to satisfy the
actions and is must to be patients symbolic need for drug
It refer to any substance that converted into the
bring about a change in therapy
pharmacologically active agent
biological function through its by metabolic processes ( Used in controlled studies to
chemical action. levodopa into dopamine ) determine the efficiency of
medicinal substance.

Dose Dosage
Amount of drug taken each time Amount of drug given to n
by an individual or quantity to be individual per unit body weight or
administered at on time. (20mg, the determination and regulation
10mg, 2 drops etc) of the size , frequency and
number of doses

Dosage types

Therapeutic dose; Average dose for an adult to produce a therapeutic effects .

Loading dose; large dose initially used to produce an effective concentration as quickly as possible .
Maintenances dose; Maintain the therapeutic effect or concentration in blood plasma.
Maximal tolerated dose; Largest dose of a drug that can be taken safely.
Toxic dose; Amount of drug , produced undesirable effect of serious nature .
Fetal dose; A dose that produces Death.
 Pharmacology

Autonomic Nervous System

The nervous system includes the brain, spinal

Nervous system cord, and a complex network of nerves.

The Nervous System

Central NS Peripheral NS
(The body's master control unit) (The body's link to the outside world)

Spinal Cord The Somatic NS

A column of nerves between the brain and Carries sensory information from sensory
peripheral nervouS system organs to the CNS and relays motor
(movement) commands to muscles; controls
voluntary movements

Spinal Cord
The Autonomic NS
A column of nerves between the brain and
peripheral nervouS system Regulates involuntary bodily processes,
including heart rate, respiration, digestion
and pupil contraction; operates automatically
without conscious direction

Spinal Cord
A column of nerves between the brain and
peripheral nervouS system Sympathetic NS
Prepares the body for action and stress. This is
called "fight or flight"

Parasympathetic NS
Calms the body and helps the body to conserve
energy
 Pharmacology

Autonomic Nervous System

Is a component of the peripheral nervous system that regulates involuntary physiologic processes including
ANS heart rate, blood pressure, respiration, digestion, and sexual arousal. (involuntary nervous system)

Neuron

(Basic structural and functional unit of nervous system )

Neuron are the fundamental units of the brain and nervous system
The cells responsible for receiving sensory input from the external world, for sending motor commands to our muscles
Transforming and relaying the electrical signals at every step in between.

Dendrite
Cell Node of Axon
Body Ranvier Terminal

Cell Schwann
Body Cell

Nucles

Classification of Nerve Cell

Motor Neuron (Efferent) Sensory Neuron (Afferent)

Which carry the motor impulses from CNS to These neuron carry the sensory impulses from
peripheral effectors organ like muscles ,gland peripheral to the CNS generally these have
and blood vessels short axon and long dendrites
 Pharmacology

Autonomic Nervous System

Receptors Neurotransmitter
Biological molecules to which a drug binds and Chemical substances that act as mediators for the
produced a measurable response. Receptors are transmission of nerve impulse from one neuron to
proteins, usually cell surface receptors, which bind to another neuron through a synapse
ligands and cause responses in the immune system,
The point at which a nervous pulse passes
from one neuron to another synapse

Synaptic Vesicle

Voltage Ca2
Presynaptic Channel
Neuron
Synaptic Neurolamiller
Cleft Molecules
Posisynaplic
Neuron Ion Channel
Receptor

Local mediators Harmons

Most cells in the body secrete chemicals that act Specialized endocrine cells secrete Harmons
locally , these chemical signal are rapidly into the blood stream
destroyed or removed . They travels through out the body exerting
Local mediators are released by many cell types effects on broadly distributed target cells in
(which are not specialized for this purpose) and the body.
diffuse through the extracellular fluid to act on
cells within the same local area
 Pharmacology

Autonomic Nervous System

Para-sympathetic NS Sympathetic NS

Rest and Digest Fight and Flight

Conserve and store energy and to regulate basic body Responding to dangerous or stressful situations. In
functions such as digestion and urination. these situations sympathetic nervous system activates
to speed up heart rate

ACTION ACTION
Produce relax or reduce your body's activities. Produce dangerous or stressful situations.

Eye Eye
Consrict Pupils Dilate Pupils

Pancreas Pancreas
Stimulate Saliva Inhibit Saliva

Heart Heart
Slow Heartbeat Increase Heartbeat

Lungs Lungs
Consrict Airways Relax Airways

Stomach Stomach
Stimulate Activity Inhibit Activity
of Stomach of Stomach

Liver Liver
Stimulate Gallbladder Inhibit Gallbladder

Instensine Instensine
Stimulate Activity Inhibit Activity
of Intestines of Intestines

Bladder
Bladder
Secrete Epinephrine &
Contract Bladder
Norephinphrine

Bladder
Relax Bladder
 Pharmacology

Autonomic Nervous System

Organ Sympathetic Action Parasympathetic Action

EYE Contraction of iris redial muscle Contraction of iris sphincter muscle

(Pupil dilate) Relaxation of ciliary (Pupil contracts) Contraction of
muscles ciliary muscle (lens accommodates
for near vision)

Decrease rate Decreased

HEART Increase rate Increase contractility
contractility

Trachea & Bronchioles Dilate Constrict Increase secretions

Contraction of sphincters Decrease

Gastrointestinal in muscle motility and tone
Increased muscle motility and tone

Genitalia (male) Stimulation ejaculation Stimulation erection

Genitalia (female) Relaxation of uterus

Salivary Gland Thick, viscous secretion Large watery secret

epinephrine & Nor- epinephrine

Adrenal Medulla secreted
Decrease activity.

Sympathetic activity increases

Lacrimal Gland before crying
Stimulates tears
 Pharmacology

Prototype Drugs of ANS

Prototype Drug A first or preliminary form of drug from which other forms of drugs are
Prototype Drug developed or copied is called prototype drug.

Drugs of ANS

Cholinergic Drugs Or Parasympathetic Drug Adrenergic Drugs Or Sympathetic Drug

Cholinergic Cholinergic
(agonist) (agonist)

Agonist; Drug bind to receptor,

producing a similar response

Antagonist ; .Drug bind to

receptors either on the primary
site or on another site , which all neuro meds
together stop the receptor from
producing a response

Anticholinergics vs Cholinergic

Acetylcholine Rest & digest response

Neurotransmitter Acetylcholine allows communication between nerve cells & muscles and plays an
Rapidly inactivate by essential role in the Parasympathetic Nervous System
acetylcholinesterase

MOA Therapeutic action and use Adverse effect

Decrease in heart rate and cardiac output Acetylcholine (1% solutions) is Diarrhea,, nausea
instilled into the eyes to produced
Decrease in blood pressure Bradycardia, flushing and
meiosis during ophthalmic surgery.
salivation
In GIT acetylcholine , increase salivary
Important neurotransmitter that
secretion , intestinal secretion and Sweating
plays a role in brain functions, such
motility
as memory, and body functions, Urinary retention , meiosis
It enhance the secretion in bronchioles
Breathing difficulty, dry
Neurotransmitter that plays a role in mouth , flushing
memory, learning, attention, arousal and
involuntary muscle movement.
 Pharmacology

Prototype Drugs of ANS

Anti- cholinergic Cholinergic

Anticholinergics are substances that block the action Inhibit, enhance, or mimic the action of the
of the acetylcholine neurotransmitter at synapses in neurotransmitter acetylcholine,
the central and peripheral nervous system.
The primary transmitter of nerve impulses within the
These agents inhibit the parasympathetic nervous parasympathetic nervous system
system by selectively blocking the binding of ACh to
its receptor in nerve cells. The primary neurotransmitter within the
parasympathetic nervous system (PNS)
Inhibits nerve impulses responsible for involuntary
muscle movements and various bodily functions.
Effects
Anticholinergic drugs block the action of a
neurotransmitter called acetylcholine. Control of heart beat,
Blood pressure,
Effects
Movement and many other functions.

Stop involuntary muscle movements Memory, digestion,

Heart rate increase Pupil constriction

Bronchial dilation Increase secretions

Decrease GI motility Decrease HR

Relax bladder GI stimulant

Decrease muscle rigidity Bladder stimulant

Pupil dilation Remember r in para for rest & digest

Decrease secretions
Blood can go to other organs: gi tract, kidneys,
Blood will be shunted to vital organs: brain, heart & muscles, etc
lungs

Fight or flight mode= survival mode

Blood will be shunted to vital organs:

brain, heart & lungs
 Pharmacology

Prototype Drugs of ANS

Benzatropine Parkinson's disease Donepezil Alzheimer's

Anticholinergic drug used to treat Parkinson's disease

MOA
Benztropine is indicated to be used as an adjunct in
the therapy of all forms of parkinsonism. Donepezil inhibits acetylcholine hydrolysis, thereby
increasing acetylcholine availability at the synapses
It can also be used for the control of extrapyramidal
and enhancing cholinergic transmission.
disorders due to neuroleptic drugs

Donepezil
MOA
Benztropine is an agent with anti-muscarinic and
antihistaminic effects. ACh

Its main mechanism of action is presented by the

selective inhibition of dopamine transporters
Acetylcholine Acetylcholinesterase
It also presents affinity for histamine and muscarinic (Ach) (AChE)
receptors

Route of Elimination Uses

Benztropine is mainly excreted in the urine but it is
used to treat confusion (dementia) related to
also found in the feces unchanged
Alzheimer's disease.
It does not cure Alzheimer's disease, but it may
Therapeutic uses improve memory, awareness, and the ability to
function.
To treat Parkinson's disease. This medication is an enzyme blocker that works by
Improving muscle control and reducing stiffness, restoring the balance of natural substances
(neurotransmitters) in the brain
Allows more normal movements of the body as the
disease symptoms are reduced.
Excretion
Adverse effects Through the kidneys, with around 17% of the drug
excreted unchanged in the urine.
Confusion
Hallucinations
Side effects
Nausea
Fast heartbeats. Diarrhea.
Feeling sick (nausea).
Headache
Feeling sleepy in the daytime or feeling dizzy.
 Pharmacology

Prototype Drugs of ANS

Ipratropium COPD/asthma Pyridostigmine Myasthenia gravis:

Bronchodilator medication that works to dilate the Pyridostigmine is a medication used to treat
airways of the lungs myasthenia gravis and underactive bladder.
It is also used together with atropine to end the
MOA effects of neuromuscular blocking medication of the
non-depolarizing type
Ipratropium is an acetylcholine antagonist via
blockade of muscarinic cholinergic receptors.
MOA
Blocking cholinergic receptors decreases the
production of cyclic guanosine monophosphate Ipratropium is an acetylcholine antagonist via
(cGMP). blockade of muscarinic cholinergic receptors.
This decrease in the lung airways will lead to Blocking cholinergic receptors decreases the
decreased contraction of the smooth muscles. production of cyclic guanosine monophosphate
(cGMP).

Therapeutic uses This decrease in the lung airways will lead to

decreased contraction of the smooth muscles.

Used to help control the symptoms of lung diseases,

such as asthma, chronic bronchitis, and
emphysema. Uses
It is also used to treat air flow blockage and prevent Treats myasthenia gravis. This condition causes
the worsening of chronic obstructive pulmonary muscle weakness
disease (COPD).
Improve muscle strength in patients.

Route of elimination
Side effects
About 80-100% of the administered dose of ipratropium
is excreted in the urine leaving less than 20% of the
dose to be eliminated through the feces Upset stomach
Diarrhea

Half-life Sweating

ipratropium presents a short half-life of about 1.6 hours

Adverse effects Although one of their common uses is for neuro

disorders, they are both used for many other
purposes
Sore throat
Blurred vision
Cough
 Pharmacology

Prototype Drugs of ANS

Oxybutynin Overactive bladder Bethanechol Urinary retention

Oxybutynin is a type of medicine called an Bethanechol is taken to treat certain disorders of the
antimuscarinic (or anticholinergic) muscle relaxant. urinary tract or bladder. It helps to cause urination
and emptying of the bladder.
Oxybutynin is used to treat symptoms of an
overactive bladder, such as incontinence (loss of
bladder control) or a frequent need to urinate.
MOA
It helps decrease muscle spasms of the bladder and
the frequent urge to urinate caused by these spasms.
Bethanechol is a direct muscarinic agonist and
stimulates the parasympathetic nervous system by
binding to postganglionic muscarinic receptors
MOA
The cholinergic effects of bethanechol lead to
increased detrusor muscle tone to promote bladder
competitive acetylcholine antagonism at emptying and increased smooth muscle tone which
postganglionic muscarinic receptors, leading to the restores gastrointestinal peristalsis and motility
relaxation of the smooth muscles of the bladder

Uses
Therapeutic uses
For the treatment of postoperative urinary retention,
To treat symptoms of an overactive bladder postpartum urinary retention,

Antispasmodics It is also indicated for the treatment of neurogenic

atony of the bladder with retention.
Oxytocin is a hormone used to help start or continue
labor and to control bleeding after delivery.
It is also sometimes used to help milk secretion in Side effects
breast-feeding.
Urinary urgency
Nausea
Adverse effects Fainting
Diarrhea
dry mouth, blurred vision, constipation feeling dizzy or
sleepy Headache
Belching
 Pharmacology

Prototype Drugs of ANS

Scopolamine Motion sickness Pilocarpine Glaucoma

Used to manage and treat postoperative nausea and

vomiting (PONV) and motion sickness. MOA
It is in the anticholinergic class of drugs
Pilocarpine directly stimulates cholinergic receptors,
acting on a subtype of muscarinic receptor (M3)
MOA found on the iris sphincter muscle, causing the
muscle to contract and produce miosis.
competitively inhibits muscarinic receptors for This effect is important in the short-term
acetylcholine and acts as a nonselective management of some angle-closure glaucoma
muscarinic antagonist, producing both peripheral
antimuscarinic properties and central sedative,
antiemetic, and amnestic effects.
Therapeutic Actions

Therapeutic Actions Used to treat dryness of the mouth and throat

Pilocarpine ophthalmic treats glaucoma
Used for anesthesia Ocular hypertension by allowing excess fluid to drain
from the eye.
To manage and treat postoperative nausea and
vomiting (PONV) Activating a cardiac M3 receptor and a K+ current.
Motion sickness.
Side effects
Adverse effects
Diarrhea

Lightheadedness Fast heartbeat

Dry mouth Chills

Confusion Headache
Sweating
 Pharmacology

Prototype Drugs of ANS

Atropine Brady arrythmias: Physostigmine ( indirect acting )

Reversible Simulate CNS

MOA
It has high affinity for muscarinic receptors where it MOA
bind competitively and preventing Ach from binding
to those site Reversibly block acetylcholine esterase enzyme and
Atropine increases the heart rate and improves the prevent its breakdown . This action enhance the
atrioventricular conduction by blocking the acetylcholine response by activating the postsynaptic
parasympathetic influences on the heart. response stimulate the central nervous system.

Therapeutic uses
Action
Reversibly block acetylcholine esterase enzyme and
Eye: dilate pupil of eye with narrow angle glaucoma prevent its breakdown . This action enhance the
acetylcholine response by activating the postsynaptic
GIT: anti-spasmodic reduce activity of the GIT response stimulate the central nervous system.
Salivary gland: Producing a dry effect swallowing Increase Intestinal and bladder motility
and talking become difficult
Treatment of glaucoma
Respiratory tract: reduce secretion of respiratory
tract Used to treat delayed gastric emptying
It crosses the blood-brain barrier, it is also used to
treat the central nervous system effects of atropine
Therapeutic uses overdose
Produced miosis and spasm
Anti- spasmodic: Relax the GIT and bladder
Ophthalmic: Used as mydriasis
Anti-secretory: Block secretion in upper and lower
Adverse effects
respiratory tract before surgery
When high dose are used fall in cardiac output
Motion sickness: Effective prophylactic agent
during short journey Increased sweating.

Antidote for cholinergic agonist: Overdose of Loss of bladder control.

acetylcholinesterase inhibitor Muscle weakness.
Nausea, vomiting, diarrhea, or stomach cramps or
Aderves effects pain

Dry mouth,
Blurred vision, (anti muscarinic agent)
Tertiary amine belladonna
Constipation, alkaloids
Confusion
 Pharmacology

Prototype Drugs of ANS

Mecamylamine ganglionic blockers act Ecothiophate indirect action

on nicotinic receptors
Organo -phosphorus irreversible

MOA
MOA
Produced a competitive nicotinic blockade of the
ganglia.
Is a organophosphate that covalently bind with
Prevents stimulation of postsynaptic receptors by acetylcholinesterase . After bonding this enzyme
acetylcholine released from presynaptic nerve permanently inactivated .
endings
Restoration of Ac-cholinesterase activity requires the
Pharmacokinetics synthesis of new enzyme molecules

The duration of action is about 10 hours after a

Action
Therapeutic Actions Ach gets accumulated in body to exert both
muscarinic and nicotinic action.
It is primarily used to lower blood pressure in
emergency situation Muscarinic action miosis ,salivation, sweating,
bradycardia , vasodilatation
Lowering high blood pressure helps prevent strokes,
heart attacks, and kidney problems. Nicotinic action muscle twitching , restlessness
confusion

Side effects
Therapeutic uses
Drowsiness,
Ophthalmic solution of drugs is used directly in the
Dizziness, eye for chorionic treatment of open angle glaucoma .
Lightheadedness,
Tiredness,
Side effects
Blurred vision,
İrritation
Burning
Stinging of eye
 Pharmacology

Prototype Drugs of ANS

Tubocurarine Non-Depolarizing (Competitive) Pralidoxime Reactivation of Acetylcholine esterase

Blocker Neuromuscular Blocker Pralidoxime is an antidote to organophosphate

MOA pesticides and chemicals.

Non-depolarizing neuromuscular blocking drugs

interact with the nicotinic receptors to prevent the MOA
binding Inhibit muscular contraction

Pralidoxime is to reactivate cholinesterase (mainly

Therapeutic Uses outside of the central nervous system) which has been
inactivated by phosphorylation due to an
Used in anesthesia during surgery to relax skeletal organophosphate pesticide or related compound.
muscle. used to facilitate intubations as well as during
orthopedic surgery
Uses
Pharmacokinetics Used in the management and treatment of
organophosphate poisoning
All neuromuscular blocking agents are injected Used to treat a muscle disorder
intravenously.
Pralidoxime may also be used for purposes not listed
They penetrate membrane very poorly and do not in this medication guide.
enter cells or cross the blood brain barrier.
They excreted in urine.
Side effects
Adverse effects Nausea
Dizziness
Cardiovascular disturbances
Blurred vision
Hypotension,
Headache
Reflex tachycardia
Drowsiness
Dry mouth
 Pharmacology

Prototype Drugs of ANS

Sluccinycholine (Depolarizing Agents) Galantamine

Neuromuscular Blockers
Galantamine is a tertiary alkaloid in nature.
Mechanism Of Action
MOA
The depolarizing neuromuscular blocking drug
succinylcholine attaches to the nicotinic receptor and
act like acetylcholine. Galantamine is a cholinesterase inhibitor with a dual
mechanism of action.
This drug remains attached to the receptor for longer
It is a reversible inhibitor of acetylcholine
Time and providing a constant stimulation of the receptor.
Esterase and enhances the intrinsic action of
acetylcholine on nicotinic receptors, leading to
increased cholinergic neurotransmission in the CNS.
Succinycholine
It works by increasing the amount of a certain natural
Chloride
substance in the brain that is needed for memory and
thought.

Uses
Action
Galantamine is used to treat mild to moderate dementia
Succinylcholine initially produces short lasting
(memory loss and mental changes) that is a sign of
twitching of the muscle (fasciculation) followed
Alzheimer's disease. Improve memory, awareness, and
within a few minutes by paralysis.
the ability to perform daily functions.
The drug does not produce a ganglionic block except
at high doses .
Contraindications
Therapeutic Uses
Galantamine is absolutely contraindicated in managing
patients with known hypersensitivity to galantamine or
Succinylcholine is useful when rapid endotracheal any of the excipients in its formulation and should not be
intubation is required during the anesthesia. prescribed
Used to relax muscles during surgery or while on a
breathing machine. Side effects
Pharmacokinetics Convulsions
Dizziness
Succinylcholine is injected intravenously Its duration of
action is short. Fainting
Slowed heartbeat
Adverse Effects Stomach cramps
Chills
Hyperthermia Hyperkalemia
Confusion
Cutaneous
 Pharmacology

Prototype Drugs of ANS

Side effects Side effects

Blurred vision Blind as a bat Urinary retention

Hot and Dry mouth Hot as a hare Abdominal cramping
Constipation Blurred vision
Hallucinations Dry eyes
Tachycardia Flushing
Urinary retention Heart problems
Decreased sweating Hypotension
Flushed skin Red as a beet Increased sweating
Confusion salivation Increased oral secretions
Difficulty peeing Increased tear production (lacrimination)
Drowsiness urination Increased bladder stimulation
Dry eyes Diaphoresis Increased sweat production
Memory problems GIT Distress Increased GI motility
Dementia Palpitation
Mydriasis Confusion
Dizziness Constipation
Fever
Glaucoma Antidote: atropine
Delirium Mad as a hatter
Insomnia

Antidote: Physostigmine
 Pharmacology

Adrenergic Agonist

Adrenergic agonist The adrenergic drugs affect receptors that are

stimulated by norepinephrine or epinephrine
(Sympathomimetic)

1.Epinephrine Or Adrenaline
(Direct Acting Agonist)

MOA

Epinephrine have direct action on tissues supplied by postganglionic sympathetic nerve ending.
They interact with receptor sites on the cell membranes.
The drugs are effective even when the sympathetic nerves have been cut or inhibited by other drugs.

Treats severe allergic reactions (anaphylaxis) or sudden asthma attacks. It may also be used to treat low blood
pressure and slow heart rate. It reduces the effects of an allergic.

Pharmacological Action

CVS (B1 receptor ) Powerful cardiac stimulant ( contraction increased) increased in heart rate.
Respiratory Tract (B2 receptor). Powerful bronchodilation by acting directly on bronchial smooth muscles.
Blood Vessels (B2 receptor). Powerful vasodilatation in skeletal muscles and coronary vessels .
GIT Smooth muscles of GIT are generally relaxed by epinephrine and contract the sphincter muscle

Therapeutic Uses Pharmacokinetics

Bronchospasm (Bronchial Asthma) Epinephrine is ineffective when given orally

because it rapidly destroyed in GIT.
Epinephrine is used in the emergency
treatment of any condition of the respiratory It is administered subcutaneously or intra
tract. muscularly.
Glaucoma It is not given intravenously as it is highly
dangerous.
2% epinephrine solution may be used
topically to reduce intraocular pressure in
open angle glaucoma. Adverse Effects
Cardiac Arrest
Epinephrine may be used in case of cardiac CNS disturbance
arrest due to anesthetic, electric shock. Cardiac arrhythmias
Anesthetic Hemorrhage
The effect of the drug is to greatly increase Pulmonary edema
the duration of the local anesthesia. It does
this by producing vasoconstriction
 Pharmacology

Adrenergic Agonist

2.Amphetamine

MOA Therapeutic Uses

Direct action on the CNS and peripheral Therapeutic uses of Amphetamine are limited due
nervous system. to psychological and physiological dependence
and the development of tolerance.
Amphetamine inhibits monoamine oxidase
(MAO) that’s why high levels of catecholamine Attention deficit hyperactivity disorder (ADHD)
are readily released into synaptic spaces and Narcolepsy
response increased.
Narcolepsy is a rare sleep disorder.

Pharmacological Action. Pharmacokinetics

Amphetamine is completely absorbed from the GIT.

Amphetamine has more powerful effects on
the CNS Metabolized by the liver and excreted in the urine.
It has both alpha and beta effects and are
largely indirectly.
Adverse Effects
Amphetamine increases both systolic and
diastolic blood pressure.
Insomnia Angina pain
Large doses produce cardiac arrhythmias.
Dizziness, Headache
It produces mydriasis.
Hypertension

Dry Mouth Insomnia

Weight Loss Nausea

Dizziness Headache
 Pharmacology

Prototype Drugs of ANS

Amphetamine Mechanism

DA pH? 5

MAO Some direct recptor

agonist actions
4 1 may contribute

Amphetamine
Vesicles
DA

DA
DA
2 3

DAT DAT DAT

DA
DA DA
Amphetamine DA
DA

Note: Amphetamine
reverses DAT, SERT & NET
 Pharmacology

Neuro Meds

A type of drug that is used to prevent or treat seizures or

Anticonvulsants convulsions by controlling abnormal electrical activity in the brain.

Action on Ion Channels Enhance GABA Transmission Inhibit EAA Transmission

NA+: Benzodiazepines Felbamate

Phenytoin (Diazepam, Clonazepam) Topiramate
Carbamazepine Barbiturates
Lamotrigine (Phenobarbital)
Topiramate Valporic Acid
Valproic Acid Gabapentin
CA++: Vigabatrin
Topiramate
Ethosuximide
Felbamate
Valproic Acid

Anticonvulsant drugs

Anti-seizure medications (anticonvulsants) were originally designed to treat people with epilepsy. But the
nerve-calming qualities of some of these medications can also help quiet the burning, stabbing or shooting pain often
caused by nerve damage

Levetiracetam

Levetiracetam is a novel antiepileptic drug used to treat partial, myoclonic, and tonic-clonic seizures

MOA USES

Modulation of synaptic neurotransmitter release To help control certain types of seizures (e.g., partial seizures,
through binding to the synaptic myoclonic seizures, or tonic- clonic seizures) in the treatment
of epilepsy.
Vesicle protein SV2A in the brain.
Seizures are bursts of electrical activity in the brain that
Levetiracetam inhibits excitatory temporarily affect how it works.
neurotransmission at the glutamatergic
Synapse through inhibition of N-type calcium
channels on the presynaptic neuron

Levetiracetam contraindicated

Levetiracetam injection is contraindicated in patients with a hypersensitivity to levetiracetam. Reactions have

included anaphylaxis and angioedema.
 Pharmacology

Neuro Meds

Levetiracetam

Adverse effects Nursing considerations

Unusual weak feeling Modulation of synaptic neurotransmitter release through

binding to the synaptic
Aggression Vomiting
Vesicle protein SV2A in the brain.
Chills Dark urine
Levetiracetam inhibits excitatory neurotransmission at
Bleeding gums Difficulty with
the glutamatergic
moving
Blisters on skin
Synapse through inhibition of N-type calcium channels
Fast heartbeat
Blurred vision on the presynaptic neuron
Mood changes
Constipation Suicidal thoughts
Dizziness

Does levetiracetam reduce anxiety?

Levetiracetam is effective in patients Levetiracetam

with anxiety disorders

Phenytoin Phenytoin is a hydration derivative, a first-generation anti- convulsant drug.

MOA USES

Phenytoin is a voltage-gated, sodium channel Phenytoin is used to control seizures Partial seizure
blocker, stabilizing the ,Generalized seizures,
Inactive state of the sodium channel and Including tonic- clonic (grand mal) and psychomotor
prolonging the neuronal refractory period. (temporal lobe) seizures, in the treatment of epilepsy.
Phenytoin acts on the sodium channels in both It is also used to prevent and treat seizures that occur
neuronal and cardiac tissue during brain surgery.

Contraindications Side effects

Hypersensitivity. Headaches. Make sure you rest and Constipation. ...

drink plenty of fluids. ...
Sinus bradycardia. Sore or swollen gums
Feeling drowsy, sleepy or dizzy
Sinoatrial block. Gingival hyperplasia
Feeling nervous, unsteady or shaky. ...
Second and third-degree A-V block.
Feeling or being sick (nausea or
Adams-Stokes syndrome. vomiting).
 Pharmacology

Neuro Meds

Phenytoin Phenytoin is a hydration derivative, a first-generation anti- convulsant drug.

Nursing considerations Signs of toxicity

Be sure to assess seizure activity in your patient, as Nausea

well as their hemodynamics while on this
medication Central nervous system dysfunction (particularly
confusion, nystagmus, and ataxia),
Be sure to teach your patient to report symptoms
as well as seizure activity to their provider. Coma, and seizures occurring in more severe
cases.
Good oral hygiene & regular dental check ups
No antacids within 3 hours of admin ( absorption)
Side effects
Decreases affect of meds like oral contraceptives,
warfarin & amiodarone
Dizziness Headache
If given IV: monitor site closely! (can cause
Acne Agitation
extravasation)
Anxiety Change in vision
Careful cardiac monitoring is needed during and
after administering intravenous phenytoin Hyponatremia Agranulocytosis
Aplastic anemia Suicidal thoughts

Nursing considerations
Oxcarbazepine
It is important to note that side effects may
increase with higher doses of oxcarbazepine.
Assess for signs of hyponatremia
MOA USES
Monitor CBC and coags
Nurses should actively participate in this
Oxcarbazepine binds to Treatment of epilepsy to
monitoring since they often have more frequent
sodium channels and control partial seizures.
contact with the patient.
inhibits high-frequency
repetitive neuronal firing. Mood stabilization, They can also assess treatment effectiveness
during follow-up visits and monitor for adverse
Oxcarbazepine also inhibits Aggressive outbursts, drug effects
the release of glutamate. Impulsivity, or anxiety Monitor for signs of suicidal ideation or depression
This medication gets
metabolized by the liver
and excreted by the Contraindications
kidneys.
Oxcarbazepine is in a class
Contraindicated in patients Signs of toxicity
with bone marrow depression
of medications called and hypersensitivity to this
anticonvulsants. Drowsiness,
drug or tricyclic compounds
such as amitriptyline. Dizziness
It works by decreasing
abnormal electrical activity Nausea, vomiting, hyperkinesia
in the brain.
Ataxia and nystagmus..
 Pharmacology

Neuro Meds

Gabapentin

MOA USES Contraindication

In vitro, gabapentin modulates the To treat epilepsy. Gabapentin is
action of the GABA synthetic contraindicated in
enzyme, glutamic acid Treat restless leg patients who have
decarboxylase (GAD) and the syndromes demonstrated
glutamate synthesizing enzyme, hypersensitivity to the
Treat hot flash from breast
branched-chain amino acid drug or its ingredients and
cancer
transaminase. avoid abrupt withdrawal.
Help menopause
Gabapentin does not bind to Reduce dose in renal
symptoms
plasma protein and is excreted impairment.
unchanged through kidneys. Manage seizures
Relief pain from post
herpetic neuralgia or Nursing Consideration
diabetic neuropathy
Assess for allergies to gabapentin.
Monitor for changes in neurological
Side effects Signs of toxicity status, changes in mood, or thoughts
of suicide.

Diarrhea. Drowsiness, Review the patient's history of

seizures.
Mood changes. ... Fast heartbeat,
Assess pain scale and
Swollen arms and legs. ... Dizziness, characteristics.
Blurred vision. ... Low blood pressure, Monitor for signs of infection.
Dry mouth. Nausea, vomiting, Review WBC count.
Weight gain Monitor for renal impairment.
GI upset Avoid CNS depressants (alcohol,
antihistamines, chamomile)
Headache
Blurred vision GBP
C

Ca2+
C
G

GLT-1
V
ŏ
a2

Astrocyte
Glu
G
A
BA

AMPA GABA-A
Descending
NA Neuron NA
Inhibition
 Pharmacology

Neuro Meds

Felbamate

Felbamate is an anticonvulsant used in the treatment

of epilepsy. It is used to treat partial seizures in adults
and partial and generalized seizures.

MOA
Felbamate is the first anticonvulsant drug with dual
actions on excitatory (NMDA)
Inhibitory (GABA) brain mechanisms.
It acts in the brain to prevent seizures. Levetiracetam

USES
to control partial seizures (convulsions) in the
treatment of epilepsy,
It is also used in children to control partial Felbamate Perampanel
Generalized seizures caused by Lennox- Gastaut Perampanel
syndrome.

Contraindications
Felbamate should not be given to patients with a history
of hepatic dysfunction or any form of blood dyscrasia.

Side Effects
Headache
Change in taste
Trouble sleeping
Vomiting
Blurred vision
Hiccups

Is felbamate taken with food?

Felbamate may be taken with food, unless your

doctor has told you to take it on an empty stomach.
 Pharmacology

Neuro Meds

Benzodiazepines Therapeutics Uses

Benzodiazepines are the most widely used Anxiolytic Anxiety Treatment
drugs. These are safer and effective than others
Benzodiazepines are effective for the treatment of the
anxiety disorder, social anxiety disorder, performance.
MOA
Muscular Disorders
The targets of benzodiazepine actions are GABAa These agents are useful in the treatment of skeletal
receptors. muscle spasms.
Benzodiazepine modulate the GABA effects by
binding to a specific site Seizures
These agents are also used in the treatment of certain
types of epilepsy.
Actions Of Benzodiazepine
Sleep Disorders
Reduction Of Anxiety
These agents are also used in the treatment of
At low doses, the benzodiazepines are Anxiolytic insomnia.
They reduce anxiety by selectively enhancing
GABAergic transmission in neurons.

Sedative And Hypnotic. Pharmacokinetics (lipophilic)

Action Benzodiazepines also have sedative properties

They are rapidly and completely absorbed after oral
and some can produce hypnosis (artificially produced
administration and distribute .
sleep) at higher doses
Adverse Effects
Muscle Relaxant
At high doses, the benzodiazepines relax the skeletal Drowsiness, Confusion early morning insomnia
muscles

Nursing considerations
Benzodiazepines may cause fetal harm when
administered to pregnant women.
Children and the elderly are more likely to experience
paradoxical reactions to benzodiazepines such as
tremors, agitation, or visual hallucinations.

GABA A receptor Gamma Cl- Synaptic Cleft

GABA
Sub-Unit Cl-
Mechanism Benzodiazipine
of Action of Benzodiazipine
Benzodiazepines (BDZ) Binding Site
 Pharmacology

Respiratory Meds

BRONCHODILATORS

Medications that help relax and open the airways

Respiratory system

The respiratory system takes up oxygen from the air we breathe and expels the unwanted carbon dioxide.
The main organ of the respiratory system is the lungs. Other respiratory organs include the nose, the trachea and the
breathing muscles (the diaphragm and the intercostal muscles).

Remember BAM for After Before

bronchodilators: Relaxed & dilated airways Tight & constricted
= increased airflow airways= reduced airflow
Nasal Cavity
Nostril Pharynx
Oral Cavity
Trachea
Larynx

Right main Left main

bronchus bronchus

Right lung Left lung

Common Diseases Related To Respiratory System

Asthma

Asthma is an inflammatory Short-Acting Long-Acting

disease of the airways Normal Inflarned þ-Agonists (4-6 h) þ-Agonists (12 h)
characterized by episodes of Airway Airway
acute bronchoconstriction Albuterol Arformoterol
causing shortness of breath, Levalbuterol Bambuterol
cough, chest tightness, Pirbuterol Clenbuterol
wheezing, and rapid respiration. Terbutaline Formoterol
Metaproterenol Salmeterol
Asthma is a chronic lung disease Mucus Protokylol
affecting people of all ages.
Approved Ultralong
It is caused by inflammation Acting þ-Agonists (24 h)
and muscle tightening around
the airways, which makes it Indracaterol
harder to breathe Odlodaterol
Vilanterol (in association with other drugs only)
 Pharmacology

Respiratory Meds

Allergic Rhinitis

Rhinitis is an inflammation of the mucous membranes of the nose and Nasal Cavity:
is characterized by sneezing, itchy nose/eyes, watery rhinorrhea, and Allergic Rhinitis
nasal congestion.
An attack may be due to inhalation of an allergen such as dust, pollen,
or animal dander.
The foreign material interacts with mast cells which, release mediators,
such as histamine that promote bronchiolar spasm and mucosal
thickening from edema and cellular infiltration.

Short-Acting
Indirect- Mixed- þ-Agonists (4-6 h)
Direct-Acting Agonists Acting Acting
Agonists Agonists Azelastine Ketofifen
Bepotastine Levocetirizine
Catacholamines Non-Catacholamines Brompheniramine Loratadine
Cetirizine Meclizine
Dobutamine Albuterol, LABAs Amphetamine Ephedrine Chlorpheniramine Promethazine
Dopamine Apraclonidine Cocaine Pseudoephedrine Clemastine
Cyclizine
Epinephrine Clonidine Cryproheptadine
Isoproterenol Midorine Desloratadine
Diphenhydramine
Norepinephrine Oxymetazoline Dimenhydrinate
Phenylephrine Doxylamine
Fexofenadine
Ritodrine Hydroxyzine

Cough
Frugs for Cough

A cough is a
reflex action to Expectorants (Mucokinetics) Adjuvant
clear your Antitussives
airways of
mucus and Pharyngeal Secretion Enhancers Mucolytics Bronchodilators
irritants such as Demulcents
dust or smoke. Pot. Citrate Bromhexine Salbutamol
Lozenges Pot. Iodide Ambroxol Terbutaline
A cough is a Syrups Guaiphenesin Acetyl Cysteine
spontaneous Glycerine Tolu Balsam Carbocisteine
reflex. When Liquorice Vasaka Antitussives (Cough Centre
things such as Ammon. Chloride Suppressants)
mucus, germs
or dust irritate
your throat
and airways.
Opioids Nonopioids Antihistaminics Pulmonary Receptor
Desensitizer
Codeine Noscapine Chlorpheniramine
Ethylmorphine Dextromethorphan Diphenhydramine Prenoxdiazine
Pholcodine Chlophedianol Promethazine
 Pharmacology

Respiratory Meds

Beta-2 agonists Suffix: -terol

Inhaled adrenergic agonists with β2 activity are the drugs of choice for mild asthma;
Direct- acting β2 agonists are potent bronchodilators that relax airway .
The beta adrenergic agonists are that are widely used in the management of bronchial asthma.
These agents act by engaging the beta-2 adrenergic receptors on smooth muscle of bronchial tissue, relieving
bronchospasm and reducing airway resistance. potent bronchodilators

MOA You have ONE heart

Memory trick & TWO lungs

These agents act by engaging the beta-2 adrenergic

receptors
On smooth muscle of bronchial tissue, relieving
bronchospasm and reducing airway resistance.
They also act on smooth muscle of the vascular system,
intestines and uterus
β2-adrenoceptor activation, intracellular signaling is
mainly produced by inducing cyclic AMP.
Beta-1 affects Beta-2 affects
This produces airway relaxation through the heart the Lungs
phosphorylation of muscle
Regulatory proteins and modification of cellular
Ca2+concentrations

Ca++ L-Type Calcium

Channel

+
Ca++ Calmodulin B2

SR GS
ATP
Ca++ Calmodulin Camp
+

MLC MLCK P

MLC Phosphatase
 Pharmacology

Respiratory Meds

Therapeutic uses
Labs (Long Acting Beta
SABAs (Short Acting Agonists) Long term
Beta-2 adrenergic agonists are a drug class Beta Agonists) Acute management
used as a mainstay treatment for respiratory symptom relief
diseases Asthma and COPD
Bronchospasm
Bronchial asthma and chronic obstructive Combination therapy
Acute asthma attack Acute asthma attack
Pulmonary disease (COPD)
Remember A in Remember A in
albuterol for acute albuterol for acute
Adverse effects action action

Hyperglycemia,
Hypokalemia
Contraindications
Hypomagnesemia. Use with caution in patients with the following conditions: Hyperthyroidism.
Tachycardia, Glaucoma. Diabetes. Hypokalemia. Seizures. Cardiovascular disease (e.g., heart
failure. , hypertension. , arrhythmias. , coronary artery disease. )
Palpitations
Tremors or shakiness
Nervousness Education
Dizziness Medicine should be inhaled over a period of 10 to 15
Dry mouth minutes. Breathe slowly and evenly, in and out, until
no more mist is left in the nebulizer cup.
Insomnia
Rinse your mouth when you are finished with the
Muscle Cramps treatment.
Give first when used in combination with steroids
or anticholinergics
Wash your face if you used a face mask.
LABA's can only be used in combination with
inhaled steroids

Beta-2 receptors are part of the Sympathetic Nervous System aka

fight or flight

Anticholinergics

MOA
Anticholinergics cause the airways to widen by blocking the cholinergic nerves.
These nerves release chemicals that can cause the muscles lining the airways to suffix: -tropium
tighten.
Anticholinergics block acetylcholine from binding to its receptors on certain nerve cells.
Ipratropium
They inhibit actions called parasympathetic nerve impulses. Tiotropium
These nerve impulses are responsible for involuntary muscle movements in the:
gastrointestinal tract.
 Pharmacology

Respiratory Meds

can be short acting or long acting

USES Ipratropium
Ipratropium is short acting &
works immediately Ipratropium is a bronchodilator
Anticholinergics (also known as Tiotropium is long acting & medication that works to dilate the
antimuscarinics) are mainly used to takes time to work airways of the lungs.
treat COPD,
used for asthma. MOA
They're usually taken using an inhaler, Ipratropium is an acetylcholine
but may be nebulized to treat sudden
and severe symptoms. Adverse effects antagonist via blockade of
muscarinic cholinergic receptors.
Chronic bronchitis Blocking cholinergic receptors
A dry mouth.
Anticholinergics cause the airways to decreases the production of cyclic
widen by blocking the cholinergic Constipation. guanosine monophosphate (cGMP).
nerves. A cough. This decrease in the lung airways will
lead to decreased contraction of the
Gastrointestinal disorders, and Headaches.
smooth muscles.
symptoms of Parkinson's disease. Feeling sick (nausea)

Can't see: blurred vision USES

Can't pee: dysuria lung diseases, such as asthma,
Can't spit: secretions chronic bronchitis, and emphysema.
Contraindications It is also used to treat air flow
Can't s**t: constipation
blockage and prevent the worsening
They should be used with caution in Education of chronic obstructive pulmonary
people with: benign prostate disease (COPD)
enlargement – where the prostate Suck on sugarless hard
gland becomes enlarged, which can candies or increase fluid
affect how you pee. intake to avoid dry mouth
(from secretions) Side effects
Sore throat
Blurred vision
Contraindications Cough
Headache
angioedema, Urticaria, severe shortness of breath, oropharyngeal edema, Palpitations
and ultimately anaphylaxis is a contraindication to ipratropium use.

Tiotropium
Tiotropium is a long-acting muscarinic antagonist
Contraindications

MOA USES Side effectst Tiotropium bromide is

contraindicated in
It works by blocking the Asthma and COPD Cough
patients with a
muscarinic receptors in (bronchitis, emphysema). Bladder pain hypersensitivity to
airway smooth muscle. It must be used regularly to Bloody nose tiotropium, ipratropium,
Tiotropium has a wide prevent wheezing and and atropine (due to
therapeutic margin, due to shortness of breath. Heartburn
the risk of anaphylaxis)
its poor gastrointestinal and narrow-angle
absorption glaucoma
Its very low systemic
bioavailability.
 Pharmacology

Respiratory Meds

methylxanthines USES Side effects

Suffix: -phylline Theophilline Treatment of asthma Nausea, vomiting,

&copd (long term Increased gastric acid
Methylxanthines are a purine-derived
management) secretion
group of pharmacologic agents that
have clinical use because of their Airway hyper Polyuria,
bronchodilatory and stimulatory effects. responsiveness,
İnsomnia,
Airway inflammation.
Palpitations,
MOA Chronic bronchitis
Headaches, and tremors
Blocking the adenosine receptors and Nervousness
competitively inhibiting the action of Used for prevention of Irritability
adenosine in the cells. symptoms in asthma &
COPD not relieved by Dizziness
This inhibition results in increased Gı upset
beta-2 agonists &
release of hormones, such as
Inhaled corticosteroids
norepinephrine, dopamine and
serotonin All side effects of
Inhibit the enzyme caffeine! Xanthine are
phosphodiesterase & suppress caffeine derivatives
airway responsiveness to stimuli to
relax bronchial smooth muscle Signs of toxicity

Tachycardia,
Cardiac dysrhythmias,
Education Feeding intolerance,
Seizures
Avoid caffeine! Monitor blood levels
(for theophylline)

There is no antidote for theophylline

 Pharmacology

Respiratory Meds

Theophylline Therapeutic uses Adverse effects

Theophylline is a bronchodilator that
relieves airflow obstruction in chronic Theophylline is used to Treatment of epilepsy to
asthma and decreases its symptoms prevent and treat wheezing, control partial seizures.
shortness of breath, and chest Mood stabilization,
MOA tightness caused by asthma,
chronic bronchitis, Aggressive outbursts,
Theophylline relaxes the smooth emphysema, and other lung
muscle of the bronchial airways diseases. Impulsivity, or anxiety
and pulmonary blood vessels
Reduces airway responsiveness to
histamine,
Pharmacokinetic Signs of toxicity
methacholine,adenosine, and tremors (most common),
allergen. . Theophylline is well absorbed Restlessness,
Theophylline competitively inhibits by the gastrointestinal tract,
and several sustained-release Agitation, and altered mental status.
type III and type IV
phosphodiesterase (PDE), the preparations are available. Dysrythmias Seizures
enzyme responsible for breaking
down cyclic AMP in smooth muscle
cells, possibly resulting in
bronchodilation.

contraindications
if the patient previously developed a hypersensitivity reaction to the drug or any component of its formulation (such as
an allergy to corn-related products (in injection use only).
 Pharmacology

Respiratory Meds

anti-inflammatory agents

Non-steroidal anti-inflammatory drugs, also known as NSAIDs are medicines that are used to relieve pain, and reduce swelling
(inflammation).and reduce inflammation in the airways to decrease airway narrowing, mucous production &
hyper-responsiveness

Definition
Remember SLM for anti- inflammatory:
It is a complex cascade of immune mechanism to Stéroides leukotriene
overcome from tissue injury and to initiate the healing
Modifier mast Cell
process by recruiting various immune cell.
Stabilizers

components of the inflammatory cascade Immune system is the inflammatory response

Vasoactive peptides Involve both the innate and adaptive immune systems
and resemble immune responses to systemic infection.
Amines,
Cytokines and TLRs are major inflammatory mediators
Pro-inflammatory cytokines, in the transition between innate and adaptive.
Eicosanoids
Acute-phase proteins to prevent tissue damage and
ultimately

Pathogen Pin

Inflammatory
Response

Chemical Signals
Phagocytic Cells
Macrophage Blood Clotting
Red Blood Cells Element
Capillary Cells
 Pharmacology

Respiratory Meds

Corticosteroid molecule
Cell wall

Steroids
suffix: -sone & -ide
Steroids, also called corticosteroids, Chaperone
are anti-inflammatory medicines Inreased anti
Reduced
used to treat a range of conditions. inflammatory
Inflammatory
mediators
• Dexamethasone, +GRE mediators
transactivation +GRE
• Prednisone transactivation
• Triamcinolone

Inhaled corticosteroids (ICS) are the

drugs of first choice in patients with Inhaled steroids Systemic steroids
any degree of persistent asthma
(mild, moderate, or severe). No other Reduce inflammation in the lungs. Systemic steroids are synthetic
medications are as effective as ICS in Not all inhaled medications derivatives of the natural steroid,
the long-term control of asthma in contain steroids. They're used to cortisol, produced by the adrenal
children and adults. These are also treat asthma and other glands, and have profound
effective when administered as nasal respiratory conditions like chronic anti-inflammatory effects. can be used
sprays for the treatment of Allergic obstructive pulmonary disease in acute and chronic conditions
rhinitis. (COPD). used for long term
MOA management

Actions On Lungs;
Inhaled corticosteroids do not
directly affect the airway smooth
muscle. They directly targets important to monitor for:
Blood sugars
underlying airway inflammation by
Loss of taste or an unpleasant taste in the mouth. (especially if
decreasing the inflammatory
Redness inside the mouth and throat. diabetic) Eye health:
cascade, reversing mucosal edema,
regular check ups
decreasing the permeability of Cracks at the corners of the mouth.
capillaries, and inhibiting the release
A painful, burning sensation in the mouth.
of leukotrienes.

Therapeutic uses Chronic Education

Reduce inflammation (asthma, Asthma RA Rinse mouth after to avoid oral

arthritis) and swelling thrush
COPD Lupus
Suppress immune response Candida is a normal organism in
IBD Allergies
your mouth, but sometimes it can
Reduce nausea and
PO/IV has multiple other uses overgrow and cause symptoms.
vomiting(as in cancer
besides respiratory conditions Oral thrush causes creamy white
chemotherapy)
Adverse effects lesions, usually on your tongue or
Reduce terminal
inner cheeks.
pain(associated with cancer)
Blood pressure Osteoporosis(Soft Sometimes oral thrush may
Acute bones) Blood sugar spread to the roof of your mouth,
(hyperglycemia) your gums or tonsils, or the back
of your throat
Gout attack Weight gain ,Starving: Increased
Never stop abruptly; always taper
Ms relapse appetite
off slowly
Rheumatoid arthritis, Sight: risk for cataracts Swollen: May need to increase dose during
Inflammatory bowel disease fluid retention stress or surgery
(ıbd),
Sick: immunosuppression GI
Anaphylaxis bleeding, Glaucoma
 Pharmacology

Respiratory Meds

Dexamethasone Therapeutic uses Adverse effects

Dextromethorphan is a synthetic Dextromethorphan is used to

temporarily relieve cough caused Blurred vision.
derivative of morphine that
suppresses the response of the by the common cold, the flu, or Confusion.
central cough center. other conditions.
Difficulty in urination.
Dextromethorphan will relieve a
cough but will not treat the cause of Drowsiness or dizziness.
It has no analgesic effects in the cough or speed recovery. Nausea or vomiting
antitussive doses. It has a low Dextromethorphan is in a class of
addictive profile Slowed breathing
medications called antitussives.

MOA
Dextromethorphan and dextrorphan Contraindications
have NMDA receptor antagonist
properties similar to ketamine and
phencyclidine. This NMDA receptor Uncontrolled infections.
antagonism is believed to result in a
Known hypersensitivity
decreased reuptake of
to dexamethasone.
catecholamine. Dextromethorphan
also inhibits the reuptake of Cerebral malaria.
serotonin Systemic fungal
infection

DXM

NMDA SERT NET Sig1R

Hallucination + ssrı, snrı, tca, ımao etc. Hypertension locomotor hyperactivity

Dissociation Serotonin syndrome Tachycardia psychotic-like mental state
Euphoria Seizure Mydriasis
Agonist
Agitation Muscle rigidity Diaphoresis
Antagonist
Coma Autonomic instability Rhabdomyolysis
 Pharmacology

Respiratory Meds

Codeine MOA Side effects

Its primary action takes place at
Codeine decreases the sensitivity the mu opioid receptors, which Constipation,
of cough centers in the central are distributed throughout the Dysphoria,
nervous system to peripheral central nervous system.
stimuli and decreases mucosal Discomfort,
secretion. Distress,
These therapeutic effects occur at Unease
doses lower than those required Therapeutic uses Fatigue
for analgesia.
Codeine is an opioid pain-relief
medicine used for the short-term
relief of mild to moderate pain.

Codeine-6-glucuronide Agonism
Morphine
K+ Channel

Adenylate
cyclase
Leads to
Gai
GB hyperpolarization
GY K+

ATP cAMP

USES Allergies,
leukotriene modifiers Asthma
Help prevent
suffix: -lukast breathing problems Chronic obstructive pulmonary disease.
Montelukast Zafirlukast associated with Exercise induced bronchoconstriction
Leukotriene modifiers, also called Treating chronic asthma and prophylaxis and
leukotriene receptor antagonists, the prevention of exercise-induced
are a group of medications. They bronchoconstriction
can help prevent breathing
problems associated with allergies, Not a rescue drug: Leukotriene modifiers are used for long term
asthma and chronic obstructive management only and are not effective in treating acute symptoms
pulmonary disease

MOA
Blocking the action of it block the effects of cysteinyl
leukotrienes, one cause leukotrienes.
of the inflammation and CysLT1 Receptor
Montelukast is used as a
nasal congestion prophylaxis of asthma but
associated with allergies. Leukotriene C4
are not effective in
Produced by immune Leukotriene D4
cells in response to situations in which immediate
allergens or trigger bronchodilation is required.
Leukotriene E4
Montelukast is selective, montelukast is also used for
reversible inhibitor of the treatment of both seasonal
Cysteinyl leukotriene-1 and perennial allergic rhinitis.
Montelukast
receptor,
 Pharmacology

Respiratory Meds

Pharmacokinetics
Education
The drug is orally active. Greater than 90 percent of
drug is bound to plasma protein. The drug is It should be taken at least two hours before exercise to
extensively metabolized, and their metabolites prevent exercise-induced asthma. Patients should not take
undergo biliary excretion. another dose within 24 hours.
Take zafirlukast on empty stomach

Contraindicated
Contraindicated In patients with hypersensitivity to
the drug or any component of their formulation.

Adverse effects
Diarrhea. Headache. Cold symptoms, such as cough,
Ear infection. Heartburn. sore throat or runny nose
Fatigue (tiredness). Itchy skin or rash.
Flu-like symptoms, such as fever. liver enzymes (zafirlukast only)

Mast cell stabilizers Adverse effects

MOA Headache.
Unpleasant taste.
Mast-cell stabilizers are thought
to prevent calcium influx across Hoarseness.
mast-cell membranes, Nose bleeding.
Thereby preventing mast-cell Temporary nasal stinging and
degranulation and mediator sneezing after administration. Sensitized
release mast cell
Nose & throat irritation
They block mast cell Bronchospasm
degranulation, stabilizing the cell
and
Thereby preventing the release of Not a rescue drug!
histamine and related mediators
Mast cell are used for long term
management only and are not
USES effective in treating acute symptoms Degranulation
To prevent allergic reactions to
common allergens.
Children 2 to 12 years of age—100
Used to control inflammation in Education mg dissolved or mixed in water
asthma
and taken four times a day, thirty
To prevent exercise-induced Adults and children 12 years of age minutes before meals and at
bronchospasm and older—200 milligrams (mg) bedtime.
Exercise induced dissolved or mixed in water and
taken four times a day, thirty minutes Admin on a regular fixed schedule
bronchoconstriction to maintain therapeutic level
before meals and at bedtime.
 Pharmacology

Respiratory Meds

Cromolyn sodium USES

Used for prophylaxis of mild to
moderate bronchial asthma and
MOA adjunctive treatment of allergic
rhinitisand systemic mast cell
Cromolyn sodium inhibits the disease (mastocytosis) in pediatric
release of mediators of patients and adults.
inflammation, induced by
specific antigens as well as
nonspecific mechanisms, such Side effects
as exercise, from mast cells.
Cromolyn may also inhibit the Coughing Diarrhea
activity of other cell types that Hives Nausea
produce inflammation. Abdominal pain Wheezing

Bronchial Asthama

Uses of
Cromolyn
Sodium
Allergic Rhinitis Vernal conjunctivitis

Mastocytosis Other Allergic Reactions

 Pharmacology

Respiratory Meds

Secretion & allergy Increasing the volume but

Expectorants decreasing the viscosity of
management respiratory tract secretions.
These medicines help reduce the Helps loosen up the mucus and
swelling in your nasal passages and Drug: guaifenesin
make the secretions in your airway
ease the stuffiness and sinus Mucoactive agents are a class of thinner. Stomach pain.
pressure or break down mucous chemical agents that aid in the By loosening up the mucus,
and relieve congestion & common clearance of mucus or sputum from expectorants make your cough
allergy symptoms the upper and lower airways, more productive.
including the lungs, bronchi, and
This makes it easier for you to
trachea.
cough up mucus effectively and
clear your throat.

MOA
Expectorants reduce the viscosity
of tenacious secretions by irritating
the gastric vagal receptors that
stimulate respiratory tract fluid, Can mask symptoms for
underlying cause of chronic cough

USES Side effects Contraindications

Used to treat the symptoms of Dizziness. If you have any of the following
respiratory tract infections Constipation. health problems, consult your
Chronic obstructive pulmonary doctor or pharmacist before
Headache. using this product: couch with a
disease
Tiredness (fatigue). lot of mucus, chronic cough
Asthma
Rash. (such as with asthma,
Cold, the flu, or allergies emphysema, smoking), diabetes,
Nausea and vomiting (if taken in
Emphysema. a certain eye condition
high doses).
(glaucoma), heart problems
Cystic fibrosis GI upset (such as heart attack, chest pain,
Bronchitis and pneumonia. heart failure),

Nursing Considerations Education

No eating or drinking for 30 minutes after It's important to practice deep breathing and
syrup Encourage client to cough and deep coughing after surgery.
breathe Encourage increased fluid intake These exercises will help your breathing, clear your
to thin secretions, if not contraindicated lungs, and lower your
Ensure adequate fluid intake risk
 Pharmacology

Respiratory Meds

Guaifenesin USES Warnings and

used for relief of wet cough and Precautions for
Glyceryl guaiacolate, is an chest congestion due to the Guaifenesin
expectorant medication common cold
This medication contains
MOA guaifenesin. Do not take
Side effects Mucinex, Bidex 400, or Organidin
Guaifenesin, a mucoactive drug, NR if you are allergic to
acts by loosening mucus in the Dizziness. guaifenesin or any ingredients
airways and making coughs contained in this drug.
Drowsiness. Contraindications
more productive.
Decreased uric Hypersensitivity to guaifenesin
Acts as an irritant to gastric acid levels.
vagal receptors and recruits
Stomach pain.
efferent parasympathetic
reflexes that cause glandular Nausea.
exocytosis in the respiratory
mucosa and reduces the
viscosity of mucus secretion

Mucolytics USES Education

Drug: n- Acetylcysteine To treat chronic lung and Ensure adequate fluid intake
breathing conditions. Encourage coughing and deep
Mucolytics are drugs belonging to Cystic fibrosis. breathing Use cautiously in
the class of mucoactive agents. Bronchiectasis. asthma or history of
bronchospasm
Chronic obstructive pulmonary
MOA disease (COPD).
Emphysema.
They work by reducing the
viscosity (thickness and
Asthma. Side effects
stickiness) of mucus in the Antidote for
Nausea or
airways. Acetaminophen Overdoes
Vomiting.
They do so by dissolving the
Diarrhea.
chemical bonds within the
secretions, causing them to thin Rash.
so they can be coughed up Has a strong (and unpleasant) Sore throat.
more readily sulfur smell like rotten eggs that Loss of voice or
They exert their effect on the is completely normal change in voice.
mucus layer lining the
Shortness of
respiratory tract with the motive
breath
of enhancing its clearance.
(dyspnea).
Chest pain.
Use cautiously in asthma patients
 Pharmacology

Respiratory Meds

N- acetylcysteine USES Side effects

Nausea,
Paracetamol poisoning
MOA vomiting,
Chronic bronchitis
Diarrhea,
AC by itself also binds to the COPD Transient skin rash,
toxic metabolites and
scavenges free radicals. Bipolar disorder Flushing,
It also increases oxygen delivery Epigastric pain,
Cystic fibrosis
to tissues, increases Constipation
mitochondrial ATP production, Influenza
and alters the microvascular Psychiatric conditions
tone to increase the blood flow
and oxygen delivery to the liver Alzheimer's disease
and other vital organs.

Disulfide reduction
NAC-SH + RSSR RSH + NAC-SSR

N-acetylcysteine (NAC)

HS O
NH

Oxidant scavenging
Glutathione replenishment
H2 O2

NAC HOCI NAC Cys GSH

OH
 Pharmacology

Respiratory Meds

Decongestants USES Side effects

Drowsiness,
Suffix: -rine Pseudoephedrine Used to relieve nasal congestion
in the upper respiratory tract. Dizziness,
Allergies Dry mouth/nose/throat,
MOA Asthma, acute Upset stomach, constipation,
Cold Symptoms Tachycardia
Decongestants produce their Hypotension Nervousness
action is activation of post Nasal Congestion Palpitations
junctional alpha-adrenergic
receptors found on precapillary Shock Insomnia
and post capillary blood vessels Supraventricular Tachycardia Headache
of the nasal mucosa. Weight Loss (Obesity/Overweight)
Decongestants act by Sinusitis
α-adrenergic stimulation, which
results in vascular constriction
and a reduction of nasal blood
supply to the sinusoids Has a strong (and unpleasant)
sulfur smell like rotten eggs that
is completely normal

Education
Decongestants are not recommended for children younger than age 6. ...
Check with MD before taking if
Decongestants can cause problems for people who have certain health
cardiac history is present
problems, such as heart disease, high blood pressure, glaucoma,
diabetes, or an overactive thyroid.
Don't take for longer than 7 days, can cause rebound congestion

Pseudoephedrine USES Pharmacokinetics

Stuffy nose and sinus Pseudoephedrine is active after oral

MOA pain/pressure administration and is easily absorbed
from the gastrointestinal tract. The
Common cold, flu onset of action occurs after 30 min
Pseudoephedrine is a Hay fever, allergies, bronchitis and after 1–4 h the drug reaches its
sympathomimetic with a mixed maximum concentration in the blood
Cough
mechanism of action, direct and
indirect.
It indirectly stimulates
alpha-adrenergic receptors, Side effects
causing the release
Of endogenous norepinephrine Dizziness Fast breathing
(NE) from the granularity of Fast or pounding heartbeat Hallucinations
neurons,
Headache High blood pressure
While it directly stimulates
beta-adrenergic receptors Nausea Weakness
Tremor
 Pharmacology

Respiratory Meds

Antihistamines USES 1st gen Side Efefcts

Suffix: -mine, -zine, -dine Rash Dry mouth

İtchiness Blurred vision
Dizziness
MOA Hay fever,
Hives, Drowsiness
First-generation antihistamines Conjunctivitis Hives
easily cross the blood-brain barrier
Allergic rhinitis Headache
into the central nervous system and
antagonize H-1 receptors, leading to Seasonal allergies Itchy and watery eyes
a different therapeutic and adverse Allergic reactions Nausea
effect profile in contrast to Sneezing
second-generation antihistamines
selectively bind to peripheral
histamine receptors. Have anticholinergic effects

2nd gen
Education
Less sedating & less side
Antihistamines can be taken with food or a glass of water or milk to lessen
effects overall
stomach irritation if necessary.
Avoid driving or operating heavy machinery (mainly in 1st gen)  Avoid
alcohol use or other CNS depressant
Do not break, crush, or chew before swallowing. 1st gen Classifications

Cetirizine,,
Fexofenadine,
Nursing Considerations Ketotifen,
Loratadine,
Proper administration. ... Increase fluid intake. ... Mzolastine
Drug effectiveness. ... Ensure voiding. ... Terfenadine,
Relief from dry mouth. ... Skin care. ...
Safety measures. ... Avoid alcohol.
2nd gen

Diphenydramine.
Doxylamine.
Pheniramine.
Promethazine

Histamine

Antihistamine
 Pharmacology

Respiratory Meds

Cetirizine 1st gen Diphenydramine 2nd gen

MOA MOA
Selective inhibition of peripheral H1 receptors and thus Diphenhydramine acts as an inverse agonist at the H1
prevents activation of H1 receptor-containing cells by receptor, thereby reversing the effects of histamine on
histamine capillaries, reducing allergic reaction symptoms

USES Contraindicated USES

Red & itchy eyes, In those patients with a
known hypersensitivity Used to relieve symptoms of allergy, hay fever,
Sneezing, to it or any of its and the common cold
Runny or stuffy nose, ingredients or It is also used to prevent and treat nausea,
Hives. hydroxyzine vomiting and dizziness caused by motion

Side effects Side effects

Headaches. Feeling sleepy,

Dry mouth. Dizzy or unsteady on
your feet.
Feeling sick (nausea)
Feeling dizzy.
Diarrhea. Side effects alcohol and other
CNS depressants
Sore throat. Premature infants and (hypnotics,
Sneezing or blocked neonates. sedatives,
and runny nose. Breastfeeding mothers. tranquilizers)
 Pharmacology

Cardiac Meds

Cardiac pharm overview

There are multiple ways to group & classify cardiac meds as they have many different uses/ characteristics. The
cardiac meds in this section are grouped by main action
This will help you better understand how they work so you can naturally understand what the effects and indications of
each medication are. But first let's review the basics of cardiac pharmacology

Focuses on the fundamental mechanisms of cardiovascular cells and how drugs influence the heart and
vascular system.

Cardiovascular system

The cardiovascular system consists of the heart, arteries, veins, and capillaries The heart and vessels work together
intricately to provide adequate blood flow to all parts of the body)
 Pharmacology

Cardiac Meds

Adrenergic receptors

Adrenergic receptors are cell surface glycoproteins that recognize and selectively bind the catecholamine,
norepinephrine and epinephrine, which are released from sympathetic nerve endings and the adrenal medulla
(hormones secreted by adrenals responsible for fight or flight).

Remember a for Remember you have Remember you have

arteries in alpha ONE heart= Beta 1 two lungs= Beta 2

Alpha 1 Alpha 2 Beta 1 Beta 2

Location Found on vascular Both in the brain and The heart, Airway smooth
smooth muscle. in the periphery. The kidney, muscles.
Found both in the Iris epithelium The fat cells Cardiac muscles,
brain and in the Skeletal muscle Uterine muscles
periphery
Skeletal muscles.
Both arteriolar
resistance and Lungs and eyes
venous capacitance

Mediate smooth decreased insulin İncreases sinoatrial (sa) Smooth muscle

Action
muscle contraction release from the nodal, relaxation,
Increasing the pancreas[19] Atrioventricular (av) Which may result in
intracellular increased glucagon nodal, peripheral vasodilation
calcium concentrations release from the Ventricular muscular with subsequent
pancreas firing, Hypotension and reflex
Their normal
action when contraction of sphincters İncreasing heart rate tachycardia.
stimulated of the GI-tract
Vasoconstriction of and contractility
arteries Vasodilation of arteries

Decrease blood Decrease blood pressure Increase cardiac output Reduce uterine smooth
Result
pressure Relax penile smooth Increasing heart rate muscle contractions
Decreasing peripheral muscles Reduce bronchial
vasoconstriction Enhance mood by smooth muscle
Relax smooth muscles increasing contraction
norepinephrine secretion

Functions Activation of Acts as an allosteric Activation of the beta-1 Stimulation of these

phospholipase C, inhibitor through Gi receptor in the heart receptors causes smooth
increasing IP3 and DAG, function, leading to an increases sinoatrial (SA) muscle relaxation,
and ultimately increasing inhibition of adenylyl nodal, atrioventricular
the intracellular calcium cyclase, decreasing the (AV) nodal, and
concentrations leading to formation of intracellular ventricular muscular
smooth muscle cAMP. firing,
contraction and
glycogenolysis.
 Pharmacology

Cardiac Meds

Agonist= stimulate Antagonist= block Also called inhibitors

Activates a receptor to produce a biological Stops the action or effect of another substance. An
response Mimics the actions of a neurotransmitter or antagonist muscle is a muscle that produces the opposite
hormone to produce a response when it binds to a action of an agonist.
specific receptor in the brain
For example:
For example: Oxycodone, morphine, heroin, fentanyl,
methadone, and endorphins are all examples of A drug that blocks the stimulating effect of estrogen on a
opioid receptor agonists tumor cell is called an estrogen receptor antagonist.

Cardiac functioning

HR (heart rate) SV (stroke volume) Co (cardiac output)

The maximum heart rate Stroke Volume (SV) is the volume of Cardiac output (CO) is the
(HRmax) is the age-related blood in millilitres ejected from the amount of blood pumped by the
highest number of beats per X each ventricle due to the X heart minute
minute of the heart contraction of the heart muscle

If any of these factors are affected, the others

Heart rate (HR) is a readily which compresses these ventricles VO2
available vital sign that holds CO =
important prognostic information SV = EDV - ESV Ca Cv
SV= stroke volume
EDV= End-diastolic volume

are affected as well

ESV= End-systolic volume

Co (cardiac output) Systemic vascular resistance, SVR BP (blood pressure)

Measurement of afterload
Cardiac output (CO) is the Elevated blood pressure is when
amount of blood pumped by the X the amount of force exerted X readings consistently range from
120-129 systolic and less than 80
heart minute on circulating blood by the mm Hg diastolic
vasculature of the body

(MAP-CVP)
SVR = *80
CO
MAP : Mean arterial Pressure mmHg
CVP : Central Venous Pressure mmHG
CO : Cardiac Output I/Min
 Pharmacology

Cardiac Meds

Optimize cardiac functioning

Cardiac output is determined by multiplying heart rate by stroke volume, highlighting the importance of both
factors in maintaining cardiovascular health. This could indicate lowering or increasing factors in either equation
depending on the patient's condition, but the main factors influenced are

Cardiac function is affected by filling

Factors of cardiac function volume (preload), vascular resistance
(afterload) and myocardial contractility.

Preload Afterload

Preload is the force that stretches the cardiac The afterload is the amount of pressure that the
muscle prior to contraction. This force is composed heart needs to exert to eject the blood during
of the volume that fills the heart from venous return ventricular contraction

Preload is the filling pressure of the heart at the end This is recorded as the systolic pressure of the heart.
of diastole. The left atrial pressure (LAP) at the end The changes in the afterload affect the stroke
of diastole will determine the preload. The greater volume, end-systolic volume, end-diastolic volume,
the preload, the greater will be the volume of blood and left ventricular end-diastolic pressure.
in the heart at the end of diastole

Contractility Heart rate

Relaxed Contracted

the tension developed and velocity of shortening heart rate is the number of times each minute that
(i.e., the “strength” of contraction) of myocardial your heart beats, which is normally between 60 and
fibers at a given preload and afterload 100 times per minute for adults

Contractility is the ability of the heart muscle to How to calculate heart rate?
contract and thereby pump blood. Cardiac
You can feel the radial pulse on the artery of the wrist
contractility is determined by the interaction
in line with the thumb. Place the tips of the index and
between intracellular calcium concentration, and
middle fingers over the artery and press lightly. Do not
the myofilament cross-bridge cycling.
use the thumb. Take a full 60-second count of the
heartbeats, or take for 30 seconds and multiply by 2.
 Pharmacology

Cardiac Meds

Adrenergic blockers

Adrenoblockers are highly effective pharmaceuticals that are used broadly in treatment of cardiac diseases. Their
physiological effects include the dilation of blood vessels, which lowers blood pressure and slows heart rate

Alpha- blockers Beta blockers

Alpha blockers are a type of blood pressure Beta blockers are medicines that lower blood pressure. They
medicine. also may be called beta-adrenergic blocking agents. The
Alpha blockers lower blood pressure by keeping medicines block the effects of the hormone epinephrine,
a hormone called norepinephrine from also known as adrenaline.
tightening the muscles in the walls of smaller
arteries and veins
Types of BB

Example Suffix: -ZOSIN 1.Beta-1 Blocker(Selective)

A selective β1-receptor antagonist used for the
management of hypertension and ventricular premature
Doxazosin Alpha- 1 blockers beats in adults
Terazosin
Prazosin 2.Beta-2Blockers(NON-Selective)
Alpha 1 receptors causes the
Tamsulosin
widening of the blood Nonselective beta-blockers are drugs that work to lower
Alfuzosin vessels by inhibiting the arterial and venous pressure.
Silodosin action of catecholamine that
cause vasoconstriction.
Inhibit smooth muscle Suffix: -OLOL
contraction
Selective NON-Selective
Atenolol, Pindolol
Alpha 1 & Alpha
2 have Alpha 2 agonists work to Betaxolol, Penbutolol
opposing stimulate alpha 2 receptors bisoprolol, sotalol
actions (opposite to alpha 1
blockers) to cause vasodila- esmolol, Propanolol
tion (Example: Clonidine) acebutolol, Labetalol
metoprolol, Carvedilol
nebivolol.
Alpha- 2blockers
Alpha-2 blockers increase noradrenaline release
This reduces the force of the vasodilation caused
by the blocking of alpha 1 receptors.
 Pharmacology

Cardiac Meds

Action Action

Act to reduce blood pressure by selective Beta blockers, also called beta adrenergic blocking
blockade of the receptor. agents, block the release of the stress hormones
adrenaline and noradrenaline in certain parts of the
These agents provide a rational approach to the body.
treatment of hypertension by correcting elevated
total peripheral resistance, This results in a slowing of the heart rate and reduces
the force at which blood is pumped around body.
They work by allowing the blood vessels to relax
and widen, so the blood has more space to flow They act by slowing conduction through the AV node,
through
Preventing release of norepinephrine &
epinephrine, and leading to smooth muscle
relaxation & vasodilation
Sympathetic nerve NE Epi
NE

Circulating
Sympathetic nerve Catecholamines
NE 2 1o 2o
NE
Epi

1o NE 2o 1 Gs 2

AC
1 2
Gq Gi
Vascular Heart rate cAMP ATP
Smooth IP3 cAMP Contractility Heart
Muscle Conduction Velocity PDE3 AMP
Contraction

Uses Uses

Treat high blood pressure by stopping A1 and A2 Angina Heart attack

receptors from activating. Arrhythmia Migraine
Benign prostatic hyperplasia (also known as Heart failure Tremors
benign prostatic enlargement) is a condition that
causes the prostate gland to enlarge High blood pressure Hyperthyroidism

Prevent damage to areas of skin caused by Anxiety Asthma

norepinephrine leaking out of your blood vessels atrial fibrillation
and into the surrounding tissue Glaucoma
Pheochromocytomas and paragangliomas
 Pharmacology

Cardiac Meds

Side effects Side effects

First-dose phenomenon“ feeling tired, dizzy or lightheaded (these can be signs
Orthostatic hypotension of a slow heart rate)
sudden drop in blood pressure (postural hypotension) cold fingers or toes (beta blockers may affect the
blood supply to your hands and feet)
headaches.
Bradycardia
nausea.
Hypotension
Palpitations
Hypoglycemia
Reflex tachycardia
difficulties sleeping or nightmares
dizziness.
difficulty getting an erection or other difficulties with
drowsiness, tiredness, sex
weakness or feeling lethargic. Bronchospasm (in non-selective) Contraindicated in
swollen legs or ankles. asthma & COPD
sleep disturbance. feeling sick
tremor.
Fluid & sodium retention
May mask symptoms in diabetic patients; need to
monitor closely
Pharmcokinetics Alpha-blockers are well absorbed
after oral administration and undergo extensive hepatic
metabolism. The main difference between agents is in
elimination half-life: short with indoramin and prazosin
and much longer with doxazosin and terazosin
Nursing considerations
check the patient's blood pressure, heart rhythm, and
pulse rate.

Nursing considerations Check it regularly with the therapy as well.

Monitor the ECG closely, especially when the dose is
Purpose of medication: blood pressure control. adjusted or given intravenously.
Take with or without food. ... Diabetic patients need to closely monitor sugars 
Take first dose at bedtime to avoid severe orthostatic Change positions slowly
hypotension and syncope. Keep an eye on the patient's vital signs and monitor
Continue to make position changes slowly, sit down if them for toxicity and adverse reactions.
dizziness occur. ... Do not abruptly stop taking; can cause rebound
Avoid alcohol. hypertension!
Take at night time
Change positions slowly
Do not abruptly stop taking; can cause rebound
hypertension
 Pharmacology

Cardiac Meds

EXAMPLES EXAMPLES

Prazosin Propranolol NON-Selective

Prazosin is used alone or in combination with other β-Blockers are competitive antagonists. Non-selective
medications to treat high blood pressure β-Blocker acts at both β 1 and β 2 receptors B-Blockers are
useful in hypertension angina, cardiac arrhythmias,
congestive heart failure and glaucoma

Pharmacological Actions Pharmacological Actions

Prazosin inhibits the postsynaptic alpha-1 Cardiovascular

adrenoceptors. Propranolol decreases the force of myocardial contraction.
Cardiac output, work, and oxygen consumption are
This inhibition blocks the vasoconstriction
decreased. It is used in the treatment of angina and heart
(narrowing) effect of catecholamine
failure.
(epinephrine and norepinephrine) on the vessels,
leading to peripheral blood vessel dilation. Respiratory Tract
Blocking of the α1-adrenergic receptors Propranolol acts on B receptors and causes Broncho-
associated with smooth muscle of the bladder constriction.
neck and prostate.
This action reduces pressure on the urethra and
improves urine flow.
Therapeutic Uses
Prazosin causes vasodilation (widening) of the
blood vessels, and consequently decreases the
Hypertension
resistance of blood flow. Propranolol lowers blood pressure in hypertension .
Decreased cardiac output is the primary mechanism.
Migraine
Propranolol is also effective in reducing migraine
Uses Treatment Of Angina
Propranolol decreases the oxygen requirement of heart
Prazosin is used with or without other muscles.
medications to treat high blood pressure.
Lowering high blood pressure helps prevent Adverse Effects Symptoms of Heart Failure
strokes, heart attacks,
Kidney problems. Prazosin belongs to a class of Hypotension Bradycardia (AV Block) Drowsiness
medications called alpha blockers.
It works by relaxing and widening blood vessels
so blood can flow more easily
Benign prostatic hyperplasia, ptsd-associated Side effects
nightmares,
Headache Diarrhea
Nausea Tinnitus
Nervousness Constipation
Pharmacokinetics.
Tachycardia Depression
Prazosin has an onset of action of 30 to 90 minutes, Dizziness Lack of energy
the elimination half-life of prazosin is 2 to 3 hours, Rash Priapism
and its duration of action is 10 to 24 hours
Urinary frequency Weakness
Blurred vision
 Pharmacology

Cardiac Meds

Atenolol Selective USES Side effects

Treat high blood pressure Feeling sleepy, tired or dizzy. As
Action (hypertension). your body gets used to
Heart attacks, atenolol, these side effects
Atenolol, a cardio selective beta-1 should wear off. ...
adrenergic antagonist, selectively Kidney problems
binds to the beta-1 adrenergic Cold fingers or toes. Put your
Chest pain (angina)
receptors in vascular smooth hands or feet under warm
muscle and the heart. running water, massage them
and wiggle your fingers and
toes. ...
Feeling sick or being sick
(nausea or vomiting) .
Diarrhoea. ...
Stomach pain.
 Pharmacology

Cardiac Meds

RAAS inhibitors

Renin-angiotensin-aldosterone system (RAAS) inhibitors are a group of drugs that act by inhibiting the
renin-angiotensin-aldosterone system
ACE inhibitor (ACEI) and angiotensin receptor blocker (ARB) are two major RAAS inhibitors commonly used in clinical
practice

1st 2nd
Choice Choice
RAAS inhibitors ARBs

Angiotensin-converting enzyme (ACE) inhibitors are Angiotensin II receptor blockers or ARBs are an
medicines that help relax the veins and arteries to effective treatment for high blood pressure, heart
lower blood pressure. failure, kidney disease and other conditions.
ACE is the conversion of Ang I to Ang II and
degradation of BK, which all play an important role in
controlling blood pressure. Suffix:
-SARTAN Examples

Telmisartan Eprosartan
suffix: -
PRIL Examples Candesartan Azilsartan
Losartan Valsartan
Ramipril Trandolapril
Olmesartan
Lisinopril Benazepril
Irbesartan
Captopril Quinapril
Enalapril Moexipril
Fosinopril Cilazapril
Action
Perindopril Imidapril
ARBs displace angiotensin II from the angiotensin I
receptor and produce their blood pressure lowering
Action effects by antagonizing angiotensin II–induced
vasoconstriction, aldosterone release, catecholamine
release, arginine vasopressin release, water intake, and
Angiotensin-converting enzyme (ACE) inhibitors are
hypertrophic response
medicines that help relax the veins and arteries to lower
blood pressure.
ACE inhibitors prevent an enzyme in the body from
making angiotensin 2, a substance that narrows blood
vessels.
This narrowing can cause high blood pressure and
forces the heart to work harder.
Angiotensin 2 also releases hormones that raise blood
pressure.
 Pharmacology

Cardiac Meds

Uses Uses

High blood pressure, also called hypertension. High blood pressure

Coronary artery disease. Heart failure
Heart failure. Chronic kidney disease
Diabetes. Kidney disease caused by diabetes
Certain chronic kidney diseases. Myocardial infarction
Heart attacks.
Scleroderma, a disease that involves hardening of the
skin and connective tissues.
Side effects
Migraines
Dizziness or lightheadedness
Confusion
Side effects Severe vomiting and diarrhea
Angioedema
Dry cough. Hyperkalemia
Too much potassium in the blood. Sinus problems and upper respiratory tract infection
Extreme tiredness or dizziness from blood pressure Cough
going too low.
Muscle cramps or weakness, back or leg pain
Headaches.
Change of taste in the mouth (metallic or salty)
Dry cough Will be
Angioedema switched to
ARB if cannot
Hyperkalemia
tolerate ACE Nursing considerations
Dizziness
Loss of taste.
Monitor her vital signs regularly and her WBC count and
serum electrolytes,
Especially potassium level, periodically.
Nursing considerations
Do not abruptly stop taking; can cause rebound
hypertension
Monitor her vital signs regularly and her WBC count and
Give potassium supplements and potassium-sparing
serum electrolytes,
diuretics cautiously because ACE inhibitors can cause
Especially potassium level, periodically. potassium retention and hyperkalemia.
Do not abruptly stop taking; can cause rebound Contraindicated in pregnancy; teratogenic to fetus
hypertension
High risk of hyperkalemia (especially if taking with
Give potassium supplements and potassium-sparing potassium-sparing diuretic)
diuretics cautiously because ACE inhibitors can cause
Avoid foods high in potassium + salt substitutes with
potassium retention and hyperkalemia.
potassium
Contraindicated in pregnancy; teratogenic to fetus
High risk of hyperkalemia (especially if taking with
potassium-sparing diuretic)
Avoid foods high in potassium + salt substitutes with
potassium
 Pharmacology

Cardiac Meds

Avoid foods like: Avoid foods like:

Dry fruits (raisins, apricots, prunes, dates). Dry fruits (raisins, apricots, prunes, dates).
Fresh fruits (bananas, strawberries, watermelon, Fresh fruits (bananas, strawberries, watermelon,
cantaloupe, honeydew, oranges, nectarines). cantaloupe, honeydew, oranges, nectarines).
Dry vegetables (beans, peas). Dry vegetables (beans, peas).
Fish Fish
Spinach Spinach

Captopril Losartan

(ACE Inhibitors) Renin Angiotensin System Blockers (Angiotensin Receptor Blocker) Renin Angiotensin
Captopril is ACE inhibiters agents that block the ACE System Blockers Losartan is a medicine called
activity. As ACE convert angiotensin-I into angiotensin receptor blocker (ARB). It's widely used to
angiotensin-II, which is a powerful vasoconstrictor. treat high blood pressure (hypertension) and heart
These agents also diminish the rate of bradykinin failure
inactivation, which is a vasodilator.
MOA
MOA
Losartan and other angiotensin receptor blockers are
Action On Heart competitive antagonist of angiotensin type 1 receptor
(AT1 receptor). Losartan have the advantage of more
Captopril and other ACE inhibitors decrease vascular complete blockade of angiotensin action. These agents
resistance and blood pressure. do not affect bradykinin level.

Uses
Action On CVS
Captopril is used to treat high blood pressure
(hypertension) All the angiotensin receptor blockers approved for
treatment of hypertension. This agent is very useful in HF
It is also used to treat heart failure, protect the kidneys
as they reduce the blood pressure
from harm due to diabetes,

Pharmacokinetics Pharmacokinetics

ACE inhibitors absorbed in GIT. The presence of food may All drugs are orally active and require only once a day
decrease absorption so they should be given empty dosing. Losartan undergoes extensive first pass hepatic
stomach except for Captopril. metabolism. All drugs are highly plasma protein bound

Adverse Effect Adverse effects

Dry cough, Angiotensin receptor blockers have similar adverse effect

Abdominal pain, of ACE inhibitor. However angiotensin receptor blockers
do not produce cough
Skin rash,
Hypotension, Dizziness Back pain
Chest pain Fainting
Renal insufficiency Hives Stuffy nose
 Pharmacology

Cardiac Meds

Cardiotonic agents
Digoxin
Cardiotonic are drugs used to increase the efficiency and improve the contraction of the heart muscle, which leads
to improved blood flow to all tissues of the body.
Cardiotonic drugs increase the force of the contraction of the muscle (myocardium) of the heart. This is called a
positive inotropic action

MOA (ACTION) class: cardiac glycoside

Digoxin induces an increase in intracellular sodium that

will drive an influx of calcium in the heart and cause an
increase in contractility.
Positive inotropic Therapeutic range 0.5-2 ng/dL
Inhibition of sodium-potassium adenosine
triphosphates pumps located on myocardial
Digoxin
cell membranes, which results in an increase in
intracellular sodium concentration.
Nursing considerations
Negative chronotropic
Digoxin also increases vagal activity through its Na+/K+- Vagal Educating patients
action on the central nervous system, thus ATPase pump Activity about potential side
decreasing the conduction of electrical effects and
impulses through the atrioventricular (AV) node. interactions with
This negative chronotropic effect (slowing of other drugs.
heart rate) is important for its clinical use in Ca2+ AV conduction Potassium rich diet
different arrhythmias
Regularly monitor dig
Negative dromotropic levels & electrolytes
Digoxin has a negative dromotropic effect on the Force Rate Nurses will also need
atrioventricular node, leading to an increase in to monitor, or
refractory periods and nodal conduction time. educate the patient
to monitor pulse,
Heart beats stronger & blood pressure,
slower Does NOT affect weight, urine output,
Side effects electrolyte levels, and
blood pressure
digoxin
Feeling. ...
Signs of toxicity concentrations in the
Feeling or being sick blood
Anorexia, (nausea or vomiting)
Uses
Monitor kidney
Nausea, Diarrhea. function (creatinine +
To treat congestive Vomiting Changes in your bun); worsened
heart failure, vision (including kidney function (high
Neurological
blurred vision and not risk of toxicity)
Atrial fibrillation symptoms
being able to look at Assess apical pulse
Arrhythmias Gastrointestinal upset
bright light) ... for one full minute
Fib/ a. flutter Anorexia before administering
Skin rashes.
Cardiogenic shock Vision changes ( hold for hr < 60
Dizziness bpm)
 Pharmacology

Cardiac Meds

Milrinone Class: phosphodiesterase 3 inhibitor

Milrinone is a phosphodiesterase-3 inhibitor that inhibits the degradation of cyclic adenosine monophosphate
(cAMP). By increasing the concentration of cAMP, milrinone enhances myocardial contractility, promotes myocardial
relaxation, and decreases vascular tone in the systemic and pulmonary circulation.
Milrinone tends to lower arterial blood pressure and pulmonary capillary wedge pressure more than dobutamine and
has a more prolonged action.

Uses Side effects Nursing considerations

Acute heart failure, Pain, redness, or irritation at Monitor heart rate and BP
Pulmonary hypertension site where injected continuously during
Irregular heartbeat; administration. Slow or
Cardiogenic shock, discontinue if BP drops
palpitations
Chronic heart failure excessively.
Breathing problems.
Monitor intake and output and
Used as last line therapy for Thrombocytopenia daily weight.
heart failure patients or during
Hypokalemia. Monitor CBC, BMP, coags
palliative care to increase
quality of life Ventricular arrhythmias Monitor ECG continuously
during infusion.
Strict I & O

Dobutamine class: beta 1 agonist

Dobutamine has a rapid onset of action and a short half-life.

Administered as IV infusion
It increases myocardial contractility, while the reflex
Reduction in sympathetic tone, in response to augmentation
Of stroke volume,
Nursing considerations
Leads to a decrease in total peripheral resistance.
Monitor bp, heart rate,
ecg, pulmonary capillary
wedge pressure (pcwp),
Uses Side effects Considerations Cardiac output, central
venous pressure (cvp),
Treats heart failure by Nausea, vomiting; The medication is and urinary output
strengthening heart Fever, tingly feeling; contraindicated in continuously during the
muscle. patients with acute administration
Headache; or myocardial infarction,
Used in the treatment of Vasopressor & vesicant;
cardiogenic shock Leg cramps. unstable angina, left
main stem disease, monitor ıv site closely!
Heart Disease Shortness of breath (Central line for long
severe hypertension,
(even with mild exertion), term use).
Hypertensive Congestive arrhythmias, acute
swelling, rapid weight
Heart Failure myocarditis idiopathic Report significant
gain;
hypertrophic sub-aortic changes in vital signs or
Hypertensive Heart (w/ Chest pain, fast or stenosis. arrhythmias.
CHF) and Renal Disease pounding heartbeats;
Maoı & tca
A light-headed feeling, antidepressants increase
like you might pass out; potency of dobutamine
Wheezing, chest
tightness;
Tachycardia
Ventricular arrythmias
 Pharmacology

Cardiac Meds

Dopamine

Synaptic
MOA vescile
Dopamine
metabolites
Dopamine
At low doses it acts through the sympathetic nervous system to increase
heart muscle contraction force and heart rate, thereby increasing cardiac
output and blood pressure.
Synaptic
Higher doses also cause vasoconstriction that further increases blood cleft
pressure.
Higher doses also cause vasoconstriction that further increases blood Signal
Dopamine
pressure. receptor
Stimulates dopaminergic receptors leading to high renal perfusion

Administered as IV infusion
Nursing considerations

Uses Monitor BP, heart rate, ECG, pulmonary

Used to treat low blood pressure,
capillary wedge pressure (PCWP),
Low heart rate, and cardiac arrest. Cardiac output, central venous pressure
(CVP), and urinary output continuously
Shock
during the administration
It plays a role in many important body functions including
Vasopressor & vesicant; monitor IV site
movement memory and pleasurable reward and motivation.
closely! (central line for long term use).
Side effect Report significant changes in vital signs or
Shortness of breath. arrhythmias.
Numbness. MAOI & TCA antidepressants increase
Feeling cold
potency of dobutamine
Ventricular arrhythmias
Fast, slow,
Pounding heartbeat.
Chest pain.
Palpitations
Headaches
Blue discoloration of hands and feet.
Darkening of skin
 Pharmacology

Cardiac Meds

Vasodilators

Vasodilators are medicines that open, also called dilate, blood vessels.
Vasodilators affect the muscles in the walls of the arteries and veins. Normal Vasodilation Vasoconstriction
They prevent the muscles from tightening and the walls from narrowing.
As a result, blood flows more easily through the vessels.

Calcium channel blockers suffix: -dipine, -zem, -mil

Calcium channel blockers are medicines used to lower blood pressure. They stop calcium from entering the cells of the
heart and arteries

MOA For arteries: Calcium channel

blockers include
The drug will bind to the alpha 1 subunit of the cell's L-type calcium channel. Amlodipine
Arterial wall smooth muscle, on this subunit there are positions N, D and V,
depending on the drug in the calcium channel blocker group, the binding site is Diltiazem
different. Thereby causing the effect of reducing the amount of calcium ions Felodipine.
entering the cell, reducing the contractility of smooth muscle, reducing the Isradipine.
resistance of the vessel wall, causing a decrease in blood pressure and
anti-spasm of the arteries, which is important for used is the coronary artery. Nicardipine.
Nifedipine
For the heart:
Nisoldipine
When entering the body, the drug will bind to the calcium ion transport
Verapamil
channels of all types of heart tissue cells. thereby reducing the concentration of
calcium ions into the cell
Calcium
Depolarization Ca2+ Channel
Blockers

-pines only lower bp -zems L-Type voltage

& -mils lower bp & hr Ex: Gated ca channel Ca2+ Nursing considerations
RyR
Nicardipine, Amlodipine Ex: Ca 2+
SR Ca2+ store
Cardizem, Verapamil Cardiac
Mytocyte Muscle contraction two of the most important
things that nurses have to
consider before giving
Therapeutic uses calcium channel blockers are
the client's blood pressure
Calcium channel blockers are medicines used to lower blood pressure.
and heart rate.
They stop calcium from entering the cells of the heart and arteries.
It is advisable to check these
Calcium causes the heart and arteries to squeeze more strongly. two factors at least 30
By blocking calcium, calcium channel blockers allow blood vessels to relax and open. minutes before the drug is
Some calcium channel blockers also can slow the heart rate. This can further lower given.
blood pressure.
Change positions slowly
The medicines also may be prescribed to relieve chest pain, called angina, and
control an irregular heartbeat. AVOID grapefruit! can cause
Calcium channel blockers are sometimes called calcium antagonists. toxicity Contraindicated in
heart block patients High fiber
Pharmacokinetics Side effect diet to prevent constipation
Most CCBs have low and Constipation. Headache.
variable oral bioavailability Dizziness. Nausea.
because of extensive
first-pass metabolism. Fast heartbeat you can feel. Orthostatic hypotension
Half-life is relatively short (< Extreme tiredness. Constipation (-MIL & --ZEM)
12 hours).
Flushing. Gingival hyperplasia (-PINE)
 Pharmacology

Cardiac Meds

Verapamil (Class-IV, Ca2+ Channel Blockers)

It works by relaxing the blood vessels so the heart does not have to pump as hard. It also increases the supply of blood
and oxygen to the heart and slows electrical activity in the heart to control the heart

Mechanism Of Action

Verapamil inhibits slow channel calcium ion transport across the cells of the coronary and peripheral vasculature.
myocardial cell membrane it also reduces intracellular calcium concentration in smooth muscle Pharmacological
Action Verapamil depress SA and AV nodal functions. Slow AV conduction is its major action making it useful as anti
arrhythmic agent. It reduces coronary and peripheral vascular resistance. It increases coronary blood flow. Verapamil
increases myocardial oxygen supply by increasing coronary blood flow. Verapamil has anti arrhythmic, anti anginal
and antihypertensive properties

Therapeutics Uses Adverse Effects

Verapamil is more effective Constipation is the most

in the treatment of arterial common side effect.
arrhythmias than Nausea,
ventricular arrhythmias. It is
also very useful in the Vomiting,
Rate
treatment of angina Headache,
pectoris and hypertension. Weakness Force
Na+ channels
Gastric disturbance may
Pharmacokinetics occur when given IV; Ca2+
Verapamil may cause
Verapamil is rapidly and Verapamil
severe hypotension, and
almost completely bradycardia.
absorbed after oral
administration. It undergoes
extensive first pass
metabolism in the liver. It is
highly bound by plasma
proteins. Its half-life is 3 to 6
hours.
 Pharmacology

Cardiac Meds

Nitrates Nitroglycerine & isosorbide

Organic nitrates and nitrites used in the treatment of angina pectoris. These are simple nitric and nitrous acid esters of
glycerol. These compounds cause a rapid reduction in myocardial oxygen demand, followed by rapid relief of
symptoms. They are effective stable and unstable angina as well as in variant angina pectoris

Pharmacological Action Uses

itrates decrease coronary vasoconstriction or Cardiovascular diseases

spasm and increase blood flow by relaxing Angina
coronary arteries. In addition they relax veins,
decreasing preload and myocardial oxygen Heart failure
consumption. Nitroglycerine, which is also known Hyertensive crisis
as glyceryl triturate, relaxes vascular smooth Coronary artery disease
muscle by their intracellular conversion to nitrite
ions and then to nitric oxide.
Other nitrates used to treat angina chest pain,
nitroglycerin converts to nitric oxide (NO) in the Nursing considerations
body. High blood flow to heart low vascular
resistance low O2 consumption Monitor the vital signs of the patient.
With IV nitroglycerin therapy, monitor the pulse and
blood pressure every 5 to 15 minutes (Hold for SBP
30mmhg)
Make the necessary dosage adjustments accordingly.
Pharmacokinetics Observe for adverse drug reactions.
Do not give with PDE 5 Inhibitors (Sildenafil aka Viagra)
Nitroglycerine is commonly given by sublingually Will result in life threatening hypotension!
or via a transdermal patch because it has Monitor the effectiveness of the drug.
significant first pass metabolism
Sublingual nitro: 3 doses 5 minutes apart
If pain not relieved or worse 5 minutes after first dose,
Adverse Effects call 911
Must be kept in original dark container
The most common adverse effect of nitroglycerine
and other organic nitrates are

Headache, Aalways wear gloves with patch or paste The medication from
Is when your
Postural hypotension, the patch or paste can easily absorb into your skin, causing
blood pressure hypotension
Facial flushing drops when you
Never rub paste into patient's skin; can cause rapid absorption
Tachycardia go from lying
down to sitting Always remove previous patch before applying a new one
Flushing
up, or from sitting
Orthostatic hypotension to standing

Route of Administration

Sublingual tablet; Intranasal Spray

Ointment; IV
Capsule; Oral,
Spray; Intravenous of
Transdermal paste transdermal routes
Transdermal patch
 Pharmacology

Cardiac Meds

Hydralazine apresoline Class: direct vasodilators

Hydralazine is an arteriolar dilator acting directly on the smooth muscle of arterioles by mechanisms that are
incompletely understood but result in reduced peripheral vascular resistance and reduced blood pressure.
Hydralazine is a direct vasodilator used orally to treat essential hypertension

Uses Side effects Nursing Contraindications

considerations
To treat high blood Rash on your face Hypersensitivity to
pressure Fever Monitor blood hydralazine; coronary
Prevent strokes, heart pressure Obtain artery disease; mitral
Tiredness
attacks, and kidney complete blood valvular rheumatic
problems. Drug-induced lupus count (CBC) and heart disease are
Loss of appetite antibody titers prior contraindications for its
It works by relaxing
to beginning this use.
blood vessels so Nausea
medication
blood can flow Hypotension
through the body Drops blood pressure
Weight loss quickly which can
more easily.
Chest pain lead to reflex
Heart failure
Reflex tachycardia tachycardia; often
used with beta
Kidney problems blocker
Report signs and
symptoms of
infection
MAOI's may increase
potency of
hydralazine leading
to hypotension
Do not give with PDE
5 Inhibitors (Sildenafil
aka Viagra)
 Pharmacology

Cardiac Meds

Antihyperlipidemic drugs are medicines that

Antihyperlipidemics help you lower your cholesterol levels.

Red blood cells

Many people have high cholesterol because of: Cholesterol and saturated fat in foods
that come from animals (like meat and dairy products) and fried foods (including
palm oil products). A lack of exercise
Cholesterol

HDL LDL Other values

HDL (high-density lipoprotein) LDL (low-density lipoprotein) total cholesterol less than 200 mg
cholesterol, sometimes called cholesterol, sometimes called / dL (5.17 mmol/L) is normal.
“good” cholesterol, absorbs “bad” cholesterol, makes up most Triglycerides Less than 150
cholesterol in the blood and of your body's cholesterol. High milligrams per deciliter (mg/dL
carries it back to the liver. have a levels of LDL cholesterol raise your
higher risk for heart disease 35 to risk for heart disease and stroke.
65 mg/dL for men, 35 to 80 mg/dL Less than 100 mg/dL
for women
Atorvastatin
Fluvastatin.
Amlodipine/atorvastatin.
Hmg-coa reductase inhibitors suffix: -statin Pitavastatin
Pravastatin
MOA
Rosuvastatin
A substance that blocks an enzyme needed by the body to make cholesterol and Simvastatin
lowers the amount of cholesterol in the blood.
HMG CoA reductase inhibitors bind reversibly to HMG CoA reductase and inhibit the
catalytic enzyme that regulates the conversion of HMG CoA to mevalonate, the
rate-limiting step in cholesterol biosynthesis. nursing considerations

Lowers ldl & increases hdl not a cure Increased HDL helps remove LDL Diet & exercise is vital to Assess for allergies to
tx of HLD HMG-CoA reductase
inhibitors.
Obtain baseline cholesterol,
MOA Contraindications Side effects triglycerides, and liver
function tests.
Lower high cholesterol include hypersensitivity, Muscle aches,) Monitor liver function
(also known as active liver disease, Drowsiness Assess for signs of muscle
hyperlipidemia or Dizziness weakness or pain.
dyslipidemia
pregnancy, lactation,
coadministration with Headache Monitor for EKG changes.
Hypercholesterolemia Nausea or vomiting
strong CYP3A4 inhibitors Assess for changes in
(high cholesterol in Bloating or gas
blood) concentration, alertness,
Diarrhea and vision.
Primary and secondary Constipation
prevention of coronary Take in evening (most
Abdominal cramping or cholesterol produced at
heart disease pain night)
Liver toxicity
Rhabdomyolysis
AVOID grapefruit! can
Difficulty sleeping
cause toxicity 
Flushing of the skin Contraindicated in
Low levels of blood platelets pregnancy
Rash
 Pharmacology

Cardiac Meds

Bile acid resins prefix: chole- & cole Cholestyramine.

Colesevelam.
The bile acid sequestrants are highly positively charged molecules that bind to the
negatively charged bile acids in the intestine, inhibiting their lipid solubilizing activity Colestid.
and thus blocking cholesterol absorption Colestipol.
LoCholest.
Bile acid binding resins

Brown adipoce tissue

SHP

CYP7A SREBP-1C PEPCK

D2
FAS
PGC-1α
Improving
fatty liver

Cholestrol Triglyceride Clucose Energy consumption

Insulin resistence
Vascular disease prevention Body weight

Improving type 2
Improving metabolic syndrome Improving
diabetes
obesity

Uses nursing considerations Side effects Contraindications

Severe diarrhea Advise patient about the Constipation Bile acid sequestrants
likelihood of GI problems should not be used in
Severe liver disease Bloating
including nausea, patients with
Cirrhosis (inflammation constipation, abdominal Heartburn hypersensitivity to active
and fibrous thickening pain, flatulence, oily/foul ingredients or any of its
Vomiting
leading to permanent smelling stools, components.
damage to liver tissue) hemorrhoids, and fecal Abdominal pain
Cholestyramine use is
Pruritus (itching of the impaction. Weight loss
contraindicated in patients
skin caused by an Interferes with absorption of Gallstones with complete biliary
accumulation of bile fat soluble vitamins obstruction where bile is not
Flatulence
acids in the skin) secreted into the intestine.
Vitamins A, D, E & K Diarrhea
Hyperthyroidism
Instruct patient to report Cholesterol gallstones
(overproduction of
severe or prolonged GI
thyroxine hormone by the
problems.
thyroid gland)
Increase fiber and fluid
Type 2 diabetes
intake to prevent
Hyperlipidemia constipation
Can be used alone or Monitor for signs of
with -STATINs gallstones (RUQ pain after
fatty meal, N/V)
 Pharmacology

Cardiac Meds

Fibrates prefix: chole- & cole

Root: -fib

Action Uses Side effects Clofibrate (Atromid-S).

Fenofibrate (TriCor)
Fibrates stimulate cellular help lower LDL (bad) Abdominal pain.
fatty acid uptake, cholesterol Fibricor, Lofibra
Constipation.
conversion to acyl-CoA Hypertriglyceridemia Gemfibrozil (Lopid)
derivatives, and Diarrhea.
catabolism by the Triglycerides, Apo Dizziness.
beta-oxidation pathways, lipoprotein B (Apo-B) and
Headaches.
which, combined with a Increase high-density Give 30 minutes before
reduction in fatty acid lipoprotein cholesterol Leg cramps breakfast & dinner
and triglyceride synthesis, (HDL). Gallstones Monitor LFT & CK levels
results in a decrease in
Liver toxicity Clients taking fibrates
VLDL production.
Muscle pain. may also develop a skin
Decreasing triglycerides rash, Urticaria, and
Decrease triglycerides by pruritus.
about 50%. Do not use with statins
Increase HDL cholesterol (increases risk of rhabdo)
by about 20%. Increases effects of
Lower total cholesterol by warfarin; monitor coags
about 10%. Fibrates can also cause
rhabdomyolysis, and the
risk increases when
combined with
medications like certain
statins or colchicine.
Fatigue, dizziness and
headache are also
common, especially with
fenofibrate.
Monitor for signs of
gallstones (RUQ pain
after fatty meal, N/V)
 Pharmacology

Diuretics (Cardiac Meds)

Diuretics help your body get rid of extra fluid.

The primary use for diuretics in heart
They are often called "water pills." There are many types of diuretics. failure is to reduce pulmonary and
systemic congestion and edema.
Some are taken 1 time a day. Others are taken 2 times a day.

Glomerulus

Actions
Acetazolamide
Thiazide
diuretics

Proximal
Blocks carbonic
Thiazides diuretics
Distal
tubule 1
convuluted
tubule
vanhydrase
1 4 NaHCO3 excretion
Chlorothiazide (Diuril), Indapamide (Lozol)
Chlorthalidone (Hygroton), Hydrochlorothiazide (Esidrix, HydroDiuril) 2 Osmotic diuretic
2
Bowman’s H20 excretion
These are mainly used for treating high blood pressure (hypertension) capsule

and fluid on the legs (oedema) Blocks sodium-potassium

3 chloride-cotransporter
Loop diuretics Mannitol Na excretion
K excretion
Bumetanide (Bumex) Furosemide (Lasix) Torsemide (Demadex) Cl excretion
Loop Diuretics 3

These are mostly used to treat heart failure.

Blocks sodium-chloride
Aldosterone 5 4
Potassium-sparing diuretics Osmotic Diuretics antagonists
(MRA)
transporter

Na excretion
Amiloride (Midamor) Osmotic Diuretics (Examples: K excretion
Cl excretion
Mannitol, Glycerin Isosorbide, Urea)
Triamterene (Dyrenium)
Osmotic diuretics are relatively inert Mannitol 2
Spironolactone (Aldactone) substances; they do not directly 5
Antagonises aldosterone
receptor
interact with renal transport systems. Na excretion
Loop of Henle
K excretion

Loop Diuretics
Contraindications
Action suffix: -ide
Loop diuretics are contraindicated in patients with hypokalemia (only to
Loop diuretics reduce sodium be administered after correction), severe hyponatremia, hypotension,
chloride reabsorption in the thick azotemia, oliguria/anuria, and hepatic coma.
ascending limb of the loop of Henle.
It is also contraindicated in any situation where fluid depletion is foreseen,
This is achieved by inhibiting the such as surgery.
Na-K-2Cl carrier in the luminal
membrane in this segment.
Minimizing the entry of luminal Side Effects Confusion Difficulty in swallowing
sodium and chloride into the cell
and increases excretion of Injection site reaction Itching Diarrhea
potassium, magnesium & calcium Gout Anemia Rash Blood in the urine
in the urine.
Low blood pressure Restlessness Light sensitivity
Bumetanide Furosemide Low potassium level Ototoxicity Hypokalemia
Ethacrynic acid Torsemide Electrolyte abnormalities Headache Hyponatremia
Ringing in the ears Nausea Glucose intolerance
Muscle cramps Weight loss Vertigo Weakness
Uses
Edema often due to congestive
heart failure Nursing Considerations Keep an eye on the patient's sodium
Chronic kidney disease and potassium levels.
Give the diuretic in the morning
Volume overload Liver cirrhosis so that the patient does not have Fast administration can cause
a complaint about nocturia. ototoxicity.
Pulmonary edema Renal disease
Administer loop diuretics slowly Check Daily Monitor
Hypertension (high blood pressure)
through the IV route in 1 to 2 BP before weights I&O
Hyperkalemia (increased minutes (20mg/min)to prevent admin.
potassium level) hypotension.
 Pharmacology

Diuretics (Cardiac Meds)

suffix: -thiazide Apical Basolateral

Thiazide Diuretics DCT Cell ATP

2K

Action 3Na+
ADP
Thiazides achieve their diuretic action via inhibition of the Na+/Cl− cotransporter NCC Na+
(NCC) in the renal distal convoluted tubule. Na+
?

The NCC facilitates the absorption of sodium from the distal tubules back to the Mg?+
Cl -
interstitium and accounts for approximately 7% of total sodium reabsorption.
Thiazides decrease the urinary excretion of calcium, while loop-diuretics have Mg2+ Cl+
the opposite effect.
TRPM6
Bendroflumethiazide. Cyclopenthiazide.
Low ceiling diuretic: After certain dose
response does not high efficacy -10 mV -65 mV 0 mV

Uses Side Effects

Used to treat high blood pressure (hypertension) Upset stomach. Hypercalcemia
Used for heart failure Hyperuricemia Dehydration
Liver disease Hypotension Skin sensitivity to sunlight
Nephrogenic diabetes Erection problems (impotence) Hypokalemia
Osteoporosis Dizziness on standing Hyponatremia
Chronic renal failure (hypotension)
Insipidus

Nursing Considerations
Contraindications Monitor the patient's blood pressure and pulse before and
Contraindications after the administration.
Daily weights
Hypotension.
Encourage K rich foods
Allergy to Sulphur-containing medications.
Avoid in patients with gout (increases uric acid
Gout.
Monitor laboratory tests before and periodically throughout
Kidney failure.
the course.
Lithium therapy.
The most common tests involve electrolytes (especially
Hypokalemia. potassium), blood glucose, BUN, and serum uric acid levels
May worsen diabetes. Monitor electrolytes
Monitor I & O.
 Pharmacology

Diuretics (Cardiac Meds)

Potassium sparing diuretics

Spironolactone
Action
Spironolactone causes increased
Potassium-sparing diuretics act to prevent sodium reabsorption in amounts of sodium and water to be
the collecting tubule by either binding ENaCs (amiloride, triamterene) excreted, while potassium is retained.
or by inhibiting aldosterone receptors (spironolactone, eplerenone).
Spironolactone acts both as a diuretic
This prevents excessive excretion of K+ in urine and decreased and as an antihypertensive drug.
retention of water, preventing hypokalemia.
To treat high blood pressure
Potassium-sparing diuretics are medicines that increase diuresis (hypertension) and heart failure. Cause;
(urination) without the loss of potassium. Breast pain, Dizziness, Blood in stools.

Serum CT
Uses Amiloride
Triamterene
To prevent low levels of potassium (hypokalemia)
In the treatment of heart failure
Cirrhosis of the liver
Nephrotic Syndrome Na+ Na+ Na+

Hyperaldosteronism
K+ K+ Aldosterone
In treating high blood pressure (hypertension)

MR
Contraindications Spironolactone
Potassium sparing diuretics are contraindicated in patients Eplerenone
with hyperkalemia or who are at risk of developing
hyperkalemia.

Side Effects
Tummy upsets. Irregular menstrual periods. Skin rash. Liver problems.
Feeling sick (nausea) Confusion. Hyperkalemia Gynecomastia
Sexual problems. Amenorrhea Hyponatremia Erectile dysfunction
Enlargement of the breasts Dizziness Excessive hair growth Potassium levels going
too high.

Nursing Considerations
Assess patients for sulfa allergies, as some diuretics Follow blood urea nitrogen and creatinine levels regularly.
are sulfonamide derivatives.
Monitor for signs of hyperkalemia (muscle cramps,
Monitor weight, intake, output, and serum dysrythmies, peaked T waves).
electrolyte levels.
Monitor blood glucose levels (some agents may V3
cause hyperglycemia).
Avoid potassium rich foods + salt substitutes.
 Pharmacology

Diuretics (Cardiac Meds)

Osmotic Diuretics
Mannitol, Osmitrol
Action
Mannitol hinders tubular reabsorption of
Osmotic diuretics primarily inhibit water reabsorption in the proximal water and enhances excretion of sodium
convoluted tubule and the thin descending loop of Henle and collecting and chloride by elevating the osmolality of
duct, regions of the kidney that are highly permeable to water. the glomerular filtrate. It treats swelling from
heart, kidney, or liver disease. It also treats
swelling around the brain or in the eyes.

Urine Blood Side Effects

Chest pain
H2O Congestive heart failure
H2O H2O H2O Hypotension (low blood pressure)
Phlebitis (inflammation of the vein)
H2O
Mannitol Solutes
Convulsions
H2O
Mannitol Chills
H2O Dizziness
Mannitol Headache
H2O H2O Acidosis (accumulation of acid in the
bloodstream)
Fluid/electrolyte imbalance
Thirst
Nausea
Vomiting
Blurred vision
Uses
Urinary retention
intracranial pressure (increased pressure in the brain) associated
with brain mass. Runny nose
Intraocular pressure (fluid pressure inside the eye). Skin rash
Anuria/oliguria (unable to pass urine/passes less urine). Hives
Cerebral edema, particularly when widespread, can increase ICP. Hypertension (high blood pressure)
Fever

Nursing Considerations
Vital signs, lung sounds, SpO2, electrolytes, BUN, creatinine, I & O.
Monitor neuro status.
Signs of fluid overload; signs of hypovolemia and hypotension.
Notify the health care provider for serum sodium more than 150 mEq/L or serum osmolality more than 320 mOsm.
Signs of IV site infiltration.
Monitor VS & EKG + electrolytes.
Drug can crystallize, assess before giving.
 Pharmacology

Anticoagulants (Cardiac Meds)

Anticoagulants are medicines that help prevent blood clots.

They're given to people at a high risk of getting clots, to reduce their chances of developing serious conditions such as
strokes and heart attacks.
A blood clot is a seal created by the blood to stop bleeding from wounds.

Blockages from blood clots can

cause the following deadly events:
Stroke.
Pulmonary embolism (PE).
Heart attack (myocardial infarction).
Atrial fibrillation.
Heart valve surgery or replacement.
Hip or knee replacement.
Deep vein thrombosis.
Blood clotting disorders.

Drugs that can increase the risk

of bleeding:
Antidepressants Fenofibrate
Antibiotics Proton pump inhibitors
Acetaminophen Alcohol
NSAIDs Influenza vaccine

Bleeding precautions implement for all

Avoid activities and sports Avoid straining with BM's
using insect repellent to avoid insect bites or stings. Avoid contact sports
NO aspirin Decrease needle sticks
Soft toothbrush Fall precautions
Eat Right Test Regularly
Stick to a Routine Medic alert bracelet
Electric razor only Avoid forceful coughing or blowing nose
 Pharmacology

Anticoagulants (Cardiac Meds)

suffix: -parin Enoxaparin (Lovenox)

Heparin
HCII thrombin

Action
Heparin catalyzes the inactivation of thrombin by ATIII by acting as a
template to which both the enzyme and inhibitor bind to form a thrombin T. Hep. HCII

ternary complex.
Anticoagulant activity by activating antithrombin which accelerates
the inactivation of coagulation enzymes thrombin (factor IIA), factor thrombin Heparin

XA and factor IXA.

T. Hep
Decrease the clotting ability of the blood and help prevent harmful
clots from forming in blood vessels. This medicine is sometimes
called a blood thinner, although it does not actually thin the blood.
low molecular weight heparin.
Only given SQ & patients can go home on it (adjusted for renal
impairment). Monitor platelets, not aptt

Monitor aPTT for IV (based on normal range: Antidote: protamine

facility protocol) therapeutic 47-70 seconds sulfate (used to reverse
goal: 1.5- 2 times normal range the effects of heparin).
1 mL Vial

Uses
Prophylaxis and treatment of venous thromboembolism and pulmonary embolism
Short term therapy
Atrial fibrillation with embolization
Administered IV infusion or SQ
Prevention of clotting in arterial and cardiac surgery; PROTAMINE
SULFATE
Prophylaxis and treatment of peripheral arterial embolism; 50 mg
Anticoagulant use in blood transfusions, extracorporeal circulation, and dialysis procedures.
IV gtt is weight based (must be within therapeutic range to work) 5 mL

Treatment of acute and chronic consumptive coagulopathies (disseminated intravascular coagulation)

Nursing Considerations
Assess for allergies to anticoagulants Verify medical history for any spinal anesthesia
Obtain CBC, PT/INR, and aPTT use or spinal procedures

Assess for bleeding risk Check peripheral pulses and skin discoloration

Obtain a history of recent trauma, head injuries, or surgeries

 Pharmacology

Anticoagulants (Cardiac Meds)

Contraindications
Contraindicated in patients with severe thrombocytopenia, this contraindication refers to full-dose heparin.
There is usually no need to monitor coagulation parameters in patients receiving low-dose heparin sodium.

Side Effects
Loss of appetite Runny nose Coughing up blood or vomit that looks like coffee grounds
Unusual tiredness Oozing iv site Skin changes where the medication was injected
Bleeding that will not stop Watery eyes Purple or red spots under your skin
Nosebleed Easy bruising Sudden numbness or weakness
Fever Blood in the urine or stool Hematuria or melena
Chills Black or tarry stools Problems with vision or speech
Heparin-induced Thrombocytopenia Swelling or redness in an arm or leg
thrombocytopenia (HIT)

Heparin induced thrombocytopenia (HIT), body reacts to heparin in a way that may cause clots instead of preventing them.
Thrombocytopenia means have a low level of platelets.
Which are blood cells that help your blood clot. Usually, low platelets would cause you to bleed.
Stop Heparin
 Pharmacology

Anticoagulants (Cardiac Meds)

Direct oral anticoagulants

suffix: -ban & -tran
Action Rivaroxaban Apixaban
Dabigatran Edoxaban
DOACs are small molecules that occupy the
catalytic site of either FXA or thrombin, preventing
their capacity to cleave and activate their Factor VII + tissue factor
substrates. PT Anti-Xa agent
Their mode of action allows for a wider therapeutic Rivaroxaban
Factor X > Xa APTT
window, enables more lenient monitoring, and has
a lower risk of drug–drug interaction. Anti-lla agent
Prothrombin Thrombin Dabigatran
DOACs interrupt part of the complex system
involved in the formation of blood clots.
This causes the blood to take longer to clot and Fibrin Fibrinogen
TT
reduces the risk of AF-related stroke.

Uses
Long term therapy Less monitoring required compared to Coumadin
Oral administration Treatment of deep vein thrombosis and pulmonary embolism
They are used in the prevention of stroke for people with non- Valvular AF,
which is when AF is not associated with a heart valve problem.Preventing harmful blood clots helps to reduce the risk
of a stroke or heart attack

Apixaban Edoxaban
Treatment of heparin‐induced thrombocytopenia Prevention and treatment of cancer associated deep vein thrombosis

Rivaroxaban Dabigatran
Prevention of thromboembolism after total Prevention of thromboembolism after total knee replacement
knee replacement and after total hip replacement

Side effects Antidotes (recently developed)

Passing blood in your urine. Andexxa: Eliquis & Xarelto
Passing blood when you poo or having black poo. Idarucizumab: Pradaxa
Severe bruising.
Nose bleeds
Hematuria or melena
prolonged nosebleeds (lasting longer than 10
minutes)
Vomiting blood or coughing up blood
Oozing IV site
Bleeding gums.
Sudden severe back pain.
In women, heavy or increased bleeding during
periods
Difficulty breathing or chest pain.
 Pharmacology

Anticoagulants (Cardiac Meds)

Nursing Considerations Contraindications

Nurses should assess the patient's understanding of Hypersensitivity to the active substance or to any of
anticoagulant therapy, including medication the excipients
adherence, dietary restrictions and precautions to Active clinically significant bleeding
minimize bleeding risk.
Hepatic disease associated with coagulopathy and
No need to limit Vitamin K intake clinically relevant bleeding risk.
Notify PCP before invasive dental procedures
They should address any knowledge gaps, reinforce
education, and provide resources for ongoing
support and education
Monitor for signs of excess bleeding
 Pharmacology

Anticoagulants (Cardiac Meds)

Warfarin Coumadin Glutamic acid Y Carboxy

glutamic acid
( Gla proteins )
( FII, FVII, FIX,
FX, protein C/s)
Action Y glutamyl
carboxylass
To produce some of the clotting factors, the liver needs a good supply of
vitamin K.
Vit K O
Warfarin blocks one of the enzymes (proteins) that uses vitamin K to Vit K
produce clotting factors. Warfarin

This disrupts the clotting process, making it take longer for the blood to clot.

Uses Long term therapy

The INR is therapeutic for at least 2 days Irregular heart rhythm (atrial fibrillation) Blood thinner
Can take up to 5 days to work Dose adjustment based on INR Heart valve replacement
Used to treat blood clots (such as in deep vein thrombosis-DVT)
Preventing harmful blood clots helps to reduce the risk of a stroke or heart attack

Side Effects
Heavy periods Headache Excessive bruising Black or bloody stool
Red or brown urine Bleeding gums Nose bleeds Prolonged bleeding from cuts
Coughing up blood Oozing IV site Hematuria or melena Dizziness

Antidote: vitamin k & FFP Monitor INR (goal 1.5-2 times normal) normal range: 2-3

Nursing Considerations
Before administration, obtain PT and INR values of the Screen the patient for any major active bleeding or any
patient and daily following therapy initiation. history of it.
Contraindicated in pregnancy (teratogenic). Take at the same time everyday.

Must be consistent with Vitamin K intake (leafy greens) However, when the patient is stable, obtain INR after every
4 to 6 weeks.
 Pharmacology

Vasopressors (Cardiac Meds)

Vasopressors help you raise your blood pressure when it’s so low that you can’t get enough blood to your organs.
This is the case with shock victims and people with other conditions that make their blood pressure very low.
Providers often give vasopressor drugs to you through an IV.

What do vasopressors do? Vasopressin Epinephrine Dopamine

Vasopressors constrict or tighten your blood vessels, making Phenylephrine Norepinephrine Angiotensin-II
heart have more forceful contractions. All of these help body
distribute blood to your vital organs. Terlipressin

Advantages of vasopressors Who needs to have vasopressors?

Vasopressors are powerful drugs that work quickly to Shock Heart failure Sepsis
narrow blood vessels and raise your blood pressure. Polio Spinal anesthesia Drug reaction
Vasopressor drugs can save your life by helping your Heart attack Blood transfusion Snakebite
organs to keep functioning.

The optimal blood pressure target likely ranges Titrated to maintain a set High MAP targets are associated with
from 65 to 85 mm Hg and probably lies MAP (mean arterial pressure) adverse effects, including atrial fibrillation,
between 65 and 75 mm Hg in most patients. usually >65 probably due to high doses of vasopressors.

For all vasopressors

Vasopressors through a central venous catheter, or central line, which is an IV tube that goes into a large vein.
Administered in ICU setting for severe hypotension
Requires continuous hemodynamic monitoring + strict I & O
Requires central line (for long term use)
If given peripherally, only for short term and must closely monitor IV site for signs of infiltration(the diffusion or
accumulation of foreign substances in amounts excess of the normal)

Always give fluids first

vasopressors are contraindicated in the early management of hemorrhagic shock due
to their deleterious consequences.
vasopressors may have a role in resuscitation when vasoplegic shock ensues and blood
pressure cannot be maintained by fluids alone.

If epinephrine or dopamine infiltrates, keep IV in

and give phentolamine
 Pharmacology

Vasopressors (Cardiac Meds)

alpha 1 & beta 1 agonist tyrosine

Norepinephrine
I-dopa

Action dopamine
Acts on both alpha-1 and beta 1(minor) agonist to cause
vasoconstriction. Its effect in-vitro is often limited to the increasing of α2 noradrenaline
blood pressure through antagonising alpha-1 and alpha-2 receptors.
NET
Causing a resultant increase in systemic vascular resistance.
noradrenaline
It is also an inotropic stimulator of the heart and dilator of coronary
arteries as a result of it's activity at the beta-adrenergic receptors.
Beta 1 receptors located in the cardiovascular system stimulated by
both epinephrine and norepinephrine result in increased heart rate
β
and contractility, also contributing to hypertension. α1 α2
Increases contractility & HR leading to increase stroke volume.
Gq/11 GI/0 Gs

Uses Key Info

Fight-or-flight” response 1st line press or in septic shock
Used to increase and maintain blood pressure alpha 1 & beta 1 agonist Only if
in limited, short-term serious health situations BP still low after fluids. High
levels of norepinephrine can
CPR (cardio-pulmonary resuscitation) lead to various health
conditions, including high blood
pressure; rapid or irregular
heartbeat; excessive sweating;
Side Effects cold or pale skin; severe
headaches; nervousness
Pain, burning, irritation, discoloration, or
skin changes where the injection was given
Sudden numbness, weakness, or cold
feeling anywhere in your body
Slow or uneven heart rate
Nursing Considerations
Blue lips or fingernails, mottled skin Assess patient frequently for headache, chest pain, or other signs
of toxicity
Little or no urination
Do not mix other medications in IV line with norepinephrine drip
Trouble breathing
Extravasation of norepinephrine may cause tissue necrosis to skin
Problems with vision, speech
monitor IV site every hour
Severe headache, blurred vision

Contraindications
norepinephrine should be avoided in patients with mesenteric or peripheral vascular thrombosis as the subsequent
vasoconstriction will increase the area of ischemia and infarction.
 Pharmacology

Vasopressors (Cardiac Meds)

alpha 1 & beta 1 + 2 agonis

Epinephrine

Action
Action on alpha-1 receptors, epinephrine induces increased vascular smooth muscle contraction,
pupillary dilator muscle contraction, and intestinal sphincter muscle contraction.
The beta1-receptor effects stimulate the heart. Activation of the beta-1 receptor in the heart
increases sinoatrial (SA) nodal, atrioventricular (AV) nodal, and ventricular muscular firing, thus
increasing heart rate and contractility.
Beta-2 effects produce bronchodilation which may be useful as an adjunct treatment of asthma
exacerbations as well as vasodilation, tocolysis, and increased aqueous humor production.

Key Info 1 mL EPINEPHrine

USP 1 mg/mL

1st line treatment in cardiac arrest Can cause abnormal heart rhythms with
a ventricular rate of 100 or more beats
Given for anaphylaxis
per minute.
Epinephrine overdose, which can lead to high blood
IV gtt usually last line treatment
pressure, stroke and death.
Can cause lactic acid build up in the bloodstream.

Uses Side Effects

Epinephrine injection is used for emergency Tachycardia Apprehension Vomiting
treatment of severe allergic reactions
(including anaphylaxis) to insect bites or Hypertension Palpitations Weakness
stings, medicines, foods, or other substances Headache Diaphoresis Tremors
It is also used to treat anaphylaxis caused by Anxiety Nausea
unknown substances or triggered by exercise
Sudden asthma attacks
It may also be used to treat low blood Nursing Considerations
pressure and slow heart rate
Patients should be monitored for heart rate, cardiac rhythm
It reduces the effects of an allergic reaction,
such as trouble breathing or swelling of the Blood pressure frequently if an IV drip is to be infused
face, lips, and throat Never interrupt an intravenous infusion of medication to
administer an IVPB or other medication
Extravasation of epinephrine may cause tissue necrosis to skin
Contraindications
include hypersensitivity to sympathomimetic
drugs, closed-angle glaucoma, anesthesia with
halothane.
 Pharmacology

Vasopressors (Cardiac Meds)

Alpha 1 agonist
Phenylephrine
Key Info
Action
Can be given as IV infusion or bolus dose press or
Phenylephrine is a selective α1-adrenergic Mild upset stomach, trouble sleeping, dizziness,
receptor agonist that increases blood lightheadedness , Headache, nervousness,
pressure mainly by increasing systemic shaking, or fast heartbeat may occur. PHENYLephrine
vascular resistance, without an associated 20 mg per 1 mL
increase in myocardial contractility. This product may reduce blood flow to your
hands or feet, causing them to feel cold.
Phenylephrine reduces maternal cardiac
output (CO) due to reflex bradycardia. Its administration causes vasoconstriction and
Glycopyrrolate is safe for the fetus, and an increase in arterial blood pressure.
increases heart rate (HR)

Uses Side Effects

Phenylephrine is used for the temporary relief Dizziness Fast heartbeat Insomnia
of stuffy nose, sinus, and ear symptoms
caused by the common cold, flu, allergies Nervousness Headache Unusual tiredness

Breathing illnesses Vomiting Blurred vision Difficult or labored

breathing
Sinusitis
Bronchitis
It may also be used in ear infections to relieve
congestion Nursing Considerations
Observe for bradycardia during instillation
Do not use this product to treat cold Monitor for adverse effects
symptoms in children younger than 6 years
Monitor oxygenation where appropriate
Do not exceed recommended dosage because systemic
effects can occur
Contraindications Avoid bright light (photophobia due to cycloplegic action)
Phenylephrine use warrants caution in
patients with a history of bradycardia, severe
cardiac dysfunction, and hypovolemia.
IV phenylephrine may worsen angina, heart
failure, or pulmonary arterial hypertension in
patients with severe arteriosclerosis or a
history of angina
 Pharmacology

Vasopressors (Cardiac Meds)

V1 & V2 Agonist
Vasopressin

Action
Vasoconstriction (V1 receptor) and reabsorption of water in the renal tubule (V2 receptor).
Vasopressin is a major vasoconstrictor involved in hind limb vascular responses to stimulation of
Vasopressin
adenosine A(1) receptors in the nucleus of the solitary tract.
20 Units per mL
Vasopressin acts both within the brain and in the periphery to modulate blood pressure through
sympathetic outflow, bar reflex modulation, vasoconstriction, and renal fluid retention.
These mechanisms vary by location and physiological state, leading to occasionally contradictory
responses to vasopressin.

Key Info
vasopressin is used with norepinephrine. Vasopressin injection is used to control the frequent urination,
increased thirst, and loss of water caused by diabetes insipidus.
To improve vascular tone, MAP, urine output, and
creatinine clearance. Not titrated (ordered at set dose).

Uses Side Effects

Control of the body's osmotic balance Abdominal cramps Headache Depression
Blood pressure regulation Chest pain or discomfort Dizziness Fainting
Sodium homeostasis Diarrhea Back pain
Kidney functioning

Nursing Considerations
Contraindications Vasopressors should be prescribed cautiously to pregnant clients and
Hypersensitivity; Vascular disease lactating mothers.
especially coronary artery disease; The drugs can harm the fetus or newborn.
chronic nephritis (until reasonable
blood-nitrogen concentration attained). Monitor blood pressure hourly during intravenous infusion and monitor
urine output, too.
Also use caution with HF and CV disease.
 Pharmacology

GI Meds
(Acid suppressing agents)

Proton‐pump inhibitors (PPIs), which stop acid secretion by inhibiting proton pumps located
in the canaliculus membrane of the parietal cell; and histamine‐2 receptor antagonists
(H2RAs), which target histamine, one of the primary regulators of acid secretion.

Oral cavity

Esophagus Gastrointestinal
Liver
The gastrointestinal (GI)
Stomach system comprises the GI GIT related disease
Pancreas
Gallbladder tract and accessory organs Peptic ulcers and
gastroesophageal
The GI tract consists of the reflux disease
oral cavity, Small intestine, Diarrhea
Small Intestine
Large Intestine Pharynx, Large intestine, Constipation
Esophagus, Anal canal Emesis
Appendix Stomach,
Rectum
Anus

Peptic ulcers Diarrhea

A peptic ulcer is an open Diarrhea is when your stools are loose and watery.
sore or raw area in the lining You may also need to go to the bathroom more often.
of the stomach or intestine. Esophogus
Short-term (acute)
There are two types
Stomach Ulcer Diarrhea lasts 1 or 2 days
of peptic ulcers: Stomach
Duodenal
Gastric ulcer Long-term (chronic)
Ulcer

Occurs in the stomach Diarrhea lasts several weeks. Increased motility of the
gastrointestinal tract and decreased absorption of
Duodenal ulcer fluid are major factors in diarrhea. Most common
Occurs in the first part antidiarrheal drugs used to treat acute diarrhea
of the small intestine Duodenum include antimotility agents, and adsorbents.

Constipation Constipation
Emesis
Laxatives are commonly Vomiting is a protective reflex mechanism for
used for constipation to eliminating irritant of harmful substances from
accelerate the movement upper GIT.
of food through the
gastrointestinal tract. Most Worse Antiemetic
constipation
common and important Poo backed up trough A medicine or other substance which causes vomiting
laxatives are listed below. the larga intestine
Causes Of Vomiting
Constipation is a condition
in which a person has Pregnancy Drug toxicity
uncomfortable or Motion sickness Renal failure
Stomach
infrequent bowel
Large intestine GI obstruction Hepatitis
movement. Small intestine
Rectum Peptic ulcer
 Pharmacology

Acid Suppressing Agents

Antacids

Action uses
The antacids act by magnesium carbonate. For immediate relief Antacids neutralize
neutralizing the acid the acid in stomach
magnesium trisilicate. Work quickly
in the stomach and by stopping an
by inhibiting pepsin, magnesium hydroxide. Antacids are a enzyme that
medicine that creates acid to
which is a calcium carbonate.
relieves heartburn break down food for
proteolytic enzyme. sodium bicarbonate. and indigestion by digestion (pepsin).
aluminum reducing the
hydroxide. amount of acid in
mix of multiple agents (Mylanta) your stomach.

side effects Education

diarrhea or constipation. stomach cramps. Take antacids about 1 hour after eating or when
you have heartburn.
flatulence (wind) feeling sick or vomiting
NOT for heart failure patients (contain Na)
Serious side effects could include:
If you are taking them for symptoms at night, do
Acid rebound: Antacids cause your body to not take them with food.
produce more acid, which worsens symptoms.
Do NOT mix with other meds (can block absorption)
Neurotoxicity: An antacid changes the function of
Antacids cannot treat more serious problems, such
your nervous system.
as appendicitis, a stomach ulcer, gallstones, or
Microcytic anemia: Iron deficiency. bowel problems.
Osteopenia: Weakened bones.
Hypercalcemia: Too much calcium in your blood.

EXAMPLE OF ANTACID Education

The nursing interventions for patients using
antacids are:
Adequate drug absorption.
Administer the drug apart from any other oral
Aluminum Hydroxide medications approximately 1 hour before or 2 hours
after to ensure adequate absorption of the other
medications.
Ensure therapeutic levels
 Pharmacology

Acid Suppressing Agents

Aluminum Hydroxide
Antacids Absorbable
An antacid is a substance, which neutralizes stomach acidity. not absorbable NaHCO3
Used for the symptomatic relief of heartburn, acid indigestion,
and sour stomach. CaCO3
Mg(OH)2
AI(OH)3
Mechanism Of Action H20+CO2
Antacids are weak bases that react with gastric acid to
form water and a salt to diminish gastric acidity. Na+ HCO-3

It is a basic compound that acts by neutralizing

hydrochloric acid in gastric secretions. H+

Subsequent increases in pH may inhibit the action of pepsin. Na+

Pancreas
Absorption
An increase in bicarbonate ions and prostaglandins may
also confer cytoprotective effects. HCO-3 Na +
HCO-3

Therapeutic Uses Adverse Effects

Aluminum hydroxide antacids are used in the Constipation, Loss of appetite,
treatment of peptic ulcer disease, Stomach pain, Muscle weakness
They may also promote healing of duodenal ulcers.
They are used as last-line therapy for acute
gastric ulcers.
Pharmacokinetics
It may be used topically, temporarily, to protect
and relieve chafed and abraded skin, minor Aluminum hydroxide is often administered orally .
wounds and burns, and skin irritations resulting Aluminum hydroxide mostly excreted in feces.
from friction and rubbing
Small amounts absorbed are excreted by the kidneys
 Pharmacology

Acid Suppressing Agents

suffix: -tidine
Histamine 2 blockers

Action uses
The H2 receptor blockers act by binding to Peak 30-60 minutes
histamine type 2 receptors on the basolateral
Histamine H2-receptor antagonists, also known
(ant luminal) surface of gastric parietal cells,
as H2-blockers,
interfering with pathways of gastric acid
production and secretion Are used to treat duodenal ulcers
prevent their return.
Famotidine Nizatidine
They are also used to treat gastric ulcers
Cimetidine Ranitidine
Zollinger-Ellison disease, in which the stomach
produces too much acid.

side effects
Diarrhea Dizziness Education
Headache Insomnia These medicines are most often taken with the
first meal of the day.
Abdominal pain Muscle aches
In some cases, you may also take them before
Drowsiness Decreased libido
your evening meal.
Confusion B12 deficiency (long
No smoking or NSAID's
Constipation term use)
It takes 30 to 90 minutes for the medicines to
work.
The benefits will last several hours.
Contraindications Take at night for ulcers
Allergy. The H2 antagonists should not be Symptoms may improve for up to 24 hours
used with known allergy to any drugs of this after taking the drug.
class to prevent hypersensitivity reactions.
Pregnancy or lactation. ...
Hepatic or renal dysfunction. ...
EXAMPLE OF HISTAMINE
Prolonged or continual use. 2 BLOCKERS

Cimetidine
 Pharmacology

Acid Suppressing Agents

Cimetidine

(H2 – Histamine Receptor Blockers) Receptors

Cimetidine is a gastric acid reducer used in the N
short-term treatment of duodenal and gastric
ulcers

C
β γ H2+
Mechanism Of Action Ga
H1 + H3+& H4+
The histamine H2-receptor antagonists
cimetidine, act selectively on H2
receptors in the stomach, blood vessels, PLC AC
and other sites, but they have no effect
on H1 receptors.
PKC Ca++ PKA
They are competitive antagonists of
histamine and are fully reversible.
Biological Activities

Therapeutic Uses Pharmacokinetics

Peptic Ulcers Cimetidine and the other H2 antagonists are
Histamine H2-receptor antagonists are equally effective given orally, distribute widely throughout the
in promoting the healing of duodenal and gastric ulcers. body and are excreted mainly in urine.

Acute Stress Ulcers Cimetidine normally has a short serum

These drugs are typically given as an intravenous half-life, which is increased in renal .
infusion to prevent and manage acute stress ulcers
associated with high-risk patients in intensive care units
Gastroesophageal Reflux Disease
Gastroesophageal reflux disease is a chronic symptom
of mucosal damage caused by stomach acid coming
Adverse Effects
up from the stomach into the esophagus. Headache, Diarrhea,
Low doses of H2 antagonists, currently available for Dizziness, Muscular pain.
over-the-counter sale, appear to be effective for the
prevention and treatment of heartburn
(gastroesophageal reflux).
 Pharmacology

Acid Suppressing Agents

suffix: -prazole
proton pump inhibitors
Uses
Action Peak 30-60 minutes
Proton pump inhibitors (PPIs) block the gastric H,K-ATPase, inhibiting (Usually for short term use)
gastric acid secretion. Acid reflux, also called gastroesophageal
This effect enables healing of peptic ulcers, gastroesophageal reflux reflux disease (GERD)
disease (GERD) Heartburn
This enzyme is responsible for the final step in the process of acid Stress ulcer prophylaxis
secretion; omeprazole blocks acid secretion in response to all stimuli.
Conditions characterized by an
Omeprazole. Lansoprazole. Pantoprazole. overproduction of stomach acid (such as
Zollinger-Ellison syndrome)
Esomeprazole. Dexlansoprazole. Rabeprazole.
Duodenal or stomach ulcers including
those caused by NSAIDs

side effects
Education
Dementia Liver disease
These medications are best administered 30 min before
Micronutrient deficiency Fracture food intake as proton pumps become activated during
risk(Osteoporosis) meals, and administration of PPIs prior to food intake will
Renal disease
Fractures enhance the drug's efficacy
Cardiovascular disease
Gastric neoplasia Regular bone density scans
Infections
Monitor for signs of diarrhea or GI upset
Reduced acid can lead to bacterial overgrowth & lead
to aspiration pneumonia the patient take the PPI first thing in the morning when
taken once daily.

nursing considerations
Proper administration. ... Ensure follow-up. ...
Safety and comfort measures. Provide patient support. ...
Institute a bowel program. ... Educate the patient and folks
Monitor nutritional status. ...
 Pharmacology

Acid Suppressing Agents

EXAMPLE OF PROTON PUMP INHIBITORS

alpha 1 & beta 1 + 2 agonis

Omeprazole
Pharmacokinetic
Omeprazole is used to treat excess stomach acid in All these agents are delayed-release formulation
conditions such as non cancerous stomach ulcers, and effective orally. Metabolites of these agents are
gastroesophageal reflux disease (GERD), active excreted in urine and feces
duodenal ulcer, Zollinger-Ellison syndrome and
erosive esophagitis.

Mechanism Of Actions Omeprazole

Proton pump inhibitors act by irreversibly blocking
the H+/K+ ATPase, or more commonly just gastric sulfenci acid
proton pump of the gastric parietal cell.
Omeprazole is a proton pump
Silfenamide +
inhibitor that inhibits secretion
Covalent bond
of gastric acid by irreversibly
H+ K+ ATPase
blocking the enzyme system
of hydrogen/potassium
Grastric acid secretion
adenosine triphosphate

Therapeutic Uses Side Effects

Proton pump inhibitors are used in the treatment of
peptic ulcer, These agents suppressing acid Headache
production and healing peptic ulcers. Dizziness

These agents are also successfully used with Dry mouth or throat
antimicrobial agents for the peptic .

Liver problems
Stomach pain or bloating
Gas or Burping

Nausea or vomiting
Diarrhea or constipation

Rash or itching
 Pharmacology

Acid Suppressing Agents

sucralfate
mucosal protectant
uses
These agents have several actions that enhance
used to treat conditions like peptic ulcers,
mucosal protection mechanisms,
NSAID-induced ulcers,
They are useful in mucosal injury, reducing
inflammation, and healing existing ulcers gastroesophageal reflux disorder or GERD.

sucralfate coats the stomach

side effects
Education Diaphoresis Cardiac arrhythmias
Medication forms a protective coating over ulcer. Headaches Thrombotic events
Take on an empty stomach one hour before meals; Constipation Increase fluid
wait at least 30 minutes before also taking an
antacid; separate sucralfate and
other medications by at least two hours. Contraindications
pregnancy Respiratory disease
loss Glaucoma Hepatic disease
Renal disease
EXAMPLE OF MUCOSAL PROTECTIVE AGENT Cardiovascular
disease

Sucralfate
These agents have several actions that enhance Food will initiate acid secretion
mucosal protection mechanisms, They are useful in Therapeutic Uses
mucosal injury, reducing inflammation, and healing Sucralfate effectively Discomfort
Due to Acidity
Parietal Cell

existing ulcers heals duodenal ulcers

and is used in
long-term maintenance H+
Antacid
therapy to prevent their
Mechanism Of Action recurrence.
Na+ HCO3
(NaHCO3)

H20 + CO2
Sucralfate creates a physical barrier that impairs Sucralfate is a H2CO3

diffusion of HCl and prevents degradation of medication used to

mucus by pepsin and acid. treat epithelial wounds,
Antacid Tablet
chemotherapy-induced
It also stimulates prostaglandin release as well as
mucositis, radiation
mucus and bicarbonate output, and it inhibits
proctitis, ulcers in
peptic digestion.
Behcet disease, and Representative
Digestive
Sucralfate exhibits its action by forming a burn wounds Process
Juice
protective layer, increasing bicarbonate
production, exhibiting anti-peptic effects,
promoting tissue growth, regeneration, and repair.

Pharmacokinetics
Little of the drug is absorbed systemically.
Adverse Effects
It is very well tolerated;
Stomach pain, Diarrhea, Vomiting
it has a very short serum half-life of 1 h and is
Constipation, Nausea, excreted almost completely by the kidneys.
 Pharmacology

Immune Meds (Antibiotics)

cell wall inhibitors

For all antibiotics:
Some antimicrobial drugs selectively interfere with
Always finish ABX course even if feeling better
synthesis of the bacterial cell wall
patients should complete their full course of
Inhibitors of cell wall synthesis require actively antibiotics as prescribed, even when their
proliferating microorganisms; they have little or no symptoms have improved, to prevent relapse
effect on bacteria that are not growing and dividing. of infection and the development of antibiotic
resistance. (unless severe reaction &
instructed otherwise by PCP)

AGENTS AFFECTING Always draw blood cultures BEFORE giving

THE CELL WALL
B-LACTAMASE antibiotics
INHIBITORS
Assess for signs of superinfection
B-LACTAM OTHER Clavulanic acid Symptoms include fever, cough, and dyspnea
ANTIBIOTICS ANTIBIOTICS
Sulbactam (additional infections)
Bacitracin Tazobactam
Assess for signs of toxicity
Vancomycin
Daptomycin Assess for hypersensitivity reactions
To evaluate whether there is an allergic
hypersensitivity reaction, skin prick tests (SPT)
PENICILLINS CEPHALOSPORINS CARBAPENEMS MONOBACTAMS and intradermal tests (IDT)
(such as anaphylaxis, Steven Johnson
Amoxicillin Ertapenem Aztreonam
Syndrome or Red Man Syndrome
Ampicillin Imipenem/
cilastatin
Dicloxacillin
Meropenem
Indanyl carbenicillin
Methicillin
Nafcillin 1st
GENERATION
2nd
GENERATION
3rd
GENERATION
4th
GENERATION
Steven Johnson syndrome
Oxacillin
Toxic epidermal necrolysis are acute, rare, and
Cefadroxil Cefaclor Cefdinir Cefepime
Penicillin G potentially fatal skin reactions involving loss of
Cefazolin Cefprozil Cefixime
Penicillin V skin and, in some cases, mucosal membranes
Piperacillin
Cephalexin Cefuroxime Cefotaxime accompanied by systemic symptoms.
Cefoxitin Ceftazidime Medications are causative in over 80 percent
of cases.
General mechanism of antibiotics
stop medication immediately
1. Inhibition of cell wall synthesis: 2. Inhibition of protein synthesis: Toxic Epidermal Necrolysis has same pathos but
penicillins, cephalosporins, chloramphenicol, erythromycin,
bacitracin, vancomycin tetracyclines, streptomycin affects larger BSA

Transcription Translation
DNA

Replication mRNA Protein

3. Inhibition of
nucleic acid
replication and Enzymatic activity,
transcription: synthesis of essential
quinolones, rifampin metabolites

4. Injury to plasma membrane: 5. Inhibition of synthesis of

polymyxin B essential metabolites:
sulfanilamide, trimethoprim
 Pharmacology

Antibiotics

prefix: -cillin
Penicillin

Action
Penicillin-binding proteins: Penicillin inactivate numerous proteins on the bacterial cell membrane. These
penicillin-binding proteins (PBPs) are bacterial enzymes involved in the synthesis of the cell wall and in the
maintenance of the morphologic features of the bacterium.
Inhibition of trans-peptidase: Some PBPs catalyze formation of the cross-linkages between peptidoglycan chains
(Penicillin inhibit this trans-peptidase-catalyzed reaction, thus hindering the formation of cross-links essential for cell
wall integrity. As a result of this blockade of cell wall synthesis
Production of autolysins: Many bacteria, particularly the gram-positive cocci, produce degradative enzymes
(autolysins) that participate in the normal remodeling of the bacterial cell wall. In the presence of a penicillin, the
degradative action of the autolysins proceeds in the absence of cell wall synthesis

Types

Pencilin

Natural Anti-Staphylococcal Extended Spectrum Beta-Lactamse Inhibitor

Penicillin G Methicillin Ampicillin Clavulanic Acib

Penicillin V Oxacillin Amoxcillin Sulbactam
Nafcillin Carbenicillin Tazobactam

Polysacharide
Aminopenicillins
chain Penicillin
Ampicillin
Amoxicillin
Peptide
Dicloxacillin
Bacampicillin
Piperacillin
Bactocill
Active
Carbenicillin DD
transpeptidase
Inactive
DD
transpeptidase

Polysacharide chain
 Pharmacology

Antibiotics Cell Wall Inhibitors

side effects
Basic: gram + ; include penicillin V, which is
nausea, abdominal pain,
given orally, and penicillin G, which is
administered intramuscularly or vomiting, urticarial.
intravenously. diarrhea, Anaphylaxis
Broad Spectrum: gram + & gram – high Steven Johnson C. diff
bioavailability, and very low toxicity. Syndrome
Penicillinase Resistant: Staph Aureous ;used
fever, chills, body aches, flu symptoms;
in the treatment of infection caused by
penicillinase-producing staphylococci. easy bruising or bleeding, unusual weakness;
urinating less than usual or not at all;
Extended Spectrum: gram -
Nephrotoxicity
Thrombocytopenia
severe skin rash, itching, or peeling;
Uses agitation, confusion, unusual thoughts or
behavior; or
used to treat throat infections, Endocarditis
seizure (black-out or convulsions).
meningitis, Urinary tract infection
syphilis meningitis,
bacterial infections. pneumonia,
Respiratory infections gonorrhea Nursing considerations
Otitis media endocarditis.
It is important to monitor patients who receive
penicillin for signs of superinfections such as
C-diff or yeast infections.
Absorbs better on empty stomach (but may
Contraindications take with food for GI upset)
of penicillin include a previous history of severe Avoid admin with citrus
allergic reactions or penicillin and its derivatives.
Make oral contraceptives ineffective (use other
method)
Penicillin is also contraindicated in patients
who have had Stevens-Johnson syndrome There is also a cross-sensitivity for patients
after administering penicillin or a penicillin allergic to cephalosporins.
derivative. Monitor Cr/BUN & coags
 Pharmacology

Antibiotics Cell Wall Inhibitors

sucralfate
Cephalosporins

Action First generation: gram + only cefazolin, cefalexin,

cephalosporins bind to penicillin binding proteins cefadroxil.
and interfere with cell wall enzymes.
Second generation gram + and some gram –
cefamandole, cefoxitin, cefaclor, cefuroxime,
loracarbef, cefotetan.
Third generation weak gram + and MORE gram –
cefotaxime, cefpodoxime, ceftizoxime,
NAM Bactericidal Effect ceftriaxone, ceftazidime, cefoperazone.
Peptidoglycan Synthesis
L-A Cephalosporiris Fourth generation: + & - & Pseudomonas
D-G G G G G G G
cefepime, cefozopran, cefpirome, cefquinome.
L-L Fifth generation; + & - & MRSA
Failure of Cross Linkage
D-A

D-A Transpeptidase
(PBP) Side effects
Nausea Steven Johnson Syndrome
Diarrhea Bleeding
Abdominal pain Dark urine
Cefuroxime Cefotaxime Cefazolin
Itchy skin Difficulty in breathing
Cefditoren Ceftriaxone Cefepime
Nephrotoxicity Anaphylaxis Dizziness
Cefixime Cefadroxil Cefpodoxime
Thrombocytopenia C. diff Fever

uses nursing considerations

Urinary tract infections Blood infection Ensure adequate Monitor. Insertion site
hydration. for extravasation.
Lower respiratory tract Meningitis
Hypersensitivity
infections Patient IV.
Pneumonia reaction. Vital signs.
Bone infections Indwelling urinary
Gonorrhea Do not use while
catheter
Skin infections Sinus infections breastfeeding
Make oral
Ear infections Sepsis Evaluate therapeutic
contraceptives
Gynecological infections response: absence of
ineffective (use other
postoperative surgical
method)
site; approximated
Monitor Cr/BUN & wound edges, infection,
coags. stable vital signs.
Confirm ordered dose. NO alcohol
 Pharmacology

Antibiotics Cell Wall Inhibitors

vancomycin
glycopeptides
uses
Treat bacterial infections C. diff (oral)
The glycopeptide antimicrobials are a group of natural Enterococci infections, Endocarditis
product and semisynthetic glycosylated peptides that
Severe skin infections Bone infections
show antibacterial activity against Gram-positive
organisms through inhibition of cell-wall synthesis. Hospital-acquired Infections that are
pneumonia resistant to other
only treats gram + bacteria Septicemia antibiotics

teicoplanin, dalbavancin, Lower respiratory tract

infections
ramoplanin; telavancin.
oritavancin,

nursing considerations
side effects Some glycopeptides can also cause side effects like
Abdominal pain Headache prolonged QT interval, arrhythmias, and peripheral
edema.
Flatulence Ototoxicity
Monitor skin for Red man syndrome (slow down
Thrombocytopenia Nephrotoxicity infusion or give Benadryl)
Vomiting Foamy urine Requires close monitoring of trough levels to avoid
Back pain Edema toxicity & sub-therapeutic dose (take before admin)
Itchy skin Red Man Syndrome Clients taking glycopeptides can also develop
anaphylactic reactions. Other serious side effects
Taste disturbance Diarrhea include nephrotoxicity, which is a boxed warning for
telavancin
 Pharmacology

Antibiotics Protein Synthesis Inhibitors

A protein synthesis inhibitor is a substance that stops or slows

the growth or proliferation of cells by disrupting the processes
Protein Synthesis
that lead directly to the generation of new proteins. Inhibitors
prefix: -mycin
macrolides C A G A U C

G U G C A C A A U G A U C A U C G U C U A G A U
Action
Macrolides inhibit bacterial protein synthesis. Translation Translation
(50S subunit) (30S subunit)
The mechanism of action of macrolides revolves
around their ability to bind the bacterial 50S
Macrolides Aminoglycosides
ribosomal subunit causing the cessation of
Streptogramins Tetracyclines
bacterial protein synthesis

targets gram + bacteria

Erythromycin acts by inhibition of protein synthesis uses
by binding to the 23S ribosomal RNA molecule in the
Mycoplasma pneumonia
50S subunit of ribosomes in susceptible bacterial
organisms. Rhino sinusitis (inflammation of the nasal cavity and
paranasal sinuses)
Roxithromycin binds to the subunit 50S of the
bacterial ribosome, and thus inhibits the synthesis of Pertussis (highly contagious respiratory tract
peptides. Roxithromycin has similar antimicrobial infection)
spectrum as erythromycin, but is more effective Diphtheria (inflammation of the mucous
against certain gram-negative bacteria membranes of the throat)
Clarithromycin; The antibacterial effect of CAM is Respiratory infections caused by Chlamydia
related to its capacity to inhibit protein synthesis in trachomatis
bacteria by binding to subunit 50S of the bacterial
ribosome Bronchiectasis (a condition where the bronchial
tubes of lungs are permanently damaged)
Azithromycin ;inhibition of pro inflammatory cytokine
production, inhibition of neutrophil infestation, and Otitis media
macrophage polarization alteration,. Chlamydia
Pelvic inflammatory
Cystic fibrosis (a disorder that produces abnormally
side effects thick mucus leading to blockage of bronchi in the
lungs)
Nausea Ototoxicity
Pharyngitis (inflammation of the back of the throat,
Vomiting Liver toxicity often referred to as sore throat)
Diarrhea Steven Johnson Syndrome Tonsillitis (inflammation of the tonsils)
Dysrhythmias Abdominal pain Acute exacerbation of COPD (chronic inflammatory
C. diff Anorexia lung disease)
Genital ulcer disease

nursing considerations
Macrolides are safe for use for most patients,
including in pregnancy and with pediatric patients. Contraindications
Absorbs better on empty stomach (but may take They are contraindicated in people who have had
with food for GI upset) an allergic reaction to them.
Macrolides can significantly impact liver function, so The use of macrolides during pregnancy needs
they should be administered with extra caution to close monitoring as it slightly elevates the risk of
anyone with liver impairment (or disease). cerebral palsy and epilepsy in children.
Avoid admin with citrus
Monitor for palpitations or chest pain
 Pharmacology

Antibiotics Protein Synthesis Inhibitors

gentamicin
Aminoglycosides
uses
Action Gentamicin and Tobramycin may be used in the
Aminoglycosides inhibit protein synthesis by treatment of meningitis, sepsis, and pneumonia;
binding, with high affinity, to the A-site on the 16S Amikacin is commonly used in the treatment of
ribosomal RNA of the 30S ribosome infections that are resistant to other
Aminoglycosides act primarily by impairing aminoglycosides;
bacterial protein synthesis through binding to Neomycin is used in the treatment of skin infections
prokaryotic ribosomes. associated with wounds and burns.
Streptomycin is used primarily in combination with
targets gram – bacteria other agents, such as with Tetracyclines in the
gentamicin, tobramycin, streptomycin. treatment of plague, tularemia, and brucellosis.
amikacin, neomycin, Severe UTI's
Septicemia
Very effective
Endocarditis
but highly toxic!
50 S Ribosome Think Aminoglycosides are
Amino Acid MEAN because they're so toxic!

1 7
2
3
4
5 6 t7 nursing considerations
Charged Nurses should monitor the patient receiving
aminoglycosides for signs of decreased renal
t5 t6 tRNA
Linezolid function such as declining urine output and
increasing blood urea nitrogen (BUN), creatinine,
30 S and declining glomerular filtration rate (GFR).
mRNA
t5 Requires close monitoring of trough levels to avoid
Uncharged tRNA Aminoglycosides toxicity

Contraindications
Aminoglycosides shouldn't be used in clients with
side effects renal or hepatic disease, pre-existing hearing loss,
Ototoxicity, Muscle spasms · and active infections that could be worsened by the
Nephrotoxicity, Headache effect of these antibiotics on normal defense
mechanisms.
Neuromuscular Ataxia
blockade Aminoglycosides can cause fetal harm when
hypersensitivity reactions administered to a pregnant woman.
Vertigo
Muscle weakness Contraindicated for Myasthenia Gravis or Parkinson's
Dizziness (inhibits ACH)
GI upset.
 Pharmacology

Antibiotics Protein Synthesis Inhibitors

Gentamicin
Uses
Gentamicin, an aminoglycoside antibiotic, is
bactericidal. Gentamicin injection is used to treat serious bacterial
infections in many different parts of the body.
Gentamicin passes through the gram-negative
membrane in an oxygen-dependent active
transport.
Side Effects
Back pain Allergic reaction

Contraindications Dizziness Difficult or troubled

breathing
Hypersensitivity to gentamicin is a contraindication to Abdominal or stomach
its use cramps or pain Nerve damage

prefix: -cycline Aa
Tetracyclines
Aminoacyl
Nascent 50 S tRNA
Action Polypeptide
Inhibit the 30S ribosomal subunit, hindering the Chain P Site A Site
binding of the aminoacyl-t RNA to the acceptor site Transferase Site
on the mRNA-ribosome complex.
inhibition of protein synthesis.
Bacteriostatic. Tetracycline
They suppress the growth of bacteria or keep them
in the stationary phase of growth.
targets gram + & gram -
mRNA template
EXAMPLES 30 S
lymecycline, minocycline doxycycline.
methacycline, rolitetracycline,
minocycline, doxycycline.
uses
Broad spectrum used for wide range of bacterial
infections such as:
side effects Acne. Staph infections.
Abdominal pain Changes in the amount of urine Actinomycosis. Syphilis.
Loss of appetite Tooth discoloration & delayed Amebiasis. Traveler’s diarrhea.
Nausea bone growth in children
Anaplasmosis (an Tularemia.
Headache Photosensitivity infection you get from a
Whipple’s disease.
Problems breathing tick bite).
Dermatitis Early Lyme disease.
Sun sensitivity and skin side Pelvic inflammatory
Diarrhea Ehrlichiosis.
effects disease.
Sore throat Legionnaires’ disease.
Unusual bleeding or bruising Pneumonia and other
Itching of the bacterial respiratory Leptospirosis
rectum or vagina Burning upper stomach pain
tract infections.
Vaginal itching or Chest pain
Rickettsia infections
discharge Chills (Rocky Mountain spotted
Black hairy tongue Decreased vision fever and typhus).

Dry mouth Dizziness

Fever
 Pharmacology

Antibiotics Protein Synthesis Inhibitors

nursing considerations Contraindications

Breastfeeding. Use is not recommended since Contraindicated in persons who have shown
tetracycline's pass into breast milk. hypersensitivity to any of the tetracycline, in children
They may cause the nursing baby's teeth to become <8 years.
discolored and may slow down the growth of the Avoid in complete renal failure. Use with caution in
baby's teeth and bones. patients with hepatic dysfunction.
Avoid foods high in calcium or iron (low absorption)
Wear sunscreen & protect self from sun

Lymecycline
side effects
Action feeling sick, Diarrhea
the ribosome synthesizes proteins through the stomach pain, headaches.
binding of aminoacyl-t-RNA to the mRNA-ribosome
complex.
Lymecycline binds to the 30S ribosomal subunit, uses
preventing amino-acyl t-RNA from binding to the A
site of the ribosome, which prevents the elongation Lymecycline is an antibiotic.
of polypeptide chains. It's used mainly for spots (acne).
This results in bacteriostatic actions, treating various It's also used to treat infections such as: chest and
infections. sinus infections.

50 S Ribosome
clindamycin
Lincosamides Amino Acid
lincosamides
1 7
2
Action 3
4
inhibits bacterial protein synthesis by binding to the 23S
5 6 t7
RNA of the 50S subunit of the bacterial ribosome. Charged
Bacteriostatic: t5 t6 tRNA
Linezolid
Lincosamides prevent bacterial replication in a
bacteriostatic mechanism by interfering with the 30 S
mRNA
synthesis of proteins.
t5
targets gram + bacteria Uncharged tRNA
Similar structure to macrolides
nursing considerations
Drug Target Type Purpose of medication: to treat infection.
Lincomycin Alpha-1-acid carrier Self-administration. Take four times a day, with at least
glycoprotein 1 eight ounces of water, with or without food.
Clindamycin Cytochrome enzyme Monitor bowel movements for diarrhea for bloody stool
P450 3A4
Notify healthcare provider immediately. Fever,
Cytochrome abdominal pain; severe or bloody diarrhea.
Clindamycin enzyme
P450 3A5
Monitor for palpitations or chest pain
Alpha-1-acid
Clindamycin carrier Monitor CBC & coags
glycoprotein 1
 Pharmacology

Antibiotics Protein Synthesis Inhibitors

Side effects Uses

Abdominal pain. Vaginal discharge
or itching. Blood infections like septicemia or toxic shock
Diarrhea.
Bloody diarrhea. syndrome (TSS).
Nausea and
vomiting. Dysrhythmias Infections in your skin, soft tissues, mouth, respiratory
tract or gastrointestinal (GI) tract.
C. diff Thrombocytopenia
Toxic shock syndrome
Bruises. Steven Johnson
Syndrom Septicemia
Dizziness or
lightheadedness. Shortness of breath Infections in the female reproductive system like
(dyspnea). pelvic inflammatory disease (PID).
Fatigue.
Skin rash. A penetrating wound in your abdomen (when an
Jaundice object such as a knife or bullet enters your belly or
(yellowing of skin Trouble swallowing gut).
and eyes). (dysphagia).
Severe acne or rosacea.
Necrotizing Fasciitis
Gangrene
Contraindications A skin or soft-tissue infection.
GI upset and Agranulocytosis. Prevent endocarditis in
diarrhea. ... people with heart valve disease.
Allergic reactions
Pseudomembrano Allergic Reactions Type Treat pneumonia in people with HIV.
us colitis. ... I hypersensitivity
Esophagitis. ... reaction against
plasma proteins in
Metallic taste. donor blood
Azotemia. ... Transfusion Reactions :
 Pharmacology

Nucleic Acid Synthetic Inhibitors

Nucleic Acid Synthesis Inhibitors

A nucleic acid inhibitor is a type of antibacterial that acts by inhibiting the production of nucleic acids. There are two
major classes: DNA inhibitors and RNA inhibitors.

DNA Synthesis DNA DNA Topoisomerase

Inhibitors Metronidazole Fluroquinolones

Quinolone

PABA

DHF
DNA
mRNA
THF
Ciprofloxacin

Bacteria Ribosome

RNA Synthesis mRNA Synyhesis

Inhibitors Rifampicin
Rifaximin
Rifapentine

Rifampicin

DNA
mRNA

Rifamycin SV

Inhibit the catalytic activity of the enzyme by binding to the active site or they stabilize the covalent enzyme-DNA
complex that is formed during the reaction.
Fluoroquinolones work by stabilizing the enzyme-DNA complex and thus interrupting the relegation step.
 Pharmacology

Antibiotics
Nucleic Acid Synthetic Inhibitors

Sulfonamides
Uses Side Effects
Sulfonamides act by blocking the synthesis of folic acid,
Bladder infections, Diarrhea
which is a vitamin that helps make DNA and red blood
cells. Ear infections, Aching of joints
and muscles
This stops the bacteria from being able to reproduce Meningitis
Hemolytic
So it's considered a bacteriostatic. Urinary tract
anemia
infections (UTIs)
Medication that kills the bacteria is needed along with the Headache
sulfonamide. Nocardiosis
Photosensitivity
Topical uses
targets gram + & gram - Azulfidine
Ulcerative colitis
Kernicterus in
Toxoplasmosis. neonates
Otitis media Crystalluria
Contraindicated if allergic to other sulfa drugs like thiazide Respiratory infections Vomiting
& loop diuretics & oral hypoglycemic. Prophylactic use Decreased
appetite
Dizziness
Photosensitivity
P-Aminobenzoic Acid Prefix: Sulfa
Steven Johnson
Sulfadiazine
Itching
Sulfamethoxazole
Tiredness
Dihydropteroate Synthase Sulfonamide Sulfasalazine
Sulfacetamide
Sulfadoxine
Dihydrofolic Acid or Dihydropfolate

Contraindications
Dihydropfolate Reductase Trimethoprim
contraindicated in patients who have had an
allergic reaction to them or who have porphyria.

Tetrahydrofolic Acid
Nursing Considerations
The medication can cause increased photosensitivity,
DNA and patients should be educated to use sunscreen
and protective clothing with sun exposure.
Assess for sulfa allergy
The patient should also report any rash, sore
throat, fever, or mouth sores that might occur.
Encourage fluids (to prevent kidney stones from
Crystalluria)
Unusual bleeding or bruising should also be
reported to the provider.
Wear sunscreen & protect self from sun
Monitor CBC & coags.
 Pharmacology

Antibiotics
Nucleic Acid Synthetic Inhibitors

Fluoroquinolones
Uses
Fluoroquinolones act by inhibiting two enzymes involved
in bacterial DNA synthesis, both of which are DNA Infections of soft tissue, bones, and joints
topoisomerases that human cells lack and that are Typhoid fever
essential for bacterial DNA replication, thereby enabling
Anthrax
these agents to be both specific and bactericidal
Intestinal and biliary tract infections
DNA topoisomerases are responsible for separating the
strands of duplex bacterial DNA, inserting another strand Intra-abdominal infections
of DNA through the break, and then resealing the Septicemia (serious infection in the blood that
originally separated strands. may be life-threatening)
Bacterial diarrhea
Bactericidal targets gram + & gram -
Urinary tract infections
Pelvic inflammatory infections
Bone infections
DNA Polymerase
Skin infections
Complex
Prostatitis (inflammation and swelling of the
prostate gland in men)
Quinolones Protein Dependent
Pyelonephritis (inflammation and infection of kidney)
Chlamydial urethritis (inflammation and infection
of the urethra) and cervicitis (inflammation and
Repliaction infection of cervix in women)
Fork Cell
SOS DNA Repair Death Pelvic inflammatory disease (infection and
inflammation of female reproductive organs)

Topoisomerase Protein Dependent

Nursing Considerations
Maintain an intake of 1500mL-2000mL per day
while taking the medication.
Side Effects
Increased risk of toxicity in elderly
Headache Diarrhea
Contraindicated in pregnancy
Drowsiness Hypoglycemia (low
blood sugar) The patient should be advised that
Sleeplessness medications containing calcium, aluminum,
Photosensitivity iron, or zinc may impair absorption and should
Dizziness
Depression be avoided
Nausea and vomiting
Aortic aneurysm Monitor for dysrhythmias
Tendon rupture
Anxiety Wear sunscreen & protect self from sun
Abdominal pain
Suicidal thoughts
Tendinopathy (a type of tendon
disorder that results in pain, QT prolongation
swelling, and impaired function)
Swelling and pain of joints and
muscles
 Pharmacology

Antibiotics
Nucleic Acid Synthetic Inhibitors

Ciprofloxacin

Action Uses Side Effects

Inhibiting a type II it's used to treat a number of Diarrhea.
topoisomerase and bacterial infections, such as: Redness or discomfort in the eye.
topoisomerase IV, necessary to uncomplicated urinary tract
separate bacterial DNA, thereby infections (UTIs) , Bad taste in the mouth.
inhibiting cell division. pneumonia; gonorrhea

Metronidazole
Antiprotozoals
Uses
Action
Treats protozoal & anaerobic bacterial infections:
Antiprotozoal agents are a class of drugs used to treat
infections caused by protozoa, which are single-cell Amebiasis,
organisms, belonging to a group of parasites. Giardiasis,
Protozoans typically are microscopic and similar to plants Trichomonas's,
and animals as they are eukaryotes, thus having a clearly Toxoplasmosis,
defined cell nucleus Cryptosporidiosis,
Inhibitors of bacterial protein synthesis (Bactericidal) Trypanosomiasis,
Inhibit protozoan folic acid synthesis, subsequently Leishmaniosis,
impairing the protozoal cell. Balantidiasis,
Works against anaerobic bacteria Babesiosis.
To treat a variety of protozoal diseases,
targets protozoa & gram – except malaria

Nursing Considerations Side Effects Examples

It can be administered PO, Nausea and vomiting. Chloroquine
parenterally, or topically. Orally is Dyspepsia. Nitazoxanide
the preferred route for GI
infections. Abdominal pain. Metronidazole
NO alcohol during or until 3 days Metallic taste Pentamidine
after treatment (will cause Dark urine Primaquine
severe GI upset)
Steven Johnson Syndrome Albendazole
The nurse should monitor the
patient carefully for side effects Diarrhea. Fexinidazole
such as seizures, peripheral Dizziness. Sulfamethoxazole
neuropathies, and dizziness.
Headache. Tinidazole
Metallic taste & dark urine are
Black box warning for cancer risk
normal side effects (no need
to report) Insomnia and vivid dreams.
 Pharmacology

Antibiotics
Nucleic Acid Synthetic Inhibitors

Metronidazole

Patients with peptic ulcer disease (both duodenal and Mechanism of Action
gastric ulcers) who are infected with H. pylori, which is a of Metronidazole
Gram-negative, microaerophilic bacterium found in the
stomach requires antimicrobial
Metronidazole Passive Diffusion

Inside Microoganism
MOA
Active Metabolite of the drug
Metronidazole diffuses into the organism, inhibits protein
synthesis by interacting with DNA, and causes a loss of DNA Fragmented DNA
helical DNA structure and strand breakage. Therefore, it
causes cell death in susceptible organisms.
It works by stopping the growth of the bacteria or
parasites causing the infection.
They act as bactericidal and antimicrobial agents. Death of
Inhibited Protein
Metronidazole binds deoxyribonucleic acid and infection-causing
Synthesis
electron-transport proteins of organisms, blocking microbe
nucleic acid synthesis.

Pharmacokinetics Adverse effects

Dizziness
Diarrhea
The majority of metronidazole and its metabolites are
excreted in urine and faeces, with less than 12% excreted Nausea
unchanged in urine. Constipation
Headache
Loss of appetite

Therapeutic uses
Metronidazole is an antibiotic. It's used to treat skin Bactericides, Bone and joint infections
infections, rosacea and mouth infections, including
Fusobacterial Gynecologic infections,
infected gums and dental abscesses.
Clostridia, Endocarditis,
It's also used to treat conditions such as bacterial
vaginosis and pelvic inflammatory disease. Rosacea Septicemia,
Metronidazole is used to treat infections caused by Oral and dental infections, Respiratory tract infections.
 Pharmacology

Antibiotics
Nucleic Acid Synthetic Inhibitors

Nitrofurans Nitrofurantoin
Uses
Action
used to treat or prevent certain urinary tract
It is decreased by bacterial flavoproteins to reactive infections. This medication is an antibiotic that
intermediates that inhibit bacterial ribosomes and other works by stopping the growth of bacteria.
macromolecules. Protein synthesis, aerobic energy
It will not work for viral infections (such as
metabolism, DNA and RNA synthesis, and cell wall
common cold, flu).
synthesis are inhibited.
Used for treatment of uncomplicated lower
Bactericidal
urinary tract infections. Caused by:
Nitrofurantoin is converted by bacterial nitro reductases to
electrophilic intermediates which inhibit the citric acid E. coli
cycle as well as synthesis of DNA, RNA, and protein
Enterococcus
It works by killing bacteria that cause infection.
Staphylococcus saprophytic
targets gram + & gram - Streptococcus pyogenic
More specific to urinary tract Aerobacter aero genes
Proteus species,
Pseudomonas aeruginosa
Streptococcus facials
Nitrofurans Gram - Gram +
O Antimicrobial
Effect
O2N O C= N N NH
H Side Effects
O
Diarrhea Fever
Nausea Hives
Reduction Increase Dizziness Liver damage
Drug-resistant Drug-discovery
Headache Pulmonary toxicity
Chills Steven Johnson
Syndrome
Lung problems
Numbness in your
Dark colored urine
hands and feet
Nursing Considerations Cough
Stomach pain
Nitrofurantoin can pass into breast milk and may harm a
nursing baby.
You should not breast-feed while you are taking this medicine.
Educate patient that discolored urine is a normal side effect
Monitor respiratory status
Monitor skin for signs of rash or peeling (SJS)
Nitrofurantoin should not be given to a child younger than
1 month old.
 Pharmacology

Immune Meds
Immunosuppressant’s

Suppresses the immune response of an individual.

Immunosuppressant is a class of medicines that inhibit or decrease the intensity of the immune response in the body. Most of
these medications, are used to allow the body less likely to resist a transplanted organ i.e., kidney, heart and liver.

Anytime the immune system is suppressed you want to implement

Neutropenic precautions Immunosuppressant are drugs that prevent your immune

system from attacking healthy cells and tissues by mistake.
Watch your diet.
Cook foods thoroughly. Nitofy PCP for
Limit your exposure to germs.
Pay attention to your skin. Elevated WBC
(A high white blood cell count usually means one of the following
NO live vaccines; inactivated only (flu shot
has increased the making of white blood cells)
okay!)
Bone marrow disease.
Get enough rest.
An immune system issue.
Avoid large crowds and sick people
Fever
Avoid fresh fruits and flowers
NOT CRP; this is expected to be elevated in autoimmune patients
Seek medical help immediately for a fever.
due to inflammation

no Class of immunosuppressive drugs Drugs Mechanism of action

Methylprednisolon
01 Corticosteroids Regulators of gene expression
e Prednisone

02 Antimetabolites Mycophenolate Inhibitors of de novo purine synthesis in

mofetil lymphocytes

03 Biologic agents Polyclonal antibodies Lysis of lymphocytes

(ATGAM, Thymoglobulin)

Monoclonal antibodies
(Muromonab, Daclizumab,
Blockers of T lymphocyte activation
Basiliximab, Rituximab,
Alemtuzumab)

04 Calcineurin inhibitors Cyclosporine A Inhibitors of an intracellular phosphatase

Tacrolimus required for interleukin 2 production in the
T lymphocyte

Inhibitors of mammalian target of

05 Non-calcineurin inhibitors Sirolimus Everolimus rapamycin (mTOR) activation in
lymphocytes, resulting in cycle cell arrest
 Pharmacology

Immunosuppressant's

METHOTREXATE
MECHANISM OF ACTION
Methotrexate inhibits dihydrofolate reductase, preventing
the reduction of dihydrobiopterin (BH2) to Folic Acid
tetrahydrobiopterin (BH4), leading to nitric oxide synthase
uncoupling and increased sensitivity of T cells to apoptosis, Dihydropteroate synthetase
thereby diminishing immune responses
Methotrexate helps lower inflammation in the body. DHFA Irreversible
inhibition
It can also kill cancer cells. DHFA reductase

THFA METHOTREXATE

MECHANISM OF ACTION Thymidylate synthase

Inhibits DNA synthesis during 5 phase of cell cycle and Partially
Thymidylate reversible
thereby inhibits cell division.
inhibition
Suppresses T cell proliferation and blocks migration of
activated T cells to certain tissues.
Purine synthesis
Suppresses B cell antibody production.
Increases adenosine production which eserts
anti-inflammatory effects. DNA

Uses key Info

Rheumatoid arthritis BLEEDING PRECAUTIONS (causes thrombocytopenia) (condition in which
the platelets are low in number, which can result in bleeding problems)
Central nervous system lymphoma
Folate deficiency, leading to anemia
Juvenile idiopathic arthritis
No pregnancy until 3 months after treatment.
Meningeal leukemia
Nonviable ectopic pregnancies
Cancer
Side Effects
Psoriasis
Loss of appetite. Eat when you would usually expect to be hungry.
For mycosis fungicides
Feeling or being sick. Eat simple meals and do not eat rich or spicy food.
Head and neck cancer
Stomach pain or indigestion. Try to rest and relax.
Osteosarcoma
Diarrhea.
Gestational trophoblastic disease
Headaches.
Psoriasis
Feeling tired or drowsy.
Multiple sclerosis
Hair loss.
Vasculitis

Nursing Considerations
With methotrexate therapy, you must monitor the patient's prescription for possible drug-drug interactions leading to
life-threatening consequences.
To avoid them, you must monitor the drugs closely that are given together.
 Pharmacology

Immunosuppressant's

HYDROXYCHLOROQUINE
Uses
Action Treat malaria caused by mosquito bites
HCQ accumulates in the lysosomes and inhibits lysosomal It can reduce skin problems in lupus and prevent
function by auto phagosome fusion with lysosomes. swelling/pain in arthritis
Inhibits replication of susceptible cells & reduces Rheumatoid arthritis
inflammation & fatigue. Used to treat certain auto-immune diseases
Chloroquine and hydroxychloroquine increase pH within Malaria
intracellular vacuoles and alter processes such as protein
degradation by acidic hydrolases in the lysosome, assembly Discoid and systemic lupus erythematosus (sle)
of macromolecules in the endosomes, and post translation juvenile idiopathic arthritis (jia).
modification of proteins in the Golgi apparatus.

Side Effects
Skin rashes, especially those made worse by sunlight
1
Feeling sick (nausea) or indigestion
Diarrhea

2
Endosome
Uncoating
Headaches

Endolysosome
Bleaching of the hair or mild hair loss

Chloroquine Hydroxychloroquine 3
Tinnitus (ringing in the ears)
RNA

HN
N
visual problems.
CI N

NH2
Basic Side Chain
Chloroquıne Hydroxychlorquine

N OH
4-Aminoquinoline: N
Core Structure HN

Basic Side Chain Desethylchloroquine Desethylhydroxychloroquine

CI N

Active
N Metabolites
HN Bisdesethlylchloroquine

Chloroquıne
CI N Transient metabolites
Oral administration:
Oral administration:
Absorption in upper
Absorption in upper
İntestinal tract
İntestinal tract
Metabolism in the liver
-Desethtylchloroquine Metabolism in the liver:
-Desethylhydroxchloroquine Desethylchoroquine 39%

Renal clearence 21% Renal clearence 51%

Volume of distribution: Volume of distribution:

-Blood 47,257 L -Blood 65,000 L
-Plasma 5,500 L -Plasma 15,000 L

Unmetabolized excretion 62% Unmetabolized excretion 58%

Terminal half-life 45+15 days Terminal half-life 41+11 days
 Pharmacology

Immunosuppressant's

Contraindications key Info

Blood or bone marrow problems Can cause Blurred vision or other vision changes Diarrhea, rash
and retinal damage;
Diabetes
Frequent eye exams needed (every 6 -12 months)
Eye or vision problems
Takes several month to reach therapeutic level & see effects
Muscle problems

Nerve problems
Nursing Considerations
Porphyria (blood disorder)
Monitor CBC and platelet count periodically during therapy.
Psoriasis (skin disease) May cause decreased RBC, WBC, and platelet counts.
Stomach or bowel problems–Use with caution If severe decreases occur that are not related to the disease
process, discontinue hydroxychloroquine .
Monitor liver function tests periodically during therapy.

C
Cyclosporine

Action C
Calcineurin Cyclophilin
Inhibition of the production of cytokines involved in the
regulation of T-cell activation. In particular, cyclosporine Interleukin-2
NF NF
inhibits the transcription of interleukin 2
Cyclosporine is as a calcineurin inhibitor, a cytochrome P450 P Interleukin-2
3A4 inhibitor, and a P-glycoprotein inhibitor.
Cyclosporine A inhibits the synthesis of interleukins (IL), NF Interleukin-2
including IL-2, which is essential for the self-activation of T
lymphocytes (LT) and their differentiation.

Uses key Info

Cyclosporine is used to prevent organ rejection Can cause gingival hyperplasia (expected side effect)
in people who have received a liver, kidney, or
Swollen or inflamed gums
heart transplant
Numbness or tingling of the hands or feet
Inflammatory bowel disease
Cyclosporine is contraindicated in patients with a
Rheumatoid arthritis
hypersensitivity to cyclosporine, abnormal renal function,
Autoimmune diseases, uncontrolled hypertension, uncontrolled infections and
Psoriasis, malignancy
Contraindicated in pregnancy
Requires lifelong administration

side effects
High blood pressure Stomach pain
Headache Acne
Decreased kidney function Increased gum size
Excess hair growth in certain areas Fatigue
Skin sensitivity Muscle, bone, or joint pain
 Pharmacology

Immunosuppressant's

infliximab , adalimumab , certolizumab pegol, golimumab

TUMOR NECROSIS FACTOR INHIBITORS

Action
Tumor necrosis factor (TNF) is a multifunctional cytokine that plays important roles in diverse cellular events such as
cell survival, proliferation, differentiation, and death. As a pro-inflammatory cytokine, TNF is secreted by inflammatory
cells, which may be involved in inflammation-associated carcinogenesis.
TNF blockers suppress the immune system by blocking the activity of TNF, a substance in the body that can cause
inflammation and lead to immune-system diseases, such as Crohn's disease, ulcerative colitis, rheumatoid arthritis.

Uses Side Effects

Suppress the immune system by blocking Dizziness
the activity of TNF Headaches
Rheumatoid arthritis Injection site reactions
Psoriasis Runny nose
Psoriatic arthritis, Throat irritation
Inflammatory bowel disease (IBD) Upper respiratory infections, including sinus infections
Ankylosing spondylitis

key info
Contraindicated in patient with active infection serious opportunistic infections TNF inhibitors should not be initiated in
the presence of serious infections and extreme caution should be used in patients with increased risk of infection, e.g.,
Bronchiectasis,
History of chronic leg ulcers
History of septic arthritis.
Can reactivate tuberculosis (negative TB test needed before starting therapy)
 Pharmacology

Pain Meds
Non-Opioid Analgesics

Non-opioid analgesics are commonly used to treat mild and moderate acute and chronic pain.
They can be used as monotherapy
They have greater efficacy in combination with weak and strong opioids.
Unlike opioids, long-term use of non-steroidal anti-inflammatory drugs does not lead to physical dependence.

NON-STEROIDAL ANTI-INFLAMMATORIES Arachıdonıc Acıd

Cytokınes Il-1, Tnf

Action
Growth Factors

Inhibition of the enzyme cyclooxygenase (COX-1 and COX-2) Cyclooxygenase

is required to convert arachidonic acid into thromboxane, prostaglandins, and COX-1 COX-2
prostacyclin. The therapeutic effects of NSAIDs are attributed to the lack of Glucocotıcolds
these eicosanoids. Constıtutıve Induced Cytokınes Il-4
Inhıbıtıon Inhıbıtıon
Undesırable Desırable
Reverse vasodilation, increase apoptosis Bradykinin antagonism
Reduce pro-inflammatory cytokines Decreased pain Homeostatıc Functıons Inflammatıon

Decreased inflammation Decreased temp

Gastroıntestınal Tract Renal Tract
Liberate corticosteroid PG synthesis inhibitions Platelet Functıon Macrophage
Dıfferentıatıon

EXAMPLES Uses
Acetaminophen (paracetamol) Used to treat mild and moderate acute and
chronic pain.
Anticonvulsants (including gabapentin and pregabalin)
They can be used as monotherapy;
Antidepressants (including amitriptyline and duloxetine)
Inflammatory diseases (Rheumatoid arthritis)
Aspirin (acetylsalicylic acid)
Fever Headache Hypothalamus
Other NSAIDs (including ibuprofen, diclofenac, naproxen,
and COX-2 inhibitors)

Side Effects Nursing Considerations

Gastric and. duodenal Avoid taking on empty stomach
ulcers. with the risk of.
OKAY to take with antacids
gastrointestinal bleeding.
Geriatric populations should not exceed 3000 mg in 24 hours, and chronic alcoholics
Increased risk of. heart
should not exceed 2000 mg in 24 hours due to the risk for hepatoxicity
attack. and stroke. (with
the exception of) Avoid drinking alcohol (high risk of ulcers)
Anorexia Alert PCP immediately for bloody stool
Renal function impairment:
Prostaglandins. normally
maintain. renal blood flow. Contraindications
Aplastic anemia. Age > 50 years and family history of gastrointestinal (GI) disease/bleeding.
Thrombosis Previous GI problems associated with NSAID use (gastritis)
Urticaria. Peptic ulcer. Uncontrolled hypertension.
History of personal GI bleeding. Renal disease.
CHF Irritable bowel syndrome.
PUD Inflammatory bowel disease.
 Pharmacology

Non-Opioid Analgesics

ASPIRIN No aspirin
Present
Serine
Residue
Aspirin
ASdministered

Action
Acetylation
non-steroid anti-inflammatory drugs (NSAIDs) inhibit the activity of the Catalytic Site By aspirin Blocks
Catalytic Site
enzyme now called cyclooxygenase (COX) which leads to the formation of CH3

prostaglandins (PGs) that cause inflammation, swelling, pain and fever. O

Reduction of inflammation,
Analgesia (relief of pain),
Thromboxane

Prevention of clotting, Syntetase

TXA2
Decreased pain Phospholipids Arachidonic PGH2
Acid
Decreased temp PGE
Prostaglandin

Reduction of fever. Acetylsalicylic acid (ASA) blocks prostaglandin synthesis.

Synthetase

Inhibition of platelet aggregation

EXAMPLES Uses Side Effects

Ecotrin used to reduce fever and relieve mild to Confusion
moderate pain from conditions such as Headache
Acetylsalicylic acid
Muscle aches, Drowsiness
Absorption. After oral
administration, aspirin is Toothaches, Fever
rapidly absorbed from the Common cold, Seizures
gastrointestinal tract and is
then distributed to tissues Headaches. Aspirin
throughout the body. It may also be used to reduce pain and Bloody or tarry stools
Distribution. Rapidly and swelling in conditions such as arthritis.
Dizziness
widely distributed, crosses Prevention of MI & CVA
the Placenta and enters Reyes Syndrome (in
breast milk. Inflammatory diseases (Rheumatoid arthritis) children
Dry mouth
Epigastric pain
Contraindications Heartburn

Allergy. Aspirin should not be taken by people who are allergic to it or to other Upset stomach
NSAIDs. Signs of an allergic reaction can include difficulty breathing, hives, and Blood in vomit
swelling of the face, lips, tongue, or throat.
Change in consciousness
Stomach bleeding. Aspirin can increase the risk of stomach bleeding, especially in
Constipation
people who have a history of ulcers or gastrointestinal bleeding. bleeding or ulcers
before taking aspirin. Occult blood loss
Bleeding disorders. Aspirin can increase the risk of bleeding, so it should be used Ringing in the ears
with caution in people with bleeding disorders or those who are taking blood Swollen hands or feet
thinners.
Vomiting
Pregnancy and breastfeeding. Aspirin should be used with caution during
pregnancy and breastfeeding. It is not recommended for use in the third trimester Agitation
of pregnancy as it may increase the risk of bleeding in the mother and the baby. Chest pain or discomfort
Children. Aspirin should not be given to children or teenagers who have or are Dark urine
recovering from chickenpox or flu-like symptoms.
Decreased frequency or
Other medications. Aspirin can interact with a number of other medications. amount of urine
Cross-sensitivity with other NSAIDs may exist (less with no aspirin salicylates.
 Pharmacology

Non-Opioid Analgesics

Phospholipids

ACETAMINOPHEN Phospholipase A2
Steroids

Action Arachidonic acid

Paracetamol (acetaminophen) is generally considered to be a weak Cyclooxygenase COX-1 NSAIDs

inhibitor of the synthesis of prostaglandins (PGs). The in vivo effects of

And COX-2 Coxibs
paracetamol are similar to those of the selective cyclooxygenase-2
(COX-2) inhibitors. Paracetamol also decreases PG concentrations in
Peroxidase COX-3 Paracetamol
vivo, but, unlike the selective COX-2 inhibitors, paracetamol does not
suppress the inflammation of rheumatoid arthritis.
Prostacylin Thromboxane
Decreased pain Decreased temp Sythase PGH2 synthase
EXAMPLES Prostaglandin
No anti-inflammatory or anticoagulation effects Synthase
Tylenol
Prostaglandins Thromboxane
Paracetamol Prostacylin (PGI2)
(PGD2. PGD2. PGE2) (TXA2)

Uses
Aspirin is used to reduce fever and relieve mild
to moderate pain from conditions such as
Nursing Considerations
Muscle aches, Monitor the patient for hypersensitivity and allergic reactions
during the infusion and for at least 30 minutes afterward.
Toothaches,
Monitor renal function.
Common cold,
Max dose 4g/ day in healthy adults
Headaches.
Many cold and flu OTC drugs also contain acetaminophen, so
Backache, important to read labels
Minor pain of arthritis, Routinely monitor serum acetaminophen levels for patients
Premenstrual and menstrual cramps receiving frequent or large doses of any form of
acetaminophen to avoid toxicity.
It may also be used to reduce pain and
swelling in conditions such as arthritis. Can be given oral or as IV infusion (depending on severity)
Close monitoring required (signs of acute liver failure)

Antidote: n- acetyl cysteine

Side Effects Contraindications

Nausea Headache Acetaminophen is contraindicated in cases of active liver
Yellow eyes or skin Itching disease or severe hepatic impairment.
Dizziness Rash Caution is advised for patients with mild hepatic
impairment, necessitating a reduced total daily dosage of
Pain above your Difficulty swallowing
acetaminophen and regular monitoring of liver function.
stomach Liver damage
Taking other hepatotoxic meds (Isoniazid)
Dark urine Unusual bleeding or
Decreased Urination bruising
Fatigue Agitation
Pharmacokinetics
Increased sweating Blistering of the skin
Upon ingestion, acetaminophen is rapidly absorbed
Stomach pain Chest pain or tightness
from the gastrointestinal (GI) tract and quickly
Bloody or cloudy Chills distributed throughout the body. Peak plasma
urine Cough concentrations are achieved within 30 to 60 minutes;
food may delay time to peak concentration, but the
extent of absorption is not affected.
 Pharmacology

Pain Meds
Opioid Analgesics

Opioids

Opioids (narcotic analgesics) are a class of medicines that are used

to provide relief from moderate-to-severe acute or chronic pain.
Agonists Mixed agonist - Antagonists
They may also be called opiates, opioid analgesics, or narcotics. antagonist (Nalxone
buprenorphine, Naltrexone)
Analgesic is another name for a medicine that relieves pain. nabuphine

black box warning

Strong Moderate
Weak
Respiratory depression. Abuse & addiction (See Substance Abuse (Morphine, (Codeine,
methadone, Oxycodone) (Propocxyphene)
Disorders in Mental Health Bundle for more info)
Meperidine)

Examples
tramadol, fentanyl, dextromethorphan, codeine,
oxycodone methadone meperidine buprenorphine

Action
Opioid agonists bind to G-protein coupled receptors
to cause cellular hyperpolarization.
Most clinically relevant opioid analgesics bind to
NA+
MOP receptors in the central and peripheral nervous cAMP
system in an agonist manner to elicit analgesia. HCN1
They activate an area of nerve cells in the brain and Opioid
body called opioid receptors that block pain signals Receptor Opioid
between the brain and the body. PLACA2
Receptor
PLA2

Types
ERK/p38
Opioid peptides Endogenous peptides that act on cSRC/PKA
opioid receptors
Opioid agonist A drug that activates some or all
opioid receptor subtypes Barr2
Partial agonist A drug that can activate an opioid
receptor to effect a submaximal response
KV
Opioid antagonist A drug that blocks some or all
opioid receptor subtypes CaV
Mixed agonist-antagonist A drug that activates K
+ KV
some opioid receptor subtypes and blocks other Ca2+
opioid receptor subtypes
CaV

Post-synaptic

Opioid
Receptor
 Pharmacology

Opioid Analgesics

Uses Side Effects

Opioids (narcotic analgesics) are a class of medicines that are used to Sedation,
provide relief from moderate-to-severe acute or chronic pain.
Dizziness,
They may also be called opiates, opioid analgesics, or narcotics
Nausea,
After surgery.
Vomiting,
Due to injury, such as a fractured bone.
Constipation,
For acute (sudden, short-term) pain, such as a twisted ankle or headache.
Hypotension
For aches and pains like menstrual cramps or muscle soreness.
Bradycardia
For chronic painful conditions such as arthritis, cancer or back pain.
Drowsiness
Physical dependence
Acute Pain Management Chronic Pain Management
Dry mouth
Rreduction of fever. Chronic headaches
Itching/ rash
Pancreatitis Neuropathic pain associated with diabetic
Confusion (especially in elderly)
peripheral neuropathy or spinal cord injury,
Dental pain
Constipation
Glossopharyngeal neuralgia
Neuropathic pain
Tolerance,
Neuropathic pain
Sickle cell crisis
Respiratory depression.
Myocardial infarction
Inflammation, and
Pruritus
temporary reduction Anti-diarrheal
of fever. Shallow breathing,
Cancer
Trauma Slowed heart rate
Fibromyalgia
Surgery Usually from prolonged use can
Back pain
Burns lead to paralytic ileus
Palliative care is specialized medical care for
people living with a serious illness, such as
cancer or heart failure
Cough suppression
Paralytic ileus occurs when
the muscle contractions
that move food through
your intestines are
Signs Of Overdose Antidote: temporarily paralyzed.
naloxone (narcan)
Pinpoint pupils,
Respiratory depression that will reverse the
effects of an opioid
Cool & clammy skin
overdose if
Unarousable administered in time.
Coma Naloxone has
Hypoxia virtually no effect in
people who have not
Decreased level of consciousness. taken opioids.
Low blood pressure Immediately
Low heart rate reverses effects of
opioids. Given every
2-3 minutes until
desired response.
 Pharmacology

Opioid Analgesics

Route Bioavailability Advantages Disadvantages

Easy to administer (self or

33% (morphine) 60%-87%
Oral family) Fewest complications Lowest bioavailability
(oxycodone)
Well tolerated

Highest titration Requires

High cost Requires
Intravenous 100% (all opioids) Not limited by infuscate
intravenous access
volumes

Intravenous access not Infuscate volume limited to 1-4

Subcutaneous 80% (hydromorphone) required mL/hour Rapid dose Requires skilled nursing support
titration Induration may occur at site

Easy to administer (self or May cost more than oral Few

Transdermal 90% (fentanyl) family Long duration of action complications Cannot
(72 hrs) perform rapid dose titration

30%-60% (morphine, Higher bioavailability than Higher bioavailability than oral

Transmucosal
fentanyl) oral Fast absorption Fast absorption

Possibly higher bioavailability Less attractive than oral route for

30%-40%
Rectal than oral take oral Available for patients who cannot
(morphine)
medications some individuals/cultures

The Oral Route The Subcutaneous Route

The oral route is the most common, least invasive, and For patients requiring parenteral opioids who do not have
easiest route for opioid administration for most in-dwelling intravenous access, the subcutaneous route
patients with cancer pain. can be used.8.
In all patients who can take oral medications, this route
should be considered first.

The Intravenous Route The Transdermal Route

While most patients can be adequately managed For patients unable to take oral
using the oral opioids, a small percentage require medications, the transdermal
alternative routes, either because route is a noninvasive option of
maintaining continuous plasma
They are unable to swallow due to the site of their
concentrations of opioid
cancer or because they are receiving end of-life care,
ALWAYS remove patch before l
When an inability to take oral medications may arise. tany
applying new one Fen
The intravenous route of administration is available for
ALWAYS time and date patch R
those patients whose pain cannot be controlled by a g/G
50.m
less invasive route Rotate sites
 Pharmacology

Opioid Analgesics

The Transmucosal /Sublingual Routes The Rectal Route

The sublingual administration of opioids is particularly beneficial This route may be a simple alternative
in the patient with cancer who is unable to tolerate oral when the oral route is not possible because
administration because of nausea/vomiting or dysphagia. of vomiting, obstruction, or altered
It may also be attractive in patients who cannot receive consciousness
parenteral opioids because of lack of venous access, emaciation,
or coagulation defects

Nursing Consideration
The nurse should evaluate the respiratory rate and pulse oximetry after administration of the medication.
Other common side effects of opioid analgesic medications are constipation or nausea.
Monitor respiratory status
Monitor HR & BP
Monitor neuro status
Reassess 15-30 minus after admin
Fall precautions
Encourage breathing exercises
The nurse may need to consider administering other medications that treat the side effects of analgesic medication.
Give stool softener & ambulate to avoid constipation
Educate patient to NOT take with alcohol
 Pharmacology

Psych Meds
Mood Stablizers

Mood stabilizers are medications used in the treatment of bipolar Natural mood stabilizers
disorder, where a person's mood changes from a depressed feeling
to a high “manic” feeling or vice versa.
These drugs can help reduce mood swings and prevent manic and
depressive episodes.

Note: Lithium is the only true mood stabilizer, while the other
three meds are in the class of anticonvulsants

LITHIUM CLASS: MOOD STABILIZER

Lithium is a type of metal that is consumed in the diet, mainly in grains

and vegetables. Various forms are used in supplements in small doses.

Action
Lithium reduces excitatory (dopamine and glutamate) but
Mood Stabilizers
increases inhibitory (GABA) neurotransmission;
These broad effects are underpinned by complex neurotransmitter Lithium
systems that strive to achieve homeostasis by way of
compensatory changes
Lithium regulates phosphorylation of GSK-3 which regulates other Anticonvulsants
enzymes through phosphorylation
Carbamazepine Lamotrigine
Lithium can also inhibit GSK-3 through interfering with the
magnesium ion in the active site Valproic acid / divalproex

therapeutic level 0.6-1.2 meq/ L

Atypical Antipsychotics
e
on in
si m
is a

Li+
m op

Cyclical dysregulation hypothesis

ns d

Quetiapine Olanzapine
ra its
ot ib

Mania: dopamine NT is increased

ur inh
ne m
iu
th

Lurasidone Aripiprazole
Li

Downregulation
D2 Y
A
B Risperidone Paliperidone
Decreased neurotransmission
associated with clinical depression

Uses
Mania (feeling highly excited, overactive or distracted)
Hypomania (like mania, but less severe)
Bipolar disorder, where your mood changes between feeling very high (mania) and very low (depression)
Effective in controlling manic phase
 Pharmacology

Mood Stabilizers

Signs of Toxicity Caused By:

Increased stomach pain, vomiting or diarrhea.
In mild lithium toxicity, symptoms include
Increased muscle weakness, shaking or twitching.
Weakness, Poor concentration
Severe drowsiness or dizziness.
Worsening tremor, Diarrhea.
Staggering or trouble walking or slurred speech.
mild ataxia,
Dry mouth, very thirsty.
With worsening toxicity Hyponatremia
Vomiting, the development of a gross tremor, Decreased renal function
Slurred speech, Ringing in the ears (tinnitus)
Confusion blurred vision.
Lethargy emerge
Anorexia
Contraindications:
Confusion
Severe renal and cardiac disease; severe dehydration, sodium
Ataxia depletion, debilitation.
Seizures
Tremors
Sedation

Side Effects: Nursing Considerations:

Diarrhea Give with caution and daily monitoring of serum lithium levels to patients
Tremor with renal or CV disease, debilitation, or dehydration or life-threatening
psychiatric disorders.
Increased thirst
Contraindicated in pregnancy (teratogenic)
Vomiting
Ensure adequate Na & fluid intake
Blurred vision
Monitor Cr & BUN
Dizziness
Check lithium levels every 2 month
Increased urination
Give drug with food or milk or after meals.
Lithium toxicity
Muscle weakness
Weight gain
Confusion
Xerostomia
Hair loss
Abnormal heart rhythms
Cognitive impairment
Feeling unusually sleepy
Headache
Hyperreflexia
Kidney disease
Polydipsia
Seizures
 Pharmacology

Mood Stabilizers

class: anticonvulsant
Valproic acid
Valproic acid Inhibit
1. Presynaptic discharge
Inhibit
2. Post synaptic discharge

Action GABA transaminase

Valproic acid is thought to reduce or prevent manic episodes by

increasing the amount of a chemical called gamma-aminobutyric Increased conc.of GABA in brain

acid (GABA) in the brain.

Inhibition of voltage-gated sodium channels:
VPA obstructs the entry of sodium ions into neurons, leading to black box warning
decreased neuron excitability and firing rate Arrange for frequent LFTs;
discontinue drug immediately with
Therapeutic level 50-100 mcg/ml
significant hepatic impairment,
suspected or apparent significant
Carbamazepine Levetiracetam Clonazepam
hepatic impairment; continue LFTs
Lamotrigine Oxcarbazepine Phenobarbital to determine if hepatic
Gabapentin Phenytoin Topiramate impairment progresses in spite of
drug discontinuation.

Uses Signs Of Toxicity

Complex partial seizures Valproic acid may cause serious or life-threatening damage to the pancreas.
This may occur at any time during your treatment
Simple and complex absence
seizures Confusion Liver failure Nausea, Loss of appetite.
Bipolar disorder Coma Seizures Vomiting,
Migraine headaches
Migraine prophylaxis

Contraindications
Contraindicated with hypersensitivity to valproic acid, hepatic disease or
Side Effects significant hepatic impairment.
Diarrhea
Drowsiness
Hair loss
Nursing Considerations
Tremor
Assessment
Weight gain
Appetite History: Hypersensitivity to valproic acid; hepatic impairment; pregnancy,
lactation
Blurry vision
Physical: Weight; skin color, lesions; orientation, affect, reflexes; bowel sounds,
Dizziness
normal output; CBC and differential, bleeding time tests, LFTs, serum
Headache ammonia level, exocrine pancreatic function tests, EEG
Rash Interventions
Thrombocytopenia
Give drug with food if GI upset occurs;
Anemia
Monitor ammonia levels, and discontinue if there is clinically significant
Elevated liver enzymes elevation in level.
Weakness Assess baseline LFT & monitor levels
Breathing problems Monitor for signs of bleeding & CBC
Changes in menstrual periods Avoid use during pregnancy (can cause congenital defects)
Chest pain Monitor serum levels of valproic acid and other antiepileptic drugs
Hives DO NOT discontinue abruptly
 Pharmacology

Mood Stabilizers

class: anticonvulsant
Carbamazepine
Open Inactıvated
Na+ Na+

Action
Enhancement of sodium channel inactivation by reducing A A
high-frequency repetitive firing of action potentials,
Action on synaptic transmission.
It works by stabilizing the electrical activity in the brain and nerves.
For epilepsy, carbamazepine works by stopping electrical signals from i NA+ Carbamazepine i Lamotrigine
building up in the nerve cells in the brain Phenytoin Valproate
A = Activation gate
Risk for LOW blood osmolality Can cause water retention leading to SIADH I = Inactivation gate

Uses Causes Nursing Considerations

Used to prevent and Dizziness, Nursing considerations- Observe for confusion and
control seizures. agitation in older people.
Imbalance,
Bipolar disorder Observe for changes in mental state.
Drowsiness,
Trigeminal neuralgia Avoid grapefruit juice (increases serum levels)
Coma,
Acute manic and Monitor CBC & electrolyte levels
Generalized seizures.
mixed episodes in Monitor for infection
bipolar I disorder
Observe for allergic reactions such as rashes, purpura. -
Treat epilepsy Leucopenia which is severe, progressive or associated
with clinical symptoms requires withdrawal.

Side Effects
Feeling sleepy, dizzy or tired. Do not drive, cycle or pharmacodynamics of carbamazepine?
use tools or machinery if you're feeling sleepy, tired
or dizzy. Carbamazepine decreases neuronal excitability or
enhances inhibition by altering sodium, potassium or
Feeling or being sick (nausea or vomiting) Stick to calcium conductance or by affecting the δ-aminobutyric
simple meals and do not eat rich or spicy food. acid (GABA), glutamate or other neurotransmitters that
Headaches. may be concerned in seizure activity.
Agranulocytosis.
Dry mouth.
Thrombocytopenia
Anemia
Steven Johnson Syndrome
Water retention
Putting on weight.
 Pharmacology

Mood Stabilizers

class: anticonvulsant
Lamotrigine Voltage gated sodium
(Na+) Channels

Action Na+

Lamotrigine is a synthetic phenyltriazine drug with analgesic and

antiepileptic properties.
It is primarily used as an anticonvulsant for the adjunctive treatment of
seizures in epilepsy.
Lamotrigine selectively binds and inhibits voltage-gated sodium
channels, stabilizing presynaptic neuronal membranes and inhibiting
Influx of sodium ions
presynaptic glutamate and aspartate release.
Enhance release of GABA. Excitotoxicity due to
glutamate release

risk for suicidal thoughts Monitor for any signs of depression

or suicidal ideation

Uses Nursing Considerations

Medications to prevent Monitor closely for changes in behavior that could indicate the emergence or
and control seizures. worsening of suicidal thoughts or behavior or depression.
It may also be used to Monitor for signs of rash
help prevent the extreme
Valproic acid can DOUBLE the serum level of Lamotrigine (usually prescribed at
mood swings of bipolar
lower dose)
disorder in adults.
Assess patient for skin rash frequently during therapy. Discontinue lamotrigine at
Treats epilepsy
first sign of rash; may be life-threatening.
Monitor for signs of worsening depression

Side Effects
Fast, slow, or pounding heartbeats or fluttering in your chest;
Chest pain, shortness of breath;
Fever, swollen glands, weakness, severe muscle pain;
Any skin rash, especially with blistering or peeling;
Steven johnson syndrome
Aseptic meningitis
Suicidal thoughts
Painful sores in your mouth or around your eyes;
Headache, neck stiffness, increased sensitivity to light, nausea, vomiting, confusion, drowsiness;
Jaundice (yellowing of the skin or eyes); or
Pale skin, cold hands and feet, easy bruising, unusual bleeding.
 Pharmacology

Psych Meds
Antidepressants

Antidepressants are a type of medicine used to treat clinical depression.

They can also be used to treat a number of other conditions, including:
obsessive compulsive disorder (OCD) generalized anxiety disorder.
post-traumatic stress disorder (PTSD)

Classification of anti-depresent
Reversible inhibitors of MAO-A (RIMAS): Moclobemide, Clorgyline
Tricyclic antidepressants (TCAS):

NA + 5-HT reuptake inhibitors: Imipramine, Amitriptyline,

Trimipramine, Doxepin, Dothiepin, Clomipramine
Predominantly NA reuptake inhibitors: Desipramine,
Nortriptyline, Amoxapine, Reboxetine

Selective serotonin reuptake inhibitors (SSRis): Fluoxetine,

Fluvoxamine, Paroxetine, Sertraline, Citalopram, Escitalopram
Atypical antidepressants: Trazodone, Mianserin, Mirtazapine,
Venlafaxine, Duloxetine, Tianeptine, Amineptine, Bupropion
5-HT2Antagonists: trazodone and nefazodone

ACETAMINOPHEN

Potentially life-threatening condition associated with increased serotonergic activity in the central nervous system.

Hyperthermia Agitation, restlessness.

Agitation Muscle twitching, involuntary muscle contractions, muscle spasms, muscle rigidity.
Muscle rigidity Sweating, shivering.
Tremors Abnormal (side-to-side) eye movement
Hyperreflexia Severe Can lead to
coma or seizures
Hallucinations Confusion, disorientation, delirium.
Mild Rapid heart rate.
Nervousness. High blood pressure.
Nausea, vomiting. High body temperature (greater than 101.3 Fahrenheit [38.5 Celsius]).
Diarrhea. Seizures.
Dilated pupils. Abnormal heartbeat.
Tremor. Passing out, fainting.
Moderate

Education Increased risk of suicide

Antidepressant dosages are started low and raised Especially in the first few weeks of taking; notify PCP for
gradually over time until the desired effect is any signs unusual behavior, or new thoughts of suicide
reached without the appearance of troublesome Regular mood changes and feelings about everyday life
side effects.
Persistent feeling of sadness and loss of interest
NEVER stop abruptly
 Pharmacology

Antidepressants

Selective serotonin reuptake inhibitors

SSRI Pre-synaptic
nerve ending SSRI Blocking
reabsorption
Action of Serotonim

SSRIs treat depression by increasing levels of serotonin in the brain.

Serotonin is one of the chemical messengers (neurotransmitters)
that carry signals between brain nerve cells (neurons).
SSRIs block the reabsorption (reuptake) of serotonin into neurons.
5-HT
This makes more serotonin available to improve transmission of
messages between neurons. SSRIs are called selective because
they mainly affect serotonin, not other neurotransmitters. Serotonim İs
Released
Citalopram (Cipramil) Fluvoxamine (Faverin) Synapse

Dapoxetine (Priligy) Paroxetine (Seroxat)

Escitalopram (Cipralex) Sertraline (Lustral) Post-synaptic
nerve ending
Fluoxetine (Prozac or Oxactin) Vortioxetine (Brintellix) Receptor Sıtes

Uses Side Effects

Clinical depression (major depressive disorder). Sexual problems, such as reduced sexual desire, difficulty
reaching orgasm or inability to maintain an erection (erectile
Generalized anxiety disorder (GAD).
dysfunction)
Bulimia nervosa.
Impact on appetite, leading to weight loss or weight gain
Depressive episodes of bipolar disorder.
Nausea, vomiting or diarrhea Dizziness
Obsessive-compulsive disorder (OCD).
Headache Insomnia
Panic disorder.
Drowsiness Sexual dysfunction
Premenstrual dysphoric disorder (PMDD).
Dry mouth Suicidal thoughts
Post-traumatic stress disorder (PTSD).
Insomnia Nervousness, agitation or
Social anxiety disorder (social phobia).
restlessness

Risks or complications of SSRIs Nursing Considerations

Risk of suicidal thoughts or behavior. Arrange for lower dose in elderly patients and in those with
renal or hepatic impairment because of the potential for
Serotonin syndrome.
severe adverse effects.
Antidepressant discontinuation syndrome.
Do NOT take with St. John's Wart or MAOI's or Tramadol (can
cause Serotonin Syndrome)
Monitor for signs and symptoms of Serotonin Syndrome Limit
drug access if patient is suicidal to decrease the risk of
overdose to cause harm.
 Pharmacology

Antidepressants

Presynaptic
serotonin norepinephrine reuptake inhibitors Neuron
SNRIS
Vesicle

Action
Serotonin
SNRIs have a similar mechanism of action as SSRIs Transporter Norepinephrine
(SERT) Transporter
(NET)
In addition to increasing serotonin (5-HT) by inhibiting the
serotonin transporter (SERT) (and thus decreasing reuptake into Serotonin
cells), SNRIs also inhibit norepinephrine (NE) reuptake via the Norepinephrine SSRI SNRI Synapse
norepinephrine transporter (NET). Receptor

Mild dopamine reuptake inhibition via the dopamine

transporter (DAT) may also exist

Classifications POSTYNAPTIC
Desvenlafaxine Milnacipran Levomilnacipran NEURON
Duloxetine Venlafaxine

Uses Risks or complications of SNRIs

Generalized anxiety disorder (GAD). Risk of suicidal thoughts or behavior.
Pain from diabetes-related neuropathy. Serotonin syndrome.
Fibromyalgia. Antidepressant discontinuation syndrome.
Chronic musculoskeletal pain.
Depressive disorders
Anxiety disorders
Nursing Considerations
Generalized anxiety disorder. SNRIs are contraindicated with MAOIs or within 14 days of use
of an MAOI.
Panic disorder.
Do NOT take with St. John's Wart or MAOI's or Tramadol (can
cause Serotonin Syndrome)
Dosage adjustment is required for use in patients with renal
and/or liver disease.
Side Effects Monitor for signs and symptoms of Serotonin Syndrome
Nausea and vomiting. Elderly patients are at greater risk for developing
Dry mouth (xerostomia). hyponatremia.

Constipation. Use with caution with other serotonin medications.

Fatigue and drowsiness.

Insomnia SNRI withdrawal
Sexual dysfunction SNRI “withdrawal” is actually called “antidepressant discontinuation
Suicidal thoughts syndrome.”
Dizziness. It can happen if you suddenly stop taking an SNRI if you’ve taken it for at
least six weeks.
Excessive sweating (diaphoresis).
Symptoms of antidepressant discontinuation syndrome include:
Sexual dysfunction.
Flu-like symptoms, such as fatigue, headache, achiness and sweating.
Insomnia.
Nausea.
Dizziness and lightheadedness.
Sensory issues, such as burning, tingling, “buzzing” or mild electric
shock-like sensations.
Anxiety, irritability and agitation.
 Pharmacology

Antidepressants

Monoamine oxidase inhibitors

MAOIS
Synthesis
1
Action Serotonin is produced
directly in the neuron
Monoamine oxidase inhibitors are responsible
for blocking the monoamine oxidase enzyme. Storage
2 VMAT2 Transports
The monoamine oxidase enzyme breaks
down different types of neurotransmitters serotonin into vesicles.
from the brain: norepinephrine, serotonin,
dopamine, and tyramine. Release
3 Vesicle release serotonin
MAOIs inhibit the breakdown of these
neurotransmitters thus, increasing their levels into the synaptic cleft.
and allowing them to continue to influence
the cells that have been affected by Reuptake pump
depression.
4 Some serotonin is naturally
reabsorbed through the
Isocarboxazid Selegiline
reuptake pump.
Phenelzine Tranylcypromine

Uses Side Effects

Depression, such as sadness, anxiety, Dry mouth Hypertensive crisis
Anxiety disorders Nausea, diarrhea or constipation Suicidal thoughts
Social phobias Headache Agitation/ anxiety
Bipolar disorder Drowsiness Orthostatic hypotension
To treat Hodgkin’s disease Insomnia Reduced sexual desire or
Parkinson’s disease difficulty reaching orgasm
Dizziness or lightheadedness
Weight gain
Skin reaction at the patch site
Difficulty starting a urine flow
Low blood pressure
Muscle cramps

Nursing Considerations
Nurses should also educate patients taking MAOIs about the potential
side effects of the medication,
Interact with MANY OTC meds (check with PCP)
Persons taking MAOI antidepressants are cautioned to avoid foods that
Tyramine Rich Foods
are rich in tyramine so that the hypertensive crises can be avoided.
Aged cheeses (like cheddar, blue, The importance of following dietary restrictions, and the need to avoid
Swiss, and Parmesan) certain medications or supplements that can interact with MAOIs
Cured meats (like salami, pepperoni, NOT for use with other antidepressants (can cause Serotonin
summer sausage) Syndrome)
Fermented soy products (like miso,
tempeh, soy sauce)
Some fruits and veggies (like
overripe bananas, and avocados)
Red wine
Chocolate
 Pharmacology

Antidepressants

Tricyclic antidepressants
TCAS Neuron
Pre-Synaptic

Action
NORADRENALINE
inhibiting serotonin and norepinephrine reuptake within
the presynaptic terminals, resulting in elevated
SEROTONIN
concentrations of these neurotransmitters within the
synaptic cleft.
The increased levels of norepinephrine and serotonin in
the synapse can contribute to the antidepressant effect.
N-methyl-D-aspartate receptor and ion channel
blockade probably also play a role in their
pain-relieving effect.
Space
Amitriptyline Imipramine svnaptic
Amoxapine Nortriptyline Reuptake X Tricvclic
Desipramine Protriptyline Receptor

Doxepin Trimipramine
Post-Synaptic Neuron

Uses Side Effects

Migraine prevention (prophylaxis). Dry mouth. Sedation
Insomnia. Slight blurring of vision Dysrhythmias
Anxiety disorders. Orthostatic hypotension Drowsiness.
Chronic pain, especially neuropathic pain Photosensitivity. Dizziness.
conditions such as myofascial pain,
Constipation. Weight gain.
diabetes-related neuropathy and post
herpetic neuralgia. Problems passing urine.
Fibromyalgia.
Bedwetting (nocturnal enuresis).

nursing considerations
Monitor for suicide ideations. patients will have dry mouths and eyes, and their appetite is affected
Protect self from sun & always wear sunscreen.
Best given at bedtime due to sedating effects
FALL RISK (due to sedation)
Monitor for dysrhythmias
Patients will have low blood pressure. patients will have orthostatic changes, sitting up and then immediately
passing out.
 Pharmacology

Psych Meds
Anxiolytics

An anxiolytic is a medication or other intervention that reduces anxiety.

This effect is in contrast to anxiogenic agents which increase anxiety.
Anxiolytic medications are used for the treatment of anxiety disorders and their related psychological and physical symptoms.

ANTIANXIETY DRUGS

Benzodiazepines Azapirones Sedativeantihistaminic ß-adrenergicblocker

Diazepam Buspirone Hydroxyzine Propranolol
Oxazepam Gepirone
Lorazepam Ispapirone
Chlordiazepoxide Enhance the activity of the neurotransmitter GABA—a
chemical in the brain that helps you to feel calm.
Alprazolam

Sign’s of Overdose C1
Drowsiness
Coma
Respiratory depression
BZD
Confusion
Dizziness
Slurred speech
Hallucinations
Cell Membrane Cell Membrane
Irregular breathing
Nystagmus
Poor coordination
Seizures
Unresponsiveness
Agitation
Blurred vision C1
Extreme blood pressure changes
Nausea
Loss of coordination
Anxiety ABC's are priority
Depression In any pharm question you get asked about benzos or
barbiturates, airway, breathing & circulation ALWAYS
Diarrhea
take priority over anything else!
Dulled reflexes
Memory problems
Restlessness
 Pharmacology

Anxiolytics

suffix: -lam & -Pam

Benzodiazepines

(Anxiolytic drug) Benzodiazepines are the Alprazolam Clorazepate Halazepam Diazepam

most widely used Anxiolytic drugs. These are
safer and effective than others Chlordiazepoxide Diazepam Lorzepam

Action Of Benzodiazepine
Reduction Of Anxiety: At low doses, the benzodiazepines are Anxiolytic. They
reduce anxiety by selectively enhancing GABAergic transmission in neurons. Causes sedation important
to monitor ABC's!
Sedative And Hypnotic: Action Benzodiazepines also have sedative properties
and some can produce hypnosis (artificially produced sleep) at higher doses Can lead to dependence for
short term use only
Muscle Relaxant : At high doses, the benzodiazepines relax the skeletal muscles.

MOA
The targets of benzodiazepine actions are Pharmacokinetics (lipophilic)
GABAa receptors. They are rapidly and completely absorbed after oral administration
Benzodiazepine modulate the GABA effects by and distribute.
binding to a specific site, these binding sites are
sometimes labeled benzodiazepine receptors. Adverse Effects
Drowsiness Headache Depression
Therapeutics Uses Memory loss Bradycardia Dizziness

Anxiety Treatment: Benzodiazepines Insomnia Amnesia Slurred speech

are effective for the treatment of the Confusion Agitation
anxiety disorder, social anxiety disorder,
Bradypnea (slow Confusion early
performance.
breathing rate) morning
Muscular Disorders: These agents are Anxiety insomnia
useful in the treatment of skeletal
muscle spasms. Not recommended in use of elderly
due to history of poor tolerance
Seizures: These agents are also used in
the treatment of certain types of
epilepsy.
Sleep Disorders: These agents are also
used in the treatment of insomnia. Antidote
Alcohol withdrawal.
Flumazenil is a nonspecific competitive antagonist at the
benzodiazepine receptor that can reverse benzodiazepine-induced
sedation.
Mechanism of action of benzodiazepines

GBA A receptor Synaptic Cleft

Nursing Considerations
Benzodiazapine
(BDZ) Binding site Benzodiazepines may cause fetal harm when administered to
pregnant women.
Benzodiazapine Gamma GABA Cl-
Sub-unit Monitor respiratory status closely
Monitor VS & ECG
Do not abruptly stop
Fall precautions
Alpha Alpha Alpha Alpha Alpha Alpha
Children and the elderly are more likely to experience
paradoxical reactions to benzodiazepines such as tremors,
agitation, or visual hallucinations.
 Pharmacology

Anxiolytics

suffix: -barbital
Barbiturates

Barbiturates are a group of sedative-hypnotic medications used for Pentobarbital Secobarbital Butalbital
treating seizure disorder, neonatal withdrawal, insomnia, preoperative
anxiety, and induction of coma for increased intracranial pressure. Amobarbital Phenobarbital

MOA Barbiturates
Barbiturate + GABA Activation of GABA Opening of chloride channel Gaba
Binding
Benzo Site
diazepine
Binding Site Barbiturate
Depression of CNS Hyperpolarization Increased the duration of GABA α β Binding Site
of cells gated channel opening
β α

Actions Plasmalemma

Depression At low doses, the barbiturates produce sedation (Have a calming

of CNS: effect and reduce excitement).
At higher doses, the drugs cause hypnosis, followed by anesthesia Causes sedation Important
(loss of feeling or sensation), and, finally, coma and death. to monitor ABC's!

Respiratory Barbiturates suppress the hypoxic and chemoreceptor response Longer half life takes longer
Depression: to CO2 and over dosage is followed by respiratory depression to leave body which causes
and death. increase risk of toxicity

Adverse Effects Nursing Considerations

Do not use for children less than 1 month of age.
Barbiturates may harm the fetus during pregnancy.
Avoid use in geriatric clients.
Drowsiness Anxiety Weakness, Nausea and Monitor VS & respiratory status closely
restlessness vomiting
Monitor serum levels!
Death can occur due to overdoses for many decades Keep emergency intubation kit at bedside
Abnormally slow breathing
Phenobarbital serum levels should be monitored to
Coma Sedation Low blood pressure ensure adequate therapeutic concentrations for
anticonvulsant activity, with a therapeutic range of
Insomnia Irritability 15-40 mcg/ml
therapeutic range
15-40 mcg/ml
Therapeutics Uses No Antidote
Anesthesia : Selection of a barbiturate is strongly influenced by the desired
duration of action. The ultra short-acting barbiturates, such as thiopental, are
used intravenously to induce anesthesia.
contraindicated in a patient with
Anticonvulsant: Barbiturates are used in long-term management of seizures, a history/manifest or latent
status epilepticus, and eclampsia. porphyria, liver impairment, and
large doses in patients with
Anxiety: Barbiturates have been used as mild sedatives to relieve anxiety, nephritic syndrome.
nervous tension, and insomnia.
 Pharmacology

Anxiolytics

class: azapirones
Buspirone
Side Effects
Buspirone is useful in the treatment of Headache Drowsiness Nervousness
generalized anxiety disorder.
Nausea Lightheadedness Pounding heartbeat
Buspirone lack the anticonvulsant and muscle
relaxant property. Disturbed sleep Blurred vision Confusion
Dizziness Diarrhea

MOA no sedative effects No risk of

respiratory depression.
Its main neuropharmacology effects are mediated by the 5-HT1A receptors.
No for acute treatment takes about
Buspirone displays some affinity for DA2 auto receptors and 5-HT2 receptors.
2 weeks to work and not effecting for
Binds to serotonin and dopamine receptors to decrease anxiety. acute symptoms

Presynaptic Presynaptic
Cell body
Busporine is an Terminal Terminal
agoonist of 5-HT
1A receptor when
it binds to 5-HT 1A
autoreceptors on
cell body, it
inhibits the
synthesis and
secretion of
serotonin
5-HT 5-HT
Receptor

Uptake Uptake

Busporine

Therapeutic uses
Nursing Considerations
This medication is used to treat anxiety.
Monitor any breathing problems, and report
It may help you think more clearly, relax, worry less, shortness of breath, rapid shallow breathing, or
and take part in everyday life. abnormal breath sounds that might indicate
It may also help you to feel less jittery and irritable, pulmonary congestion.
and may control symptoms such as trouble Do NOT take if taking MAOI's.
sleeping, sweating, and pounding heartbeat.
Do NOT take with grapefruit juice.
Long onset
Monitor personality changes, including excitement
Generalized OCD PTSD and nervousness.
anxiety disorder
Notify physician if these changes become
problematic.
Take consistently with or without food to prevent
change in absorption.
 Pharmacology

Psych Meds
Antipsychotics

Antipsychotics and Neuroleptics drugs are used primarily to treat schizophrenia. They are also used in other psychotic
states such as manic states.

Schizophrenia General MOA of Neuroleptics drug

Schizophrenia is caused by increased Dopamine Receptor Blocking In The Brain All of the older and new
dopamine activity in activity mesolimbic Neuroleptics drugs block dopamine receptor in the brain and the
pathway and mesocortical pathway. periphery.
During schizophrenia, glutamic acid in mid The Neuroleptics drugs bind to these receptors to varying degrees.
brain is decreased and now there is a new Serotonin Receptor Blocking Activity In The Brain.
emergence of role of serotonin in the
development of schizophrenia. Some of these drugs also inhibit serotonin.

PSYCHOTROPIC DRUG

Atypical Phenothiazine Butyrophenones TXNS

Clozapine Chlorpromazine Haloperidol Thiothexene
Risperidone Promazine Droperidol Flupenthixol
Quetiapine Fluphenazine Penfluridol
Olanzapine

aka 2nd generation aka 1st generation

Atypicals Atypicals
Suffix-PINE & -DONE Suffix-PERIDOL & -AZINE

Actions Actions
Haldol
Atypical antipsychotics have lower affinity and Typical antipsychotic drugs act HALOPERİD
OL
occupancy for the dopaminergic receptors, and a high on the dopaminergic system, 5MG PER M
degree of occupancy of the serotoninergic receptors blocking the dopamine type 2 L
5-HT2A. (D2) receptors.

function of dopamine function of dopamine

Mood, sleep Movement.
Digestion Memory.
Nausea Pleasurable reward
Wound healing and motivation.

Happiness hormone Behavior and cognition.

Bone health Attention.

Blood clotting Sleep and arousal.

ol
Hald ERİDOL
Pain perception Mood. HALOP

Sexual desire Learning.

Lactation.
 Pharmacology

Antipsychotics

Uses Uses
Used to treat the symptoms of schizophrenia or a To treat people with schizophrenia (hallucinations,
psychotic episode delusions, thought disorders)
In the treatment of severe depression Acute agitation Acute mania
Severe agitation or anxiety Tourette syndrome Other serious mood disorders
Mania Diseases associated with low levels of dopamine:
Bipolar Disorder Attention deficit hyperactivity disorder (ADHD).
Autistic disorder Parkinson’s disease. Restless legs syndrome.
Parkinson's Disease Psychosis
Diseases associated with high levels of dopamine:
Persistent Depressive Disorder
Schizoaffective Mania Obesity Addiction

Severe agression Diseases associated with both high and low levels
of dopamine:
Schizophrenia.

Side Effects Metabolic syndrome

Constipation Dry mouth Hyperlipidemia
Side Effects Anticholinergic effects
Drowsiness Weight gain Metabolic effects
Dry mouth Drowsiness Memory problems
Blurry vision Sedation Trouble urinating
Constipation Hallucinations
QT prolongation (ziprasidone)
Headaches Anticholinergic effects Agranulocytosis (risk for infection)
Dysrhythmias (causes QT prolongation)
Extrapyramidal symptoms Cataract Sedation
Seizures Diabetes Orthostatic hypotension
Myocarditis Hyperprolactinemia
Hyper salivation/ drooling Prolongation of QTc interval
Extrapyramidal Symptoms (EPS)
Extrapyramidal symptoms Seizures
Sexual side effects Orthostatic hypotension Acute dyskinesia Tardive dyskinesia Akinesia

Hypercholesterolemia Decreased libido Dystonic reactions Parkinsonism Akathisia

Neuroleptic malignant syndrome.
Sedation (decreases over time with tolerance)
Dystonia (involuntary muscle contractions)
Agranulocytosis (risk for infection)
Pseudo parkinsonism (shuffling gait, bradykinesia,
Anticholinergic effects (blurred vision, urinary retention,
tremors, rigidity)
constipation, dry mouth)
Akathisia (restlessness)
Tardive Dykinesia (involuntary movements of mouth,
face & neck)
black box warning
contraindicated in dementia patients. Severe cardiac
abnormalities. History of seizure disorder. Narrow-angle usually with
glaucoma or prostatic hypertrophy. Neuroleptic malignant syndrome long term use

The use of atypical antipsychotics has been shown to is a life-threatening neurologic emergency associated
increase mortality rates in patients in dementia (always with the use of antipsychotic (neuroleptic) agents and
question if ordered) characterized by a distinctive clinical syndrome of mental
status change, rigidity, fever, and dysautonomia.

Immediately notify
HCP & hold med
 Pharmacology

Antipsychotics

EXAMPLES EXAMPLES

Clozapine Atypical Neuroleptics Haloperidol (Typical Neuroleptics (High Potency)

Clozapine is used to treat severely ill patients with (First-generation typical antipsychotic) The medication is
schizophrenia who have used other medicines that did not used to manage the positive symptoms of schizophrenia,
work well. It is also used to lower risk of suicidal behavior in including hallucinations and delusions.
patients with schizophrenia or schizoaffective disorder.

MOA
MOA Haloperidol competitively blocks post-synaptic
The blocking of 5-HT2A/5-HT2C serotonin receptors and dopamine (D2) receptors in the brain, eliminating
the D1-4 dopamine receptors, with the highest affinity for dopamine neurotransmission and leading to the relief
the D4 dopamine receptor. of delusions and hallucinations that are commonly
associated with psychosis.

Antiemetic Effects Most of the drugs have antiemetic

effects.
Sedative actions
H1 Weight gain Antimuscrinic Effects Some of the Neuroleptics produce.

Olanzapine HO

Blocking NH2
D2 (Hit and Run)
N

Clozapine
H

5-HT2A
Inhibiton
Postural Drop
2A Activation
1
5H
T
α Haloperidol PLD Neurotoxicity

Neuroprotection
3
M
nd

Anticholinergic
1a
M

Actions
Therapeutic uses
Schizophrenia: Antipsychotic drugs produce an
immediate quieting action. However, their antipsychotic
Uses effects typically take longer time to occur (a week or
more).
Clozapine is used to treat severely ill patients with
schizophrenia who have used other medicines that Depression with psychotic manifestations.
did not work well. Tourette syndrome (haloperidol or risperidone).
It is also used to lower risk of suicidal behavior in Agitation, delirium (in mentally retarded or demented
patients with schizophrenia or schizoaffective disorder. patients)
Irritability, in autistic children (risperidone)
Huntington's disease Alcoholic hallucinosis
Side Effects
Pharmacokinetics After oral administration the
Neuroleptics show variable absorption. These agents
Constipation Dry mouth Dizziness readily pass into the brain.
Seizures Urinary incontinence Excess saliva
Drowsiness Blurred vision Headache Side Effects
Tremors Constipation Confusion
Movemen Urinary retention Sexual dysfunction
t disorder
 Pharmacology

Antipsychotics

Typical Neuroleptics
Risperidone Chlorpromazine

Risperidone is medicine that helps with symptoms of (Low Potency) Chlorpromazine is a medication used to
some mental health conditions such as: schizophrenia. manage and treat schizophrenia, bipolar disorder, and
acute psychosis.
Mechanism of Action
Clozapine is used to treat severely ill patients with
MOA
schizophrenia who have used other medicines that The antiemetic effect of chlorpromazine stems from the
did not work well. combined blockade of histamine H1, dopamine D2, and
muscarinic M1 receptors in the vomiting center.
It is also used to lower risk of suicidal behavior in
patients with schizophrenia or schizoaffective disorder.

SARS-CoV-2
Uses Risperidone is used to treat
Schizophrenia Bipolar disorder
Irritability associated with autistic disorder

Monocyte MEK/p38/ERK

Side Effects Chlorpromazine

NF-kB (CPZ)
Feeling sleepy or tired Feeling dizzy Nucleus

Unusual body movements A fast heartbeat Nucleocapsid (N) NF-kB IL-6

Problems standing and walking A seizure or fit

Actions
Pharmacokinetics
Antipsychotic: Actions All of the Neuroleptics drugs can
Risperidone undergoes hepatic metabolism and renal
reduce the symptoms of schizophrenia by blocking
excretion. Lower doses are recommended for patients
dopamine receptors in the brain.
with severe liver and kidney disease.
Antiemetic Effects: Most of the drugs have antiemetic
effects.
WARNING: Monitor patient regularly for signs and Antimuscrinic Effects: Some of the Neuroleptics produce
symptoms of diabetes mellitus.
Therapeutics Uses
The Neuroleptics are considered to be the only
efficacious treatment for schizophrenia. Prevention Of
Severe Nausea And Vomiting old Neuroleptics are
useful in the treatment of drug-induced nausea and
vomiting.

Pharmacokinetics
After oral administration the Neuroleptics show variable
absorption. These agents readily pass into the brain.

Side Effects
Sweating Psychosis Seizures
Dry mouth Agitation Drowsiness
 Pharmacology

Tpyes of Insulin

Types Of Insulin

lın
Insulin Insu ion
injec
t

Insulin is a hormone created by pancreas that controls the amount of glucose in

bloodstream at any given moment. It also helps store glucose in your liver, fat,
and muscles.
It regulates your body's metabolism of carbohydrates, fats, and proteins.

Functions of insulin? Insulin

Insulin is a peptide hormone secreted by the β cells Insulin Receptor Plasma Membrane Glucose
of the pancreatic islets of Langerhans and maintains
GLUT 4
normal blood glucose levels by facilitating cellular
glucose uptake, regulating carbohydrate, lipid and
protein metabolism and promoting cell division and P P GLUT 4 Translocation
CBL
growth through its mitogenic effects. Glucose
CAP

P P Hexokinase II

SHC IRS PROTEINS Glucose -6-

Actions Phosphate
p85
Insulin initiates its action by binding to a
glycoprotein receptor on the surface of the cell. p110
PI-3 Kinase
This receptor consists of an alpha-subunit, which Metabolism
binds the hormone, and a beta-subunit, Storage

Which is an insulin-stimulated, tyrosine-specific Cell Protein Glycogen Glucose

protein kinase. Growth Synthesis Synthesis Transport

Actions
Onset: Is defined as the length of time before insulin hits your bloodstream and begins to lower blood glucose.
Peak: Is the time during which insulin is at its maximum effectiveness at lowering your blood glucose levels.
Duration: Is the length of time insulin continues to lower your blood glucose levels.

Insulin Type Onset Peak Time Duration

Rapid acting 15 minutes 15 minutes 15 minutes

Short-acting inhaled 30 to 60 minutes 15 minutes 15 minutes

Intermediate acting 60-120 minutes 15 minutes 15 minutes

Long acting 60-120 minutes 15 minutes 15 minutes

 Pharmacology

Tpyes of Insulin

Rapid Acting
Generic Trade
This type of insulin begins to affect Insulin aspart Apidra
blood glucose approximately 15
Humulin N Fiasp
minutes after injection. It peaks in
about an hour, and then continues Insulin lispro Lyumjev
to work for a few more. Rapid-acting Novolin R NovoRapid
insulin is sometimes also known as
bolus insulin or mealtime insulin. Insulin glulisine Trurapi
Admelog Admelog
HUMALOG Basaglar Humalog
Fiasp
Humalog
Think of a log
rolling RAPIDLY
down a hill.

Mechanism of Action Key Info

Rapid-acting insulin analog that facilitates passage of glucose, Rapid-acting insulin usually contains 100
potassium, magnesium across cellular membranes of skeletal units of insulin per 1ml of liquid, but some
and cardiac muscle, adipose tissue; brands are also available containing 200
units of insulin per 1ml of liquid.
Controls storage and metabolism of carbohydrates, protein, fats.
Make sure you know what strength of
Promotes conversion of glucose to glycogen in liver.
insulin you're taking. You'll usually take a
dose of rapid acting insulin around 10 to 15
minutes before each meal.
Highest risk of Hyperglycemia (high blood
Uses sugar).
It is used to treat type 1 diabetes, type 2 diabetes, gestational These include dizziness, dry mouth and skin,
diabetes, and complications of diabetes such as diabetic nausea and increased urination.
ketoacidosis hyperosmolar hyperglycemic states.
Hypoglycemia (low blood sugar).

Side Effects
Hypoglycemia (hypos)
Itching or redness where you inject
Pain when you inject
Bleeding or bruising where you inject
Fatty lumps under the skin (lipohypertrophy)
Changes in your vision
 Pharmacology

Tpyes of Insulin

Short Acting
Generic Trade
Regular insulin, soluble insulin or Regular Humalin r
neutral insulin) starts to work quickly,
Novolin r
and you take it before meals to stop
your blood glucose from going too
high when you eat carbohydrates.

30
70/
ulin
Hum ane
oph an
n is
in suli d hum
an an
Hum ension ion
p t
sus n injec
li
insu

Action Key Info

Rapid-acting insulin analog that facilitates passage of glucose, Short-acting insulin around 30 minutes
potassium, magnesium across cellular membranes of skeletal before each meal.
and cardiac muscle, adipose tissue. Doctor or diabetes nurse will advise you on
Controls storage and metabolism of carbohydrates, protein, fats. when to take it.
Promotes conversion of glucose to glycogen in liver. The timing may depend on which brand
you take.
Only type that can be given IV.
Can be mixed with NPH.
Uses
Take it before meals to stop your blood glucose from going too
high when you eat carbohydrates. Short-acting insulin is
sometimes also known as bolus insulin or mealtime insulin.

Side Effects
Sweating
Trembling or shaking
Fast heartbeat (palpitations)
tingling lips
Feeling dizzy
Feeling hungry
 Pharmacology

Tpyes of Insulin

Intermedia Acting
Generic Trade
Is a type of insulin that you inject once NPH (Neutral Humalin N
or twice a day. It works throughout the Protamine Novolin N
day and night to provide you with low Hagedorn)
levels of insulin all the time. Also
known as basal insulin.

ulin
N
Hum ane
oph an
n is
in suli d hum
an an
Hum ension ion
p t
sus n injec
li
insu

Action Key Info

It helps increase the cellular intake of glucose in the liver, Insulin once or twice a day.
adipose tissue, and skeletal muscles.
If you take it once day, try to stick to the
same time each day.
If you take it twice a day, take your doses
between 8 and 12 hours apart, depending
Uses on your daily routine.
Used to control high blood sugar in people with type 1 (T1DM) Can be mixed with regular insulin.
and type 2 diabetes mellitus (T2DM) along with a proper diet
and exercise.

Side Effects
Sweating.
Trembling or shaking.
Anxiety, confusion or difficulty concentrating.
Fast heartbeat (palpitations)
Tingling lips.
Changes to your vision such as blurred vision.
Feeling dizzy.
Feeling hungry.
 Pharmacology

Tpyes of Insulin

Long Acting
Generic Trade
Is a type of insulin that you inject once Glargine Lantus
or twice a day. It works throughout the
Detemir Levemir
day and night to provide you with low
levels of insulin all the time. Also
known as basal insulin.

us
Lant

Action Key Info

It helps increase the cellular intake of glucose in the liver, Inject long-acting insulin under the skin of
adipose tissue, and skeletal muscles. the abdomen, upper arms, or thighs.
Injections into the abdomen are the
quickest route for insulin to reach the
blood.
The process takes a little more time from
They can control blood sugar for an entire day. This is similar the upper arms and is even slower from the
to the action of insulin normally produced by your pancreas thighs.
to help control blood sugar levels between meals. Can never be mixed

Side Effects Contraindications

Sweating A patient history of allergic reactions to
insulin, its reuse is contraindicated.
Trembling or shaking
In patients with insulinoma, where there is
Anxiety, confusion or difficulty concentrating
excessive endogenous insulin production,
Fast heartbeat (palpitations)
The use of exogenous insulin is
tingling lips contraindicated.
Changes to your vision such as blurred vision
Feeling dizzy
Feeling hungry
 Pharmacology

Tpyes of Insulin

Mixing Insulin

Example
The doctor has asked you to mix 10 units of regular, clear insulin with Vial B Vial A
15 units of NPH cloudy insulin to a total combined dose of 25 units. Regular NPH

Always draw “clear before cloudy” insulin into the syringe. This is to
prevent cloudy insulin from entering the clear insulin bottle.

100 100

90 90

80 80

How to prepare a mixed dose of insulin 70 70

12 Units Air
İnjected 30 Units Air
60 60 İnjected

Roll the cloudy insulin bottle gently between your hands. 50 50

10 10
30 Units Air
Clean the lids of the bottles.
40 40
İnjected 20 20
30 30
12 Units Air 30 30
Draw air into the syringe for the cloudy insulin dose. 20 İnjected 20
40 40

Before drawing the cloudy intermediate insulin into the syringe,

10 10
50 50

roll it gently between the palms 10–20 times. This helps to mix the 60 60

insulin suspension gently. 70 70

80 80

Force air into the cloudy insulin bottle. 90 90

Draw air into the syringe for the clear insulin dose. 100 100

Force air into the clear insulin bottle.

Inject the insulin mixture immediately.
Inject 10 units of AIR into NPH & remove syringe. NPH Regular
Vial A Vial B
Inject 8 units of AIR into Regular Insulin & then turn vial upside
down & draw up 8 units INSULIN & remove syringe.
Insert syringe into NPH & turn upside down & draw up 10 units
INSULIN; plunger should be pulled to 18. Step 1 Step 2 Step 3 Step 4

How to Inject Insulin with a Syringe

Insulin is injected subcutaneously, which means into
the fat layer under the skin.
In this type of injection, a short needle is used to
inject insulin into the fatty layer between the skin and
the muscle.
To avoid injecting into muscle, gently pinch a 1- to 900
2-inch portion of skin. Insert the needle at a
90-degree angle.

Subscutaneous
layer

Muscle Layer
NEURO
 Neuro

Nervous System Overview

The nervous system is the body's communication network, transmitting signals between
the brain, spinal cord, and the rest of the body to control movement, sensation, and
bodily functions, facilitating both voluntary and involuntary actions.

The nervous system can be divided into two main parts:

CNS PNS
Central Nervous System Peripheral Nervous System

Central Nervous System (CNS)

The Central Nervous System (CNS) comprises the brain and spinal cord, serving as the main processing
center for sensory information, motor commands, and higher cognitive functions in the body.

Brain

The brain is the central organ

of the nervous system in
humans and other vertebrates. Parietal
It serves as the command Frontal

center, responsible for

l
ita

processing sensory input, Temporal

cip

regulating bodily functions,

Oc

coordinating movements, and

enabling higher cognitive
functions such as thinking,
memory, and emotion.

Spinal Cord

The spinal cord is a long,

cylindrical bundle of nervous
tissue that extends from the 1
1 Cord
base of the brain down through
the vertebral column. It serves 2 3
2 Nerves

as a pathway for transmitting 3 Pia master

sensory information from the 4 4 Arachnoid

mater
body to the brain and motor 5 Dura mater
commands from the brain to 5
the body, while also facilitating
reflex actions.
 Neuro

Nervous System Overview

FUNCTIONS

The functions of the central nervous system are distributed

across various regions of the brain.

Cerebral Cortex:

Frontal Lobe: Parietal Lobe: Temporal Lobe: Occipital Lobe:

Controls voluntary touch, Manages Auditory Central To Visual
movements, Processing Processing
temperature,
decision-making, Memory Interpreting Visual
pain
Formation Stimuli
planning, contributes to
Language Discerning Shapes,
Expressive speech spatial perception
and attention. comprehension Colors, And Motion.
personality.

Limbic System: Basal Ganglia:

Amygdala: Processes emotions, particularly fear and aggression. Responsible for motor
control, procedural
Hippocampus: Crucial for memory formation and retrieval.
learning, habit
Hypothalamus: Regulates essential bodily functions like hunger, formation, and
thirst, sleep, body temperature, and hormone release. emotional processing.

Brainstem: Cerebellum:
Medulla Oblongata: Controls involuntary functions like Coordinates voluntary
breathing, heart rate, and blood pressure. movements, maintains
balance, posture, and
Pons: Regulates sleep, respiration, swallowing, bladder control,
facilitates motor
and facial movements.
learning.
Midbrain: Involved in visual and auditory reflexes, arousal, and
motor control.
 Neuro

Nervous System Overview

Peripheral Nervous System (PNS)

The Peripheral Nervous System (PNS) is a network of nerves and ganglia that extends from the central
nervous system (CNS) to the rest of the body. It transmits sensory information from the body to the CNS and
carries motor commands from the CNS to muscles and glands, enabling voluntary and involuntary actions.

Peripheral Nervous system

Somatic nervous system Autonomic Nervous system

Sensory Division Motor Division Parasympathetic Sensory Division Enteric Nervous

stimuli from stimuli from CNS to Division "fight and flight" System
periphery to the skeletal muscles "rest and digest" myenteric and
CNS (NMJ) submucosal plexuses
 Neuro

Nervous System Overview

Think S for senses

Somatic Nervous System (SNS)
The division of the Peripheral Nervous System (PNS) is responsible for voluntary movements
and sensory perception.

Sensory Neurons: Voluntary Movements:

Also known as afferent neurons. Initiated and coordinated by signals
from the brain's motor cortex.
Detect stimuli such as touch,
temperature, pressure, and pain. Transmitted through the spinal cord
to specific muscles.
Transmit signals to the Central
Nervous System (CNS). Enable purposeful actions like
REST OF
walking, reaching, and speaking.
BODY CNS
Example: detect stimuli and
transmit signals to the central
nervous system for processing.

Motor Neurons: Reflex Arcs:

Also referred to as efferent neurons. Neural pathways for involuntary reflex actions.
Carry signals from the CNS to Bypass conscious control.
skeletal muscles.
Generate rapid, automatic responses to stimuli.
Control voluntary movements.
Example of Reflex Arc:
Example: transmit signals
CNS REST Touching a hot object triggers sensory neurons.
from the central nervous OF BODY
system to muscles or glands, Signals quickly sent to the spinal cord.
controlling movements or Immediate motor response causes hand
glandular secretion. withdrawal, without conscious thought.

Memory Tricks

SAME DAVE
Sensory Afferent Motor Efferent Dorsal Afferent Ventral Efferent

Sensory neurons (also called afferent neurons) Dorsal (back) nerve roots contain
transmit sensory information from receptors to sensory (afferent) neurons entering the
the central nervous system (CNS). spinal cord.

Motor neurons (also called efferent neurons) Ventral (front) nerve roots contain
carry motor commands from the CNS to motor (efferent) neurons exiting the
muscles and glands. spinal cord.
Afferent= arrives Efferent= exits Signals
Signals arrive at CNS exit CNS body
 Neuro

Nervous System Overview

Autonomic Nervous System (SNS)

The Autonomic Nervous System (ANS) is a division of the peripheral nervous system responsible for regulating
involuntary bodily functions, including heart rate, digestion, respiratory rate, and glandular secretion, to maintain internal
balance (homeostasis) and respond to changes in the environment.

Sympathetic Nervous Parasympathetic Nervous Example of ANS

System (SNS): Remember S for Stress System (PNS): Remember R In para for relax Functioning:
Mobilizes body's resources Promotes relaxation, rest, and Encounter a threat
during stress or danger restoration ("rest and digest"). Sympathetic activation
("fight or flight"). (rapid heart rate, increased
Slows heart rate, constricts
breathing).
Increases heart rate, dilates airways, stimulates digestion,
airways, redirects blood flow and conserves energy. After threat passes
to muscles, and releases Parasympathetic
Dominates during rest,
adrenaline. dominance (slowed heart
facilitating digestion,
rate, relaxed state).
Prepares for physical absorption, and tissue repair.
activity and enhances
response to threats.

Think things that Automatically occur

Heart rate regulation Breathing patterns adjustment Digestive system function

Parasympathetic Sympathetic

Dilates pupil

Stimulates flow of saliva Inhibits flow of saliva

Slow heartbeat Accelerates hearbeat

Constricts bronchi Dilates bronchi

Solar
Plexus

Inhibits peristalsis & secretion

Stimulates peristalsis & secretion

Stimulates release of bile Secretion of adrenaline & noradlenaline

Chain of
Contracts bladder sympathetic Inhibits bladder contraction
ganglia
 Neuro

Neuro Assessment

A neurological assessment is an evaluation of a person's

nervous system function, including the brain, spinal cord, and
peripheral nerves, typically performed by healthcare
professionals to diagnose and monitor neurological conditions.

GLASCOW COMA SCALE

(GCS) assesses the level of consciousness (LOC) in patients through
eye, verbal, and motor responses, assigning a score from 3 to 15.

Eye Opening (E) Verbal Response (V) Motor Response (M)

This component assesses the This component evaluates the This component assesses the
patient's spontaneous eye opening patient's verbalizations or patient's motor responses to
in response to stimuli. It is scored responses to verbal stimuli. It is stimuli. It is scored on a scale from 1
on a scale from 1 to 4, with the scored on a scale from 1 to 5, with to 6, with the following descriptors:
following descriptors: the following descriptors:
Obeys commands (e.g.,
Oriented and converses 6
4 Spontaneous eye opening 5 "squeeze my hand")
coherently
3 Eye opening in response to speech
Disoriented conversation, but 5 Localizes to pain (e.g., moves
4 hand away from painful
able to answer questions stimulus)
2 Eye opening in response to pain
Words, but not coherent (e.g., Withdraws from pain (e.g., pulls
1 No eye opening 3 4
moaning) away from painful stimulus)

2 Incomprehensible sounds Decerebrate posturing

3 (extension) in response to pain
Remember ESPN
1 No verbal response
(like the sports channel)
Decorticate posturing (flexion)
2
in response to pain
Remember our country win
Score Interpretation 1 No motor response

8 or less: Severe brain injury, urgent medical attention required,

patient may be unresponsive. Remember old BE
9-12: Moderate brain injury, patient may be conscious but confused.
13-15: Mild brain injury, minimal symptoms or deficits such as brief Lower score= worse loc
confusion. Establish a BASELINE UPON admission and
conduct subsequent assessments according
≤3 Deep coma or brain dead
to facility protocol.
 Neuro

Neuro Assessment

ORIENTATION Example Questions

Orientation refers to a person's awareness TIME:

of themselves, their surroundings, and the What is the current date?
current situation. It typically includes What day of the week is it?
awareness of time, place, and person.
Can you tell me the time of day?

PLACE:
AAOx4 Means Where are we right now?
Can you tell me the name of
AAOx4 stands for "Awake, Alert & Oriented to this hospital/clinic?
Person, Place, Time, and Events/Situation."
What city or town are we in?
It indicates that an individual is fully conscious
and aware of four key aspects: PERSON:
Person: They know their own identity and Can you tell me your name?
recognize others around them.
Do you know who I am?
Place: They are aware of their physical location
Can you identify any family
or surroundings.
members or caregivers present?
Time: They know the current date and time.

Events/Situation: They understand the

circumstances or events occurring around them.

AAOx4 is a positive indication of intact cognitive

function and awareness.

Posturing
Posturing refers to abnormal body positions or movements that can
occur in response to neurological injury or dysfunction.

Flexed posturing Extended posturing Worse outcome

Decorticate Posturing: Decerebrate Posturing:

Characterized by rigid extension of Characterized by flexion of the
the arms and legs, with the arms arms and wrists toward the
positioned away from the body body, with the legs extended
and the wrists and fingers flexed. and internally rotated.
Typically indicates severe Indicates damage to the
brainstem injury and dysfunction cerebral cortex or severe
of the upper brainstem. damage to the diencephalon.

Problem In cervical Problem In Midbrain Or Pons

Spine Or cerebral Cortex

Look At E's To Remember

Remember core for decorticate DECEREBRATE
 Neuro

Neuro Assessment

LOC Assesses wakefulness

??? !z? ...

!!!
"LOC" stands for "Level of

zZz
Consciousness." It refers to a person's
degree of wakefulness and awareness
of themselves and their surroundings.
Assessing LOC is crucial in evaluating !!! X X
neurological function and detecting
changes in mental status. The level of
consciousness can range from fully
awake and alert to unconsciousness. - !!!

Awake: Lethargic: Stuporous:

Fully conscious and alert, with Shows reduced responsiveness Represents a state of deep
normal cognitive function. and increased drowsiness. unconsciousness, with minimal
Able to interact with the environment Individuals may exhibit slowed responsiveness to stimuli.
and respond appropriately to stimuli. speech and movement, with Individuals may only briefly
diminished interest in their rouse in response to vigorous or
Exhibits normal patterns of eye
surroundings. painful stimuli, such as pinching
movement, speech, and motor
activity. or shaking.

Very Drowsy, Falls Asleep

Alert & Awake, Eyes Open: Sleeping/Sleepy, Awake Easily
Between Care:
Similar to being fully awake but with Stimuli:
Characterized by profound
specifically denotes that the Presents as if asleep or in a
drowsiness, with a tendency
individual's eyes are open. drowsy state but can be
to drift off to sleep frequently,
Indicates a state of heightened quickly awakened with
even during brief periods of
awareness and attentiveness. minimal stimulation.
wakefulness.
Typically occurs when
Often seen in individuals
individuals are fatigued or
experiencing extreme fatigue
Comatose: have been resting.
or sleep deprivation.
The most profound level of
unconsciousness, characterized
by the complete absence of Somnolent:
responsiveness to all stimuli. Obtunded:
Characterized by drowsiness
Individuals do not exhibit any Indicates a decreased level of or sleepiness, with reduced
voluntary movements, speech, or consciousness, with significant alertness.
eye opening. difficulty in arousal.
Individuals may appear to be
Often indicative of a severe Individuals may require on the verge of falling asleep
neurological injury or dysfunction, repeated stimulation, such as but can be easily aroused
requiring immediate medical shaking or loud noises, to with mild stimuli, such as
attention and intervention. maintain wakefulness. verbal cues or gentle touch.
 Neuro

Neuro Assessment

Pupil Assessment Assesses PERRLA

Pupil assessment is a critical component of

neurological examination that involves evaluating the
size, shape, and reactivity of the pupils. It provides
valuable information about the integrity of the nervous No Light Normal Respon Positive RAPD
system, particularly the cranial nerves and brainstem. to Light of Right Eye

Equal Size: Round Shape: Reactivity to Light:

Both pupils are the same size Both pupils have a round Both pupils constrict briskly and
upon inspection, indicating shape, which is considered a equally when exposed to light,
bilateral symmetry. normal anatomical feature. demonstrating a normal
Absence of unequal pupil size Round pupils ensure optimal pupillary light reflex.
(anisocoria) suggests integrity of light entry into the eye and The rapid and equal response
the neurological pathways facilitate accurate visual indicates intact function of the
controlling pupil size. perception. optic nerve (CN II) and
oculomotor nerve (CN III).

Reactivity to Accommodation: Symmetry and Consistency:

Normal Tracking:
Both pupils constrict and exhibit Both pupils demonstrate
convergence when focusing on symmetrical size, shape, and Both pupils constrict and equally
a near object, known as the reactivity to stimuli, move to follow a finger towards
accommodation reflex. suggesting consistent findings the nose, indicating intact ocular
This response ensures clear across assessments. motor function and coordination.
vision at close distances and Symmetry and consistency This coordinated movement
indicates intact function of the are key indicators of normal ensures accurate visual tracking
oculomotor nerve (CN III) and neurological function and and alignment of the eyes,
accommodation pathway. provide valuable information indicating normal function of the
about the integrity of the oculomotor nerve (CN III) and
cranial nerve pathways. associated pathways.

DTR Assesses Motor Response

DTR stands for "Deep Tendon Reflexes," which are involuntary

muscle contractions elicited by tapping or stretching a tendon.
4+ (Very brisk; hyperactive; with clonus): 2+ (Expected response; normal):
Extremely exaggerated response Normal, expected response
with sustained muscle with moderate intensity. Spinal
cord
contractions (clonus).
Reflects intact sensory and
Associated with upper motor motor pathways.
neuron lesions or CNS pathology.
1+ (Somewhat diminished):
3+ (Brisker than average; hyperreflexic):
Weak or slightly reduced 0 (Absent):
Brisk response, often with
response compared to normal. No observable reflex response despite
increased intensity.
Suggests mild impairment of stimulation.
Indicates heightened reflex
the reflex arc. Indicates significant damage to the reflex arc
excitability, possibly due to
conditions like spinal cord or neurological dysfunction.
compression.
 Neuro

Neuro Assessment

Test Positive Negative

Positive findings are typical in newborns to 2-year-olds

but indicate ABNORMALITY in adults.

Babinski Reflex Corticospinal Tract (CST)

Reflex in which the big toe extends upward and the Neural pathway for voluntary motor control from
other toes fan out when the sole of the foot is the cerebral cortex to the spinal cord.
stroked.
Originates in the motor cortex, travels through the
Normal in infants but abnormal in adults, indicating brainstem, and descends down the spinal cord.
potential neurological dysfunction.
Responsible for skilled movements and fine motor
May suggest conditions like spinal cord injury, stroke, control.
or other neurological disorders.
Damage can lead to motor deficits like weakness
Bilateral assessment for symmetry is crucial. and spasticity.
Further evaluation and documentation are essential Assessed through neurological examination and
for proper diagnosis and management. imaging studies. Understanding the CST helps
diagnose and manage motor-related conditions.

Assesses integrity of the

Corticospinal Tract (CST)
 Neuro

Cranial Nerves

Cranial nerves are a set of twelve pairs of nerves that emerge directly from the brain and
primarily innervate structures of the head and neck. These nerves play essential roles in
sensory perception, motor control, and autonomic functions in the head and neck region.

Memory Tricks Cranial nerves

The 12 pairs of cranial nerves include

Olfactory Nerve (CN I) Facial Nerve (CN VII)

Optic Nerve (CN II) Vestibulocochlear Nerve (CN VIII)
Oculomotor Nerve (CN III) Glossopharyngeal Nerve (CN IX)
Trochlear Nerve (CN IV) Vagus Nerve (CN X)
1
Trigeminal Nerve (CN V) Accessory Nerve (XI)
Abducens Nerve (CN VI) Hypoglossal Nerve (XII)

2
Cranial Nerves Mnemonic: Names and Function
3
The mnemonics are: 5
“Only One Of The Two Athletes Felt Very Good, Victorious, 4
And Healthy” and “Some say marry money but my brother
says big brains matter most.”
This will help you remember the following: 7 6
8
9
Only = Olfactory (CN I) =some (sensory) 5
10
One = Optic (CN II) =say (sensory) 11
Of = Oculomotor (CN III) =marry( motor)
The = Trochlear (CN IV) =money (motor)
Two = Trigeminal (CN V) =but (both)
Athletes = Abducens (CN VI) =my (motor)
Felt = Facial (CN VII) =brother(both)
Very = Vestibulocochlear (CN VIII) =says(sensory)
Good = Glossopharyngeal (CN IX) =big(both)
Victorious = Vagus (CN X) =brains(both)
And = Accessory (XI) =matter(motor)
Healthy = Hypoglossal (XII) =most(motor)
 Neuro

Cranial Nerves

CN I Olfactory
The Olfactory nerve (CN I) is
Clinical Significance:
responsible for smell, transmitting Dysfunction can cause loss or distortion
sensory signals from the nose to of smell and may result from infections,
the brain. trauma, or neurological conditions.

Function: Normal Response:

The Olfactory nerve is responsible for Means it can correctly identify the smell
smell (olfaction), transmitting sensory
information from the nose to the brain.
Neuroanatomy:
Test: The nerve consists of olfactory receptor
Patients are asked to identify various cells in the nose, which send signals
scents to assess olfactory function. directly to the olfactory bulbs in the brain
SENSORY

CN II optic Clinical Significance:

Damage can lead to visual disturbances, including
The Optic nerve (CN II) is decreased visual acuity, visual field defects, color
responsible for vision, transmitting vision abnormalities, and blindness. Causes
visual information from the eyes include optic neuritis, glaucoma, trauma, tumors,
to the brain. and neurodegenerative diseases
Function: Normal Response:
Responsible for vision, transmitting It can be able to read with each eye& both
visual information from the eyes to eyes together.
the brain.
Test: Anatomy:
Visual acuity, visual fields, pupillary Originates from the optic disc in the eye and
reflexes, and fundoscopic carries axons to the visual cortex in the brain.
examination are used to assess Partial decussation occurs at the optic chiasm,
SENSORY
optic nerve function. where some fibers cross over to the opposite side.

CN III Oculomotor Clinical Significance:

Dysfunction can cause various eye movement
The Oculomotor nerve (CN III) disorders, ptosis (drooping eyelid), and pupillary
controls eye movements, pupil abnormalities. Causes include compression,
size, and eyelid elevation, trauma, vascular issues, or inflammation.
originating from the midbrain.
Normal Response:
Function: Pupils constrict equally when brought
Controls most eye movements, towards Nose & when exposed to light
including upward, downward, and
medial movements, as well as pupil Anatomy:
constriction and eyelid opening. Originates from the midbrain and innervates
several extraocular muscles (superior rectus,
Test: inferior rectus, medial rectus, and inferior oblique)
Assess for upward, downward, and the levator palpebrae superioris muscle. It
and medial eye movements, as also supplies parasympathetic fibers to the
MOTOR well as pupillary reflexes and pupil-constricting muscles (sphincter pupillae)
eyelid opening. and the ciliary muscle for accommodation.
 Neuro

Cranial Nerves

CN IV Trochlear
The Trochlear nerve (CN IV) Clinical Significance:
controls downward and inward Dysfunction can lead to eye movement
eye movements and originates disorders, ptosis, and pupillary abnormalities
from the midbrain. due to compression, trauma, or inflammation.
Function: Normal Response:
Controls downward and inward It can be able to move eyes down& medially.
eye movements, pupil constriction,
and eyelid elevation. Anatomy:
Test: Originates from the midbrain and innervates
Assess for downward, inward, and the superior oblique muscle, aiding in
upward eye movements, pupillary downward and inward eye movements
MOTOR reflexes, and eyelid elevation.

CN V trigeminal Clinical Significance:

Dysfunction can lead to facial
The Trigeminal nerve (CN V) provides numbness, pain, or weakness, as well as
Ophthalmic nerve (v1) sensation to the face and controls chewing difficulty chewing. Causes include
Maxillary Cervical muscles. Dysfunction leads to facial trigeminal neuralgia, nerve compression,
nerve (v2) Nerves
numbness, pain, or difficulty chewing. or injury.
Function: Normal Response:
Sensory: Can distinguish between sharp & dull
Responsible for sensation in the face
(including touch, pain, and temperature), as Motor: Can open mouth against resistance & bite
well as controlling the muscles involved in
chewing (mastication).
Anatomy:
Originates from the pons and divides into
Test: three branches: ophthalmic (V1), maxillary
Mandilbular Superficial
Nerve (v3) cervical plexus Assess for facial sensation by touching (V2), and mandibular (V3). These branches
various areas of the face with a cotton innervate different areas of the face and
BOTH swab or sharp object. Test motor function provide sensory information. The mandibular
by asking the patient to clench their jaw branch also innervates the muscles involved
or move it from side to side. in chewing.

CN VI Abducens
The Olfactory nerve (CN I) is responsible
Clinical Significance:
lateral for smell, transmitting sensory signals Dysfunction can lead to difficulty moving the
rectus
from the nose to the brain. affected eye outward, resulting in impaired
Abducens eye coordination and double vision.
Function:
nerve

Controls lateral eye movement, Normal Response:

Abducens
nucleus allowing the eye to move outward. It can be Able to moves eyes laterally

Test: Anatomy
Assess lateral eye movement by Originates from the pons in the brainstem
observing the patient's ability to and innervates the lateral rectus muscle,
MOTOR move their eyes outward. which moves the eye laterally.
 Neuro

Cranial Nerves

CN VII Facial
The Facial nerve (CN VII) is responsible for Clinical Significance:
controlling facial expression muscles, Dysfunction can result in facial
taste sensation for the anterior two-thirds weakness or paralysis (Bell's palsy), loss
of the tongue, and providing secretomotor of taste sensation, and dry eyes or
innervation to glands. Dysfunction can mouth. Causes include viral infections,
cause facial weakness, taste loss, and dry trauma, or tumors affecting the nerve.
eyes or mouth, with origins from the
Normal Response:
Function:
Sensory: Able to distinguish taste
Controls facial expression muscles, taste
sensation for the anterior two-thirds of the Motor: Able to perform facial
tongue, and provides secretomotor expressions without difficulty
innervation to various glands, including the
salivary and lacrimal glands. Anatomy:
Originates from the pons and exits the
Test: skull through the stylomastoid foramen.
BOTH Assess facial symmetry at rest and with It branches into five main divisions:
various facial expressions. Test taste sensation temporal, zygomatic, buccal, marginal
on the anterior two-thirds of the tongue. mandibular, and cervical, innervating
Check for normal tear and saliva production. different facial muscles.

CN VIII Vestibulocochlear
The Vestibulocochlear nerve (CN VIII) is Clinical Significance:
responsible for transmitting auditory Dysfunction can lead to hearing loss,
(hearing) and vestibular (balance and vertigo (dizziness), imbalance, or
spatial orientation) information from the nystagmus (involuntary eye movements).
inner ear to the brainstem. Causes include inner ear infections,
acoustic neuromas, or head trauma.
Function:
Responsible for transmitting auditory Normal Response:
information (hearing) from the cochlea Hearing: Can hear clearly in both ears
and vestibular information (balance and
Balance: Able to stand & walk upright
spatial orientation) from the semicircular
while maintaining balance
canals and otolith organs to the brain.

Test: Anatomy:
Assess hearing acuity using tuning forks Originates from the inner ear and divides
SENSORY or audiometry tests. Evaluate balance into the cochlear nerve (for hearing) and
and vestibular function through various the vestibular nerve (for balance), which
positional maneuvers and balance tests. travel together to the brainstem.
 Neuro

Cranial Nerves

CN IX Glossopharyngeal
The Glossopharyngeal nerve (CN IX) is Clinical Significance:
responsible for various functions including Dysfunction can lead to loss of taste
sensation in the posterior third of the tongue, sensation, difficulty swallowing,
taste sensation for the posterior one-third of impaired gag reflex, and alterations
the tongue, monitoring blood pressure and in blood pressure and heart rate
blood gas levels, and innervating muscles regulation. Causes include trauma,
involved in swallowing. tumors, or neurological disorders.
Function: Normal Response:
Responsible for sensation in the posterior third Sensory: Able to distinguish taste
of the tongue, taste sensation for the posterior Motor: Uvula rises symmetrically
one-third of the tongue, monitoring blood upon saying "ahhhh"
pressure and blood gas levels, and innervating
muscles involved in swallowing (pharynx). Anatomy:
Originates from the medulla
Test: oblongata and exits the skull through
BOTH Assess taste sensation on the posterior the jugular foramen. It innervates
one-third of the tongue, evaluate gag reflex, various structures in the throat,
and monitor blood pressure and heart rate including the stylopharyngeus muscle
responses to stimuli. and the pharyngeal mucosa.

CN X Vagus
The Vagus nerve (CN X) regulates Clinical Significance:
autonomic functions such as heart rate, Dysfunction can lead to a variety of
digestion, and vocal cord movement, symptoms, including difficulty swallowing,
originating from the brainstem and changes in heart rate, gastrointestinal
innervating structures in the throat, motility issues, and vocal cord paralysis.
chest, and abdomen. Causes include nerve damage, tumors, or
Function: neurological conditions.
Responsible for a wide range of autonomic Normal Response:
functions, including regulating heart rate,
Gag reflex should be assessed followed
controlling gastrointestinal peristalsis,
by swallow
controlling sweating, and regulating various
organs such as the liver, spleen, and
pancreas. It also plays a role in vocal cord Anatomy:
movement and swallowing. Originates from the medulla oblongata
and travels down through the neck and
BOTH Test: chest, innervating structures in the
Assess swallowing function, evaluate throat, chest, and abdomen. It is the
vocal cord movement, and monitor heart longest cranial nerve and has the widest
rate and gastrointestinal function. distribution in the body.

CN IX & CN X Work Together For Gag & Swallow

 Neuro

Cranial Nerves

CN XI Accessory
The Accessory nerve (CN XI) Clinical Significance:
controls movements of the Dysfunction can lead to weakness or atrophy
sternocleidomastoid and of the sternocleidomastoid and trapezius
trapezius muscles, facilitating muscles, resulting in difficulty with head or
head and shoulder movements. shoulder movements. Causes include
Function: trauma, surgery, or neurological conditions.
Controls movements of the Normal Response:
sternocleidomastoid and trapezius Able to shrug shoulders & turn
muscles, which are involved in head to each side without difficulty
head and shoulder movements.
Anatomy:
Test: Originates from the medulla oblongata and
Assess strength and symmetry spinal cord, exiting the skull through the
MOTOR of shoulder shrugging and head jugular foramen. It innervates the
rotation against resistance. sternocleidomastoid and trapezius muscles.

CN XII Hypoglossal
The Hypoglossal nerve (CN XII) controls Clinical Significance:
movements of the tongue muscles, Dysfunction can lead to weakness or
facilitating functions such as swallowing, atrophy of the tongue muscles, resulting
speech articulation, and tongue in difficulty with speech articulation,
movements for chewing and licking. swallowing, and tongue movements.
Function: Causes include trauma, tumors, or
neurological conditions.
Controls movements of the tongue muscles,
including swallowing, speech, and tongue
movement for tasks like chewing and licking. Normal Response:
Able to move tongue without difficult
Test:
Assess tongue strength and mobility by Anatomy:
asking the patient to protrude their tongue, Originates from the medulla oblongata
MOTOR move it from side to side, and press it and travels through the hypoglossal
against the cheek. canal to innervate the tongue muscles.
 Neuro

Amyotrophic Lateral Sclerosis

What is it?
Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease causing muscle
weakness and paralysis due to the degeneration of motor neurons in the brain and spinal cord.

A Myo Trophic Lateral Sclerosis

No/none Muscle Nutrition Sides Abormal hardening of body tissue

Affects
Normal nerve cell

Upper Motor Neurons (UMNs)

Located in the cerebral cortex or brainstem.

Transmit signals from the brain to the lower
motor neurons in the spinal cord or brainstem.
Responsible for initiating and modulating
voluntary muscle movements.
Damage to UMNs can result in muscle
weakness, spasticity, and hyperreflexia.
Muscle contracts

Never with sclerosis

Lower Motor Neurons (LMNs)

Located in the spinal cord or brainstem (cranial

nerve nuclei).
Receive signals from the upper motor neurons
and directly innervate skeletal muscles.
Responsible for executing motor commands,
leading to muscle contraction.
Damage to LMNs can result in muscle weakness,
atrophy, and hyporeflexia or areflexia.

Muscle unable to contract

 Neuro

Amyotrophic Lateral Sclerosis

Causes/Risk Factors Signs & Symptoms Muscular

Problems

Genetic factors: Approximately 5-10% of ALS Twitching and cramping of muscles,

cases are familial, resulting from inherited especially those in the hands and feet
genetic mutations. Loss of motor control in the hands and arms
Environmental factors: Exposure to toxins like Impairment in the use of the arms and legs
heavy metals or pesticides may increase the risk.
Tripping and falling
Age: ALS typically occurs in adults between 40
and 70 years old, with risk increasing with age. Dropping things

Gender: ALS is slightly more common in men Persistent fatigue

than in women. Uncontrollable periods of laughing or crying
Smoking: Smoking has been associated with a Slurred or thick speech and trouble in
higher risk of ALS. projecting the voice
Physical activity: Some studies suggest
high-intensity physical activity may increase risk, As the disease As ALS progresses
but evidence is inconclusive. progresses, symptoms will have issues with:
may include:
Other medical conditions: Conditions like Eating
frontotemporal dementia may be associated Trouble breathing Speaking
with an increased risk.
Trouble swallowing Breathing
Most common among
Paralysis
40 to 60 year old males

Life Expectancy

Life expectancy typically ranges from 3 to 5 The patient experiences muscle

years following diagnosis. paralysis, and breathing requires
the use of muscles.
ALS is incurable and invariably fatal.
Respiratory failure is the primary cause of
death in most ALS cases.
 Neuro

Amyotrophic Lateral Sclerosis

DIAGNOSTICS Treatment
Lab tests: Blood, urine, and thyroid Medications: FDA-approved drugs like
functioning tests help evaluate overall Riluzole, Edaravone, and Sodium
health and detect any underlying phenylbutyrate-taurursodiol may help slow
conditions. symptom progression.
Muscle or nerve biopsy: Tissue or cell Riluzole (Rilutek, Exservan, Tiglutik). Taken by
samples are examined under a microscope mouth, this medicine can increase life
to diagnose muscle or nerve disorders. expectancy by about 25%. It can cause side
effects such as dizziness, gastrointestinal
Spinal tap (lumbar puncture): Measures conditions and liver problems. Your health care
pressure in the spinal canal and brain, and provider typically monitors your liver function
analyzes cerebral spinal fluid for infections with periodic blood draws while you're taking the
or other issues. medicine.
X-ray: Uses electromagnetic energy beams Edaravone (Radicava). This medicine can
to produce images of internal tissues, bones, reduce the speed of decline in daily functioning.
It's given through a vein in your arm or by mouth
and organs.
as a liquid. Its effect on life span isn't yet known.
Magnetic resonance imaging (MRI): Side effects can include bruising, headache and
Provides detailed images of organs and trouble walking. This medicine is given daily for
structures using magnets, radiofrequencies, two weeks each month.
and a computer.
Symptom management: Medications and
Electrodiagnostic tests (EMG/NCS): therapies address muscle cramps, fatigue,
Evaluates muscle and motor neuron pain, depression, and other symptoms.
disorders by recording electrical activity and
Therapies: Physical therapy improves
muscle responses with electrodes.
mobility, occupational therapy aids in daily
tasks, speech therapy enhances
communication, and nutritional support
ensures proper diet.
Breathing care: Mechanical ventilation
assists breathing, with options like
noninvasive ventilation or tracheostomy.
Psychological and social support: Social
workers and psychologists offer emotional
support, while financial assistance and
equipment provision may be available.
 Neuro

Amyotrophic Lateral Sclerosis

NURSING INTERVENTIONS

Symptom Management: Mobility Support: Respiratory Support:

Administer medications as Assist with the use of mobility Monitor respiratory status closely
prescribed for pain relief. aids like walkers or for any changes.
Provide medication for wheelchairs. Provide respiratory treatments
alleviating muscle cramps. Help with proper positioning such as nebulization or chest
Administer respiratory to prevent discomfort or physiotherapy.
medications to address pressure ulcers. Assist with ventilation devices as
breathing difficulties. Aid in safe transfers to needed for optimal breathing.
maintain independence and
prevent falls.

Nutritional Support: Emotional Support: Education:

Collaborate with dietitians Offer counseling and Educate patients and caregivers
to plan and monitor emotional support to patients about ALS, its progression, and
proper nutrition. and their families. expected symptoms.
Assist with feeding tube Provide information and Provide guidance on symptom
placement and resources about coping management techniques and
management if strategies and support groups. available resources.
swallowing is impaired. Ensure patients feel heard and Empower patients with
Monitor and address any supported throughout their knowledge to make informed
difficulties with swallowing journey. decisions about their care.
or chewing.

Coordination of Care:

Collaborate with interdisciplinary teams to develop individualized care plans.

Communicate effectively with physicians, therapists, and other healthcare professionals.
Ensure seamless coordination and continuity of care for optimal outcomes.
 Neuro

Alzheimer's disease

What is it?
Alzheimer's disease is a progressive
neurodegenerative disorder characterized by Healthy Severe
memory loss, cognitive decline, and changes
in behavior. It is the most common cause of
Brain Alzheimer's
dementia, affecting primarily older adults

Alzheimer's disease typically starts

gradually and progresses slowly, making
it challenging to detect in its early stages.
DEMENTIA
Highest risk:
Age >65
African Americans
Alzheimer's is a type of dementia RISK FACTORS Latinos

Dementia is an umbrella term representing a Age: Advancing age is the greatest risk factor, with
spectrum of symptoms rather than a specific the likelihood of developing Alzheimer's increasing
ailment. significantly after the age of 65.
Different forms of dementia include Family history: Having a close relative, such as a
Alzheimer's disease, Vascular Dementia, Lewy parent or sibling, with Alzheimer's increases the risk
Body Dementia, and Frontotemporal of developing the disease.
Dementia. Genetics: Certain genetic mutations, such as those
Each type of dementia presents with distinct in the APOE gene, can increase the risk of
characteristics and underlying causes Alzheimer's.
Down syndrome: Individuals with Down syndrome
Alzheimer’s is the most common type of Dementia
are at a higher risk of developing Alzheimer's
disease as they age.
Head injury: Severe or repeated head injuries,
especially those involving loss of consciousness,
have been linked to an increased risk of Alzheimer's.
Cardiovascular health: Conditions such as high
blood pressure, diabetes, obesity, and high
cholesterol may increase the risk of Alzheimer's
disease.
Lifestyle factors: Lack of physical activity, smoking,
excessive alcohol consumption, and a diet high in
saturated fats and refined sugars may contribute to
a higher risk of Alzheimer's.
 Neuro

Alzheimer's disease

DIAGNOSTICS

Cognitive assessments: These tests evaluate Biomarker tests: These involve analyzing
memory, language, attention, and other cognitive cerebrospinal fluid or blood samples for
functions to detect any impairment. markers associated with Alzheimer's, such as
Medical history and physical examination: A levels of amyloid-beta and tau proteins.
thorough review of the patient's medical history and Genetic testing: Testing for certain genetic
a comprehensive physical examination can help mutations, such as those in the APOE gene,
rule out other potential causes of cognitive decline. can help identify individuals at increased risk
Neurological examination: This assesses reflexes, of developing Alzheimer's.
muscle strength, coordination, and sensory function Neuropsychological testing: These
to identify any neurological abnormalities. assessments evaluate specific cognitive
Imaging studies: Magnetic resonance imaging (MRI) functions in detail, helping to differentiate
and computed tomography (CT) scans can reveal Alzheimer's from other types of dementia.
brain changes associated with Alzheimer's, such as Positron emission tomography (PET) scans:
shrinkage of brain tissue and the presence of PET imaging can detect amyloid plaques and
amyloid plaques and tau tangles. tau tangles in the brain, providing additional
evidence for an Alzheimer's diagnosis.

Goal of treatment:
Symptom control &
improve quality of life
TREATMENT Nursing Interventions

Manage symptoms effectively and enhance Provide emotional support and reassurance to the patient
overall quality of life. and family members.
Cholinesterase Inhibitors (e.g., Donepezil): Educate the patient and family about the disease process,
treatment options, and available resources.
Prevent the breakdown of acetylcholine, a
Neurotransmitter Crucial For Memory And Monitor the patient's cognitive and functional status
Cognitive Function. regularly.
Commonly used as the first line of treatment, Assist with activities of daily living, such as grooming,
showing modest improvements in symptoms like bathing, and dressing.
memory loss and behavioral issues. Encourage proper nutrition and hydration to maintain
Can help improve symptoms related to behavior, overall health.
such as agitation or depression. Implement fall prevention measures to ensure patient
Available in oral form or as a transdermal patch. safety.
Facilitate communication between the patient, family, and
SSRIs (e.g., Sertraline): interdisciplinary healthcare team.
May have a role in delaying the development and Administer medications as prescribed and monitor for
growth of amyloid-beta proteins and plaques, side effects.
which are linked to Alzheimer's disease.
Promote a calm and supportive environment to reduce
Often prescribed to manage symptoms of agitation and anxiety.
depression and anxiety in Alzheimer's patients.
Provide education and support for caregivers to prevent
Can contribute to overall well-being and quality of burnout and promote self-care.
life by addressing mood-related symptoms.
Regular monitoring for side effects such as
gastrointestinal disturbances or sleep
disturbances is necessary.
 Neuro

Alzheimer's disease

STAGES OF ALZHEIMER'S

Mild Cognitive Mild Moderate Severe

Impairment Alzheimer’s Alzheimer’s Alzheimer’s

Duration: 7 Years Duration: 2 Years Duration: 2 Years Duration: 3 Years

Early Stage: Mild Middle Stage: Moderate Late Stage: Severe

Forgetfulness, especially Increased memory loss and Severe memory impairment.

recent events. confusion. Loss of verbal
Minor challenges in Difficulty recognizing family communication.
planning and organization. and friends. Swallowing difficulties and
Mood changes and mild Behavioral changes and weight loss.
personality shifts. restlessness. Complete dependence on
Aware of memory lapses Communication challenges caregivers.
but still independent. and wandering. Limited mobility and
Mild difficulties in Need assistance with daily confinement.
problem-solving. tasks. Increased vulnerability to
Higher risk of accidents and infections.
falls.

Memory loss is often

first & main symptom
Forgetting names
Misplacing items
Not recalling events
 Neuro

Delirium

What is it?
Delirium is a sudden, fluctuating change in mental state characterized
by confusion, disorientation, and impaired attention. It often occurs in
response to an underlying medical condition or medication.

There is always an underlying cause of delirium

Difference Between Delirium And Dementia

Delirium Dementia

Acute and reversible, often caused Chronic and irreversible condition.

by medical conditions or
Dementia progresses slowly over time.
medications
Dementia primarily affects memory,
Delirium typically has a rapid onset
language, and problem-solving
and fluctuating course,
abilities.
Delirium is characterized by
Dementia is primarily caused by
disturbances in attention,
neurodegenerative diseases such as
awareness, and cognition, often
alzheimer's.
accompanied by hallucinations or
delusions Dementia has no cure and requires
ongoing management of symptoms.
Delirium may be triggered by
infections, medications, surgery, or
metabolic imbalances
Delirium can often be resolved with
treatment of the underlying cause.

A sudden change in neuro status is a medical emergency Alert PCP immediately!

 Neuro

Delirium

Fluctuate throughout
RISK FACTORS SYMPTOMS the day

Advanced age: Increased risk in older adults. Mental confusion (especially new confusion
Dementia or cognitive impairment: that develops over hours or days)
Pre-existing conditions elevate susceptibility. Difficulty in paying attention, listening or
Hospitalization: Higher risk due to illness and absorbing information
medications. Lack of interest in one’s surroundings, seeming
Surgery: Major procedures or anesthesia raise “out of it”
susceptibility. Difficulty thinking or remembering
Medical conditions: Infections and organ Drowsiness or lethargy
failure can precipitate delirium.
Feeling disoriented as to time and place
Medications: Certain drugs, especially
Sensitivity to light and sounds
psychoactive ones, increase risk.
Distortions in sensory perception: seeing or
Substance abuse: Alcohol or drug misuse
hearing things differently
contributes to delirium.
Hallucinations: seeing or hearing things that
Sensory impairment: Vision or hearing issues
are not there. The person may pick at or brush
heighten vulnerability.
their hands over their bedclothes to remove
Sleep disturbances: Disrupted sleep patterns dirt or insects that are not present.
exacerbate cognitive dysfunction.
Delusions: fixed ideas not based in reality. For
Dehydration or malnutrition: Inadequate instance, people with delirium may fear that
intake leads to metabolic disturbances. providers or family members are trying to
Stressful life events: Trauma or loss can trigger harm them.
delirium. Euphoria, anxiety or agitation
Environmental factors: Hospital settings and
disruptions impact susceptibility.
Prolonged stays in the intensive care unit (ICU)

ICU delirium

ICU delirium: Acute confusion in ICU patients.

Symptoms: Altered consciousness, disorientation,
hallucinations.
Risk factor: Prolonged ICU stays.
Consequences: Increased morbidity and mortality.
Importance: Early recognition and management
crucial.
 Neuro

Delirium

Goal: Treat
Diagnostics Treatment underlying cause!

Symptom observation: Diagnosis is primarily Sedatives: Given sparingly to alleviate

based on observing abrupt changes in agitation or anxiety, but some may
mental status. exacerbate delirium.
Urine and blood tests: Identify underlying Antipsychotics: Used cautiously for severe
causes like infection or metabolic agitation or psychosis associated with
imbalances. delirium.
EEG: Detect certain seizure disorders Benzodiazepines: Occasionally used for
associated with delirium-like symptoms. sedation in specific cases, but can worsen
Imaging tests: Brain CT or MRI may be delirium symptoms.
recommended to identify inflammation or Antidepressants: Not typically used for
strokes. delirium treatment, but may be considered
Lumbar puncture: Used to diagnose or rule if depression is a contributing factor.
out meningitis in some cases.
Monitor closely!
Can cause respiratory
depression

Nursing Interventions

Regular Assessment of Mental Status and Monitoring Promoting Sleep Hygiene: Assisting in
for Changes: Consistently evaluating the patient's maintaining a regular sleep schedule and
cognitive function and watching for any alterations. minimizing disruptions to improve rest.
Providing a Calm and Supportive Environment: Collaborating with the Healthcare Team:
Creating surroundings that are tranquil and Working together with other medical
reassuring to minimize agitation. professionals to address underlying health issues.
Ensuring Patient Safety: Taking measures to prevent Educating Patients and Caregivers: Offering
accidents and falls, eliminating potential hazards. guidance and information to both patients and
Encouraging Orientation to Time, Place, and Person: their caregivers about preventing and managing
Helping the patient remain oriented to their delirium
surroundings, time of day, and identity.
 Neuro

Delirium

CAM Scale (Confusion Assessment Method)

The CAM Scale is an evidence-based tool used to identify delirium by examining specific criteria such
as rapid changes in behavior, attention deficits, disorganized thinking, and alterations in consciousness.

Rapid Change & Fluctuating Behavior: Interdisciplinary Use: It can be administered by

Checks if there is a sudden change in various healthcare professionals, including nurses,
behavior or thought process and if it varies physicians, and psychologists.
over time. Diagnostic Aid: Helps clinicians differentiate
Lack of Focus: Assesses if the patient has delirium from other cognitive impairments like
difficulty maintaining attention and is easily dementia or depression.
distracted. Monitoring Tool: Used to track changes in a
Disorganized Thinking: Determines if the patient's condition over time, especially in critical
patient's thoughts seem jumbled or unclear. care settings.
Altered Consciousness: Evaluates the Training Requirement: Proper training is
patient's overall level of awareness and necessary for accurate administration and
alertness. interpretation of CAM Scale results.
Methodical Assessment: The CAM Scale Sensitivity and Specificity: It has demonstrated
follows a structured approach to evaluate high sensitivity and specificity for detecting
each criterion systematically. delirium in various clinical settings.

A positive CAM Score requires Constantly switching subjects

immediate further investigation!
Irrelevant topics
Illogical flow of ideas
 Neuro

Types Of Stroke

What is it?
Cerebrovascular accident (stroke) is a sudden disruption of Stroke
blood flow to the brain, leading to neurological deficits, such as
paralysis or impaired speech, typically caused by a clot or
ruptured blood vessel.

Patho

Cerebrovascular accident (stroke) disrupts blood

flow to the brain.
Ischemic strokes occur due to blocked blood
vessels, while hemorrhagic strokes result from Hemorrhagic strokes involve intracerebral
ruptured vessels. or subarachnoid bleeding.
Ischemia leads to neuronal injury or death by Severity and deficits following a stroke
depriving brain cells of oxygen and nutrients. depend on the extent of brain damage.
Ischemic strokes can be caused by thrombotic or Early recognition and treatment are
embolic occlusions. critical for better outcomes.

1. Ischemic
Ischemic stroke occurs due to a blockage or Blocked Artery
obstruction in a blood vessel supplying the brain.

Thrombotic
Normal Artery
Thrombotic stroke is caused by a blood
clot forming in an artery supplying blood
to the brain.
Treatment

FIBRINOLYTIC THERAPY
Embolic
The treatment of ischemic stroke typically involves
Embolic stroke results from a clot or administering clot-busting medications such as tissue
debris traveling from elsewhere in the plasminogen activator (tPA) or performing a
body and lodging in a brain blood vessel, procedure called thrombectomy to remove the clot
causing sudden blockage and impaired and restore blood flow to the affected area of the brain.
blood flow. It's commonly linked to
conditions like atrial fibrillation or heart
valve issues. Must be given within 4.5 hours of onset of symptoms
 Neuro

Types Of Stroke

2.Transient Ischemic Attack (TIA)

A transient ischemic attack (TIA), often referred
to as a "mini-stroke," is a temporary disruption
of blood flow to the brain, resulting in symptoms
similar to those of a stroke but lasting for a Treatment
shorter duration, typically less than 24 hours..
Antiplatelet Therapy
Aspirin: Often prescribed
Symptoms: Mimic those of a stroke, to reduce the risk of blood clot formation.
such as sudden weakness, numbness,
Clopidogrel: Another antiplatelet medication that
or vision changes.
may be used alone or in combination with aspirin.
Duration: Typically lasts for a few
minutes to 24 hours and resolves Carotid Endarterectomy:
without causing permanent damage. Surgical procedure to remove plaque buildup in the
Warning Sign: Indicates high risk for a carotid artery, reducing the risk of stroke in individuals
potential ischemic stroke and requires with significant blockage.
immediate medical attention.
Statin Therapy: Prescribed to lower cholesterol
Risk: Individuals who experience a TIA levels and decrease the risk of future
are at higher risk of having a stroke in cardiovascular events.
the future and should undergo
thorough evaluation and treatment to Anticoagulants: Used in cases of atrial fibrillation or
reduce this risk other conditions where blood clots are a concern.

3.Hemorrhagic
Treatment
A hemorrhagic stroke is characterized by the
bursting or weakening of blood vessels in the brain,
leading to the leakage of blood into brain tissue. CRANIOTOMY: Surgical procedure to remove blood
clots or repair ruptured blood vessels in the brain,
reducing intracranial pressure (ICP).
MANNITOL: Administration of mannitol, a diuretic, to
promote osmotic diuresis and decrease ICP.
Blood Pressure Management: Controlling and
stabilizing blood pressure to prevent further bleeding
and reduce the risk of recurrent hemorrhage.
Monitoring and Supportive Care: Continuous
monitoring of vital signs and neurological status,
along with supportive care such as oxygen therapy
Leads to Ischemia & Increased ICP
and fluid management.
Rehabilitation Therapy: Physical, occupational, and
The leading cause often stems from speech therapy to help regain lost function and
poorly managed high blood pressure. improve quality of life after the stroke.
Medications: Administration of medications such as
anti-seizure drugs, pain relievers, and medications to
Linked to greater rates of illness and
death compared to ischemic strokes.
prevent complications like infections.

Ineligible For Tpa Due To The

Risk Of Exacerbating Bleeding.
 Neuro

Types Of Stroke

SYMPTOMS Risk Factors

High blood pressure (hypertension).
Sudden numbness or weakness in the face, Diabetes.
arm, or leg, especially on one side of the body. High cholesterol.
Sudden confusion, trouble speaking, or Obesity.
understanding speech.
Physical inactivity.
Sudden trouble seeing in one or both eyes. Family history of stroke.
Sudden trouble walking, dizziness, loss of Age over 55.
balance, or coordination.
Previous stroke or transient ischemic attack (TIA).
Sudden severe headache with no known
Cardiovascular diseases such as heart disease or
cause. atrial fibrillation.
Difficulty swallowing.
Changes in consciousness or loss of Life Style Factors
consciousness. Smoking.
Facial drooping. Excessive alcohol consumption.
Difficulty with fine motor skills or coordination. Poor diet high in saturated fats, cholesterol, and
sodium.
Loss of bladder or bowel control.
Lack of physical activity or exercise.
Obesity or overweight.
Inadequate sleep or sleep disorders.
Left side symptoms Right side symptoms Substance abuse.
Weakness or Weakness or Poor management of chronic conditions like
paralysis on the right paralysis on the left diabetes or hypertension.
side of the body. side of the body. Social isolation or lack of social support.
Difficulty speaking or Difficulty speaking or
understanding understanding
language. language.
Vision problems in Vision problems in
the right eye. the left eye.
Numbness or tingling Numbness or tingling
on the right side of on the left side of the
the body. body.
 Neuro

Types Of Stroke

Diagnostics NURSING INTERVENTIONS

Neurological exam: Assesses reflexes, Neuro checks: Regular monitoring of

strength, and coordination. consciousness and vital signs.
Blood tests: Evaluate cholesterol, clotting Positioning: Proper positioning to prevent
factors, and glucose levels. complications like pressure ulcers.
ECG: Examines heart rhythm. Mobility aid: Assisting with mobility
Carotid ultrasound: Assesses blood flow in exercises to prevent complications.
neck arteries. Dysphagia management: Monitoring
Angiography: X-rays with contrast dye for swallowing and preventing aspiration.
brain vessel visualization. Skin care: Regular assessments to prevent
Doppler ultrasound: Evaluates brain artery pressure ulcers.
blood flow. Bowel/bladder care: Monitoring and
Lumbar puncture: Collects spinal fluid for preventing urinary retention/constipation.
analysis. Medication administration: Administering
EEG: Records brain wave patterns. prescribed medications.

Imaging: CT or MRI scans for visualizing brain Education: Providing stroke prevention and
structures. rehabilitation guidance.
Emotional support: Offering support to
patients and families.
Collaboration: Working with the team for
REPEAT CT optimal care coordination.
SCAN AT
24 HOURS
when given TPA
 Neuro

GUILLAIN-BARRE Syndrome

What is it?
Gullain-Barre
Guillain-Barré syndrome (GBS) is a rare
neurological disorder where the body's Syndrome
immune system mistakenly attacks its
Affects nerves in the
peripheral nerves, leading to muscle weakness,
brain and spinal cord
numbness, and in severe cases, paralysis.

Normal Nerve

Patho

Autoimmune disorder where the immune Myelin

system attacks peripheral nerves.

Results in demyelination (damage to the myelin

sheath) and sometimes axonal damage.
Affected Nerve

Leads to muscle weakness, paralysis, and

sensory disturbances.

Often preceded by a viral or bacterial infection Exposed

nevrve fiber
triggering the immune response.
Damaged Myelin

Myelin sheath: Protective covering for nerve

Risk Factors

Prior viral or bacterial infection,

such as respiratory or No Known Cause
CAMPYLOBACTER
gastrointestinal infections.
JEJUNI INFECTION
Recent vaccination, particularly Family history of
MOST COMMON
influenza or tetanus vaccines. Guillain-Barré syndrome.
CAUSE
Other autoimmune conditions, Certain medications or
like systemic lupus surgeries may also
erythematosus or HIV/AIDS. increase the risk.
 Neuro

GUILLAIN-BARRE Syndrome

ACUTE onset & ASCENDING

Symptoms MUSCLE WEAKNESS

Weakness or tingling sensations

starting in the legs and
spreading to the upper body. 2
Loss of reflexes, particularly in
1 Hands and feet begin to
have a tingling sensation.
the legs and arms.
Difficulty with bladder control or 2 Muscle weakness stats in
on both sides of the body,
bowel function. 1
making it difficult to climd
Severe pain, particularly in the stairs or walk.
back or legs.
Breathing difficulties, 3 Within two weeks, the
respiratory system could
requiring mechanical 3
become paralyzed.
ventilation in severe cases.
Progressive muscle
weakness or paralysis,
usually ascending from the
legs to the arms and face.

Treatment
Begins in LOWER EXTREMITIES &
progresses UPWARD bilaterally
Intravenous immunoglobulin (IVIG) therapy: Administered to reduce
the severity and duration of symptoms by suppressing the immune
response.
DIAGNOSTICS
Plasma exchange (PLASMAPHERESIS): Removes antibodies from the
blood that may be attacking the nerves, helping to alleviate symptoms.
Electromyography (EMG) and nerve Supportive care: This includes physical therapy to maintain muscle
conduction studies (NCS) to assess strength and mobility, respiratory support if breathing becomes
nerve and muscle function. impaired, and pain management.
Blood tests to check for elevated white Monitoring: Close monitoring of respiratory function, blood pressure, and
blood cell count and antibodies overall neurological status is essential to manage complications and
associated with Guillain-Barré ensure timely intervention.
syndrome.
Symptom Management
Imaging studies such as MRI or CT
scans to rule out other conditions and Analgesics: Used to alleviate muscle and joint pain associated with
assess nerve damage. Guillain-Barré syndrome.

Physical examination to evaluate Anticoagulants: Not typically prescribed for VTE prevention in paralyzed
muscle strength, reflexes, and sensory patients with Guillain-Barré syndrome.
function. Other measures: Include frequent position changes, compression
Lumbar puncture (spinal tap) to stockings, and early mobilization to reduce the risk of VTE.
analyze cerebrospinal fluid for
elevated protein levels.
GBS is self-limiting, but�severe muscle paralysis
can�lead to RESPIRATORY FAILURE
High protein in CSF may indicate
antibodies/ inflammation
 Neuro

GUILLAIN-BARRE Syndrome

Nursing interventions for ABC's Airway is priority!

Monitor breathing, vital signs (VS), and arterial blood Anticipate need for mechanical ventilation:
gases (ABGs): Regularly assess respiratory status and Be prepared to initiate ventilatory support if
oxygenation to detect any changes promptly. respiratory failure ensues.
Chest physiotherapy: Perform techniques such as Venous thromboembolism (VTE)
percussion and postural drainage to help clear prophylaxis (SCDs): Implement measures
respiratory secretions and improve lung function. to prevent blood clots, such as applying
Keep head of bed (HOB) elevated: Maintain the sequential compression devices (SCDs) to
patient in a semi-Fowler's position to optimize lung promote venous return.
expansion and reduce the risk of aspiration.

Nursing interventions for Supportive care

Comfort measures: Provide a conducive environment, Nutritional support: Ensure adequate nutrition
including pain management and emotional support, and hydration through oral intake or alternative
to enhance the patient's well-being. methods such as tube feeding or parenteral
Hygiene assistance: Assist with personal hygiene nutrition.
tasks to maintain cleanliness and dignity. Psychosocial support: Offer emotional support
Positioning and mobility: Help the patient change and engage in therapeutic communication to
positions regularly and encourage gentle movements address the patient's psychological needs and
to prevent pressure ulcers and maintain mobility. promote coping mechanisms.

Guillain Barre inpatient rehabilitation

interdisciplinary team

Speech Psyical Dietitian Occupational Nurse Physician Social

Language Therapist Therapist Worker
pathologist
 Neuro

Encephalopathy

What is it?
Encephalopathy refers to a broad term describing brain
dysfunction or damage, leading to altered mental status,
cognitive impairment, and neurological symptoms.

SYMPTOMS Encephalo Pathy

Brain Disease
Infections
Metabolic disorders Encephalitis Encephalopathy
Toxins
Lack of oxygen Encephalitis involves Encephalopathy refers to a broad
Autoimmune diseases inflammation of the brain term for brain dysfunction that can
usually due to an infection. have various causes such as
Genetic disorders metabolic disorders, toxins, or lack
(Encephalitis can cause
Traumatic brain injury encephalopathy ) of oxygen.
Vascular disorders Examples: Hepatic encephalopathy
Nutritional deficiencies Examples: Herpes simplex (due to liver dysfunction), uremic
virus, West Nile virus, encephalopathy (due to kidney
Other factors Japanese encephalitis virus. failure), toxic-metabolic
encephalopathy (due to toxins or
metabolic disturbances).

TYPES OF ENCEPHALOPATHY
Acute (Rapid alterations, reversible upon prompt treatment of the underlying cause)

1.Wernicke 2.Hepatic
Neurological disorder caused by thiamine deficiency. Relating to the liver.
Causes: Causes:
Alcoholism: Medications: Certain drugs, Liver disease or damage.
Malnutrition especially sedatives or Excessive alcohol consumption.
opioids, may impair cognitive
Gastrointestinal function and contribute to Viral infections like hepatitis.
disorders: Conditions like encephalopathy. Medications and toxins.
liver disease or intestinal
malabsorption. Prolonged IV feeding Metabolic disorders.
Medical conditions: Other factors: Traumatic brain Autoimmune conditions.
Underlying diseases injury, genetic disorders, or
Inherited disorders.
such as kidney failure exposure to toxins can also
precipitate encephalopathy. Ischemic injury.
or infection.
 Neuro

Encephalopathy

3.Toxic metabolic 4.Uremia

Toxic metabolic encephalopathy occurs due to Relating to or caused by the accumulation of
the buildup of toxins in the body, affecting brain waste products normally excreted in the urine,
function and causing neurological symptoms typically due to kidney dysfunction.

Causes: Causes:
Medication side effects Infections Kidney Dysfunction Infections and
Alcohol or drug intoxication Metabolic Medications: Autoimmune Diseases

Liver or kidney failure disorders Chronic Urinary Tract

Poisoning Conditions: Obstructions: Rarely,
Electrolyte imbalances blockages or
Diseases like
diabetes or high congenital
blood pressure can abnormalities in the
lead to kidney urinary system can
5.Hypertensive damage over time. lead to uremia.

Characterized by high blood pressure above

normal levels.

Causes: Certain medications or drug use, such as cocaine.

Uncontrolled high blood pressure. Adrenal gland tumors or disorders.
Kidney disease or dysfunction. Thyroid disorders.
Preeclampsia or eclampsia during pregnancy. Use of birth control pills or hormone therapy.

Chronic
Chronic (Changes occur gradually, leading to irreversible consequences as the progression unfolds over time.)

1.Hypoxic Ischemic 2.Hashimoto's Exact cause unknown

Hypoxic-ischemic encephalopathy Hashimoto's thyroiditis is an autoimmune disorder

(HIE) refers to brain injury caused characterized by inflammation of the thyroid gland,
by oxygen deprivation and leading to hypothyroidism.
reduced blood flow to the brain.
Causes:
Causes:
Autoimmune reaction targeting the thyroid gland.
Prolonged lack of oxygen due to
cardiac arrest or respiratory failure Gradual destruction of thyroid tissue by immune cells.

Near drowning incidents Production of antibodies that attack thyroid cells.

Complications during childbirth Genetic predisposition may play a role.

Severe trauma or injury resulting in Environmental factors, such as viral infections, may
restricted blood flow to the brain trigger the autoimmune response.
 Neuro

Encephalopathy

3.Traumatic 4.Glycine
Resulting from physical injury Central nervous system neurotransmitter regulating
or trauma. motor and sensory functions.

Causes: Causes:
Head trauma or injury Inborn errors of Impaired glycine reuptake
metabolism. or transport mechanisms.
Severe blows to the head
Deficiency in enzymes Certain medications or
Penetrating injuries to the skull
involved in glycine drugs affecting glycine
Accidents or falls causing degradation. metabolism.
brain damage
Mutations in genes Abnormalities in liver
related to glycine function affecting glycine
metabolism. clearance.

5.Spongiform Excessive dietary Genetic disorders affecting

intake of glycine. glycine receptors or
Characterized by the formation of synaptic function.
sponge-like holes in the brain tissue

Causes:
Prion protein misfolding and
SYMPTOMS Hallmark Sign

accumulation.
Genetic mutations affecting Altered mental status, ranging from confusion to coma.
prion protein. Cognitive dysfunction, including memory loss and
Consumption of contaminated impaired concentration.
meat products. Changes in personality or behavior.
Familial history of prion diseases. Impaired motor function, such as tremors or involuntary
movements.
Sleep disturbances, including insomnia or excessive
drowsiness.
Progressive Nature of
Speech difficulties, such as slurred speech or difficulty
Encephalopathy Symptoms finding words.
Gradual worsening of symptoms Sensory changes, such as blurred vision or hearing
over time impairment.
Confusion Physical symptoms like headache, nausea, or vomiting.
Cognitive dysfunction Seizures or abnormal movements.
Behavioral changes Symptoms of underlying conditions contributing to
encephalopathy, such as liver failure or kidney
Impaired motor function
dysfunction.
Sleep disturbances
Speech difficulties
Sensory changes
Persistent physical symptoms
Increased risk of seizures or
abnormal movements
 Neuro

Encephalopathy

Nursing Inventions LOC

Labs
ICP EKG
Monitor neurological status regularly.
VS Airway
Implement fall prevention measures.
Provide adequate hydration and nutrition.
SAFETY
Administer medications as prescribed.
Monitor and manage symptoms of underlying conditions. Bed alarm on

Monitor for signs of worsening symptoms and complications. Hourly rounding

Educate patient and family about the condition and its management. Near nurse's station

Collaborate with the healthcare team for comprehensive care.

HOB elevated
Maintain a safe environment to prevent injury.
stimuli
Provide emotional support and reassurance to the patient and family.
Avoid straining

Treatment depends on cause & type of encephalopathy

Wernicke’s Toxic Metabolic

Thiamine supplementation: High-dose Discontinuing or adjusting medications that are
thiamine is given intravenously to rapidly causing toxicity.Providing supportive care, such as
replenish depleted thiamine levels in the intravenous fluids, to maintain hydration and
body. This is usually the first and most critical electrolyte balance.
step in treatment.
Hypertensive
Uremic Intravenous medications such as nicardipine,
Dialysis: Hemodialysis or peritoneal dialysis is labetalol, or nitroprusside to rapidly reduce
often necessary to remove waste products and blood pressure.
excess fluids from the blood, reducing uremic Rehabilitation therapies, including physical
toxins and improving overall kidney function. therapy, occupational therapy, and speech
therapy, to address any deficits in motor
Hepatic function, cognition, or communication.
Lactulose and rifaximin are commonly Collaboration with a multidisciplinary
prescribed to lower ammonia levels and healthcare team to provide comprehensive
prevent its absorption from the intestines. care and address the complex needs of
patients with encephalopathy.

Medications
Lactulose or rifaximin to lower blood Thiamine for Wernicke's encephalopathy.
ammonia levels. Diuretics for cerebral edema.
Benzodiazepine antagonists for Sedatives or antipsychotics for agitation.
overdose-related cases.
Symptomatic relief with analgesics or antiemetics.
Anti-seizure drugs to control seizures.
 Neuro

Fibromyalgia

What is it?
Fibromyalgia is a chronic disorder characterized Fatigue Sleep Jaw pain
disturbance,
by widespread musculoskeletal pain, fatigue, cognitive problems,
sleep disturbances, and tender points in specific memory problems, Paired tender
areas of the body. headaches, and points
dizziness

Problems
FIBRO MY ALGIA with vision Nausea

Fibrous tissue Muscle Pain Urinary

problems
Dysmenorrhe
a (in women)
Fibromyalgia Pathophysiology Skin
problems

Fibromyalgia's exact cause is unknown.

Patients with fibromyalgia often have low levels
of serotonin.
Serotonin inhibits pain signals transmitted by
nerves (nociceptors). Joints pain and Restless leg
morning stiffness syndrome
It decreases the activity of substance P, a pain
perception chemical.
Serotonin limits the production of nerve growth
factor, which amplifies pain signals.
These biochemical changes contribute to
heightened pain sensitivity in fibromyalgia.
Serotonin = Happy Hormone

Risk Factors

Gender: Women are Other disorders: Fibromyalgia is often Sedentary lifestyle:

more likely to develop associated with other conditions like Lack of physical
fibromyalgia than men. rheumatoid arthritis, lupus, or irritable activity or exercise
Family history bowel syndrome. Sleep disturbances
Trauma Stress Obesity
Infections Genetics
 Neuro

Fibromyalgia

Primary Symptoms Secondary Symptoms

of Fibromyalgia of Fibromyalgia
Gender: Women are Stress Headaches
more likely to develop Trauma
fibromyalgia than men. Mood disorders: Anxiety, depression, or
Infections mood swings.
Family history
Genetics Irritable bowel syndrome (IBS): Abdominal
Other disorders: pain, bloating, diarrhea, or constipation.
Fibromyalgia is often Sedentary lifestyle:
associated with other Lack of physical Sensory sensitivities: Heightened
conditions like activity or exercise sensitivity to light, sound, touch, or
rheumatoid arthritis, Sleep disturbances temperature changes.
lupus, or irritable bowel Numbness or tingling
Obesity
syndrome.
Joint pain
Other symptoms: Restless legs syndrome,
dry eyes or mouth, frequent urination, or
sensitivity to certain foods or
No specific laboratory
medications.
Diagnostics or imaging test

Widespread pain index (WPI): Assessing the To Diagnose Fibromyalgia,

presence of pain in specific body regions.
Need To Have Pain In 4/5 Areas:
Symptom severity scale (SSS): Evaluating the
severity of symptoms such as fatigue, cognitive
Left Upper Right Upper
difficulties, and waking unrefreshed.
Region: Including Region, Including
Physical examination: Based On Clinical Findings
Shoulder Shoulder
Examination conducted according to observed Arm
clinical symptoms, including BILATERAL pain Arm
both above and below the waist. Must meet Jaw Jaw
both criteria
Enduring widespread pain persisting for a
minimum of three months. Left Lower Right Lower
Region, Including Region, Including
Blood tests: These may be conducted to rule out
other conditions such as autoimmune disorders, Hip, Hip,
thyroid dysfunction, or vitamin deficiencies. Buttock Buttock
Imaging tests: X-rays, MRIs, or other imaging Leg Leg
studies may be ordered to rule out other causes
of pain.
Axial Region, Which Includes
Trigger point examination: Identifying areas of
Neck, Chest
heightened sensitivity or pain response to
pressure. Back, Abdomen
Medical history: Discussing symptoms, onset,
duration, and impact on daily activities with the
healthcare provider.
 Neuro

Fibromyalgia

Goal of treatment:
TREATMENT Symptom control &
NURSING INTERVENTIONS
improve quality of life
ALTERNATIVE THERAPIES TEACH to avoid triggers
A variety of different therapies can help reduce Identify triggers Environmental
the effect that fibromyalgia has on your body factors
Stress management
and your life. Examples include:
Sleep hygiene Activity pacing
Physical therapy: Journaling
Dietary modifications
Occupational therapy:
Encourage lifestyle modifications
Counseling:
Diet Social support:
Medications Exercise Emphasize the
importance of building
Pain relievers: Stress a strong support
Over-the-counter pain relievers like management: network of friends,
acetaminophen, ibuprofen, or naproxen can Teach relaxation family, or support
help. Avoid opioids due to side effects and techniques groups for emotional
dependence, which worsen pain over time. Sleep hygiene and practical support.
Antidepressants: Pace activities Self-care: Encourage
self-care practices
Antidepressants like duloxetine and
milnacipran can relieve pain and fatigue. TEACH Stress reduction techniques
Amitriptyline or cyclobenzaprine may
aid sleep. Deep breathing: Practice slow, deep breaths
for relaxation.
Anti-seizure drugs:
Progressive muscle relaxation: Tense and
Anti-seizure drugs like gabapentin and relax muscles to relieve tension.
pregabalin can reduce fibromyalgia
Mindfulness meditation: Focus on present
symptoms.
moment to reduce stress.
Guided imagery: Visualize calming scenes for
relaxation.
Yoga or Tai Chi: Gentle movements for stress
relief.
Biofeedback: Monitor and control
physiological responses.
Stress management: Learn time
management and problem-solving.
 Neuro

Hydrocephalus

Definition: Normal Hydrocephalus

Hydrocephalus is a disorder in which the
cerebral ventriculaar system contains an
excessive amount of Ceebrospinal Fluid (CSF)
and is dilated because of increased pressure.

Derived from Greek words: “Hydro”= Water

“Cephalus”= Head

Leads to increased
intracranial pressure (ICP)

FUNCTIONS OF CSF CAUSES

CUSHIONING: CSF acts as a protective Congenital abnormalities: Structural

cushion for the brain and spinal cord, defects present at birth can obstruct the
absorbing shock and preventing injury. flow of cerebrospinal fluid (CSF) or
Waste removal: CSF helps remove interfere with its absorption.
metabolic waste products from the central Infections: Certain infections, such as
nervous system, maintaining a clean meningitis or encephalitis, can lead to
environment for optimal neural function. inflammation in the brain and blockages in
Regulation of intracranial pressure: CSF the pathways of CSF circulation.
regulates pressure within the skull, Tumors: Brain tumors can obstruct the flow
ensuring stable conditions for proper brain of CSF or disrupt the normal production
function. and absorption processes.
Nutrient transport: CSF transports Hemorrhage: Bleeding in the brain, either
essential nutrients, such as glucose, due to trauma or other medical conditions,
hormones, and ions, to the brain cells while can lead to the accumulation of blood and
removing metabolic waste. subsequent obstruction of CSF flow.
Signaling: CSF serves as a medium for Trauma: Head injuries or trauma to the
signaling molecules, facilitating brain can cause damage to structures
communication between different parts of involved in CSF circulation, leading to
the central nervous system and hydrocephalus.
coordinating various physiological Idiopathic: In some cases, the exact cause
processes. of hydrocephalus may not be identified,
and it is termed idiopathic.
 Neuro

Hydrocephalus

Early detection and

SYMPTOMS TREATMENT treatment= Better outcome

Headache Difficulty walking or Shunt Placement: Involves inserting a

Nausea and balancing catheter into the ventricle to drain excess
vomiting Cognitive decline or cerebrospinal fluid (CSF) into another body
memory problems cavity where it can be absorbed.
Blurred or double
vision Difficulty walking Endoscopic third ventriculostomy (ETV): A
procedure that drains excess CSF into an
Loss of bladder Macrocephaly external collection system.
control. (enlarged head)
Neurosurgery: If there's a mass or tumor
Changes in mood Problems with causing the hydrocephalus, neurosurgical
or behavior balance, coordination, intervention may be necessary.
speech or memory
Observation: In cases where hydrocephalus
is stable and not causing significant
SUNSET SIGN symptoms, close monitoring without
refers to the bilateral downward gaze of immediate intervention may be appropriate.
the eyes, where the lower eyelid covers Medications: Depending on the underlying
the bottom portion of the iris and pupil. cause or associated symptoms, medications
such as

Diuretics: Diuretics are drugs that increase

urine output and help remove excess fluid
DIAGNOSTICS and electrolytes from the body.
Anticonvulsants: Anticonvulsants are
Imaging: CT scans or MRI to visualize drugs designed to prevent or reduce the
ventricles and brain structures. occurrence of seizures.
Lumbar puncture: Measurement of CSF Antibiotics : (if caused by infection)
pressure and analysis of fluid composition.
Ultrasound: Used in infants to assess
ventricular size and monitor progression.
Neurological examination: Assessment of Contraindications For
symptoms such as headache, nausea, and
visual disturbances.
Lumbar Puncture
Fundoscopic exam: is swelling of the optic Elevated intracranial pressure (ICP) from
nerve head due to increased pressure within conditions like brain tumors, where lumbar
the skull, often caused by conditions such as puncture could increase the risk of herniation.
hydrocephalus. aka Papilledema Presence of infection near the puncture site,
Observation: Monitoring symptoms and as performing the procedure in such cases
progression over time. may introduce pathogens into the
cerebrospinal fluid (CSF), leading to further
infection.
Abnormal coagulation or bleeding disorders,
as these conditions can increase the risk of
bleeding or clotting complications during or
after the procedure.
 Neuro

Hydrocephalus

PATHOLOGY NURSING INTERVENTIONS

Monitoring neurological status and vital signs

CSF overproduction, poor absorption, regularly.
or obstruction
Assessing for signs and symptoms of
increased intracranial pressure (ICP).

CSF accumulates in the brain's Positioning the patient to promote venous

ventricular system drainage and reduce ICP.
Administering prescribed medications, such
as diuretics or anticonvulsants.
Excessive CSF pressure compresses Educating patients and caregivers about the
brain tissue condition, treatment, and signs of
complications.
Providing emotional support to patients and
Elevated pressure inside the skull occurs families coping with the diagnosis.
Collaborating with the healthcare team to
ensure appropriate management and
follow-up care.
Neurological decline due to
brain compression.

NOTE: Chronic hydrocephalus leads to

ventricular dilation while maintaining
normal intracranial pressure (ICP).
 Neuro

Increased ICP

Definition:
Increased ICP refers to elevated pressure INCREASED INTRACRANIAL PRESSURE (ICP)
within the skull, which can result from various
conditions such as head trauma, brain tumors,
or hydrocephalus.

Normal ICP: 5-15 mmHg *Life-threatening

>20 mmhg NEEDS TREATMENT pressure w/in skull

ICP LEADS TO
CERBRAL BLOOD FLOW

Monro Kellie Hypothesis

Increased pressure in the brain: Refers to elevated Monro Kellie Hypothesis states that within the skull, the
levels of intracranial pressure within the cranial cavity. combined volume of the brain, blood, and
cerebrospinal fluid remains relatively constant.
Brain gets "squeezed": Describes the compression of If one component, such as the brain, blood, or CSF,
brain tissue due to increased pressure, which can lead increases in volume, another must decrease to
to various neurological symptoms. maintain normal intracranial pressure.
Failure of this compensatory mechanism can lead to
Brain swelling & edema: Indicates the accumulation of increased intracranial pressure, which may result in
fluid within the brain tissue, causing swelling and serious neurological consequences.
potential damage to brain cells.

If Pressure Is Continuous, Body Is Unable To Compensate

Can lead to HERNIATION if not treated
Displacement of brain due to severe skull pressure

Risk Factors
Treat the underlying cause
Traumatic brain Hydrocephalus Intracranial
(Hypertension, Infection, Brain Tumor, Etc.) injury (TBI) hemorrhage
Infections such
Brain tumors as meningitis Intracranial
Stroke Encephalitis hypertension
syndromes
TREATMENT Hemorrhage Brain abscess

Craniotomy: Surgical procedure to remove

part of the skull, relieving pressure caused by
swelling.
Ventriculostomy: Placement of a catheter into Medications:
the ventricles of the brain to drain excess
Diuretics (Acetazolamide and Mannitol): Promote osmotic
cerebrospinal fluid and reduce pressure.
diuresis, reducing fluid volume in the brain and lowering ICP.
Hyperventilation: Inducing controlled
Pressors or Antihypertensives: Maintain adequate blood
hyperventilation to lower carbon dioxide levels
pressure to support cerebral perfusion while managing ICP.
in the blood, which can help reduce cerebral
blood volume and intracranial pressure. Barbiturates: Reduce metabolic demand and lower ICP by
inducing coma-like states.
Decompressive craniectomy: Surgical
removal of part of the skull to allow the brain to Anticonvulsants: Prevent seizures, which can exacerbate
expand without being compressed by the skull. cerebral metabolic demand and increase ICP.
 Neuro

Increased ICP

SYMPTOMS Cushing's Triad

Papilledema (swelling of the optic nerve)
Hypertension
Severe headache Changes in behavior or personality
Irregular breathing
Nausea and vomiting Lethargy or drowsiness
Pupillary changes
Blurred or double vision Weakness or paralysis
Bradycardia LATE SIGN
Altered level of consciousness Difficulty speaking or understanding
Seizures
EARLIEST SIGN

NURSING INTERVENTIONS
MANNITOL
CLOSE MONITORING
Mannitol is an osmotic diuretic, a type of
Elevate the head of the bed to promote venous
medication that works by drawing excess fluid drainage.
from brain tissues into the bloodstream, ultimately
promoting its excretion through the kidneys. Maintain a quiet and dimly lit environment to
reduce stimuli.
Monitor for signs of Monitor for signs of fluid overload Administer medications as prescribed to reduce
ICP, such as diuretics or osmotic agents.
Crackles: Abnormal lung sounds indicating fluid
accumulation in the lungs. Monitor neurological status frequently for any
changes in level of consciousness or
JVD (Jugular Venous Distention): Swelling of the jugular
neurological deficits.
veins in the neck due to increased venous pressure.
Implement seizure precautions if indicated.
Edema: Swelling caused by fluid retention in body
tissues. Monitor vital signs closely, especially blood
pressure and respiratory rate.
Assess for signs of herniation, such as changes
SEIZURE PRECAUTIONS in pupil size or responsiveness, and report
promptly.
Provide emotional support and education to the
Suction at bedside: Having suction equipment patient and family about the condition and
readily available near the patient's bed to manage treatment plan.
secretions and prevent aspiration during seizures.
Padded siderails: Placing padded rails on the sides MAINTAIN ICP
of the bed to prevent injury in case of seizures and
HOB ≥30 degrees: Elevate the head of the bed
provide a cushioned surface.
to at least 30 degrees to promote venous
Side rails up: Raising the side rails of the bed to drainage from the brain and reduce
prevent the patient from accidentally falling out intracranial pressure.
during a seizure episode.
Avoid valsalva maneuver (straining): Instruct
Bed in low position: Lowering the bed to the lowest the patient to avoid activities that increase
position to minimize the risk of injury if the patient intra-abdominal pressure, such as straining
were to fall during a seizure. during bowel movements or heavy lifting,
which can elevate intracranial pressure.
Decreased stimuli: Minimize environmental
Oxygen and
stimuli, such as noise and bright lights, to
suction ready
reduce agitation and stress, which can
exacerbate increased intracranial pressure.

Depressed breathing can lead to HYPERCAPNIA

Cause cerebral vessels to dilate & ICP to rise

bed in lowest position Side rails up Pad side rails

 Neuro

Meningitis

Pia mater
Definition:
Dura mater
Meningitis is an infection and inflammation of
the fluid and membranes surrounding the Arachnoid
brain and spinal cord. These membranes are mater
called meninges.

DURA MATER
The dura mater is the outermost and toughest
layer of the meninges, the protective membranes Normal Meningitis
surrounding the brain and spinal cord. It serves to
provide structural support and protection for the
Can Cause Rapid Increase In Csf & Icp
central nervous system.

Head
ARACHNOID MATER Skull
The arachnoid mater is a thin, delicate membrane
between the dura mater and pia mater, forming a
protective barrier around the brain and spinal cord.

PIA MATER
The pia mater is the innermost layer of the
meninges, directly covering the brain and
spinal cord.

RISK FACTORS
Risk factors for meningitis include:
Skipping vaccinations. Risk rises for anyone who hasn't Weakened immune system. AIDS,
completed the recommended childhood or adult alcohol use disorder, diabetes, use
vaccination schedule. of immunosuppressant drugs and
Living in a community setting. College students living in other factors that affect your
dormitories, personnel on military bases, and children in immune system increase the risk of
boarding schools and child care facilities are at greater meningitis. Having a spleen
risk of meningococcal meningitis. This is probably removed also increases risk. People
because the bacterium is spread through the respiratory without a spleen should get
route, and spreads quickly through large groups. vaccinated to lower the risk.

Pregnancy. Pregnancy increases the risk of an infection Age. Most cases of viral meningitis
caused by listeria bacteria, which also may cause occur in children younger than age
meningitis. The infection increases the risk of miscarriage, 5 years. Bacterial meningitis is
stillbirth and premature delivery. common in those under age 20.

Viral Bacterial
Most common in children <5 years old Most common in newborns & teens
 Neuro

Meningitis

SYMPTOMS TREATMENT

Early meningitis symptoms may be similar to Medication:

the flu. Symptoms may develop over several
Antibiotics: Administered promptly, often
hours or over a few days.
intravenously, to treat bacterial meningitis.
Possible symptoms in anyone older than the
Antiviral medications: Used to treat viral
age of 2 years include:
meningitis caused by specific viruses.

Sudden high fever. Sleepiness or Antifungal medications: Administered to

trouble waking. treat fungal meningitis, which is less
Stiff neck. common but can be severe.
Severe headache. Sensitivity to light.
Corticosteroids: Sometimes prescribed to
Nausea or vomiting. No appetite or thirst. reduce inflammation and swelling in the
Positive Brudzinki's brain.
Confusion or trouble
concentrating. sign
Supportive care:
Seizures. Positive Kernig's sign
Including pain relief, hydration, and
management of any complications such as
seizures or increased intracranial pressure.
BRUDZINSKI'S SIGN KERNIG'S SIGN Isolation precautions: Implemented to
Knee & Hip Flexion Pain with passive prevent the spread of contagious forms of
When Neck Flexed extension of knee meningitis.
Vaccination: Encouraged to prevent certain
types of bacterial meningitis, such as those
caused by Haemophilus influenzae type b
DIAGNOSTICS (Hib), Streptococcus pneumoniae, and
Neisseria meningitidis.
Diagnostics for meningitis typically include:

Lumbar puncture: Analyzing cerebrospinal

fluid (CSF) for signs of infection. COMPLICATIONS
Blood cultures: Identifying bacteria or
other pathogens in the bloodstream. Meningitis complications can be severe. The
longer you or your child has the disease without
Imaging studies: Such as MRI or CT scans
treatment, the greater the risk of seizures and
to visualize any abnormalities in the brain
permanent neurological damage, including:
or meninges.
Hearing loss. Trouble walking.
Memory Seizures.
VIRAL BACTERIAL problems. Kidney failure.
clear & normal cloudy & Learning Shock.
glucose glucose disabilities.
Death.
Brain damage.
 Neuro

Meningitis

More Severe: Remember

BACTERIAL B inbacterial for BAD VIRAL

Caused By Caused By
Herpes simplex Neisseria Enteroviruses Mumps virus
virus meningitidis
Herpes simplex Lymphocytic
Mycoplasma Haemophilus virus choriomeningitis virus
pneumoniae influenzae type B
West Nile virus Varicella-zoster virus
Listeria Group B (causes chickenpox
Influenza viruses
monocytogenes Streptococcus and shingles)
Measles virus
Streptococcus Staphylococcus Epstein-Barr virus
pneumoniae aureus HIV (causes infectious
Escherichia coli Salmonella species mononucleosis)

CSF Profile
CSF Profile
Appearance: Clear - Refers to the clarity or
Pressure: Increased: Elevated intracranial transparency of the cerebrospinal fluid (CSF).
pressure.
Pressure: Normal - Indicates the pressure
Protein: Increased: Higher protein levels in within the CSF, which should fall within a
cerebrospinal fluid. typical range.
Glucose: Decreased: Lower glucose levels in Protein: Normal - Represents the
cerebrospinal fluid. concentration of protein in the CSF, which
Gram stain: Positive: Presence of bacteria should be within normal limits.
visible under Gram staining. Glucose: Normal - Reflects the glucose level
WBC: Neutrophils: Elevated neutrophil count in the CSF, which should be within the normal
in cerebrospinal fluid. range.
Appearance: Cloudy: Turbid or opaque Gram stain: Negative - Indicates the result of
appearance of cerebrospinal fluid. a Gram staining procedure, which is used to
identify bacteria in a sample. A negative
result means no bacteria were detected.
WBC: Lymphocytes - Refers to the type of
white blood cells (WBCs) present in the CSF,
NURSING INTERVENTIONS which may indicate the presence of infection
or inflammation. Lymphocytes are a type of
immune cell.
INITIATE DROPLET PRECAUTIONS Can also be caused by fungi or
parasites but not common
Implement infection control
measures to prevent the spread
of infectious agents transmitted
by respiratory droplets. PREVENT INCREASED ICP
HOB ≥30 degrees: Elevate the head of the bed to at least 30 degrees to
Frequent Neuro Checks & promote venous drainage from the brain and reduce intracranial pressure.
Vital Signs Avoid Valsalva maneuver (straining): Advise the patient to avoid activities
Ice packs/cooling blanket as that increase intra-abdominal pressure, such as straining during bowel
needed for fever: Seizure movements, as it can elevate intracranial pressure.
precautions: such as padding Decreased stimuli: Minimize environmental stimuli such as noise, bright
siderails and maintaining a lights, and unnecessary interventions to reduce stress and prevent
safe environment. exacerbation of intracranial pressure.
 Neuro

Multiple Sclerosis

Definition: Multipple sclerosis

Multiple sclerosis (MS) is a chronic autoimmune
disease of the central nervous system (CNS)
characterized by inflammation, demyelination, and
subsequent damage to the myelin sheaths
surrounding nerve fibers. This leads to impaired Healthy Effected
Exposed
Neuron Neuron
nerve signaling. Nerve

Damage
usually associated with relapses & remissions Nerve Nerve Damage
Signal Signal Myelin
Sheath

MYELIN SHEATH

The myelin sheath is a fatty covering around

nerve fibers, aiding in efficient nerve impulse Affects Nerves In Brain & Spinal Cord,
transmission. Leading To Sensory & Motor Defecits
In multiple sclerosis, the body is
attacking it's own Myelin Sheath!

SYMPTOMS
RISK FACTORS
SENSORY
Age. MS can occur at any age, but onset usually Numbness or weakness in one or more limbs
occurs around 20 and 40 years of age. However, that typically occurs on one side of your
younger and older people can be affected. body at a time
Sex. Women are more than 2 to 3 times as likely as Tingling
men are to have relapsing-remitting MS.
Electric-shock sensations that occur with
Family history.
certain neck movements, especially bending
Certain infections. the neck forward (Lhermitte sign)
A variety of viruses have been linked to MS, including Problems with sexual, bowel and bladder
Epstein-Barr, the virus that causes infectious function
mononucleosis. LHERMITTE SIGN
Race. White people, particularly those of Northern short & intense electric shock
European descent, are at highest risk of developing MOTOR sensation that travels down
neck & spine to extremities
MS. People of Asian, African or Native American
descent have the lowest risk. A recent study suggests Lack of coordination
that the number of Black and Hispanic young adults Unsteady gait or inability to walk
with multiple sclerosis may be greater than
previously thought. Partial or complete loss of vision, usually in
one eye at a time, often with pain during eye
Climate. since exposure to the sun when a mother is
pregnant seems to decrease later development of movement
multiple sclerosis in these children.
COGNITIVE
Vitamin D. Having low levels of vitamin D and low
exposure to sunlight Prolonged double Fatigue
vision Slurred speech
Your genes. A gene on chromosome 6p21 has been
found to be associated with multiple sclerosis. Blurry vision Cognitive problems
Obesity. Vertigo Mood disturbances
Certain autoimmune diseases.
thyroid disease, pernicious anemia, psoriasis, type 1 symptoms may worsen with heat
diabetes or inflammatory bowel disease.
Smoking.
 Neuro

Multiple Sclerosis

DIAGNOSTICS TYPES of MS Most Common

Neurological examination Relapsing-remitting MS (RRMS):

Magnetic resonance imaging (MRI) of the brain and Characterized by periods of symptom
spinal cord exacerbation (relapses) followed by periods of
partial or complete recovery (remissions).
Lumbar puncture (spinal tap) to analyze
cerebrospinal fluid Secondary progressive MS (SPMS):
Electrophysiological tests, such as nerve conduction
Begins as relapsing-remitting MS but eventually
studies and evoked potentials
transitions into a progressive form with a
continuous worsening of symptoms.
Primary progressive MS (PPMS):
TREATMENT Symptoms worsen gradually from the onset of
the disease, without distinct relapse or remission
NO CURE phases.
BETA INTERFERON: An immunosuppressant and Progressive-relapsing MS (PRMS):
anti-inflammatory medication aimed at reducing
the frequency and severity of relapses. Features a steady progression of symptoms
with occasional relapses and minor remissions.
Corticosteroids: Used during relapses to reduce
inflammation and shorten the duration of
symptoms.
Baclofen: Helps alleviate muscle spasms, a
common symptom of MS. NURSING INTERVENTIONS
Monitoring neurological status: Regular assessments
GOAL OF TREATMENT: Symptom control of motor function, sensation, and cognitive abilities.
& slow disease progression
Assisting with mobility: Providing support and aids as
needed for ambulation.
Managing symptoms: Administering medications for
(MS) TRIGGERS pain, spasticity, and bladder dysfunction.
Educating patients: Providing information on
symptom management, energy conservation
Environmental factors: Pollution, exposure to toxins techniques, and lifestyle modifications.
Hormonal changes: Pregnancy, menstrual cycle Promoting safety: Preventing falls and injuries by
fluctuations ensuring a safe environment and educating
Medications: Certain medications may worsen patients on fall prevention strategies.
symptoms or interact with MS treatments Supporting emotional well-being: Offering emotional
Emotional stress: Anxiety, depression, or other support, counseling, and referrals to support groups
emotional stressors or mental health professionals as needed.
Poor hydration: Dehydration can exacerbate Encouraging range of motion (ROM) exercises and
symptoms gentle strengthening exercises: Assist patients in
maintaining mobility and muscle strength to prevent
Smoking: Smoking has been linked to an increased muscle weakness and contractures.
risk of MS progression
Providing education to avoid triggers:
Poor diet: High-fat diets, low in fruits and
vegetables Educate patients about potential triggers such as
stress, overheating, or infections, and strategies to
Allergies: Allergic reactions may trigger minimize their impact on exacerbating MS
inflammation and worsen symptoms symptoms.
 Neuro

Myasthenia Gravis

NORMAL NEUROMUSCULAR MS AFFEDTED

JUNCTION NEUROMUSCULAR JUNCTION

Definition:
BLOCKED
Myasthenia gravis is an autoimmune ACH
ACH
ACH
neuromuscular disorder characterized by muscle RECEPTOR RECEPTOR
weakness and fatigue, particularly in the muscles
that control eye movement, facial expression,
chewing, swallowing, and speaking.

MYASTHENIA GRAVIS MUSCLE

Abnormal Muscle Grave/ severe
Weakness
IN MYASTHENIA GRAVIS, some ACH receptors are
blocked, not allowing muscle fibers to access ACH,
which leads to MUSCLE WEAKNESS
NEUROMUSCULAR JUNCTION
The neuromuscular junction is the site where
ACETYLCHOLINE (ACH)
the motor neuron and muscle connect,
allowing for the release of acetylcholine. Acetylcholine (ACH) is a neurotransmitter
responsible for facilitating muscle contraction.

The neuromuscular system involves our nervous

system and muscles working together to control, The main function of acetylcholine is to. Help in
direct and allow movement of the body. synaptic transmission of nerve impulse.
Movement-related disorders include motor neuron
disease, Parkinson's disease, multiple sclerosis,
Huntington's disease, muscular dystrophy and polio.
SYMPTOMS

Risk factors Common symptoms of myasthenia gravis include:

Droopy eyelids (ptosis). Slurred

Risk factors for myasthenia gravis include: speech(dysarthria)
Double vision.
Gender (more common in women) Weak arms, legs or neck.
Difficulty making facial
Age (most commonly diagnosed before age 40 expressions. Shortness of breath and
or after age 60) occasionally serious
Problems chewing and
breathing difficulties.
Family history of myasthenia gravis difficulty swallowing.

Certain autoimmune diseases, such as thyroid

disorders or lupus
Descending Weakness
Exposure to certain medications, such as
antibiotics or heart medications Weakness starts in face and progresses downwards

Thymoma, a tumor of the thymus gland

THYMUS PLAYS LARGE ROLE IN IMMUNE SYSTEM
The presence of a tumor may lead to an
overproduction of antibodies, which then attack
and interfere with receptor sites, contributing to the
development of myasthenia gravis.
 Neuro

Myasthenia Gravis

DIAGNOSTICS TENSILON TEST

Edrophonium test: Temporary improvement If a patient's symptoms exhibit temporary

in muscle strength after injection of improvement after injection, it indicates a
edrophonium chloride. Also known as positive result for myasthenia gravis during
Tensilon Test the Tensilon test, confirming the diagnosis.

Blood tests: Detection of antibodies against

acetylcholine receptors or muscle-specific
kinase (MuSK) If a patient's symptoms exhibit temporary
Electromyography (EMG): Measures electrical improvement after injection, it indicates a
activity in muscles to assess muscle positive result for myasthenia gravis during
weakness the Tensilon test, confirming the diagnosis.
Nerve conduction studies: Evaluates nerve
function and transmission to muscles

If Negative, Must Give Atropine For Antidote

Take 30-60 Mins Before
TREATMENT Meals For Strength For
Chewing & Swallowing

NO CURE
Anticholinesterase (Pyridostigmine):
Action: Prevents breakdown of ACH
EDROPHONIUM (TENSILON)
(acetylcholine) at neuromuscular junction
Prevents breakdown of acetylcholine at the
Purpose: Increases availability of ACH, neuromuscular junction refers to the action of
enhancing muscle contraction acetylcholinesterase inhibitors, which prolong
the availability of acetylcholine, enhancing
Corticosteroids:
muscle contraction and alleviating symptoms
Action: Decreases inflammation of myasthenia gravis.
Purpose: Helps alleviate symptoms by
reducing autoimmune response IVIG
(Immunoglobulin):
Action: Provides passive immunity by
administering antibodies
Purpose: Used in severe cases to
modulate immune response and reduce
symptoms
Thymectomy
Action: Surgical removal of the thymus
gland
Purpose: Reduces abnormal immune
response and may help improve
symptoms of myasthenia gravis

Goal of treatment: Symptom

prevention & management
 Neuro

Myasthenia Gravis

COMPLICATIONS

Cholinergic Crisis Cholinergic Crisis Myasthenia Crisis Myasthenia

(Overmedication) Crisis(undermedication

Pupil constriction: Excessive narrowing of

the pupils due to overstimulation of the Severe muscle weakness caused by the
nervous system by acetylcholine. exacerbation or deterioration of symptoms.

Bronchoconstriction: Constriction of the

airways in the lungs, leading to difficulty in
breathing, caused by excessive Can Cause Respiratory Failure!
acetylcholine activity.
Abdominal cramping: Pain or discomfort
in the abdomen resulting from increased Treatment: Ivig
neuromuscular activity due to excess
acetylcholine.
NURSING INTERVENTIONS
Urinary frequency: Increased urge to
urinate frequently due to heightened
Monitor respiratory status closely
activity of the bladder muscles caused by
an excess of acetylcholine. Assist with activities of daily living as needed
Provide frequent rest periods to conserve
Treatment: Atropine energy
Administer medications as prescribed and
monitor for adverse effects
Safety precautions; HIGH FALL RISK
Educate patient on the importance of
avoiding triggers and adhering to treatment
regimen

weakness gets worse with activity & improves

with rest Schedule rest periods with activity
 Neuro

Parkinson’s Disease

Definition:
PARKINSON'S DISEASE (PD) or PARALYSIS AGITANS is an
autoimmune disorder characterized by the
Decrease
progressive loss of nerve cells in the Substantia Nigra Healthy Affected Dopamine
region of the brain, leading to a deficiency in Neuron Neuron Production
DOPAMINE production.

SUBSTANTIA NIGRA

The substantia nigra is a region in the midbrain

of the brainstem that plays a key role in Dopamine Receptor
Cell
movement control. It is involved in the production
of dopamine, a neurotransmitter that is essential
for coordinating smooth and controlled muscle A decrease in dopamine levels results in an
movements. imbalance in neurotransmitters, including
an increase in acetylcholine activity. This
imbalance contributes to the motor
symptoms observed in Parkinson's disease.
DOPAMINE

Dopamine is a neurotransmitter responsible for Leads to overstimulation and

regulating various functions in the brain, including :
increased cholinergic activity
Movement The Experience of pleasure progresses gradually overtime
and satisfaction.
Memory
Motivation
DIAGNOSTICS
Cause Not
RISK FACTORS Completely Known No specific test to diagnose
Clinical Evaluation: Neurologists assess
Age: The risk of developing Parkinson's disease movement, muscle tone, and coordination, along
increases with advancing age. with reviewing medical history and symptoms.
Genetics: Having a family history of Parkinson's disease Response to Medication: Positive response to
increases the likelihood of developing the condition. dopaminergic drugs like levodopa supports the
diagnosis.
Environmental Factors: Exposure to certain
environmental toxins, such as pesticides or herbicides, DaTscan: Measures dopamine transporter levels in
may increase the risk. the brain to detect reduced uptake.
Gender: Men are slightly more likely to develop Blood Tests: Rule out other conditions causing
Parkinson's disease than women. similar symptoms.
Head Trauma: Previous head injuries or trauma to the Imaging: MRI, CT, and PET scans help rule out other
brain may be associated with an increased risk. brain disorders and assess dopamine activity.
Rural Living: Some studies suggest that living in rural Electrophysiological Studies: Evaluate muscle
areas or farming communities may be associated with activity and nerve function.
a higher risk of Parkinson's disease, possibly due to Cerebrospinal Fluid Analysis: Occasionally used to
pesticide exposure. analyze biomarkers associated with Parkinson's
Certain Medical Conditions: Certain medical disease.
conditions, such as Wilson's disease or Lewy body
dementia, may increase the risk of developing
Parkinson's disease.
Medications: Some medications, particularly
antipsychotic drugs and drugs used to treat nausea,
may slightly increase the risk of Parkinson's disease.
 Neuro

Parkinson’s Disease

Diagnosed Based Off Eval For Symptoms

Speech & swallow eval: Assessment to evaluate any speech or swallowing

difficulties, common in Parkinson's disease due to muscle control issues.
Barium swallow: A diagnostic test where a patient ingests barium, allowing
visualization of the swallowing process on X-rays to detect any abnormalities.
PT eval: Physical therapy evaluation aimed at assessing motor function,
Must have bradykinesia & 1
mobility, and balance to develop a tailored exercise plan. or more of other 3 hallmark
signs for diagnosis
OT eval: Occupational therapy evaluation to assess functional abilities in daily
activities and recommend strategies or aids to improve independence and
quality of life.

SYMPTOMS TREATMENT

The HALLMARK signs of Parkinson's Treatment of Parkinson's Disease typically involves

Disease include: a combination of medications, therapy, and lifestyle
modifications. Common treatments include:
Bradykinesia: Slowed movement and difficulty
initiating movement. Medications: Most Common
Tremor: Involuntary shaking, often seen in Levodopa/ Carbidopa: Converts into
hands, arms, legs, or jaw. dopamine in the brain, helping to alleviate
motor symptoms.
Rigidity: Stiffness or inflexibility of muscles,
making movement difficult. Dopamine agonists: Mimic the effects of
dopamine in the brain.
Postural instability: Impaired balance and
coordination, leading to instability and falls. MAO-B inhibitors: Increase dopamine levels
by inhibiting its breakdown.
Stooped posture: Bent or hunched-over posture,
COMT inhibitors: Extend the duration of
often due to muscle stiffness and rigidity.
levodopa's effects.
Pill-rolling tremor: Tremors of the hands and
Anticholinergics: Help control tremors and
fingers that resemble the motion of rolling a pill
muscle stiffness.
between the fingers and thumb.
Mask-like face: Reduced facial expression, Deep brain stimulation (DBS): Surgical procedure
leading to a fixed or expressionless facial involving the implantation of electrodes in the brain
appearance. to modulate abnormal brain activity.
Shuffling gait: Walking pattern characterized by Physical therapy: Exercises to improve mobility,
short, shuffled steps and reduced arm swing. flexibility, balance, and posture.
Cogwheel rigidity: Muscle rigidity that causes a Occupational therapy: Strategies to manage daily
jerky, stop-and-go movement when extending activities and maintain independence.
a limb, resembling the movement of a Speech therapy: Techniques to improve speech
cogwheel. clarity and swallowing function.
Depression: Persistent feelings of sadness, Lifestyle modifications: Regular exercise, balanced
hopelessness, and loss of interest or pleasure in nutrition, and adequate rest can help manage
activities, commonly associated with symptoms and improve overall well-being.
Parkinson's Disease.
Supportive care: Counseling, support groups, and
educational resources can provide emotional
support and practical guidance for individuals and
their caregivers.
 Neuro

Parkinson’s Disease

NURSING INTERVENTIONS

AMBULATION HIGH FALL RISK NUTRITION

Always assist with ambulation: Provide Assess swallow ability: Evaluate the patient's
physical support and supervision during ability to swallow safely to prevent aspiration
walking to prevent falls and ensure safety. and choking.
Wear low heeled shoes: Encourage the use of OT & PT: Involve occupational and physical
footwear that provides stability and reduces therapists to assist in addressing any
the risk of falls. functional limitations related to eating and
Reduce rugs & cords to avoid tripping: swallowing.
Ensure the environment is free from obstacles Adequate fiber intake (at risk for
that may cause tripping hazards. constipation): Encourage a diet rich in fiber to
Encourage assistive devices: Recommend promote regular bowel movements and
the use of walking aids such as canes or prevent constipation, which is common in
walkers to improve stability and mobility. Parkinson's disease.
Increase calorie, soft diet: Recommend a diet
that is higher in calories and consists of softer
foods to accommodate chewing and
swallowing difficulties often experienced by
EDUCATION individuals with Parkinson's disease.

Use rocking motion to initiate movement:

Teach the patient techniques such as Avoid foods high in B6 (affect Levodopa intake): Advise
rocking back and forth or shifting weight the patient to avoid consuming foods high in vitamin
from side to side to help initiate movement B6, as it may interfere with the absorption and
when experiencing freezing episodes. effectiveness of Levodopa, a common medication used
Include regular exercise to help maintain to manage Parkinson's symptoms.
movement: Educate the patient on the Never abruptly stop taking meds: Emphasize the
importance of regular physical activity, importance of adhering to the prescribed medication
including exercises that promote flexibility, regimen and the potential risks associated with
strength, and balance, to help manage abruptly discontinuing Parkinson's medications, which
symptoms and maintain mobility. can lead to worsening symptoms or withdrawal effects.
 Neuro

Spinal Cord Injury

Definition: Cercical Cervical nerves: Include

vertebrae C1-C8, controlling various body
A spinal cord injury involves
C1-C8 functions and sensations.
damage to any part of the spinal
cord. It also can include damage Quadriplegia + loss of
to nerves at the end of the spinal respiratory function above T1:
cord, known as the cauda equina. Paralysis of all limbs and
The spinal cord sends and potential respiratory
receives signals between the impairment if injury occurs
brain and the rest of the body. above T1.
Quadriplegia: Paralysis
Thoracic affecting both arms and legs,
Spinal cord injury vertebrae often due to cervical spinal
damage is IRREVERSIBLE T1-T12 cord injury.

Thoracic nerves refer to the

Classified As spinal nerves originating from
the thoracic region of the spinal
cord, specifically T1-T12. These
Complete nerves control sensory and
If all feeling and all ability to motor functions in the chest,
control movement are lost abdomen, and upper back.
below the spinal cord injury, Lumbar Below T1, the nerves of the
the injury is called complete. vertebrae spinal cord control various
Incomplete L1-L5 functions related to the lower
extremities, trunk, and pelvic
If some feeling and control
organs.
of movement remain below
the affected area, the injury Paraplegia is the paralysis of
is called incomplete. There Sacral the lower extremities, usually
are varying degrees of vertebrae resulting from spinal cord injury
incomplete injury. s1-S4 or disease below the cervical
vertebrae.

Lumbar nerves refer to the spinal nerves originating "Sacral vertebrae" refers to the bones of
from the lumbar region of the spine, including L1 to L5. the sacrum, which form the lower part of
Above L1: Hypertonia (spastic muscle tone) and spastic the vertebral column.
neurogenic bladder are common manifestations. Encompassing vertebrae S1 to S4.
Below L2: Hypotonic (flaccid muscle tone) and flaccid
neurogenic bladder are typical symptoms.
 Neuro

Spinal Cord Injury

CAUSES SYMPTOMS

Traumatic: The symptoms of spinal cord injury can vary

Automobile accidents Violence (e.g., depending on the severity and location of
gunshot wounds, the injury
Falls from heights
stabbings) Loss of movement
Sports injuries
Industrial accidents Loss of sensation
Non-Traumatic: Loss of bowel or bladder control
Degenerative spine Vascular disorders Difficulty breathing
conditions (e.g., (e.g., spinal cord
spinal stenosis) infarction) Pain or pressure in the neck, back, or head
Tumors or masses Congenital Numbness or tingling
compressing the conditions (e.g., Difficulty walking or balancing
spinal cord spina bifida)
Muscle spasms or exaggerated reflexes
Infections (e.g., Inflammatory
Sexual dysfunction
spinal abscess) conditions (e.g.,
transverse myelitis) Paralysis (partial or complete)

Higher up the injury= more severe

TREATMENT

Immobilization: Stabilizing the spine with Rehabilitation: Physical therapy,

braces, collars, or traction devices to prevent occupational therapy, and other rehabilitation
further damage. interventions to improve mobility, strength,
Medications: Pain management medications, and function.
muscle relaxants, and steroids to reduce Assistive devices: Wheelchairs, braces, and
inflammation. other assistive devices to aid mobility and
Surgery: Surgical intervention to remove independence.
fragments of bone, herniated discs, or foreign Psychological support: Counseling or therapy
objects, stabilize the spine, or decompress the to address emotional and psychological
spinal cord. challenges associated with the injury.

PROCEDURE

Laminectomy: A surgical procedure to remove the Foraminotomy: Surgical enlargement of the neural foramen
lamina (the back part of the vertebra) to relieve (the openings through which spinal nerves exit the spinal
pressure on the spinal cord or nerves caused by canal) to relieve pressure on nerves caused by foraminal
bone spurs, herniated discs, or tumors. stenosis.
Spinal fusion: A surgical procedure that involves Decompression surgery: Various surgical procedures aimed
joining two or more vertebrae together using bone at relieving pressure on the spinal cord or nerves, which may
grafts, metal rods, or screws to stabilize the spine involve removing bone, ligaments, or other structures
and prevent movement between the vertebrae. pressing on the spinal cord.
Discectomy: Surgical removal of a herniated or Vertebroplasty or kyphoplasty: Minimally invasive procedures
damaged disc to relieve pressure on the spinal to stabilize compression fractures in the spine by injecting
cord or nerves. bone cement into the fractured vertebrae.
 Neuro

Spinal Cord Injury

COMPLICATIONS

Neurogenic Shock Autonomic Dysreflexia

Neurogenic shock is a condition in which Autonomic dysreflexia is a potentially

you have trouble keeping your heart rate, life-threatening condition characterized by
blood pressure and temperature stable a sudden and dangerous increase in blood
because of damage to your nervous pressure, often triggered by stimuli below
system after a spinal cord injury. the level of a spinal cord injury.

Hypotension: Neurogenic shock can lead to Hypertensive crisis: Autonomic dysreflexia

a sudden drop in blood pressure, which may often leads to a sudden, dangerous increase
result in inadequate blood flow to vital in blood pressure, which can result in
organs. hypertensive crisis, stroke, or other
Bradycardia: Due to disruption of cardiovascular complications.
autonomic nervous system function, the Headache: Elevated blood pressure can
heart rate may decrease, leading to cause severe headaches, which may be
bradycardia (abnormally slow heart rate). accompanied by nausea or vomiting.
Hypothermia: Loss of sympathetic tone can Bradycardia: In response to increased blood
impair the body's ability to regulate pressure, the body may attempt to lower heart
temperature, resulting in hypothermia. rate, leading to bradycardia or irregular heart
Venous pooling: Vasodilation causes blood rhythms.
to pool in the veins, reducing venous return Seizures: Severe cases of autonomic
to the heart and cardiac output. dysreflexia may trigger seizures due to the
Organ dysfunction: Prolonged hypotension abrupt changes in blood pressure and
and inadequate tissue perfusion can lead to cerebral perfusion.
organ dysfunction or failure, particularly in Stroke: Prolonged or untreated episodes of
the kidneys, liver, and gastrointestinal tract. autonomic dysreflexia can increase the risk of
Decreased consciousness: In severe cases, stroke or transient ischemic attacks (TIAs) due
neurogenic shock may lead to altered to the elevated blood pressure and vascular
mental status or loss of consciousness due damage.
to inadequate cerebral perfusion. Retinal hemorrhage: The increased blood
Respiratory compromise: Impaired pressure associated with autonomic
sympathetic control of respiratory muscles dysreflexia can cause retinal hemorrhage or
can lead to respiratory compromise, other eye-related complications.
especially in patients with high cervical Cardiac complications: Chronic autonomic
spinal cord injuries. dysreflexia can contribute to the development
Risk of deep vein thrombosis (DVT) and of cardiac hypertrophy, heart failure, or other
pulmonary embolism (PE): Prolonged cardiovascular issues.
immobilization and venous stasis increase Skin breakdown: Patients experiencing
the risk of blood clots forming in the deep autonomic dysreflexia may be unable to
veins of the legs, potentially leading to DVT sense pain or discomfort below the level of
or PE. injury, increasing the risk of skin breakdown,
pressure ulcers, or other skin-related
complications.
 Neuro

Spinal Cord Injury

INJURIES ABOVE T6

TREATMENT TREATMENT

IV fluids: Administered to restore blood volume High Fowler's position: Elevating the patient's head
and improve perfusion. to a 90-degree angle to promote venous return
and reduce blood pressure.
Vasopressors: Medications used to constrict
blood vessels and increase blood pressure. Call MD immediately: Alerting the physician
promptly to address the potentially life-threatening
Atropine: Anticholinergic medication used to
condition.
counteract bradycardia and improve heart rate.
Look for stimuli: Identifying and removing triggers
or stimuli that are causing autonomic dysreflexia.

Skin breakdown Fecal impaction

NURSING INTERVENTIONS Distended bladder Tight clothing

Ongoing Care

Maintain strict bedrest: Limit movement to prevent

further injury or exacerbation of symptoms. Acute Phase
Assist with bladder and bowel care: Help with
catheterization and bowel management to prevent
complications like urinary retention or constipation.
Log roll patient (turn as one unit): Move the
patient while maintaining alignment to
Assess for signs of autonomic dysreflexia: Monitor prevent spinal injury aggravation.
for symptoms such as severe hypertension,
bradycardia, headache, or flushing. Closely monitor vital signs & breathing:
Administer medications as prescribed: Provide Regularly assess blood pressure, heart rate,
medications for pain management, muscle spasms, respiratory rate, and oxygen saturation to
or other symptoms as ordered by the healthcare detect any deterioration.
provider.
Monitor for complications: Watch for signs of
Encourage deep breathing exercises: Promote lung neurogenic shock, autonomic dysreflexia,
expansion and prevent respiratory complications. infection, or any other complications.
Monitor for signs of infection: Watch for fever, Q2 turning to prevent skin breakdown: Turn
increased pain, or changes in wound appearance
the patient every two hours to prevent
that may indicate infection.
pressure ulcers.
Educate patient and family: Provide information
about the condition, treatment plan, potential Provide emotional support: Offer
complications, and how to manage care at home. reassurance, empathy, and encouragement
Facilitate communication: Assist with to the patient and their family.
communication needs, especially if the patient has ROM exercises & PT/OT: Encourage range of
impaired speech or motor function. motion exercises and collaborate with
Promote comfort: Provide a supportive environment physical and occupational therapists to
with adequate pain management and positioning. maintain mobility and function.

C4 & ABOVE CAUSES LOSS

OF RESPIRATORY FUNCTION!
 Neuro

Traumatic Brain Injury

Definition: Skul

Traumatic brain injury usually results from a violent

blow or jolt to the head or body. An object that goes
through brain tissue, such as a bullet or shattered
piece of skull, also can cause traumatic brain injury.
Mild traumatic brain injury may affect your brain
cells temporarily. force force

DIFFUSE= DISTANT
FOCAL= LOCAL Refers to widespread
Indicates brain damage damage affecting multiple
limited to a specific area, areas of the brain, rather
rather than widespread. than being localized to one
specific region.

CLASSIFIED AS

PRIMARY SECONDARY
Injury that occurs at the time of impact or Changes that develop over hours to days
injury event. following the initial injury.
Examples include head trauma from car Can include secondary insults such as
accidents, gunshot wounds, falls, or sports ischemia (reduced blood supply), hypoxia
injuries. (oxygen deprivation), and cerebral edema
Direct physical damage to brain tissue (brain swelling).
such as contusions, lacerations, and Other factors may include intracranial
diffuse axonal injury. hemorrhage, infection, seizures, and
metabolic disturbances.
These secondary processes can exacerbate
the initial injury and lead to further
neurological damage and complications.
TYPES OF DAMAGE

Open (Penetrating): Closed (Blunt):

Occurs when an object pierces the skull and Occurs when the brain is injured without any penetration
enters brain tissue. of the skull.
Often associated with high-velocity injuries Typically caused by external forces such as falls, motor
such as gunshot wounds or stab wounds. vehicle accidents, or assaults.
Can result in direct damage to brain tissue Brain moves within the skull due to impact forces, leading
along the path of penetration. to contusions, lacerations, or diffuse axonal injury.
Increased risk of infection due to the Can result in widespread damage throughout the brain,
introduction of foreign materials into the brain. depending on the force and direction of impact.
HIGHER RISK OF INFECTION HIGHER RISK OF ICP
 Neuro

Traumatic Brain Injury

DIAGNOSTICS SYMPTOMS

CT Scan (Computed Tomography): MILD SYMPTOMS:

Used to assess for hematomas (collections of Surface Wounds CSF leakage from ears or nose
blood) within the brain. Headache may indicate skull fracture
Provides detailed images of the brain's Dizziness.
structure and can detect abnormalities such LATE SIGN
warning for
as bleeding or swelling. brain herniation
CUSHING'S TRIAD:
Particularly useful for identifying acute injuries
shortly after trauma. Hypertension
Bradycardia: Abnormally slow heart rate,
MRI (Magnetic Resonance Imaging): typically below 60 beats per minute.
Provides more detailed images of the brain Irregular Breathing
compared to CT scans.
Helps assess for brain tissue damage, MODERATE TO SEVERE SYMPTOMS:
including contusions, shearing injuries, and Decreased Level of Consciousness (LOC):
diffuse axonal injury. Altered mental status ranging from confusion
Can detect subtle changes in brain structure to coma.
and is often used for more comprehensive Confusion.
evaluations.
Amnesia: Memory loss, particularly related to
X-ray: events occurring before or after the injury.
Utilized to assess for skull fractures, Vision Abnormalities: Changes in vision such
particularly in cases of blunt trauma. as blurred vision, double vision (diplopia), or
visual disturbances.
Can reveal fractures, dislocations, or foreign
objects that may be lodged in the skull. Seizures

Glasgow Coma Scale (GCS): ADDITIONAL SYMPTOMS:

Used to assess a patient's level of Nausea and Vomiting
consciousness and neurological status.
Sensory Changes: Alterations in sensation,
Evaluates eye opening, verbal response, and such as tingling, numbness, or
motor response to assign a numerical score. hypersensitivity.
Helps classify the severity of traumatic brain Motor Weakness: Weakness or paralysis in
injury and guide treatment decisions. one or more limbs, affecting movement and
coordination.
Intracranial Pressure Monitoring: Personality Changes: Shifts in behavior, mood,
Invasive procedure used to directly measure or personality traits, such as irritability,
pressure inside the skull. agitation, or emotional lability.
Provides real-time information about brain Difficulty Speaking
swelling and helps guide management
strategies.
Involves placing a catheter or probe into the
brain's ventricles or subarachnoid space.
 Neuro

Traumatic Brain Injury

TYPES OF HEMATOMAS TYPES OF CLOSED TBI

Epidural Hematoma: Concussion:

An epidural hematoma refers to bleeding that occurs Concussion refers to a mild traumatic brain
between the skull and the dura mater, the outermost injury resulting from rapid back-and-forth
membrane covering the brain. movement of the brain inside the skull,
It typically results from a traumatic injury, such as a typically caused by a blow or jolt to the head.
skull fracture or a blow to the head, causing tearing of
the middle meningeal artery or other blood vessels. It can lead to temporary disruption of normal
brain function, often manifesting as
Epidural hematomas can lead to a rapid increase in
symptoms such as headache, confusion,
intracranial pressure, potentially causing symptoms
such as headache, dizziness, confusion, weakness,
dizziness, nausea, and sensitivity to light or
and loss of consciousness. noise.
Urgent surgical intervention is often necessary to Concussions are usually considered mild and
evacuate the hematoma and relieve pressure on the may not involve structural damage visible on
brain to prevent further damage. imaging studies like CT scans or MRIs.
Caused by arterial bleeding rapidly expanding
Contusion:
Subdural Hematoma:
Contusion is a type of closed traumatic brain
A subdural hematoma occurs when there is bleeding injury characterized by localized bruising or
between the dura mater and the arachnoid mater,
bleeding on the brain's surface, usually
the middle layer of the meninges.
resulting from a direct impact or sudden
It can result from trauma, particularly when veins deceleration of the head.
bridging the brain and the dura mater rupture or tear
due to sudden acceleration or deceleration forces. Symptoms can range from mild to severe
and may include headache, dizziness,
Subdural hematomas can present with a range of
symptoms, including headache, confusion, confusion, vomiting, and neurological deficits
drowsiness, weakness, and seizures. corresponding to the affected brain region.
Treatment may involve close observation for small Larger contusions may require surgical
hematomas, but larger or symptomatic cases often intervention to remove blood clots and
require surgical drainage or evacuation to alleviate alleviate pressure on the brain, while smaller
pressure on the brain. ones may resolve with supportive care.
Caused by venous bleeding slowly expanding
Laceration:
Subdural Hematoma:
Laceration involves tearing or cutting of brain
Subarachnoid hemorrhage involves bleeding into the tissue, often caused by a penetrating injury
space between the arachnoid mater and the pia such as a sharp object or skull fracture that
mater, the innermost layer of the meninges.
breaches the protective layers surrounding
It is commonly caused by the rupture of an the brain.
intracranial aneurysm, although other factors such as
head trauma or vascular malformations can also Symptoms can be severe and may include
contribute. loss of consciousness, seizures, focal
Patients with subarachnoid hemorrhage typically neurological deficits, and signs of intracranial
experience a sudden, severe headache, often bleeding.
described as the worst headache of their life, along Treatment typically involves prompt medical
with other symptoms such as nausea, vomiting, neck attention, including surgical repair to address
stiffness, and altered consciousness.
any skull fractures or open wounds and to
Prompt medical evaluation and treatment, including minimize the risk of infection and further brain
neurosurgical intervention to address the underlying damage.
cause of bleeding, are essential to improve outcomes
and prevent complications such as vasospasm and
hydrocephalus.
Most common cause: ruptured aneurysm
 Neuro

Traumatic Brain Injury

RISK FACTORS TREATMENT Mild injury= supportive care

AGE: Young children, adolescents, and older adults Supportive Care for Mild Injuries:
are at higher risk. Supportive care involves managing symptoms and
Gender: Males are more likely to experience TBI than allowing the body to heal naturally.
females. Rest is crucial to promote recovery, and
Participation in certain activities: Activities such as over-the-counter analgesics may be used to
contact sports, military service, and high-risk alleviate pain.
occupations increase the risk of TBI. Close monitoring for any signs of worsening
Alcohol and substance abuse: Engaging in symptoms is essential to ensure timely intervention
activities under the influence of alcohol or drugs if needed.
increases the likelihood of accidents leading to TBI. Medications:
History of previous TBI: Individuals who have had a
Anticonvulsants: These medications are used to
previous TBI are at higher risk of experiencing
treat and prevent seizures, which may occur following
another.
a traumatic brain injury to control abnormal electrical
Certain medical conditions: Conditions such as activity in the brain.
epilepsy, dementia, and mental health disorders
Osmotic Diuretics (Mannitol): Osmotic diuretics such
may increase the risk of TBI.
as Mannitol are administered to decrease
Socioeconomic factors: Low socioeconomic status intracranial pressure by drawing excess fluid out of
and lack of access to proper safety equipment or the brain tissues.
healthcare services may contribute to the risk of TBI.
Sedation (Induced Coma): In severe cases where
Environmental factors: Living in areas with high there is significant brain swelling and intracranial
rates of violence or accidents can increase the risk pressure, sedation may be induced to place the
of TBI. patient in a medically induced coma, allowing the
Unsafe behaviors: Not wearing seatbelts or brain to rest and reducing metabolic demands.
helmets, reckless driving, and engaging in risky (comatose brain requires less O2 & risk of
behaviors increase the risk of TBI. secondary injury)

Procedures:
Ventriculostomy: This procedure involves the
insertion of a catheter into the brain's ventricular
NURSING INTERVENTIONS system to drain excess cerebrospinal fluid (CSF),
thereby reducing intracranial pressure.
Close Monitoring: Craniectomy: In cases of severe brain swelling, part
Regular monitoring of vital signs including blood of the skull may be temporarily removed through a
pressure, heart rate, respiratory rate, and temperature craniectomy to relieve pressure on the brain. This
is essential to detect any changes indicating procedure allows the brain to expand outward,
deterioration or improvement in the patient's reducing the risk of further damage.
condition.
Monitoring intracranial pressure (ICP) and
neurological status through frequent assessments
such as Glasgow Coma Scale (GCS) to evaluate level Encourage the patient to avoid activities that may
of consciousness, pupil response, and motor function. increase intracranial pressure, such as straining during
bowel movements (valsalva maneuver) which can
Continuous monitoring of respiratory status to ensure further elevate ICP.
adequate oxygenation and ventilation, especially in
patients at risk of respiratory compromise. Provide a calm and quiet environment with decreased
stimuli to minimize agitation and stress, which can
contribute to increased intracranial pressure.
Prevent Increased Intracranial Pressure (ICP):
Minimize the frequency of suctioning to prevent
Elevate the head of the bed (HOB) to 30 degrees or
stimulating the gag reflex and triggering a rise in
more to promote venous drainage from the brain,
intracranial pressure, only suctioning when necessary
reducing intracranial pressure.
and using gentle techniques.
FREQUENT NEURO CHECKS
LOC PUPIL
GCS ASSESSMENT
 Neuro

Ventricular Drains

Definition:
Ventricular drains are catheter-based devices used
to remove excess cerebrospinal fluid from the
brain's ventricles, reducing intracranial pressure.
STERILE PROCEDURE

INDICATIONS

Hydrocephalus:
Excessive accumulation of cerebrospinal fluid in the
brain's ventricles.

Traumatic Brain Injury:

Damage to the brain caused by an external force Anything That Causes Csf
or trauma. Buildup In The Brain

Meningitis:
Inflammation of the protective membranes covering
VENTRICULOPERITONEAL SHUNT (VP SHUNT)
the brain and spinal cord.
Intraventricular hemorrhage A cerebral shunt that drains excess
Intracranial hemorrhage cerebrospinal fluid (CSF) when there is an
obstruction in the normal outflow or there is a
Brain tumors affecting cerebrospinal fluid circulation
decreased absorption of the fluid.
Normal pressure hydrocephalus
Idiopathic intracranial hypertension For Permanent Drainage

Ventricles

Ventricular
EXTERNAL VENTRICULAR DRAINAGE cather

A medical device consisting of a catheter

inserted into one of the cerebral ventricles Cather lies
tunneled
of the brain, typically used to drain excess
under the skin
cerebrospinal fluid (CSF) and relieve
intracranial pressure. The catheter is Tube emoties
connected to an external drainage system, into chest or
allowing for controlled removal of CSF. abdomen
cavity
For Temporary Drainage
 Neuro

Ventricular Drains

NURSING INTERVENTIONS

EXTERNAL VENTRICULAR DRAIN (EVD) When to Notify MD:

Monitor for signs of infection or shunt If there is no drainage for an hour: This could
malfunction. indicate a catheter occlusion, potentially
leading to increased intracranial pressure
Assess neurological status regularly. (ICP).
Monitor for signs of increased intracranial If a sudden increase in drainage occurs: The
pressure. MD may need to adjust the drainage level or
Ensure proper positioning and securement of clamp the drain to manage the sudden
the shunt. increase.
Educate the patient and family about signs of If clots or tissue debris begin to drain: This
shunt malfunction and when to seek medical may indicate a blockage or other issue with
attention. the drainage system.
In the event of a drastic change in ICP, either
PRESSURE SCALE MUST BE LINED UP WITH high or low: Significant changes in ICP levels
require medical attention and intervention.

LEVEL OF TRAGUS where ventricles

Pressure Scale Must Be Lined Up with Level of Tragus: Aligning the pressure scale with the level of the
tragus ensures accurate measurement at the level of the ventricles.
If Too High: Excessive suction may occur, leading to overdrainage of cerebrospinal fluid (CSF).
If Too Low: Inadequate suction may result, causing insufficient drainage of CSF or potential backflow
issues.
 Neuro

Ventricular Drains

NURSING INTERVENTIONS VENTRICULOPERITONEAL SHUNT (VP SHUNT)

Neurological Checks & Vital Signs: Perform UPON DISCHARGE:

regular assessments to monitor neurological
status and vital signs for any changes Do Not Touch Site: Avoid touching the shunt
indicating complications. insertion site to prevent infection and
disruption of healing.
Pain Management: Administer prescribed
pain medication as necessary to alleviate Avoid High-Risk Physical Activities: Refrain
discomfort and promote patient comfort. from engaging in activities that could
potentially damage the shunt or increase
Monitor Incision Site: Assess the shunt
the risk of injury.
insertion site for signs of infection, such as
redness, swelling, or drainage, and report any Keep Incision Clean & Dry: Maintain
abnormalities. cleanliness of the incision area and ensure it
remains dry to promote healing and prevent
Intracranial Pressure (ICP) Monitoring:
infection.
Continuously monitor intracranial pressure to
ensure it remains within normal range and No Showering Until Approved by MD: Follow
intervene promptly if elevated. instructions from the medical provider
regarding when it is safe to resume
Assisting with Activities of Daily Living (ADLs):
showering.
Aid the patient in performing ADLs while
taking care to avoid activities that may No Heavy Lifting for 6 Weeks: Avoid lifting
increase intracranial pressure. heavy objects for the specified duration to
prevent strain on the surgical site and
Positioning: Assist the patient with position
minimize the risk of complications.
changes to prevent straining and minimize
the risk of elevated ICP.
Patient Education: Provide education to the
patient and family about signs of shunt AT RISK FOR INFECTION
malfunction or infection, as well as when to
seek medical attention.
Requires check up at least every 3 years
RESPIRATORY
 Respiratory

Respiratory System Overview

The respiratory system is a complex network of organs and tissues that Right bronchus is
work together to facilitate breathing, enabling the exchange of gases more vertical, broader
between the body and the environment. & shorter than left one.

It is divided into two main types Right bronchus is more

prone to ASPIRATION.

Upper respiratory tract

organs and their functions
Lower respiratory tract
Consists of those organs that are located organs and their functions
outside the chest cavity
Nose and Nasal Cavity: Responsible for Consists of those organs that are located
Filtering, Humidifying, and warming inside the chest cavity
incoming air.
Trachea (Windpipe): A tube that carries air
Sinus: Air-filled space that is involved in from the larynx to the bronchi.
mucous production. Mucous keeps the
nose moist. Bronchi and Bronchioles:

Pharynx (Throat): Serves as a passage for The trachea branches into two bronchi,
air traveling between the nasal cavity and each leading to a lung
the larynx. The bronchi further divide into smaller
Larynx (Voice Box): Contains the bronchioles, which eventually lead to
the alveoli.
Vocal cords that helps to produce
They distribute air throughout the lungs
sounds for speech.
through bronchioles & alveoli.
Epiglottis that covers the vocal cords
during swallowin Alveoli: Tiny air sacs in the lungs where gas
exchange occurs between the air and the
bloodstream.
Lungs: Paired organs located in the chest
cavity, consisting of lobes filled with
Upper Respiratory Tract bronchial tubes and alveoli.
Nasal Cavity Diaphragm and Intercostal Muscles:
Pharynx Muscles involved in the process of breathing.
Larynx

Lower Respiratory Tract

Trachea
Primary Bronchi
Lungs
 Respiratory

Respiratory System Overview

STEPS OF GAS EXCHANE

Gas exchange typically involves the transfer of oxygen (O2) from the environment into the body's cells
and the removal of carbon dioxide (CO2) from the cells to the environment.
Steps:

Breathing: involves the acts of inhalation and exhalation of air in the respiratory system.
Ventilation: Movement of air in & out of the alveoli
Diffusion: involves the diffusion of gases across the respiratory membrane
Transport: Binding of diffused O2 with hemoglobin of RBCs & diffusion of CO2 from plasma to alveoli.
Circulation: Flow of oxygenated blood throughout the body.
Cellular respiration: Dispersal of O2 & CO2 at cellular level O2 enters the cell & CO2 leaves the cell.

Gas Exchange Cycle Gas Exchange at Alveoli Level

Alveoli

Carbon
Oxygen Dioxide

Lungs Alveolar
Wall
Oxygen CO2 Carbon Dioxide CO2
Capillary
Air
CO2 O2 Red
Carbon Blood
Dioxide Out Cells
Oxygen in
Red Blood Cells
 Respiratory

Breathing Mechanics

The action of breathing is due to changes of pressure within the THORAX, in comparison to outside

Inhalation Exhalation

Air Rib cage gets

Rib Cage expand Air
inhaled smaller as rib
in rib muscles exhaled
muscles relax
contract

Internal interecostal muscle relaxed Internal interecostal muscle contract

External interecostal muscle contract External interecostal muscle relaxed
Rib cage moves upwards & outwards Rib cage moves downwards & inwards
Diaphragm contracts & flattens Diaphragm relaxes
Volume of thorax cavity increase Volume of thorax cavity decrease
Pressure in alvcoli decrease Pressure in alvcoli increase
Air moves in Air moves out

O2 enters the lungs with air. CO2 is also removed from lungs with air.
Intrapulmonary pressure is less than Intrapulmonary pressure is above than
atmospheric Pressure. atmospheric Pressure.

Oxygen Attributes

FIO2 PAO2 SaO2

FRACTION OF PARTIAL PRESSURE ARTERIAL OXYGEN SATURATION
INSPIRED OXYGEN OF OXYGEN O2 saturation in blood flowing in arteries
the %age of oxygen in the air Total pressure of Normal range: 94-100 %
Normal range O2 in arterial blood
of oxygen in air: 21% Normal range: Hypoxia low levels of
One liter of O2 adds about 4% 80-100 mmHg oxygen in tissues
Examples: It can impair tissue function
1L= 24% 2L=28% 3L=32% Commonly measured by Pulse Oximeter

Hypoxemia low
Monitored critically in blood oxygen levels Monitored critically in managin
managin patients with It can impair tissue patients with
Respiratory conditions function Respiratory conditions
During surgery Lead to complications During surgery
Critical care if not corrected Critical care
 Respiratory

Assessment of Respiratory System

Auscultating The Normal Sounds Produced

Sound of Lungs During Breathing

LISTENING OF SOUNDS produced Vesicular

by the respiratory system using a
stethoscope. Duration Expiration
How is it done….? Inspiratory Soft low itch
Preparation Expiratory Location
Ask the patient to be seated Insp louder Over the whole lungs
or lye down comfortably. No gap Bottom of lungs
Ensure a quiet environment to
better hear the sounds.
Chest should be exposed up.
Bronchovesicular
Stethoscope Placement: Place
the flat, circular part of the Duration Expiration
stethoscope on the chest Inspiratory Medium loud
Expiratory Medium pitch
Listening for Sounds: Before
listening, ask the patient to Louder than Location
vesicular Peristernal
Take deep breath.
Ins & exp interscapular
Do not listen on clothing same loudness
(bare skin is preferred) No gap
Listen the inhalation and
exhalation sounds from the front,
back and sides of both chests.
Bronchial
Also listen from top to bottom.
Assessment of the quality, Duration Expiration
intensity, and location of the Expiratory Loud, strong
sounds heard Inspiratory high pitched
Documentation of findings Same loudness Location
from auscultation. Exp longer Above Clavicle
Gap Manumbrum Sterni

Tracheal

Duration Expiration
Expiratory Very loud high pitched
Inspiratory Location
Above trachea
 Respiratory

Adventitious Lungs Sounds

ADVENTITIOUS LUNG SOUNDS

Type Description Cause Location Condition

Fine, short, Pneumonia

interrupted. Air passing Pulmonary edema
Crackles sound can be through fluid or heard in the Pulmonary fibrosis
(rales) stimulate by mucus in any air bases of lower Bronchitis
rolling a lock of passage. lung lobes. Asthma
hair near the ear. Emphysema

Heard over
Continuous, low Upper respiratory
AIr passing throw most lung
pitched, gurgling, tract infections
a narrow air areas but
Gurgles harsh, louder Pneumonitis
passage due to predominate
(rhonchi) sounds with Bronchiectasis
secretion. tumors, over the
moaning Chronic Bronchitis
swelling. trachea and
(complaining) Cystic Fibrosis
bronchi

Lung cancer
heard over the Pneumonia
Superficial Rubbing together
areas of Emphysema
Friction rub grating (harsh) of inflamed
greatest pulmonary
or creaking. pleural surfaces.
thoracic embolism
expansion. Pleurisy

high pitched, Air passing throw

Wheeze heard over all Asthma
squeaky (noisy) constricted
(expiration) lung field. COPD
musical sounds bronchus.

Pleural layers
Foreign body
High pitched, rubbing against Heard over all
Stridor Croup
Whistle sound each other due to lungs
Epiglottitis
inflammation
 Respiratory

Hypoxia

Immediate nursing
What is it? interventions
A condition in which tissues in the body are deprived of O2.
This is due to decreased O2 supply. Evaluate respiratory
therapy requirement
Adjust bed angle &
Elevate its head side
SIGNS & SYMPTOMS Oxygen supplementation

Depends on its severity and duration Clear airway with suction

Early Signs & Symptoms Adjust positioning for

comfort
Shortness of breath
Rapid breathing (Tachypnea) Provide pain relief
medication
Rapid heart rate (Tachycardia)
Restlessness Verify pulse OXIMETER
Anxiety ACCURACY

Late Signs & Symptoms FACTORS AFFECTING

Shortness of breath PULSE OXIMETER ACCURACY
Rapid breathing (Tachypnea) Nail Paint Application
Rapid heart rate (Tachycardia)
Cyanosis (bluish discoloration of the skin and mucous membranes) Poor circulation of blood
Confusion Cold fingers and
Dizziness fingertips
Loss of consciousness Patient movement during
assessment
Emergency !
Poor placement of
Notify the DOCTOR immediately aximeter
Complete interventions mentioned above
Call rapid response or emergency services
Do NOT leave the patient
 Respiratory

Arterial Blood Gas

Arterıal Blood Gas

What is it? What is it?
ACID BASE COMPONENTS
Measurement of Total amount of CO2
PRESSURE OF GASES
acid-base balance in the blood
in the body NORMAL VALUES FOR ADULTS
REGULATED BY:
REGULATED BY: LUNGS
LUNGS & KIDNEYS THINK CO2 FOR ACID

pH PaCO2
O O C
O C O
7
7.35-7.45 35-45 mmHg

Memory Trick
Once you remember HCO3- PaO2 SaO2
7.35=7.45, just drop
O O O O O
the 7 to get 35-45 O O
for CO2 O
C
O
C O O C
O O
R R 80-100mmHg >95%
R
Lungs are above
kidney so think 21-28 mEq/L
CO2 above HCO3

What is it? What is it? What is it?

Total amount of bicarbonate Total amount of O2 in the blood Saturation of O2 in
ions in the blood the blood
REGULATED BY:
REGULATED BY:
REGULATED BY: LUNGS
LUNGS
KIDNEYS
Not used to determine ABG; just
THINK BASE FOR BICARBONAT Measures oxygenation status
 Respiratory

Arterial Blood Gas

Interpretation of ABG
To remember which is which:
IS THE pH ACIDIC OR BASIC….? Use ABA & BAB
To remember which value is ACIDIC or BASIC in
nature, pair this with this MEMORY TRICK A

Write out the numbers & match the values to A

the correlating side

IS THE CO2 HIGH or LOW….? A

Practice the ABA & BAB table
<35 (low CO2) = BASIC
>45 (high CO2) = ACIDIC

IS THE BICARBONATE HIGH or LOW….? Reference Problem

Practice the ABA & BAB table Acidic Basic pH 7.26
<22 (low CO2) = BASIC Normal paCO2 7.26
>26 (high CO2) = ACIDIC
7.35-7.45 HCO3 18
IS IT RESPIRATORY OR METABOLIC IN NATURE….? 45-35 Solution
use the Tic-Tac-Toe Method 22-26 Metabolic Acidosis
Partially compensated
IS THE pH ACIDIC OR BASIC….?
If pH is out of range and CO2 or HCO3 are in
range UNCOMPENSATED Respiratory
Acidic Normal Basic
example with
If all three values are out of range PARTIALLY reference
COMPENSATED (normal)
values
If pH is normal COMPENSATED pH PaCO2

HCO3

if pH & CO2 in same column, it is respiratory

in nature
If pH & HCO3 in same column, it is metabolic
in nature
 Respiratory

Arterial Blood Gas

RESPIRATORY ACIDOSIS RESPIRATORY ALKALOSIS

Excess of CO2 in the blood due to its retention in lungs Exhaling excessive carbon dioxide
Memory trick: Carbon makes the body more aCidiC. Memory trick: LOW CO2 makes the body more ALKALOTIC.
CO2 (>45) causes pH (< 7.35) CO2 (< 35) causes pH (> 7.45)
aCidiC environment ALKALOTIC environment

*Kidneys attempt to retain the bicarbonate to *Kidneys attempt to EXCRETE the bicarbonate to
neutralize acidosis and bring pH back to normal. neutralize ALKALOSIS and bring pH back to normal.

Causes Causes
Anything that cause airway obstruction or Anything that cause hyperventilation
respiratory depression Mechanical ventilation Drugs
Sleep apnea Sedatives Liver disease Pregnancy
Tumors Anesthesia Pulmonary embolism Fever
Depressant drugs Sepsis Pain
Increased ICP (affects neuro functioning that controls RR) Asthma High altitude
Neuromuscular disease (Guillain-Barre) Central nervous system disorders
Breathing excessively fast due to anxiety, panic attacks,
Anything that cause decreased ventilation or or fever.
impaired gas exchange Brain injuries affecting the center that controls
COPD Chest wall trauma respiratory rate
Pneumonia Pulmonary edema Breathing out allows CO2 to be released, so think if you're
Asthma Respiratory muscle weakness exhaling really fast,
Too much CO2 is being released

Symptoms
Respiratory Symptoms
Hypoventilation Hypoxia Lethargy & Confusion
Rapid, Shallow Respirations Stimuli Seizures
(Anesthesia, Deep, Rapid Breathing Light Headedness
BP with Vasodilation Nausea, Vomiting
Dyspnea Drug Overdose) Hyperventilation
COPD Tachycardia Tetany (may have +
Headache Chvostek’s Sign)
Hyperkalemia Pneumonia or Normal BP
Atelectasis Hypokalemia Dysrhythmias (from
Drowsiness, Dizziness, Disorientation hypokalemia)
Muscle Weakness, Hyperreflexia Numbness & Tingling
Dysrhythmias ( K) of Extremities

To counteract alkalosis,
To counteract acidosis, hydrogen
hydrogen ions moves out of the
ions shift into cells, reducing pH,
cells, Increasing pH, leading to
leading to potassium exiting cells
potassium entering cells and
and entering the bloodstream,
leave the bloodstream,
resulting in hyperkalemia
resulting in hypokalemia

Treatment is directed towrds improving

Treatment Treatment is directed towrds improving
ventilation; may be mechanical ventilation Treatment
ventilation; May be mechanical ventilation
Provide oxygen
Teach patient relaxation breathing exercises to aid in
Remove secretions as necessary
slowing down
Encourage turning, coughing, and deep breathing
Breathing (e.g., slow deep breaths)
Prescribe antibiotics (for pneumonia) Offer emotional reassurance and support
Monitor and address elevated potassium levels Administer supplemental oxygen as needed
Refrain from administering medications known to Monitor and address low potassium and calcium levels
depress respiration Prescribe anti-anxiety medication if necessary
Respiratory therapy may be necessary Provide analgesics for pain relief
Sodium bicarbonate in severe instances Adjust tidal volume and respiratory rate for patients on
May necessitate intubation in cases where CO2 levels mechanical ventilation
exceed 50 and severe respiratory distress
 Respiratory

Arterial Blood Gas

METABOLIC ACIDOSIS METABOLIC ALKALOSIS

Excessive accumulation of acid in the body Excessive accumulation of HCO3 or Too little ACID in the body
HYDROGEN IONS HYDROGEN IONS
HCO3 (< 22) causes pH (< 7.35) HCO3 (> 26) causes pH (> 7.45)
ACIDIC environment ACIDIC environment

*LUNGS attempt to EXCRETE the CO2 BY EXHALING *LUNGS attempt to retain the CO2 BY INHALING
FASTER to bring pH back to normal. SLOWER to bring pH back to normal.

Causes Causes
Anything that cause acid production Anything that cause Acid excretion/loss
Diabetic ketoacidosis (DKA) (ACIDS/KETONES Emesis
ACCUMULATE IN BODY HCO3) Excessive gastrointestinal aspiration
Malnutrition (BREAKDOWN OF FATS KETONES Anything that cause Bicarbonate
PRODUCTION ACID) Alcoholism
Lactic acidosis Overdose of sodium bicarbonate
Renal tubular acidosis (RTA) Excessive intake of alkaline substances
Ingestion of toxins Hyperchloremic acidosis
Starvation or fasting (dairy products, milk, antacids, baking soda etc.)
Sepsis Hyperaldosteronism (causes Na & H exchange
Anything that cause acid excretion in kidneys HYDROGEN IONS & HCO3 )
Kidney dysfunction (BUILDUP OF WASTE ACIDS TRY Loop diuretics
TO BREAKDOWN WASTE) (causes kidneys to release H+ through urine
hydrogen & HCO3 )
Anything that cause HCO3 excretion
Severe diarrhea
MEMOARY TRICK BICARB comes out of your BASE Symptoms
Tremors, Muscle Cramps, Tingling of Fingers & Toes
Restlessness Followed by Lethargy
Symptoms Dysrhythmias (Tachycardia)
Muscle Tone, Reflexes (Confusion, Drowsiness) Compensatory Hypoventilation
Acid or
Kussmaul Respirations (Compensatory Hyperventilation) Confusion ( LOC, Dizzy, Irritable)
in Base
Headache Muscle Twitching Nausea, Vomiting, Diarrhea
#BP Warm, Flushed Skin (Vasodilation) Hypokalemia
pH HCO3
Hyperkalemia Nausea, Vomiting Chvostek's Sign
Higher pH causes more calcium to bind
H+ Production Deep rapid breathing to albumin, leading to HYPOcalcemia
(DKA, hypermetabolism) in which body tries to
H+ Elimination compensate by
(renal failure) exhaling CO2
HCO3 Production Too much H Treatment
pH HCO3
(dehydration, liver failure) (Acid) too Administer antiemetics such as Zofran to alleviate vomiting
HCO3 Elimination little bicarb Monitor electrolyte levels
(diarrhea, fistulas) Provide intravenous fluids to replenish fluid deficits
Monitor intake and output
Implement seizure precautions
Discontinue loop diuretics
Treatment Administer Diamox (Carbonic Anhydrase Inhibitor): a
Monitor electrolyte levels and neurological status diuretic that enhances bicarbonate excretion through urine
Implement seizure precautions
Administer sodium bicarbonate as needed
Monitor respiratory function (potential need for Diabetic ketoacidosis (DKA)
intubation if severe respiratory distress occurs) Accumulation of ketones (acids) in the body
Dialysis may be necessary in cases of renal
Administer regular insulin to As acidosis is corrected,
failure to eliminate toxins.
inhibit fat breakdown potassium shifts back into cells,
Monitor potassium levels closely leading to hypokalemia
 Respiratory

Acute Respiratory Distress Syndrome (ARDS)

Patho
Risk factor
What is it?
It is a severe form of acute RESPIRATORY FAILURE
characterized by Inflammatory response
sudden and progressive difficulty in breathing.
Ventilation
Life-threatening condition. induced lung ARDS
In this, severe injury occur to the ALVEOLI. injury
Alveolar epithelial permeability
(Atelectrauma
It results due to INFLAMMATION and PULMONARY EDEM Pulmonary endothelial permeability
and/or
ARDS IS NOT A PRIMARY LUNG DISEASE volutrauma)

Alveolar flooding
It is a consequence of systemic injury leading to
widespread inflammation, which inflicts damage upon
the alveoli
Mechanical Atelectasis Surfactant
Hypoxia
ventilation & shunt abnormalities
Alveoli is a site of gas exchange between O2 & CO2
Direct injury to the LUNG

Causes IMPAIRED GAS EXCHANGE &

Lungs becomes STIFF & NONCOMPLIAN
Causes Direc Injury to the LUNGS
Pulmonary injury
Pneumonia
Aspiration of gastric contents
Inhalation injury (e.g., smoke inhalation) DIAGNOSIS
Near-drowning incidents
Chest X-Ray: "white out" infiltrates
Trauma to the chest & lungs.
ALSO called "ground glass opacities"
Indirect injury to the LUNGS Arterial Blood Gas (ABG)
Systemic injuries Autoimmune diseases Blood cultures to evaluate for
Sepsis Certain viral infections infection
Severe pancreatitis Drug overdose
Hypovolemic shock Bronchoscopy possibly coupled
Transfusion-related acute lung injury (TRALI) with lavage to clear airways &
High-altitude pulmonary edema (HAPE) obtain bronchial specimens

ARDS PHASES

Exudative
Edema fluid
Cell injury
accumulation
Injured Alveolar- Occurs 4-7 days post-injury
Inflammatory cells
capillary barrier
recruitment (Neutrophil Damage to capillary membrane resulting in
Increased permeability predominate) pulmonary edema
Reduced surfactant causing atelectasis
Reduced space for gaseous exchange (collapse of alveoli)

Breathing difficulties Formation of hyaline membrane leading to

diminished lung elasticity
Assisted ventilation needed (Mechanical ventilator)
 Respiratory

Acute Respiratory Distress Syndrome (ARDS)

ARDS PHASES

Fobrotic very few progress into FIbrotic phase

Proliferative proliferation of type II cells
Fibroblasts proliferation
Type II differentiate into type I cells
Increased fibrosis
Lymphatic drained of edema fluid
Intra-alveolar Interstitial fibrosis
Recovery of alveolar capillary barrier
Lymphatic capilary fibrosis
Edema fluid resorption

Poor prognosis
patient feels better
Ventilator dependent breathing
mechanical ventilation might not be required

Most patient recover in this phase

Most patient recover in this phase
Occurs beyond 3 weeks post-injury
Occurs 7-21 days post-injury
Extensive lung fibrosis evident
Lung repair initiation and resolution of edema
Lungs become rigid and firm (resembling cement)
Some patients improve during this stage
Alveolar structure deteriorates, exacerbating gas
Non-recovering patients: lung tissue undergoes
exchange impairment, reduced lung compliance,
progressive fibrosis and densification
and hypoxemia

TREATMENT NURSING INTERVENTIONS ICU care required

Medications: Direct monitoring
Antibiotics: for treatment and prevention of infection Close monitoring of vital signs and breathing pattern
Corticosteroids: to reduce inflammation Arterial blood gas (ABG) and laboratory tests
Diuretics: to decrease pulmonary edema monitoring
Inhaled vasodilators (e.g., nitric oxide): for pulmonary Strict intake and output monitoring
vascular dilation (often used as rescue therapy
Supportive care
Oxygenation management:
Q2 turning: Changing position every 2 hours
Early use of high-flow oxygen or BiPAP
Early enteral feeding (tube feeds)
Mechanical ventilation needed for most patients
Deep vein thrombosis (DVT) prophylaxis and stress
Paralyzed patients require complete ventilator
ulcer prevention
control (requires deep sedation)
Ventilator-associated pneumonia (VAP) bundle care
Prone positioning to improve gas exchange
Sedation interruptions/weaning as deemed
Extracorporeal membrane oxygenation (ECMO) may
appropriate
be necessary in severe case
 Respiratory

Asthma

What is it? Because of an INFLAMMATORY REACTION, the patient

encounters a stimulus that activates MAST CELLS,
Asthma is a chronic respiratory condition characterized prompting the DISCHARGE OF INFLAMMATORY AGENTS
by inflammation and narrowing of the airways, leading including:
to difficulty in breathing due to mucus production.
Prostaglandins Histamines
Leukotrienes Cytokines

It triggers INFLAMMATORY CASCADE

*Bronchi are the large air
Increased sensitivity Mucous
passages in the respiratory
production
tract that branch off from Swelling of mucosal lining
the trachea (windpipe)
B Plasma Cell Mast Cell

*Bronchioles are small air

Allergen
passages in the respiratory
tract that branch off from the Hystamine
bronchi & divide into ALVEOLI Leukotrienes ASTHMA
Prostaglandis
Cytokines
Antigene
Presenting Cell

Th2 cell Eosinophil

RISK FACTORS OF ASTHMA

Genetics Air pollution
Atopy (allergic condition) Obesity
SYMPTOMS OF ASTHMA
Environmental allergens Physical activity
(molds, pollens) Wheezing Difficulty breathing
Medications
Respiratory infections Cough Pale and wet skin
Psychological factors
Tobacco smoke Shortness of breath Dyspnea
GERD
Occupational exposure Tachycardia Chest tightness

TRIGGERS TREATMENT OF ASTHMA

Environmental:
BRONCHODILATORS
Allergen, smoke, pollen, air pollution, weather (Dilates smooth muscles of airway)
changes, occupational exposure
RESCUE DRUGS
Stress related:
Emotional factors, physical activity & exercise
Medical conditions related:
GERD, respiratory infections
Medication related: INHALED CORTICOSTEROIDS
Beta-blockers causing bronchospasm, NSAIDs -ASONES&-IDES
LONG-TERM
especially aspiri EXAMPLE:
MANAGEMENT
Fluiticasone&budesonide
Triggers are the factors that induce/exacerbate LEUKOTRIENE RECEPTOR
the worsening of asthma symptom BLOCKER:
EXAMPLE: Montelukast
Long Acting
Bronchodilators (LABA)
EXAMPLE: Salmeterol
 Respiratory

Asthma

NURSING INTERVENTIONS
Administer oxygen
Educate
Elevate head of bed (High Fowler's position)
Ensure open airway Identify and avoid triggers
Foster relaxed surroundings Emphasize adherence to medications

Monitor Carry rescue inhaler at all times

Vital signs Take SABA prior to physical activity (if triggered)

Respiratory effort Instruction on peak flow meter usage
Auscultate lung sounds

PEAK FLOW METER Red Zone Yellow Zone Green Zone

Measures how fast air can be forcefully

expelled from lungs
Assists in evaluating asthma control and
identifying deterioration
Marker Zone Measured in units of
Indicators liters per minute (lpm)
HOW TO USE…?
80-100% 50-80% <50%
Establishing a personal
best baseline reading of best reading. of best reading. of best reading.
initially for comparison follow your regular Caution, your asthma Medical alert,
Conducted prior to medication plan, and might be worsening. follow get medical advice and
medication go ahead with your medications to get attention immediately
administration. normal activities back to your green zone
Patient exhales forcefully
to obtain measuremen INTERPRETATION OF FINDINGS

Acute asthma exacerbation SYMPTOMS

Status asthmaticus: severe asthma exacerbations Severely difficult breathing
that progress rapidly and do not repond to standard Inability to communicate verbally
acute asthma therapy
Altered level of consciousness
Normal Asthmatic Asthmatic Airway Bluish discoloration of the skin (Cyanosis)
Airway Airway during Attack
Relaxed
smooth Air Trapped
muscles In alveoli TREATMENT
Oxygen supplementation
Intravenous fluids
Bronchodilator medication (Albuterol)
Steroidal anti-inflammatory drugs (Corticosteroids)
Epinephrine administration
Wall inflamed Tightened
and Thickened Smooth Muscles If left untreated, it can result in cardiac
or respiratory failure.
 Respiratory

Chest tubes (thoracostomy)

What is it? CHEST TUBE CHAMBERS

It is a medical procedure used to drain air, fluid or Connected Connected
pus from the pleural space of the chest. to suction to patient
It is used to relieve pressure and re-expand the lungs

monitor level, Fluid level No tidaling

INDICATIONS replace with moves Normal:
serosanguinous
sterile water up and down (pink)drainage
Pneumothorax: Air accumulates in the pleural as needed “tidaling”
space
Hemothorax: Blood accumulation in the pleural
cavity
Pleural Effusion: Accumulation of fluid (such as pus,
blood, or lymph) in the pleural space. Suction control Water seal Drainage collcetion
Empyema: Accumulation of pus in the pleural chamber chamber chamber
cavity.
Thoracic Surgery: After certain thoracic surgeries to Tidaling refers to the up and down movement of water
drain any postoperative air, blood, or fluid in the water seal chamber. the water level rises during
accumulation. inspiration and falls during expiration. Absence of
tidaling indicates that there is an obstruction in the
Trauma: Such as penetrating injuries or rib fractures
chest tube or that the lung has fully re-expandedd
causing lung injury. Bronchopleural Fistula

Wall suction Pleural space

INSERTION SITE
Pressure-regulating bottle At the 4th or 5th intercostal space
Space between chest
Water bottle wall and lungs in the mid or anterior
Fluid collection bottle axillary line, also called "midclavicular line.

Drainage Chamber WATER SEAL CHAMBER SUCTION CONTROL CHAMBER

Assembles & drains blood into A one-way flutter valve One-way It controls the suction pressure
calibrated chamber to measure valve that permits the air to delivered to the pleural cavity.
the amount of drainage exit the pleural cavity on exhalation *Bubbling in wet suction is NORMAL
& prevents air entering on inhalation means the suction is working
MONITOR COLOR & AMOUNT Persistent bubbling is indicative of
an ABNORMALITY indicating air
Quick bright red drainage (blood) *Bubbling in dry suction is
leakage
>100 mL/hour should be reported ABNORMAL
to the primary care physician However any form of bubbling indicates an
Discontinuous bubbling is called air leak
TIDALING & is NORMAL
*If tidaling STOPS Indicate Lung
re-expansion (positive) Or potential
system obstruction (negative)
 Respiratory

Chest tubes (thoracostomy)

WET VS DRY CHEAST TUBE COMPARASION

Learning TIP: Clinical TIP:

Chest drainage with use of suction removes air or Amount of suction is dependent on the provider order,
fluid from the pleural space and recreates be sure to check prior to connecting suction to patient.
negative ressure.
Dry suction:
Wet suction: Silent-regulating, negative
Gentle bubbling in pressure is controlled by
suction control indicates vents and controlled
suction is working. release system, can be set
Water level controls to suction or gravity.
negative pressure. As
Self regulating. Negative
water evaporates, the
pressure is controlled
negative pressure can
release system, can be
change, so it is
set to suction or gravity.
important to check
water level frequently.
Consideration:
Wider range of
Consideration: suction level
Clinical TIP:
water evaporation If system is knocked, Quieter Orange bellow inflated
Longer set up time water can get
Faster setup indicates the patient is

Suction regulated by the height of a column of water. Suction regulated by suction control dial. Monitor
Monitor water level (water will evaporate & needs to suction bellows to ensure suction is working
be refifilled)

NURSING INTERVENTION
Parts of CHEST TUBE Maintain chest tube below insertion site

Suction part Filtered manual Avoid stripping or clamping tubing without

highly negitivity vent physician instruction
Positive pressure
release valve Needless access Promote patient coughing and deep breathing
port Monitor lung sounds and insertion site
Water seal chamber
In-line connector Observe drainage color and volume
Dry suction regulator
Multi-position Instruct patient to perform Valsalva maneuver
Suction monitor
hangers during chest tube removal
bellows
Easy-to-grip handle
Air leak monitor
Collection chamber
Patient pressure
float ball Patient tube clamp WHEN TO NOTIFY PHYSICIAN…?
Swing out floor stand Patient conenctor When subcutaneous
emphysema (skin IF CHEST TUBE FALLS OUT
palpation reveals Immediately cover insertion
Both share a collection chamber and water popping sensation) site with sterile gauze
seal chamber, is observed
but their suction control mechanisms vary. It is accompanied
by bright red blood IF SYSTEM GETS DAMAGED
Insert tubing into sterile water
Results in exceeding to maintain water seal
100 mL per ho
 Respiratory

Chronic Obstructive Pulmonary Disease

What is it? Pink Puffer Blue Bloater

A group of diseases that cause airflow blockage and
breathing-related problems.
It is a progressive inflammatory condition of lungs. Chronic
Healthy Alveoli Emphysema Healthy Airway Bronchitis
Damage caused by COPD is IRRETRIEVABLE .
COPD includes EMPHYSEMA and chronic BRONCHITIS.
Chronic BRONCHITIS is long-tern air-flow Narrowed
airwa
OBSTRUCTION
EMPHYSEMA is inability to fully BREATH OUT due to
Thickened
Damage & rupture to inner structure of alveoli production smooth muscle

RISK FACTORS
DIAGNOSIS Caused by lung damage due to RESPIRATORY IRRITANTS

Lung function tests AAT deficiency test Smoking (MOST COMMON) Occupational
Exposure to Environmental exposure
Arterial blood gas test X-ray or CT scan
Pollutants Indoor air pollutants
6-minute walk Genetics (Alpha1- Second hand smoke
Antitrypsin deficiency that Frequent respiratory
protects lining of lungs) infections as child
Respiratory infections Age over 65 years
LUNG FUNCTION TEST (SPIROMETERY) Asthma old
Age
FVC FEV1

SYMPTOMS SYMPTOMS
Dyspnea Chronic, productive
Minimal cough cough
Increased minute Purulent sputum
Give O2 with caution
ventilation Hemoptysis
NURSING INTERVENTION Patient at risk for Pink skin, Pursed-lip Mild dyspnea initially
HYPERCAPNEA, O2 is breathing Cyanosis (due to
Close monıtorıng given in low amounts Accessory muscle use hypoxemia)
Observing O2 Evaluating with target SPO2 Cachexia Peripheral edema
saturation respiratory between 88-93% (due to cor
Hyperinflation, barrel
levels auscultation chest pulmonale)
Arterial blood Monitoring respiratory Decreased breath Crackles, wheezes
gas analysis secretions sounds Prolonged expiration
Tachypnea Obese
Most patient recover in this phase
Quitting of smoking Minimize exposure to triggers
Practice effective to reduce exacerbations Complications Complications
respiratory techniques Diet should base on small, Pneumothorax due to Secondary
including coughing & frequent meals bullae polycythemia vera
breathing Weight loss due to work due to hypoxemia
Protein & high caloric diet is
Maintain vaccination required of breathing Pulmonary
schedule hypertension due to
Hydration should be assured reactive
Vasoconstriction
from hypoxemia
TREATMENT NO CURE, ONLY SYMPTOMATIC TREATMENT RESPIRATORY Cor pulmonale from
REHABILITATION PROGRAM chronic pulmonary
MEDICATIONS
TAKE IN THIS ORDER! Breathing exercises hypertension
1. Bronchodilators: dilate airways
TEROL Ex: Salmeterol & Albuterol Open airways first so Physical conditioning
steroids can work
2. Corticosteroids: inflammation Dietary guidanc
SONE Ex: Prednisone & Hydrocortisone
 Respiratory

Pneumothorax Vs Hemothorax

WHAT IS IT…? PLEURAL SPACE

The potential space between the visceral pleura (lining of the lungs) and the parietal
Situations that cause ACCUMULATION pleura (lining of the chest cavity)
of air or blood in the pleural pace Maintains a negative pressure environment
surrounding the lungs Any introduction of air or blood into this space disrupts the negative pressure,
potentially leading to lung collapse.

PNEUMOTHORAX
LEAKAGE OF AIR INTO PLEURAL SPACE

CAUSES Tension
pneumothorax
Closed Open The pleural cavity pressure is >the
pneumothorax pneumothorax athmospheric pressure
The pleural cavity pressure is The pleural cavity pressure is
<the athmospheric pressure <the athmospheric pressure Air can't outflow causing pressure
in thoracic cavity
Air enters the pleural cavity Air enters the pleural cavity
through an external opening: WITHOUT an external opening: Treatment
Gunshot Sucking Rib fracture Bleb rupture Needle Decompression
Stabbing chest wound
Primary: No previous
Treatment history of LUNG DISEASE SYMPTOMS
Put sterile occlusive dressing Dyspnea Subcutaneous
Secondary: Previous
on wound, taped on 3 sides Absent breath emphysema
history of LUNG DISEASE
treatment Inhibits tension sounds on the Unequal chest
PNEUMO affected side expansion
Hyperresonance Tachycardia
on percussion Hypoxia.
HEMOTHORAX
LEAKAGE OF BLOOD INTO PLEURAL SPACE TREATMENT
CAUSES Pulmonary
Trauma Embolism PROCEDURES
Thoracic Surgery Cancer Chest tube insertion: To evacuate
Ruptured Blood Chest Wall Lesions fluid or air from the pleural space to Chest tube insertion
Vessels Thoracentesis facilitate lung re-expansion. Prepare suction tubing
Coagulopathies
Thoracentesis: Minimally invasive Administer analgesic if
technique involving needle insertion prescribed
into the chest cavity to aspirate air or Offer supplemental oxygen
SYMPTOMS fluid accumulation, often followed by Confirm placement with
Dyspnea Bloody and chest tube placement if necessary. chest X-ray
Absence of lung frothy sputum Follow vital sign monitoring
Thoracotomy: Surgical intervention
sounds on the Hypotension protocol post-procedure
involving partial removal of the chest
affected side Unequal chest Maintain occlusive
wall to restore lung inflation, typically
Dullness on expansion dressing over insertion site.
reserved for severe cases of
percussion Tachycardia
hemothorax.
Hypoxia

NURSING INTERVENTION
MONITOR MONITOR CHEST TUBE FOR
Vital signs Monitor for air leaks Promote coughing and deep breathing
Chest tube placement Observe color and volume of drainage Instruct on splinting the area during coughing
n site Check water level or suction bellows Adjust positioning to facilitate drainage
Pulmonary sounds to ensure appropriate suction Encourage mobility as allowed by physician's order
 Respiratory

Pleural Effusion Vs Pulmonary Edema

Space between the two Small air sacs at end

PLEURAL EFFUSION layers of the pleura PULMONARY EDEMA of bronchioles where
Fluid accumulation in the surrounding the lungs and Fluid accumulation in the
lines the chest cavity O2 & CO2 exchanges.
PLEURAL CAVITY ALVEOLI

Causes: Causes:

TRANSUDATIVE EXUDATIVE CARDIOGENIC NON-CARDIOGENIC

EFFUSION EFFUSION cardiac insufficiency Due to the damage to
Accumulation of watery Accumulation of Due to inability of the lungs leading to
fluid due to pressure protein-rich fluid due heart to pump conditions like:
buildup and backflow to inflammation of appropriately. This
into the lungs. Leads to capillaries causing Acute Respiratory
may be due to:
conditions like: them to leak, leading Distress Syndrome
to conditions like: Left-sided heart Toxin inhalation
Heart failure failure Malnutrition due
Pulmonary embolism Pneumonia Myocardial infarction to low intake of
Pulmonary edema Cancer (heart attack) protein that leads
due to post-open- Pleural effusion Mardiomyopathy to edema
heart surgery. due to kidney Pneumonia
disease
SYMPTOMS
SYMPTOMS
Hemoptysis with frothy COMPLICATIONS FLASH
COMPLICATIONS
Shortness of breath appearance PULMONARY EDEMA
EMPYEMA
(dyspnea) Tachypnea
Acute shifting of Fluid
Chest pain Accumulation of Breathlessness in from pulmonary
pus/infected fluid in recumbent position
Dry cough vasculature into alveoli
the pleural cavity.
Difficulty breathing Rales
Symptoms: Symptoms
when lying down Dullness on percussion
Severe shortness
(orthopnea) Fever & Chills Altered mental status of breath
Fatigue Chest pain: Intercostal retractions Severe crackles &
Reduced chest Shortness of breath rales
expansion (dyspnea)
HR , BP, RR
Fever Cough TREATMENT
Decreased appetite Fatigue Treatment
Swelling (edema) Malaise PROCEDURE High-flow oxygen
Decreased appetite mask
Elevated head of bed Diuretics: Water pills
Oxygen therapy Nitroglycerin
TREATMENT Respiratory support
NURSING planning
INTERVENTION Continuous patient
PROCEDURE
assessment
NURSING
Thoracentesis or chest Maintaining INTERVENTION
semi-fowler's position. Rigorous intake and
tube insertion output monitoring
Vigilant monitoring of Maintaining
Pleurodesis: Chemical
vital signs and semi-fowler's position.
used to bind visceral &
respiratory function MEDICATION Vigilant monitoring of
parietal lining,
performed to prevent Providing oxygen Inotropes to improve vital signs and
recurrent effusions supplementation as contractility respiratory function
required (Dobutamine & Dopamine) Providing oxygen
MEDICATION supplementation as
Diuretics/water pills to
required
Diuretics emove excess fluid
Antibiotics Nitroglycerin to reduce
Anti-inflammatory preload in heart
drugs ACE inhibitors to decrease
afterload in heart
 Respiratory

Pneumonia

What ıs ıt…? Types of pneumonıa

Infection that inflames the air sacs
Acquired from the hospital
in one or both lungs
Patient must have been
It can be caused by bacteria, viruses, or fungi.
Admitted for more than 48 hours
Infectious agents infiltrate the lungs via
inhalation, aspiration, or hematogenous Extensively drug resistant
spread, targeting the alveoli.
Alveoli undergo inflammation and Pneumonia
accumulate exudate & results
In purulent and fluid-filled air sacs Impaired
Hospital Acquired
gas exchange
(Nosocomial) Pneumonia

ICU-acquired pneumonia
Bronchiole
Healthy Alveoli
Non-ventilated intensive
care acquired
pneumonia (NV-ICUAP)

Ventilator associtated
Pneumonia (VAP)
Open air space
Non-ICU acquired
pneumonia
Swollen Bronchiole
Pneumonia
Community-acquired
pneumonia

Air space Infection acquired after being

filled with fluid placed on ventilator
Onchi

Intubation time is > 48 hours

inflammation in
alveolar wall

Acquired from the community

ASPIRATION is the Inhalation of fluid, food, or
Streptococcus pneumonia
secretions into airway
It can be occurred inside the hospital or in is the most common causative agent
community.
 Respiratory

Pneumonia

Rısk factors Dıagnostıcs Treatment

Age Chest X-Ray: Radiograph imaging Medıcatıons

of the chest
Weakened immune system Antibiotics: If cause agent is
Labs: Laboratory tests or bacterial
Chronic diseases such as COPD investigations
Antivirals: If cause agent is viral
Smoking Sputum culture: Microbiological
analysis of sputum or microbial Antipyretics: To reduce fever
Hospitalization
culture Nebulizers: To loosen the
Respiratory tract infections secretions
Aspiration
Bacterial & viral pneumonia are
Immobilization CONTAGIOUS Fungal pneumonia
is NOT CONTAGIOUS
Malnutrition Educatıon
Exposure to pollutants
Promote utilization of the
Alcohol abuse Nursıng ınterventıons spirometer for deep breathing
exercises. You can give it as
Close contact incentive.
Continuously assess vital signs
These risk factors vary in severity and respiratory condition. Facilitates alveolar recruitment
and may interact with each other. and enhances gas exchange.
Perform chest physiotherapy or
percussion therapy to aid in Advocate for regular changes
secretion clearance. in position to facilitate postural
Maintain a semi-Fowler's drainage.
Symptoms position or elevate the head of
Ensure completion of antibiotic
the bed by 30 degrees.
course without interruption,
Flu-like symptoms Provide oxygen therapy as regardless of symptom
required or administer improvement.
Pyrexia & sweating additional oxygen as
necessary.
Chills
Regularly assess the
Muscle pain appearance and texture of
secretions.
Preventıon
Anorexia or loss of appetite
Perform suctioning when
Abnormal sound of breathing necessary or use aspiration as Proper hand washing or
(coarse crackles & rhonchi) required. meticulous hand cleanliness

Oxygen deficiency or hypoxia Maintain immunization status

& CO2 or adhere to vaccination
schedules
Increased heart rate Dıet
Minimize contact with
Increased respiratory rate individuals who are ill or
Grazing eating pattern or
Cough associated with frequent small meals practice social distancing
phlegm from sick individuals
Protein-rich diet or protein
supplementation Quit smoking or tobacco
High number of WBC
Calorie-dense diet or cessation
Neurological changes most high-energy intake
common in elderly patients Promote hydration (unless
and can be only presenting limited by congestive heart
signs. failure) or encourage fluid intake
 Respiratory

Pulmonary Embolism

What ıs ıt…? Rısk Factors

Birth Control +
Recent surgical procedure or surgical Smoking = Very
Blood clot blocks a blood vessel in the lung
intervention High Risk!
(typically pulmonary artery), hindering blood flow
Atrial fibrillation or irregular heartbeat
Excessive weight or adiposity
Tobacco use or cigarette smoking
Causes Birth control pills or hormonal
Can lead to Fat
Emboli Fat
contraceptives (containing estrogen &
Particle breaks
Deep veın thrombosıs (dvt) progesterone)
off & travels
Blood clot IS MADE in one of the LOWER EXTREMITIES Immobility (long flights or bed-bound) to lungs
and gets extricated & TRAVELS UP the vascular Long bone fracture (femur)
system & becomes STUCK IN THE LUNGS.
It leads to IMPAIRED BLOOD FLOW & OBSTRUCTED GAS
EXCHANGE. Symptoms
Dyspnea or breathlessness
Dıagnostıcs Nervousness or apprehension Feeling of IMPENDING DOOM
Rapid heartbeat or elevated heart rate
Rapid breathing or increased respiratory rate
CT SCAN GOLD STANDARD
Pleuritic chest pain or chest discomfort exacerbated
D-dimer: It will be elevated for (+) PE by breathing
Must get CT scan if elevated Low blood pressure or decreased blood pressure
Sweating or perspiration
Acute alteration in mental status or abrupt
Treatment cognitive change

Medıcatıons Nursıng ınterventıon

Anticoagulants: To prevent new clot formation &
getting them bigger Physiological parameters or vital functions
Thrombolytics: Dissolve clot Breathing condition or respiratory function
Example: ALTEPLASE (used in more severe cases) Blood thinning treatment or clot-dissolving therapy
Indicators of hemorrhage or manifestations of
Procedures excessive blood loss
Provide supplemental oxygen as required or oxygen
Thrombectomy: Removal of blood clot through
supplementation as necessary
surgery
Encourage frequent changes in position to enhance
IVC Filter: Filter inserted into vein to stop clots from gas exchange or advocate for regular positional
traveling up to lungs changes to optimize oxygenation
Raise the head of the bed for optimal lung expansion
If left untreated may result in: or elevate the head of the bed to facilitate maximum
respiratory capacity
Respiratory failure
These require DVT Prevention
Core pulmonale Can lead to
immediate Early ambulation
Cardiac arrest interventions Bleeding gums ROM exercises if immobile
Sudden death Bloody nose
Compression stockings
Hematuria
Avoid crossing legs

Bleeding Precautions
Soft toothbrush only Do NOT take aspirin
Electric razor to shave Avoid falls
 Respiratory

Tuberculosis

Dropless from a cough or

sneeze by an infected person

What ıs ıt…?
It is a bacterial infection Causative agent is Mycobacterium
MYCOBACTERIUM TUBERCULOSIS that mainly affects tuberculosis
the lungs

Tuberculosis

CNS (brain
and meningest)

Tonsil

Bone, Muscle
Liver

Adrenal gland

Intestine Ureter

Adnexa
 Respiratory

Tuberculosis

Both types require treatment

If latent type is not treated, it
Rısk factors Types can lead to active TB

Laten TB TB Disease
Immunosuppression TB lives but doesn't TB is active and
grow in the body grows in the body
Chronic disease
Doesn't make a Makes a person feel
Malnutrition person feel sick or sick and have
have symptoms symptoms
Geography Can't spread from Can spread from
person to person person to person
Substance use
Can advance to TB Can cause death if
disease not treated

*Usually asymptomatic until

Symptoms infection becomes active

Persistent
Coughing up
coughing moe Chills
blood
than 3 weeks

Fever Chest pain Fatigue

Dıagnostıcs Treatment REMEMBER PRIEST as 1ST

line treatment

• Mantoux Test/ TB skin test: In this test, purified Pyrazinamide

protein derivative (PPD) solution is administered by Can be HEPATOTOXIC
intradermal injection to the skin. EDUCATION: No alcohol & monitor for jaundice
• Acid fast bacilli: Sputum samples taken to Rifampin
categorize mycobacterium Colors the urine & other secretions to orange
EDUCATION: Monitor for signs of hepatotoxicity
• Quantiferon gold: Blood sample to examine the
mycobacterium Isoniazid
Decreases vit B6 levels (can cause peripheral
• Chest x-ray: Evaluate for lesions in lungs (positive neuropathy)
Mantoux test requires chest x-ray follow up) EDUCATION: Supplement B6 & monitor for
hepatotoxicity
Ethambutol
Is associated with optic neuritis
EDUCATION: Frequent vision examination is necessary
STreptomycin
 Respiratory

Tuberculosis

Nursıng ınterventıon Whats DOT?

Isolatıon ın negatıve-pressure envıronment for Direct observation of therapy (DOT) involves pro- viding
aırborne ınfectıon control the antituberculosis drugs directly to the patient and
watching as he/she swallows the medications. It is the
Continuously assess vital signs and intake/output preferred core management strategy for all patients
with tuberculosis.
Encourage expectoration and respiratory exercises

Advocate for mobility and proper dietary intake

Educatıon
Steer clear of crowded areas or confined
environments with others

Utilize face covering when in proximity to others

Minimize contact with or steer clear of

IMMUNOCOMPROMISED

Emphasize the necessity of finishing the course of

treatment

Refrain from alcohol and acetaminophen

consumption

Reduces efficacy of oral contraceptives (consider

alternative contraception)

Requires the patient to take up to four medications for

a duration spanning 6 to 12 months

Medication compliance is crucial to treatment

CDC recommends DOT (Directly Observed

Therapy) for all TB patients
 Respiratory

Upper Respiratory Disorders

What are they…? UPPER RESPIRATORY TRACT Organs of respiratory

system outside the chest cavity’ includes:

Infections of the upper respiratory airway causing Nose Larynx

localized inflammation and irritation Typically resolve Sinuses Epiglottis
on their own & necessitate only supportive care Pharynx Tonsils

Rhinitis Sinusitis Pharyngitis

INFLAMMATION and IRRITATION Inflammation of spaces inside Inflammation, discomfort,
of the mucous membrane of the nose, known as sinuses pain, or scratchiness in the
the nose throat (pharynx)

Treatment Treatment Treatment

Normal saline nasal sprays/drops Hydration therapy or mucolytics. Antibiotics for bacterial infections
Decongestants Antifungals for fungal infections
Anti-histamines
Antibiotics in case of bacterial Hydration with fluids
Decongestants infection Gargling with salt water, which
Corticosteroids Normal saline rinse can help soothe a sore throat
and reduce inflammation

Symptoms Symptoms Symptoms

Snoring Green/yellow mucus drips from Throat discomfort

nose down back of throat Difficulty swallowing
Blocking Nose
Pain/tenderness around eyes, Enlarged or tender lymph nodes
Itchy Skin
forehead or cheeks
Increased Heart Rate Raspy or husky voice
Reduced sense of smell
Ruinny Nose A high tempereature (38c or
higher)
Tiredness
 Respiratory

Upper Respiratory Disorders

Laryngiitis Tonsilitis Epiglottitis

Inflammation of Larynx (VOICE Tonsillitis is an infection of It is inflammation and swelling
BOX) tonsils, in which inflammation of the epiglottis. It's often
of tissues occur caused by an infection

Most common causative agent

Treatment Treatment
is “Haemophilus influenza”
Resting the voice to prevent strain Incourage rest.
Staying hydrated with fluids Provide adequate fluids
Treatment
Avoiding smoking, which can Provide comforting foods and
irritate the throat beverage Steroid medication (to reduce
Taking antibiotics if the cause is Prepare a saltwater gargle airway swelling)
bacterial Humidify the air Intravenous (IV) fluids
Offer lozenges Humidified oxygen
Symptoms
Avoid irritants Breathing tube in EMERGENCY
Hoarse voice Pain relievers ANTIBIOTICS
Loss of voice Treat pain and fever with
antipyretics Symptoms
Painful to speak
Painful to swallow Severe sore throat.
Symptoms
Shortness of breath Difficulty and pain when
Upper respiratory infection Red, swollen tonsils. swallowing.
Sore throat White or yellow coating or Difficulty in breathing, which may
patches on the tonsils. improve when leaning forwards.
Sore throat. Breathing that sounds abnormal
Difficult or painful swallowing. and high-pitched (stridor)
Fever. High temperature as 1st sign
Enlarged, tender glands (lymph Irritability and restlessness.
nodes) in the neck. Muffled or hoarse voice.
A scratchy, muffled or throaty Drooling
voice.
Bad breath
It can block airway if swelling
becomes severe
May require tonsillectomy for
frequent episodes
CARDIAC
 Cardiac

Cardiac System Overview

The Cardiovascular system is sometimes called the blood-vascular, or simply the circulatory, system. It consists of
the heart, which is a muscular pumping device, and a closed system of vessels called arteries, veins, and capillaries.

THERE ARE FOUR CHAMBERS ATRIUMS : Blood Recievers

The Left Atrium And Right Atrium (Upper Chambers) Right Atrium:
The Left Ventricle and Right Ventricle (Lower Chambers) Receives deoxygenated blood from the body via
the vena cavae and sends it to the right ventricle.
Superior Aorta
Vena Cava Left Atrium:
Pulmonary Receives oxygenated blood from the lungs via the
Artery pulmonary veins and sends it to the left ventricle
Pulmonary
Vein Pulmonary
Vein
Right VENTRICLES : Blood Pumpers
Atrium Left
Atrium Right Ventricle:
Pulmonary Receives blood from the right atrium and pumps it to the
Valve Mitral
Valve lungs for oxygenation through the pulmonary artery.
Tricuspid
Valve Aortic Left Ventricle:
Valve Receives blood from the left atrium and pumps
Inferior oxygenated blood to the body through the aorta.
Vena Cava
Right Ventricle Left Ventricle

Blood Passes Through A

VALVES: Prevent Backflow Valve Before Leaving Each
Chamber Of The Heart.
Valves in the cardiac system prevent backflow by opening and closing in
response to changes in pressure within the heart chambers.

There are two types of valves in the heart:

ATRIOVENTRICULAR (AV) VALVES: SEMILUNAR VALVES

They regulate blood flow between the atria and Include the pulmonary valve (exit of right ventricle)
ventricles of the heart. and aortic valve (exit of left ventricle).
Tricuspid valve (on the right side) and mitral valve Found at the exits of the ventricles, guarding against
(on the left side) are AV valves. backflow into the ventricles.
Function:
Function:
Open during ventricular contraction to allow blood
Open during atrial contraction to allow blood into
out of the heart, then close to prevent backflow
the ventricles, then close to prevent backflow when during relaxation.
ventricles contract. Pulmonary Valve
Tricuspid Valve Regulates blood flow from the right ventricle to the lungs,
The tricuspid valve is positioned between the right atrium preventing backflow, ensuring efficient oxygenation.
and right ventricle AORTIC Valve
Mitral Valve The Aortic valve regulates blood flow from the left
is located between the left atrium and the left ventricle. ventricle to the aorta, ensuring one-way flow of
oxygenated blood to the body.
The mitral valve also called bicuspid valve
 Cardiac

Cardiac System Overview

LAYERS OF THE HEART

The wall of the heart separates into the following three main layers: EPICARDIUM, MYOCARDIUM, AND ENDOCARDIUM.
These three layers of the heart are embryologically equivalent to the three layers of blood vessels: tunica adventitia, tunica
media, and tunica intima, respectively.

EPICARDIUM

The Epicardium refers to the outermost protective layer of the heart. The epicardium is composed of mesothelium, a cell
type that covers and protects most of the internal organs of the body as well as fat and connective tissue. The
epicardium predominantly surrounds the heart and the roots of the coronary vessels emerging from it, including the
aorta, the superior vena cava, and inferior vena cava.

Its FUNCTION

Epicardium, beyond its protective role, serves multiple functions.

As the innermost layer of the pericardium, it plays a crucial protective role.
It signals proper heart formation and maturation in embryos.
Epicardium secretes factors vital for cardiomyocyte proliferation and survival.
Cells from the epicardium can become various types of cardiac cells.
Epicardial signals are involved in the heart's injury response, such as myocardial infarctions, and subsequent regeneration.

MYOCARDIUM

The MYOCARDIUM is the middle muscular layer of the heart. It is the thickest layer which lies between the single-cell
endocardium layer, and the outer epicardium, which makes up the visceral pericardium that surrounds and protects the
heart. The myocardium is composed of specialized muscle cells called cardiomyocytes.

Its FUNCTION

Myocardium's primary function:

Facilitates contraction and relaxation of heart walls for blood pumping into systemic circulation.
Myocardial cells also serve as scaffolding for heart chambers.
They conduct electrical stimuli essential for heart rhythm regulation

ENDOCARDIUM

The endocardium is a thin, smooth tissue that makes up the lining of the chambers and valves of the heart. The innermost
layer of the heart’s walls, it serves as a barrier between cardiac muscles and the bloodstream and contains necessary
blood vessels. It also houses the heart’s conduction system, which regulates the activity of cardiac muscles.

Its FUNCTION

Anatomic function:
A tissue covering the inside of the heart, the endocardium keeps the blood flowing through the heart separate from the
myocardium, or cardiac muscles. It also lines the valves, which open and close to regulate blood flow through the
chambers of the heart.

Conduction system:
Heart activity and rhythm are regulated by electrical signals, which travel through the nerves embedded in the
endocardium. These nerves are connected to the myocardium, causing the muscle to contract and relax, pumping blood
through the body.
 Cardiac

Cardiac System Overview

PERICARDIUM

The PERICARDIUM is a fibro-serous, fluid-filled sack that surrounds the muscular body of the heart and the roots of the
great vessels (the aorta, pulmonary artery, pulmonary veins, and the superior and inferior vena cavae).
Endocardial Layer: This layer is found within the endocardium and is composed of endothelial cells. It lines the inside of
theheart chambers and helps maintain smooth blood flow.
Pericardial Layers: The pericardium has two layers:

Parietal Pericardium: This is the outer layer of the pericardium that surrounds the heart.
Visceral Pericardium (Epicardium): This is the inner layer of the pericardium that directly covers the heart. It is also
known as the epicardium.

Its FUNCTION

Protection: The pericardium provides physical protection to the heart, shielding it from external trauma and preventing
overdistension.
Prevention of Friction: The pericardial fluid between the two layers of the pericardium acts as a lubricant, reducing
friction as the heart beats and allowing smooth movement within the chest cavity.
Maintenance of Position: The pericardium helps maintain the position of the heart within the chest cavity, preventing
excessive movement that could disrupt its function.
Barrier to Infection: The pericardium forms a barrier that helps protect the heart from infections that may spread from
neighboring structures.
Contribution to Hemodynamic Stability: By limiting excessive movement of the heart and stabilizing its position, the
pericardium contributes to hemodynamic stability, ensuring efficient blood flow and cardiac function.
 Cardiac

Cardiac System Overview

CARDIAC TERMS

CARDIAC OUTPUT (CO) EJECTION FRACTION EJECTION FRACTION (EF)

Cardiac output (CO) is dependent on the heart as well Ejection fraction (EF) is a measurement that your
as the circulatory system- veins and arteries. CO is the physician may use to gauge how healthy your heart is.
product of heart rate (HR) by stroke volume (SV), the Your ejection fraction is the amount of blood that your
volume of blood ejected by the heart with each beat. heart pumps each time it beats. Ejection fraction is
Cardiac output (CO) refers to the amount of blood measured as a percentage of the total amount of blood
pumped by the heart per minute in your heart that is pumped out with each heartbeat.
FORMULA
Normal EF: 50-70%
Cardiac Output = Stroke Volume * Heart Rate
Writen as: HEART RATE (HR)
CO = SV * HR
Heart rate is the number of times each minute that
Normal CO: 4-8L/ min
your heart beats.
CONTRACTILITY
Normal HR: 60-100 bpm
Contractility refers to the ability of the heart muscle
(myocardium) to contract and generate force during STROKE VOLUME (SV)
each heartbeat. It's a measure of the strength and
efficiency with which the heart pumps blood. Stroke Volume (SV) is the volume of blood in millilitres
Contractility = = sv ejected from the each ventricle due to the contraction
of the heart muscle which compresses these ventricles.
Contractility results in a stronger contraction of the
heart muscle, leading to greater ejection of blood Normal SV: 50-100 mL/ min
from the heart chambers, thus increasing the overall
blood output.

PRELOAD AFTERLOAD

Preload is the amount of blood in the heart's ventricles Afterload refers to the resistance the heart must
just before contraction. It reflects the stretch on the heart overcome to pump blood out into the body or lungs.
muscle fibers and influences the force of contraction It's influenced by factors like vascular resistance and
during systole. Optimal preload ensures efficient cardiac artery elasticity. High afterload increases the heart's
function and adequate blood circulation. workload, while lower afterload improves efficiency.
 Cardiac

Cardiac Functioning

BLOOD FLOW THROUGH THE HEART Superior Aorta

Vena Cava
Pulmonary
Blood comes into the right atrium from the body, Artery
moves into the right ventricle and is pushed into the
pulmonary arteries in the lungs. After picking up
Pulmonary
oxygen, the blood travels back to the heart through the
Vein
pulmonary veins into the left atrium, to the left ventricle
and out to the body's tissues through the aorta Right
Atrium Left
Atrium
Pulmonary
Valve Mitral
Lungs Valve
Tricuspid
Pulmonary Artery Pulmonary Vein Valve Aortic
Valve
Pulmonary Semilunar Valve
Inferior
Right Ventricle Left Atrium Vena Cava
Right Ventricle Left Ventricle
Tricuspid AV Valve Bicuspid AV Valve

Right Atrium Left Ventricle OXYGEN RICH BLOOD OXYGEN POOR BLOOD
Aortic Semilunar
Valve Enters the heart from Enters the heart from
Vena Cava Aorta the lungs and goes out the body and goes out
to the body to the lungs
Body Tissues

RIGHT DEOXYGENATED BLOOD LEFT OXYGENATED BLOOD

Superior and Inferior Vena Cavae: Deoxygenated Pulmonary Vein: Carries oxygenated blood from the
blood from the body returns to the heart through the lungs to the heart's left atrium.
superior and inferior vena cavae, the largest veins in Left Atrium: Receives oxygenated blood from the
the body. pulmonary veins before it is pumped into the left
Entry into the Right Atrium: The vena cavae empty ventricle.
their blood into the right atrium of the heart, specifical- Aortic Valve: Opens to allow oxygenated blood to flow
ly into the right atrial appendage. from the left ventricle into the aorta.
Passage to the Right Ventricle: From the right atrium, Aorta: Carries oxygenated blood to the body's tissues
the deoxygenated blood flows through the tricuspid and organs from the left ventricle.
valve into the right ventricle.
Left Ventricle: Contracts to pump oxygenated blood
Ejection into the Pulmonary Artery: The right ventricle through the aortic valve into the aorta.
contracts, pumping the deoxygenated blood through
the pulmonary valve and into the pulmonary artery. Mitral/Bicuspid Valve: Prevents backflow of blood
from the left ventricle to the left atrium during
Tricuspid Valve : The tricuspid valve regulates the flow ventricular contraction.
of deoxygenated blood from the right atrium to the
right ventricle, preventing backflow during ventricular
contraction. Blood to body
Transport to the Lungs: The pulmonary artery carries
the deoxygenated blood away from the heart and
toward the lungs, where it will be oxygenated during
the process of respiration.

Blood to LUNGS
 Cardiac

Cardiac Functioning

CONDUCTION SYSTEM

A network of specialized muscle cells is found in the heart's walls. These muscle cells REPOLARIZATION= RELAX
send signals to the rest of the heart muscle causing a contraction. This group of
muscle cells is called the cardiac conduction system. DEPOLARIZATION= CONTRACT

SINOATRIAL (SA) NODE P WAVE

The P WAVE is the first deflection seen on an
The Sinoatrial (SA) node is the HEART'S NATURAL electrocardiogram (ECG) and represents ATRIAL
PACEMAKER, initiating electrical impulses that trigger DEPOLARIZATION, which is the electrical activation of the
atrial contraction. atria as they contract to push blood into the ventricles.

BEATS 60-100 BPM Starts

QRS complex
BUNDLE OF HIS Atrial repolarization
A combination of the Q wave, R wave and S wave, the
The Bundle of His conducts electrical signals from the “QRS complex” represents ventricular depolarization.
(AV) node to the bundle branches, coordinating This term can be confusing, as not all ECG leads
ventricular contraction. contain all three of these waves; yet a “QRS complex” is
said to be present regardless.
BEATS 20-40 BPM
Starts

BUNDLE BRANCHES

Bundle branches transmit electrical impulses from Complete

the bundle of His to the Purkinje fibers, facilitating
coordinated ventricular contraction.

BEATS 20-40 BPM

ATRIOVENTRICULAR (AV) NODE PR interval

The PR interval on an ECG indicates the time it takes
The Atrioventricular (AV) node delays and regulates for the electrical signal to travel from the atria to the
electrical impulses between the atria and ventricles ventricles, encompassing conduction through the AV
in the heart. node and bundle of His, reflecting the delay between
“GATEKEEPER” between the atria and the ventricles atrial and ventricular contraction for optimal
ventricular filling.

BEATS 40-60 BPM

Complete

PURKINJE FIBERS T WAVE

The T wave on an electrocardiogram (ECG) is
Purkinje fibers rapidly conduct electrical impulses representative of ventricular repolarization. Changes in
throughout the ventricles, coordinating ventricular T wave morphology can be indicative of various benign
contraction. or pathologic conditions affecting the myocardium.

BEATS 20-40 BPM Starts

 Cardiac

Cardiac Functioning

Conduction

SA Node 1 SA Node
2 AV Node
3 Bundle of HIS
4 R/L Bundle Branches
5 Purkinje Fibers
Internodal Pathway
SA Bachmann’s Bundle

AV Left Bundle Branch

AV Node
Bundle of HIS

Right Bundle Branch

Purkinje Fibers Purkinje Fibers

Blood vessels
From Heart To Heart
Blood vessels are the channels or conduits through
which blood is distributed to body tissues. The vessels Capiliaries
make up two closed systems of tubes that begin and Artery Vein
end at the heart. One system, the pulmonary vessels,
transports blood from the right ventricle to the lungs
and back to the left atrium.

The 3 Main Types of Blood Vessels Are:

ARTERIES
These carry blood pumped away from the heart; they
are the largest and strongest blood vessels.

Think A for a Away

EXCEPTIONS
VEINS
Veins are blood vessels that carry deoxygenated blood
PULMONARY ARTERY
towards the heart from various parts of the body.
The pulmonary artery is an exception among arteries
as it carries deoxygenated blood from the heart to the
Think V for a Visit lungs for oxygenation, contrary to most arteries that
carry oxygenated blood away from the heart.
CAPILLARIES PULMONARY VEIN
These are tiny vessels that connect arteries and veins. The pulmonary vein is an exception among veins as it
Their thin walls allow blood to come into close contact carries oxygenated blood from the lungs back to the
with tissues to exchange oxygen, carbon dioxide, heart, while most veins carry deoxygenated blood
nutrients and waste products. towards the heart.
 Cardiac

Cardiac Assessment

Cardiac assessment is the evaluation of heart function and health through exams and tests to detect and manage
heart conditions effectively.

AUSCULTATING HEART SOUNDS

AORTIC VALVE
Auscultating the aortic area involves listening to heart sounds over
the aortic valve to assess for normal and abnormal sounds
indicating aortic valve function.
PULMONARY VALVE
Auscultating the pulmonary area assesses heart sounds over the
pulmonary valve for normal and abnormal sounds indicating
pulmonary valve function.
ERB'S POINT
Erbs point is a specific auscultation site located at the third

APE TO MAN
intercostal space along the left sternal border, where the sounds of
the aortic and pulmonic valves can be best heard. ORTIC VALVE
TRICUSPID VALVE ULMONARY VALVE
The tricuspid valve is located between the right atrium and right RB’S POIINT
ventricle and prevents the backflow of blood from the ventricle to the
atrium during ventricular contraction. RICUSPID VALVE
MITRAL VALVE
The mitral valve, also known as the bicuspid valve, is situated
between the left atrium and left ventricle, preventing the backflow of MITRAL VALVE
blood from the ventricle to the atrium during ventricular contraction.

NORMAL HEART SOUNDS ABNORMAL HEART SOUNDS

The First Heart Sound, Occurs During

Diastole Systole Indicative of impaired ventricular
Systole And Is Produced By The Closure Of
filling, often heard in conditions like
The Atrioventricular Valves (Tricuspid And
heart failure.
Mitral Valves)
S1 S3
The First Heart Sound, Corresponds To The Sounds like "lub-dub-ta"
Closure Of The Tricuspid Valve During
Ventricular Systole.

Generated by the closure of the semilunar Venticular Venticular

valves during ventricular diastole. Associated with stiff ventricular walls,
Systole Diastole
typically found in conditions such as
S2 hypertrophic cardiomyopathy.
The second heart sound (S2) represents S4
the closure of the semilunar valves,
specifically the aortic and pulmonary Sounds like "ta-lub-dub"
valves, during ventricular diastole.
 Cardiac

Cardiac Assessment

CARDIAC MEASUREMENTS

Blood Pressure (BP) Mean Arterial Pressure (MAP)

Blood pressure (BP) is the force of blood against artery Mean Arterial Pressure (MAP) is the average pressure in
walls, with systolic pressure being the pressure during the arteries during a cardiac cycle, calculated using both
heart contraction and diastolic pressure being the systolic and diastolic blood pressures and often used as
pressure between beats. It's a vital indicator of an indicator of tissue perfusion.
cardiovascular health. Mean Arterial Pressure (MAP) is considered a more
reliable indicator of perfusion to vital organs compared
Systolic Blood Pressure (SBP)
to systolic blood pressure.
Systolic Blood Pressure (SBP) is the highest pressure in
the arteries during heart contraction. Normal MAP: 70-100 mmhg

DIASTOLIC BLOOD PRESSURE (DBP)

Diastolic Blood Pressure (DBP) is the lowest pressure in EXAMPLE
the arteries when the heart is at rest between beats.
Let's calculate the Mean Arterial Pressure (MAP)
using the given blood pressure (BP) values:
FORMULA BP = 120/80 mmHg
Substituting the given values:
MAP= SP + 2DP MAP = 120 + 2(80) So, the Mean Arterial
3 3 Pressure (MAP)
= 120 + 160 is approximately
3 93.33 mmHg.
Where DP is the diastolic blood pressure, SP is the systolic
= 280 / 3 ≈ 93.33 mmHg
blood pressure.

CARDIAC BIOMARKERS

TROPONIN (TRP)
Cardiac biomarkers are proteins or molecules released
Troponin (TRP) is a cardiac biomarker released into the into the bloodstream in response to heart damage or
bloodstream following heart muscle injury. dysfunction, aiding in the diagnosis and assessment of
It is primarily used for diagnosing acute coronary cardiac conditions.
syndromes, particularly myocardial infarction
(heart attack).
NORMAL: <0.04 NG/ML DIAGNOTICS

CREATINE KINASE MYOCARDIAL BAND ELECTROCARDIOGRAM (EKG or ECG):

is a Diagnostic tool used to assess the electrical activity
Creatine Kinase-MB (CK-MB) is an enzyme mainly found of the heart and detect any abnormalities in its rhythm
in the heart muscle and is released into the bloodstream or conduction system.
when there is heart muscle damage, aiding in the
diagnosis of conditions like heart attacks.
ECHOCARDIOGRAPHY(ECHO):
To Help Diagnose And Monitor Acute Myocardial is a diagnostic imaging method utilizing ultrasound to
Infarction (heart attack). create images of the heart's structure and function,
NORMAL: <5 NG/ML aiding in the assessment of various cardiac conditions.

BRAIN NATRIURETIC PEPTIDE (BNP) CARDIAC CATHETERIZATION

Cardiac Cath, is a diagnostic procedure that uses a
BNP is released by the heart's ventricles in response to catheter to visualize coronary arteries and measure
increased pressure and volume, which causes them to heart chamber pressures, often followed by interventions
overfill and stretc like angioplasty or stent placement.
(BNP) is used to detect and assess heart failure and its
severity
Normal: <100 pg/ml >700= SEVERE HF
 Cardiac

EKG Basics

EKG BASICS involve understanding EKG waveforms, recognizing cardiac rhythms, and using EKG tracings for diagnosing
heart conditions.

P WAVE Normal Values

The P wave in an ECG represents Atrial Depolarization,
indicating the electrical activation of the Atria During PR Interval
Contraction.
Measured from the beginning of the P wave to
the beginning of the QRS complex on an
QRS COMPLEX electrocardiogram (ECG), typically ranges from
0.12 TO 0.20 SECONDS
The QRS complex in an ECG represents Ventricular
Depolarization, while atria repolarization occurs
simultaneously, signifying contraction of both ventricles and QRS Complex
relaxation of both atria.
Ranging from 0.06 TO 0.12 SECONDS in duration
on an electrocardiogram (ECG)
T WAVE

The T wave in an ECG signifies Ventricular Repolarization, QT Interval

where both ventricles relax, with changes in T wave
morphology reflecting different myocardial conditions. The time interval between the onset of the QRS
and the end of the T wave is the QT interval.
The QT interval normally ranges between 0.35
AND 0.45 SECONDS

QT interval
QRS REPOLARIZATION= RELAX

Enabling the chambers to passively receive

blood from the veins.

DEPOLARIZATION= CONTRACT

P Wave T Wave Forcing blood out of the chambers into the arteries.

PR Interval ST Segment
 Cardiac

EKG Basics

INTERPRETING AN EKG

1 IDENTIFY THE RATE

BOX METHOD
6-Second Method (Best for regular rhythms)
(Best For Irregular Rhythms)
The 300 Method(Big Box): Count the number of large
The second method can be used with an irregular boxes between 2 successive R waves and divide by 300
rhythm to estimate the rate. Count the number of to obtain heart rate.
R waves in a 6 second strip and multiply by 10. 300/ 4 big boxes= 75 bpm
For example, if there are 7 R waves in a 6 second strip,
the heart rate is 70 (7x10=70).
There are 30 big boxes in a 6 second strip
The 1500 Method(small box): you count the number of
small boxes between R waves, then divide 1,500 by that
number, and that will give you the heart rate in beats per
minute.
RATE= 60 BPM 1500/ 19 small boxes= 79 bpm

2 IDENTIFY THE RHYTHM 4 MEASURE PR INTERVAL

Assessing if the R-R intervals are consistent Involves The PR interval on an EKG is measured from the
Checking if the number of boxes between each R wave beginning of the P wave to the beginning of the QRS
is the same, aiding in determining the regularity of the complex, representing the time it takes for the electrical
cardiac rhythm. impulse to travel from the atria to the ventricles.
Normal: 0.12-0.20
Same number of boxes= regular >0.20 may indicate heart block
Box number of varies= irregular

3 IDENTIFY THE P WAVE 5 MEASURE QRS COMPLEX

A wide QRS complex (>0.12 seconds) on an EKG indicates

Are the P waves present & upright?
a delay or abnormality in ventricular depolarization,
Refers to checking if there is a distinct upward deflection
often associated with conditions such as
in the waveform corresponding to atrial depolarization.
The presence and upward orientation of the P wave Electrolyte Imbalances,
indicate normal atrial activation. Premature Ventricular Contractions (Pvcs), Or
Drug toxicity
Is there a P wave for every QRS complex? Normal: 0.06-0.12
Involves assessing if each ventricular depolarization
QRS complex) is preceded by an atrial depolarization
(P wave), indicating synchronized electrical activity
between the atria and ventricles.
6 IDENTIFY YOUR FINDINGS!
 Cardiac

Cardiac Rhythms

NORMAL SINUS RHYTHM SINUS BRADYCARDIA

Normal sinus rhythm (NSR) is the rhythm that originates Sinus bradycardia is a cardiac rhythm with appropriate
from the sinus node and describes the characteristic cardiac muscular depolarization initiating from the sinus
rhythm of the healthy human heart. node and a rate of fewer than 60

Rate: The rate of Normal Sinus Rhythm (NSR) typically Rate: <60 bpm Heart rate is less than 60 beats per
ranges from 60 to 100 beats per minute in adults. minute, indicating bradycardia.
Rhythm: REGULAR Rhythm: Regular Intervals between cardiac cycles are
P-Wave: Upright P waves occurring before every QRS consistent, suggesting a regular cardiac rhythm.
complex indicate normal atrial depolarization and P-Wave: Upright & before every QRS Upright P waves
conduction. precede each QRS complex, indicating normal atrial
PR interval: Normal depolarization.
QRS: Normal PR interval: Normal - Duration between the start of the P
wave and the start of the QRS complex falls within normal
limits.
QRS: Normal Duration and morphology of the QRS
complex are within normal parameters, suggesting
normal ventricular depolarization.

CAUSES: SYMPTOMS

Vagal stimulation: Symptoms of sinus bradycardia may include:

Increased activity of the vagus nerve leading to
Fatigue
bradycardia.
Dizziness or lightheadedness
Athletes:
Fainting or near-fainting episodes (syncope)
Regular exercise and physical conditioning resulting in a
Shortness of breath
lower resting heart rate.
Chest pain or discomfort
Medications (CCB, Digoxin, beta blockers):
Confusion or difficulty concentrating
Pharmacological agents that can decrease heart rate
Weakness or tiredness
by various mechanisms such as blocking calcium
Exercise intolerance
channels, enhancing vagal tone, or inhibiting
Palpitations
sympathetic activity
sensations of skipped heartbeats or fluttering in the
chest)
CONSIDERED NORMAL May be completely ASYMPTOMATIC
Athletes typically exhibit a lower resting heart
rate attributed to their stronger heart muscles,
which pump blood more efficiently.

TREATMENT:

If Asymptomatic
(If Patient Is Asymptomatic Treatment May Not
Be Required)
ATROPINE: Administered to increase heart rate by
blocking vagal stimulation.
Transcutaneous pacing: Temporary external pacing to
stimulate the heart and increase heart rate.
 Cardiac

Cardiac Rhythms

SINUS TACHYCARDIA SUPRAVENTRICULAR TACHYCARDIA

Sinus Tachycardia is a regular cardiac rhythm originating Supraventricular tachycardia (SVT) is as an irregularly
from the sinoatrial (SA) node with a heart rate greater fast or erratic heartbeat (arrhythmia) that affects the
than 100 beats per minute. heart's upper chambers.

Rate: >100 bpm - Heart rate exceeds 100 beats per minute, Rate: 151-200 bpm - Heart rate exceeds 150 beats per
indicating tachycardia. minute, characteristic of supraventricular tachycardia
Rhythm: REGULAR (SVT).
P-Wave: Upright & before every QRS Rhythm: REGULAR
PR interval: Normal - Duration between the start of the P-Wave: Undetectable (hidden in T waves) - P waves
P wave and the start of the QRS complex falls within may be obscured by the rapid heart rate, making them
normal limits. difficult to identify.
QRS: Normal PR interval: Normal
QRS: Narrow
CAUSES:
CAUSES:
Causes of sinus tachycardia may include:
Physiological stressors (e.g., exercise, fever, pain, anxiety) Thyroid disease Stimulants Often
Increased sympathetic tone (e.g., dehydration, Hypertension Caffeine triggered by
hypovolemia, hypoxia) Smoking Cardiomyopathy premature
Stimulant use (e.g., caffeine, nicotine, medications) Emotional Stress Heart disease beats
Fever or infection
Thyroid disorders (e.g., hyperthyroidism)
Cardiac conditions (e.g., heart failure, myocardial
infarction) SYMPTOMS
Anemia
Pulmonary embolism Very fast (rapid) heartbeat.
Medications (e.g., beta-agonists, stimulants, thyroid A fluttering or pounding in the chest (palpitations)
hormone) A pounding sensation in the neck.
Weakness or feeling very tired (fatigue)
SYMPTOMS Chest pain.
Shortness of breath.
Symptoms of sinus tachycardia may include: Lightheadedness or dizziness.
Sweating
Palpitations (sensation of rapid or irregular heartbeat)
Feeling a rapid or pounding heartbeat
Shortness of breath
Chest discomfort or pain TREATMENT:
Dizziness or lightheadedness
Fatigue or weakness Maneuvers to stop SVT, such as bearing down.
Sweating Medicines to stop SVT, like calcium channel blockers,
Anxiety or nervousness beta blockers, or adenosine.
Fainting or near-fainting episodes (syncope) Electrocardioversion, which sends a shock to the heart
Difficulty concentrating or feeling "foggy" in the head to get it back to a normal rhythm.
Catheter ablation.
TREATMENT: 2 doses max
Dosing starts by giving 6mg and then 12mg if
Find & treat underlying cause! unsuccessful
Beta blockers or calcium channel blockers (CCB)
(if symptomatic): Prescribed to reduce heart rate and Given FAST with flush immediately after
symptoms associated with sinus tachycardia.
NSAIDs (for fever): Nonsteroidal anti-inflammatory drugs
used to lower fever, which can be a trigger for sinus
tachycardia.
Fluid resuscitation: Administer fluids to restore
intravascular volume and treat hypovolemic shock,
a potential complication of conditions causing sinus
tachycardia.
 Cardiac

Cardiac Rhythms

ATRIAL FIBRILLATION SYMPTOMS

Atrial fibrillation (AF) is an irregular and rapid heart Symptoms of atrial fibrillation (AF) may include:
rhythm due to chaotic electrical signals in the atria. Palpitations (feeling of rapid, irregular heartbeat)
Shortness of breath
Fatigue
Dizziness or lightheadedness
Chest discomfort or pain
Fainting or near-fainting episodes (syncope)
Weakness
Rate: Controlled (<100) or Uncontrolled (>100) - Heart rate Anxiety or feeling of impending doom
may be managed or uncontrolled. Reduced exercise tolerance
Rhythm: Irregularly irregular - Heartbeat intervals lack a Heart palpitations, especially when lying
discernible pattern, characteristic of AF.
P-Wave: Unidentifiable - P waves are absent or May be completely May be completely asymptomatic
indistinguishable due to erratic atrial electrical activity
in AF.
PR interval: Unmeasurable - Duration between the start TREATMENT:
f the P wave and the start of the QRS complex cannot be
reliably measured due to the absence of identifiable Oxygen:
P waves. Supplemental oxygen therapy to improve oxygen levels
QRS: Narrow - Duration and morphology of QRS in the blood.
complexes are within normal limits despite the irregular Cardioversion: Synchronized electrical shock delivered
atrial activity in AF. to the heart to restore normal heart rhythm
MEDICATIONS:
CAUSES: Beta blockers: Metoprolol
Medications that block the effects of adrenaline on the
heart, slowing the heart rate and reducing blood pressure.
CAUSES INCLUDE: Calcium channel blockers: Cardizem
Atrial Fibrillation (AF) Is Caused By Various Factors, Medications that relax blood vessels and decrease the
Including: heart's workload by blocking calcium channels.
STRUCTURAL HEART DISEASE: Such as hypertension, Antiarrhythmics: Amiodarone, Digoxin
coronary artery disease, heart failure, or valvular heart Medications used to prevent or treat abnormal heart
disease. rhythms.
AGE: AF becomes more prevalent with increasing age. Blood thinners:
OTHER MEDICAL CONDITIONS: Such as hyperthyroidism, Anticoagulant medications that reduce the risk of blood
obstructive sleep apnea, chronic lung diseases, and clot formation and stroke.
obesity.
LIFESTYLE FACTORS: Including excessive alcohol
consumption, smoking, and illicit drug use. Increased risk of Increased risk of blood clots
FAMILY HISTORY: Genetic predisposition may contribute
to the development of AF.
OTHER FACTORS: Such as acute illnesses, emotional
stress, and certain medications or stimulants.

Test to Identify Cause

Diagnosis Blood Tests

Abnormal glucose, thyroid,
electrolytes, renal, etc.
Test to Diagnose AF Echocardiogram
Structural heart disesase, etc.
Electrocardiogram (ECG) Ambulatory Monitoring
Chest X-ray
Absence of P waves Holter monitoring
Pulmonary disease,etc.
Presence of F-Waves Extended monitoring
Irregularly irregular rhythm Implantable loop recorder Stress Test
irregular ventricular rate Coronary artery disease,etc.
 Cardiac

Cardiac Rhythms

ATRIAL FLUTTER
MAIN DIFFERENCE ATRIAL FLUTTER
BETWEEN ATRIAL FIBRILLATION
Atrial flutter is a type of abnormal heart rhythm, or
arrhythmia. It occurs when a short circuit in the heart
causes the upper chambers (atria) to pump very rapidly. The main difference between atrial flutter and atrial
fibrillation lies in their respective patterns of atrial
electrical activity:
Atrial flutter is characterized by a regular atrial rhythm
with a distinctive "sawtooth" pattern on ECG, while atrial
fibrillation exhibits irregular and chaotic atrial activity.
In atrial flutter, the atrial rate is typically more organized
and faster, often around 250-350 beats per minute,
Rate: Controlled (<100) or Uncontrolled (>100) - Heart rate
compared to atrial fibrillation where the rate can vary
may be managed or uncontrolled, respectively, with
widely and is usually faster than normal.
irregularly regular heartbeats typical of atrial flutter.
The ventricular response in atrial flutter tends to be
Rhythm: Irregularly regular - Heartbeat intervals display
regular due to the presence of an organized atrial
a consistent pattern despite irregularity, characteristic of
rhythm, whereas in atrial fibrillation, the ventricular
atrial flutter.
response is irregular due to the chaotic atrial activity
P-Wave: Sawtooth flutter waves - Distinctive waveform
pattern on electrocardiogram (ECG) indicative of atrial
flutter.
PR interval: Unmeasurable - Duration between the start TREATMENT:
of the P wave and the start of the QRS complex cannot
be reliably measured.
Rate control:
QRS: Regular - Duration and morphology of QRS
Medications such as beta-blockers or calcium channel
complexes are within normal limits despite irregularities
blockers to slow the heart rate.
in atrial activity.
Rhythm control:
Antiarrhythmic drugs or cardioversion to restore normal
CAUSES: heart rhythm.
Anticoagulation therapy:
Blood thinners (anticoagulants) to prevent blood clots
CAUSES INCLUDE: and reduce the risk of stroke.
High blood pressure Catheter ablation:
Congenital heart disease A minimally invasive procedure to destroy abnormal
Hyperthyroidism heart tissue responsible for triggering atrial flutter.
Coronary artery disease Electrical cardioversion:
Heart valve disorders A procedure where an electrical shock is delivered to the
Alcohol abuse heart to restore normal heart rhythm.
Diabetes Lifestyle modifications:
Lung disease Adopting a healthy lifestyle, including limiting alcohol
Cardiomyopathy and caffeine intake, managing stress, and quitting
smoking, may help manage symptoms and reduce the
risk of recurrence.
SYMPTOMS

Shortness of breath.
Tiredness (fatigue)
Chest pain.
Fluttering heartbeats (palpitations)
Lightheadedness.
Fainting.
Swelling in your feet and legs (fluid retention)
if you have heart failure.
 Cardiac

Cardiac Rhythms

JUNCTIONAL RHYTHMS SYMPTOMS

Anxiety.
A junctional rhythm is an abnormal heart rhythm that
Chest pain.
originates from the AV node or His bundle. This activity
Dizziness.
reviews the evaluation and management of junctional
Fainting.
rhythm and highlights the role of the interprofessional
Feeling fatigued or weak.
team in educating patients about their prognosis.
Heart palpitations
(feeling a fast, fluttering or pounding heartbeat in
ABBSENT P WAVE
your chest).
Shortness of breath.
Slow heart rate.

TREATMENT:
Rate: The heart rate can be categorized as bradycardia
(<40), regular (40-60), or accelerated (60-100) beats
per minute. Observation:
Rhythm: Heartbeats occur at regular intervals Usually no treatment necessary unless symptomatic or
P-Wave: The P-wave may be inverted or absent, persistent.
indicating abnormal atrial depolarization. Atropine:
Main Sign Used For Identifying Administer if heart rate becomes excessively slow
PR interval: The PR interval cannot be measured reliably (bradycardia).
due to the absence of a distinct P-wave. Address reversible causes:
QRS: The QRS complex is narrow, indicating normal Correct electrolyte imbalances or discontinue
conduction through the ventricles. medications contributing to the rhythm disturbance.
Medications:
Consider beta-blockers or calcium channel blockers to
control heart rate.
Electrical cardioversion:
CAUSES: May be necessary in cases of severe symptoms or
hemodynamic instability.
Causes Of Junctional Rhythms Include: Permanent pacing:
Sinus Node Dysfunction Consider pacemaker implantation for persistent or
Cardiac Conduction System Abnormalities, refractory junctional rhythm.
Ischemic Heart Disease
Cardiomyopathy, Electrolyte Imbalances
Medications
Autonomic Nervous System Dysfunction
Digoxin toxicity Most Common
 Cardiac

Cardiac Rhythms

Premature ventricular contractions (PVCs) PAC'S (Premature Atrial Contractions)

Premature ventricular contractions (PVCs) are (PACs) are extra heartbeats that begin in one of your
abnormal heartbeats that originate from the ventricles heart's two upper chambers (atria). These extra beats
prematurely, disrupting the heart's regular rhythm. disrupt your regular heart rhythm.
PVC Characteristics: PAC Characteristics:
Big, wide, & UGLY Small & narrow
No p wave befor Compensatory
pause after

CAUSES: CAUSES:

Cardiac Conditions:
High blood pressure.
Heart diseases like coronary artery disease or heart
Long history of cigarette smoking and/or drug abuse.
failure.
Excessive amounts of alcohol consumption over the
Electrolyte imbalances:
years.
Abnormal levels of potassium, magnesium, or calcium.
Excessive amount of caffeine or other stimulants.
Stimulants:
Little to no physical activity.
Caffeine, nicotine, or certain medications.
Extreme levels of anxiety.
Medications:
Some drugs, including asthma medications or
antiarrhythmics. SYMPTOMS
Lifestyle factors:
Excessive alcohol, stress, fatigue, or sleep deprivation. Symptoms Of PAC’s Include :
Structural abnormalities: Fluttering
Anatomical issues in the heart's ventricles or conduction Skipped heartbeats or missed heartbeats
pathways. Increased awareness of your heartbeat
Idiopathic: Heart palpitations
PVCs occurring without an identifiable cause.

SYMPTOMS Diagnosis of Premature Atrial Contractions

Symptoms Of Pvcs Include : Typically, your doctor will perform the following diagnostic
Fluttering Or Flip-flop Feeling In The Chest tests and procedures:
Pounding Or Jumping Heart Rate, Electrocardiogram (EKG/ECG)
Skipped Beats And Palpitations, Stress test
An increased awareness of your heartbeat. Holter monitor
Dizziness or lightheadedness. Event recorder
Anxiety or feelings of impending doom.
Fatigue or weakness.
Notify MD immediately TREATMENT:
If frequency increases or chest pain is present
Treatments Can Include:
Lifestyle Changes
TREATMENT:
Lower Stress
Stop Smoking
Correct electrolyte imbalances:
Cut Back On Caffeine
Addressing abnormal levels of potassium, magnesium,
Treat Other Health Issues Like Sleep Apnea And High
or calcium through dietary changes or supplementation.
Blood Pressure.
Avoid stimulants:
Eliminating or reducing intake of substances like caffeine,
Most Of The Time, Though,
tobacco, and alcohol, which can exacerbate PVCs.
Pacs Don't Need Treatment.
Assess for pain:
Investigating and managing any chest discomfort or
pain associated with PVCs to alleviate symptoms and
ensure patient comfort.
 Cardiac

Cardiac Rhythms

VENTRICULAR FIBRILLATION SYMPTOMS

Ventricular fibrillation is a life-threatening arrhythmia Lightheadedness or dizziness.

characterized by rapid, erratic electrical activity in the Palpitations
ventricles, leading to ineffective pumping of the heart (skipping, fluttering or pounding in the chest)
and loss of consciousness. Fatigue.
Loss of consciousness
Chest pressure or pain.
Shortness of breath.
Fainting spells.
Most likely no pulse or blood pressure

Rate: Ventricular fibrillation presents with a rapid and Medical Emergency

disorganized heart rate.
Rhythm: The rhythm of ventricular fibrillation is irregular
due to chaotic electrical impulses.
P-Wave: P-waves are not visible on an ECG during TREATMENT:
ventricular fibrillation.
PR interval: The PR interval is unmeasurable in ventricular Treatment For Ventricular Fibrillation Includes:
fibrillation due to the absence of organized atrial activity.
QRS: QRS complexes are unmeasurable as the ventricles Cardiopulmonary resuscitation (CPR) & defibrillator
are not contracting effectively during fibrillation.
Shocks to the heart with a device called an automated
external defibrillator (AED)

CAUSES Follow ACLS protocol(See ACLS & BLS protocol sheet

Cardiomyopathies
An acute or prior heart attack
Electrolyte abnormalities
Congenital heart disease
Brugada syndrome
Certain medicines that affect heart function
Potassium
Heart attack or angina
Cardiac surgery
Tension pneumothorax
 Cardiac

Cardiac Rhythms

VENTRICULAR TACHYCARDIA TREATMENT:

STABLE with pulse

Ventricular tachycardia (VT or V-tach) is a type of
abnormal heart rhythm, or arrhythmia. It occurs when
IV Amiodarone:
the lower chamber of the heart beats too fast to pump
Administer intravenous amiodarone, a potent
well and the body doesn't receive enough oxygenated
antiarrhythmic medication, to help stabilize the heart
blood.
rhythm and prevent further episodes of ventricular
tachycardia.
Synchronized Cardioversion:
Consider synchronized electrical cardioversion, a
procedure involving the delivery of a synchronized
electrical shock to the heart at the appropriate point in
the cardiac cycle, to restore a normal heart rhythm.
Rate: Ventricular tachycardia typically presents with a Cardiovascular Evaluation:
heart rate between 100 and 250 beats per minute. Perform a comprehensive cardiovascular evaluation to
Rhythm: The rhythm of ventricular tachycardia is regular, assess for structural heart disease, coronary artery
with consistent intervals between heartbeats. disease, or other cardiac abnormalities that may
P-Wave: P-waves are not visible on an ECG during contribute to ventricular tachycardia.
ventricular tachycardia due to the abnormal origin of the Beta-Blockers:
electrical impulses. Initiate or adjust beta-blocker therapy to reduce the risk
PR interval: The PR interval is unmeasurable in ventricular of recurrent ventricular tachycardia and to help control
tachycardia as there is no organized atrial activity. heart rate and blood pressure.
QRS: QRS complexes are wide due to abnormal
ventricular depolarization during tachycardia.

CAUSES TREATMENT:

Coronary artery disease. PULSELESS

Heart failure.
Myocarditis. Cardiopulmonary Resuscitation (CPR):
Enlarged heart (cardiomyopathy). Initiate CPR immediately to maintain blood flow to vital
Heart valve disease. organs.
Heart surgery. Defibrillation:
Previous heart attack (myocardial infarction) or heart Deliver a shock using a defibrillator as soon as possible
surgery that made scar tissue on your heart. to attempt to restore a normal heart rhythm. High-energy
Sarcoidosis. shocks are typically used for ventricular tachycardia with
pulselessness.
Advanced Cardiac Life Support (ACLS):
SYMPTOMS Follow ACLS protocols, including the administration of
medications such as epinephrine and amiodarone to
Chest pain. support cardiac function and stabilize the heart rhythm.
Dizziness. Airway Management:
Fainting (syncope) Ensure proper airway management, including the use of
Shortness of breath. an advanced airway device if necessary, to optimize
Cardiac arrest oxygenation and ventilation.
Palpitations and SOB Identify and Treat Underlying Causes:
Loss of conciousness Identify and address any reversible causes of ventricular
tachycardia, such as electrolyte imbalances, ischemia,
Medical Emergency or drug toxicity.
Consideration of Advanced Therapies:
MAY BE ASYMPTOMATIC In certain cases, advanced interventions such as
But Will Become extracorporeal membrane oxygenation (ECMO) or
Symptomatic If Sustained cardiac catheterization may be considered to support
cardiac function and identify and treat underlying
causes
 Cardiac

Cardiac Rhythms

ASYSTOLE/ FLATLINE CARDIOVERSION

Asystole, or flatline, is a state of cardiac arrest Cardioversion is the delivery of a synchronized electrica
characterized by the absence of any electrical activity in shock to the chest to restore a normal heart rhythm in
the heart, leading to the absence of a detectable individuals with certain types of abnormal heart rhythms.
heartbeat on an electrocardiogram (ECG).
Cardioversion Is Used For
SVT:
Cardioversion used for rapid heart rhythm above
ventricles.
Afib:
Cardioversion for irregular rapid heart rate.
Rate: Stable vtach with pulse:
Rhythm: NONE Cardioversion for stable fast ventricular rhythm
P-Wave: There Is NO Electrical with pulse
PR interval: Activity Presen
QRS: WHY IS IT SYNCED?
JOULES USED: If shock is delivered on T wave can
200 cause R on T Phenomenon & lead to
CARDIAC ARREST!
CAUSES
Need consent
Blood loss. prior to procedure
Low oxygen levels.
Electrolyte problems or dehydration.
Heart attack.
Pulmonary embolism.
Irregular heart rhythms (arrhythmias), especially
ventricular fibrillation and ventricular tachycardia.
Trauma (either directly to the heart or to the chest
overall).
Electrocution.
DEFIBRILLATION
Toxins, especially certain types of prescription
medications or recreational drugs (such as cocaine).
Defibrillation is the emergency delivery of an
unsynchronized high-energy electrical shock to the heart
SYMPTOMS to restore a normal rhythm during cardiac arrest or
certain life-threatening arrhythmias.
Symptoms of asystole, or flatline, may include:
Sudden loss of consciousness Defibrillation is used for
Absence of pulse Pulseless Vtach:
No breathing or gasping Defibrillation is used to treat pulseless ventricular
Pallor or cyanosis (bluish discoloration of the skin) tachycardia (Vtach), a rapid heart rhythm originating
Loss of response to stimuli in the ventricles without a detectable pulse.
Dilated pupils Vfib:
Defibrillation is used to treat ventricular fibrillation
(Vfib), a chaotic and ineffective heart rhythm
TREATMENT: originating in the ventricles.

Treatments Are Possible:

CPR. JOULES USED:
Medical professionals will immediately start this when a 200-360
person goes into cardiac arrest.
Epinephrine.
This medication, also known as adrenaline, can help
restart your heart.
Treating the underlying problem.
When asystole happens because of an underlying
problem, such as an electrolyte imbalance or
hypothermia, treating that problem is key. In many cases,
remedying that underlying problem will help restart the
heart and return it to a normal rhythm.
 Cardiac

Cardiac Rhythms

HEART BLOCKS
Heart block, also called AV block, is when the electrical
signal that controls your heartbeat is partially or
completely blocked. This makes your heart beat slowly
2ND DEGREE TYPE I
or skip beats and your heart can’t pump blood effectively.
or Wenckebach block
1ST DEGREE HEART BLOCK "Longer and longer, then a drop—now it's a Wenckebach!"
Second-degree type I heart block involves a progressively
The electrical impulse still reaches the ventricles, but lengthening PR interval on an ECG, occasionally resulting
moves more slowly than normal through the AV node. in dropped beats due to delayed conduction between
The impulses are delayed. This is the mildest type of the atria and ventricles.
heart block. cycle restarts

1st pr longer pr even longer

interval interval pr interval dropped qrs

prolonged pr interval Rate: Normal heart rate.

Rhythm: Regular heart rhythm.
P-Wave: Normal appearance of atrial depolarization.
Rate: Normal but can be slower than usual. PR interval: Gradually lengthening period between atrial
Rhythm: Regular heartbeat pattern. and ventricular depolarization.
P-Wave: Upright and present before every QRS complex. QRS: Periodic dropping of QRS complexes in a repeating
PR interval: Prolonged, exceeding 0.20 seconds. pattern.
QRS: Normal duration.

CAUSES CAUSES

Causes of First Degree Heart Block Causes of First Degree Heart Block
Increased vagal tone Increased vagal tone (e.g., during sleep)
Athletic training Medications (e.g., beta-blockers, calcium channel
Inferior MI blockers)
Mitral valve surgery Ischemia or infarction affecting the conduction system
Myocarditis (e.g. Lyme disease) Electrolyte imbalances (e.g., hyperkalemia)
Electrolyte disturbances (e.g. Hyperkalaemia) Inflammatory or infiltrative processes affecting the
AV nodal blocking drugs (beta-blockers, calcium conduction system
channel blockers, digoxin, amiodarone) Idiopathic factors
May be a normal variant
Medications (Beta blockers & calcium channel blockers)
SYMPTOMS

SYMPTOMS May be May be asymptomatic:

Dizziness.
Usually Asymptomatic (individuals may not experience
Fainting.
any noticeable symptoms.)
The feeling that your heart skips beats.
In some cases, individuals may report mild symptoms
Chest pain.
such as:
Trouble breathing or shortness of breath.
Dyspnea Nausea.
Malaise Fatigue.
Lightheadedness
Chest Pain
Even Syncope Due To Poor Synchronization Of Atrial and TREATMENT:
ventricular contractions.
Treatment of symptomatic second-degree type I heart
block (Wenckebach block) may involve:
TREATMENT:
Notifying the medical doctor for further evaluation and
management
Treatment for 1st degree heart block is typically not Checking vital signs
required. Administering oxygen
Management may involve addressing any underlying Conducting an electrocardiogram (EKG)
conditions contributing to the heart block. Performing relevant laboratory tests
If symptoms are present or if there is an underlying
cause, interventions may be considered based on
individual circumstances.
 Cardiac

Cardiac Rhythms

2ND DEGREE TYPE II

3RD DEGREE HEART BLOCK
or MOBITZ II
"If P waves and QRS complexes don't agree, then
A form of 2nd degree AV block in which there is it's third-degree."
intermittent non-conducted P waves without progressive The rhythm of the P waves occurs completely
prolongation of the PR independently of the rhythm of the QRS waves.
If some P-waves fail to conduct, then it's a Mobitz II! The electrical impulses stop getting through from the
atria to the ventricles. The heart may stop beating, and
the person may die without treatment.
p wave hidden in qrs

p waves in equal intervals

same same
dropped qrs

qrs complexes in equal intervals

Rate: Normal heart rate.

Rhythm: Heart rhythm is regular. Rate: Usually less than 60 beats per minute.
P-Wave: Normal P-waves, "marching" along. Rhythm: Regular heartbeat pattern.
PR interval: Constant duration, does not progressively P-Wave: Not directly related to QRS complexes.
lengthen. PR interval: Variable durations between P waves and QRS
QRS: Randomly drops, indicating intermittent failure of complexes.
conduction to the ventricles. QRS: Independent from P waves, not directly correlated.

More likely to progress More likely to progress to to

3rd degree 3rd degree heart block CAUSES

The causes of third-degree heart block can include:

CAUSES
Ischemic heart disease
Cardiomyopathy
Anterior MI (due to septal infarction with necrosis of the
Myocarditis
bundle branches)
Conduction system diseases
Idiopathic fibrosis of the conducting system
Certain medications, such as beta-blockers or calcium
(Lenègre-Lev disease)
channel blockers
Cardiac surgery, especially surgery occurring close to
Digoxin toxicity
the septum e.g. mitral valve repair
Inflammatory conditions (rheumatic fever, myocarditis,
Lyme disease)
Autoimmune (SLE, systemic sclerosis) SYMPTOMS
Infiltrative myocardial disease (amyloidosis,
haemochromatosis, sarcoidosis) Dizzy or faint
Hyperkalaemia Fatigued and possibly confused
Drugs: beta-blockers, calcium channel blockers, digoxin, Pressure or pain in their chest
amiodarone Short of breath Form Cardiac
Hypotention Output
Pale
SYMPTOMS

Dizziness
Fainting (syncope) TREATMENT:
Chest pain
Shortness of breath Intravenous fluids
Atropine
Temporary pacing
TREATMENT: And permanent pacemaker placement
Close monitoring
IF SYMPTOMATIC notify md Consultation with a cardiac electrophysiologist for
Hospitalize Further management
Monitor closely
NOTIFY MD
Consider temporary pacing
Permanent pacemaker
IF ASYMPTOMATIC:
Consulting a cardiologist
Reviewing medications may be recommended.
 Cardiac

Coronary Artery Disease

What is
Coronary artery disease (CAD) limits blood flow in your coronary arteries,
Healthy artery
which deliver blood to your heart muscle. Damage to the coronary arteries
due to atherosclerosis. Cholesterol and other substances make up plaque
that narrows your coronary arteries.

athlerosclerosis myocardial infarction

Atherosclerosis is the narrowing of arteries due to the buildup of plaque,
composed of cholesterol, fats, and other substances. It restricts blood flow
and increases the risk of heart disease, stroke, and other cardiovascular
complications.

Coronary artery disease types Symptoms :

There are two main forms of coronary artery disease: Chest pain or discomfort (angina), which may feel like
Stable ischemic heart disease: pressure, squeezing, heaviness, or tightness in the chest.
This is the chronic form. Your coronary arteries gradually Pain or discomfort that spreads to the arms, neck, jaw,
narrow over many years. Over time, your heart receives shoulders, or back.
less oxygen-rich blood. You may feel some symptoms, Shortness of breath, especially during physical activity
but you’re able to live with the condition day to day. or exertion.
Acute coronary syndrome: Fatigue or weakness, often accompanying other
This is the sudden form that’s a medical emergency. symptoms.
The plaque in your coronary artery suddenly ruptures Nausea or indigestion.
and forms a blood clot that blocks blood flow to your Sweating.
heart. This abrupt blockage causes a heart attack. Dizziness or lightheadedness.
Palpitations (unusual awareness of heartbeat).

RISK FACTORS
Non-Modifiable (cannot be changed)
Age (risk increases with age, especially over 65 years)
Gender (men generally have a higher risk, but risk
increases in women after menopause)
Family history of coronary artery disease or heart
attacks at a young age

Modifiable risk
Smoking
High blood pressure (hypertension)
High cholesterol levels (hypercholesterolemia)
Diabetes
Obesity
Physical inactivity
Unhealthy diet
Excessive alcohol consumption
 Cardiac

Coronary Artery Disease

Diagnostics : Treatment
Electrocardiogram (ECG or EKG): Lifestyle modifications:
Records the electrical activity of the heart to detect Adopting a heart-healthy diet low in saturated fats,
irregularities in heart rhythm and signs of previous cholesterol, and sodium.
heart attacks. Engaging in regular physical activity, such as brisk
Stress test: walking or cycling.
Measures the heart's response to physical exertion, often Quitting smoking.
with treadmill exercise or medication-induced stress, Managing stress through relaxation techniques or
to detect abnormal heart function under stress. counseling.
Echocardiogram: Achieving and maintaining a healthy weight.
Uses sound waves to create images of the heart's
structure and function, helping to assess blood flow and Medications:
identify areas of reduced function.
Antiplatelet medications (e.g., aspirin) to prevent blood
Coronary angiography:
clots. aspirin
Involves injecting contrast dye into the coronary arteries
Statins to lower cholesterol levels.
and taking X-ray images to visualize blockages or
Beta-blockers to reduce heart rate and blood pressure.
narrowing in the arteries.
ACE inhibitors or angiotensin II receptor blockers to
Cardiac CT or MRI:
lower blood pressure and reduce strain on the heart.
Provides detailed images of the heart and blood vessels
Nitroglycerin to relieve chest pain (angina) by dilating
to assess coronary artery blockages, heart function, and
blood vessels.
potential damage.
Calcium channel blockers to relax blood vessels and
Blood tests:
reduce blood pressure.
Measure levels of certain substances in the blood, such
as cholesterol, triglycerides, and cardiac enzymes, which
can indicate heart muscle damage. Medical procedures:
Coronary calcium scan: Percutaneous coronary intervention (PCI), such as
Uses computed tomography (CT) to measure the amount angioplasty and stent placement, to open blocked or
of calcium in the coronary arteries, which correlates with narrowed arteries.
the presence of plaque and risk of CAD. Coronary artery bypass grafting (CABG) to create new
Fractional flow reserve (FFR): routes for blood flow by bypassing blocked arteries with
Measures blood pressure and flow through a specific part healthy blood vessels from other parts of the body.
of the coronary artery to assess the severity of blockages
and guide treatment decisions. Cardiac rehabilitation:
Labs Structured exercise programs and education sessions
to improve cardiovascular health and reduce the risk
of future heart problems.
HDL, LDL,
or high-density or low-density lipoprotein,
lipoprotein, is often referred is often called "bad" Lifestyle management:
to as "good" cholesterol. cholesterol. Lower levels of Regular monitoring of blood pressure, cholesterol levels,
Higher levels of HDL are LDL are generally and other relevant health parameters.
associated with a lower considered healthier. Following up with healthcare providers for ongoing care
risk of heart disease and adjustments to the treatment plan.
and stroke. Adopting heart-healthy habits to prevent disease
progression and improve overall quality of life.
>60 mg/dl <100 mg/dl

other values
triglycerides: <150 mg/dL total chol: <200 mg/dL
 Cardiac

Coronary Artery Disease

Procedure: PATIENT EDUCATION

Patient education to prevent the progression of coronary
Artherectomy: artery disease (CAD) through lifestyle modifications and
Artherectomy involves the removal of plaque buildup dietary changes.
from inside the artery walls.
This procedure helps to clear blockages in the arteries Patient Education:
and restore blood flow to the heart muscle. Smoking cessation: Encourage quitting smoking to
reduce cardiovascular risk.
Percutaneous Coronary Intervention (PCI): Moderate exercise 3-4 times per week: Recommend
PCI, commonly known as angioplasty, is a minimally regular physical activity for heart health.
invasive procedure that opens up narrowed or blocked Stress management: Teach stress reduction techniques
coronary arteries. for overall well-being.
During PCI, a balloon-tipped catheter is inserted into Weight management: Emphasize maintaining a healthy
the artery and inflated to widen the narrowed area, weight through diet and exercise.
improving blood flow to the heart. Monitor heart rate & blood pressure: Educate on the
importance of tracking vital signs to monitor
Coronary Artery Bypass Grafting (CABG): cardiovascular health.
CABG is a surgical procedure used to create new routes
Dietary Recommendations:
for blood flow to the heart muscle.
During CABG, a healthy blood vessel, usually taken from Reduce sodium and saturated fat intake to support
the chest, leg, or arm, is grafted onto the blocked heart health.
coronary artery to bypass the blockage and improve Limit alcohol consumption to prevent adverse effects
blood flow to the heart. on cardiovascular function.
CABG is typically recommended for individuals with Increase fiber intake and consume more fruits and
severe coronary artery disease or multiple blockages vegetables for a heart-healthy diet.
that cannot be effectively treated with medications or
less invasive procedures. Medication Adherence:
Stress the importance of taking prescribed medications
consistently and as directed to manage CAD effectively.

Symptom Recognition:
Educate patients on recognizing and promptly
reporting symptoms of CAD or related cardiovascular
issues for early intervention.

Regular Follow-up:
Emphasize the necessity of regular follow-up
appointments with healthcare providers for ongoing
monitoring and adjustments to the treatment plan to
optimize CAD management.
 Cardiac

Angina Pectoris

What is
This is chest pain or discomfort that keeps coming back.
It happens when some part of your heart doesn't get
enough blood and oxygen.

Angina can be a symptom of coronary artery disease (CAD).

Blocked coronary artery Thightess or pain in chest

2 Forms Of Angina Pectoris

Variant angina pectoris Microvascular angina

(or Prinzmetal's angina)

A recently discovered type of angina
Is rare People with this condition have chest pain but have no
Occurs almost only when you are at rest apparent coronary artery blockages
Often doesn't follow a period of physical exertion or Doctors have found that the pain results from poor
emotional stress function of tiny blood vessels nourishing the heart,
Can be very painful and usually occurs between as well as the arms and legs
midnight and 8 a.m. Can be treated with some of the same medicines used
Is related to spasm of the artery for angina pectoris
Is more common in women Was once called Syndrome X
Can be helped by medicines such as calcium Is more common in women
channel blockers. These medicines help dilate the
coronary arteries and prevent spasm.

Symptoms Causes
A pressing, squeezing, or crushing pain, usually in the Angina results from reduced blood flow to the heart
chest under your breastbone muscle, termed ischemia.
Pain may also occur in your upper back, both arms, Coronary artery disease (CAD) is the primary cause,
neck, or ear lobes where fatty deposits called plaques narrow the heart
Pain radiating in your arms, shoulders, jaw, neck, or back arteries (atherosclerosis).
Shortness of breath Plaque rupture or blood clot formation can abruptly
Weakness and fatigue block or diminish blood flow, leading to angina.
Feeling faint Angina symptoms typically manifest during periods of
increased oxygen demand, such as physical exertion.
Resting periods may not trigger symptoms, as the
Common Triggers heart muscle can tolerate reduced blood flow during
low oxygen demand.
Physical exertion or exercise.
Emotional stress or anxiety.
Exposure to cold temperatures.
Heavy meals or overeating.
Smoking or exposure to secondhand smoke.
High blood pressure.
High cholesterol levels.
Stimulant use, such as caffeine or certain medications.
Extreme temperatures, either hot or cold.
Strenuous activities, such as lifting heavy objects.
Angina may also be triggered by specific medications
or medical conditions, so it's important to consult with
a healthcare provider for personalized advice.
 Cardiac

Angina Pectoris

Types OF Angina

Stable Angina (Exertional Angina): Unstable Angina:

Predictably occurs during physical activity or stress. Considered a medical emergency.
Typically resolves with rest or medication. Occurs unpredictably, often at rest or with minimal
Symptoms include chest discomfort or pain that may exertion.
radiate to the arms, shoulders, neck, or jaw. Symptoms are typically more severe and prolonged
Triggered by increased oxygen demand on the than stable angina.
heart muscle. May not fully resolve with rest or medication.
Often associated with coronary artery disease (CAD). Higher risk of heart attack or other serious cardiac events.
ECG changes may occur during episodes. Requires immediate medical attention and evaluation.

Variant Angina (Prinzmetal's Angina): Microvascular Angina (Cardiac Syndrome X):

Rare type caused by coronary artery spasms. Affects the tiny blood vessels in the heart
Often occurs at rest or during sleep. (microvascular system).
Can cause severe chest pain similar to other types of Chest pain or discomfort similar to other types of angina.
angina. Diagnostic tests may not show blockages in major
May occur in individuals without significant coronary coronary arteries.
artery disease. More common in women and those with risk factors
Nitroglycerin can help relieve symptoms. like diabetes.
Treatment may include medications to improve blood
flow and symptoms.

Silent Ischemia:
Individuals experience lack of blood flow to the heart
without typical angina symptoms.
Often occurs in people with diabetes or those who have
had previous heart attacks.
Detected through diagnostic tests like ECG, stress
testing, or imaging.
Can increase the risk of future cardiac events.
Treatment aims to control risk factors and prevent
complications.
 Cardiac

Angina Pectoris

Medications Nitroglycerin
Nitrates: Nitroglycerin is a vasodilator medication commonly used
Dilate blood vessels to increase blood flow and reduce to relieve chest pain (angina) by relaxing blood vessels
angina symptoms. and increasing blood flow to the heart. It's important to
Aspirin: store it in its original container away from light and
Reduces blood clot formation, lowering the risk of heart moisture, and to check the expiration date regularly.
attack and stroke.
Clot-preventing drugs: Administer nitroglycerin sublingually every 5 minutes,
Prevent blood platelets from sticking together, reducing up to a maximum of 3 doses.
clot formation. Avoid nitroglycerin if sildenafil (Viagra) has been taken
Beta blockers: within the last 24 hours.
Slow heart rate and decrease blood pressure, reducing If chest pain persists 5 minutes after the initial dose of
the heart's workload. nitroglycerin, seek emergency medical help by dialing 911.
Statins:
Lower cholesterol levels in the blood, reducing the risk of
heart disease.
Calcium channel blockers: Nursing Interventions
Relax blood vessels and increase blood supply to the
heart. Continuous Monitoring:
Other blood pressure medications: Monitor vital signs and heart rhythm to assess for
Control blood pressure levels to reduce strain on the changes indicative of angina or complications.
heart. Oxygen Therapy:
Ranolazine: Administer supplemental oxygen as prescribed to
Helps relieve chronic stable angina that doesn't respond improve oxygenation and reduce myocardial workload.
to other medications by improving blood flow to Medication Administration:
the heart. Administer prescribed medications such as nitrates,
aspirin, beta-blockers, and calcium channel blockers to
manage symptoms and prevent complications.
Pain Management:
Procedures : Provide analgesics and monitor pain levels to alleviate
discomfort and anxiety associated with angina episodes.
Percutaneous Coronary Intervention (PCI): Patient Education:
This procedure involves inserting a tiny balloon into a Educate patients on angina triggers, medication
narrowed artery, inflating it to widen the artery, and then adherence, lifestyle modifications, and when to seek
inserting a stent to keep it open. It's effective in improving medical assistance.
blood flow to the heart and reducing or eliminating Emotional Support:
angina symptoms, especially for unstable angina or when Offer reassurance and emotional support to reduce
lifestyle changes and medications are ineffective. anxiety and stress, which can exacerbate angina
symptoms.
Coronary Artery Bypass Surgery (CABG): Dietary Counseling:
During CABG, a vein or artery from another part of the Provide guidance on heart-healthy diets low in saturated
body is used to bypass a blocked or narrowed coronary fats, cholesterol, and sodium to manage risk factors
artery. This increases blood flow to the heart and is contributing to angina.
considered for both unstable and stable angina that Activity Modification:
hasn't responded to other treatments. Instruct patients on activity modifications to avoid triggers
and reduce the risk of angina episodes.
Risk Factor Management:
Assess and address modifiable risk factors such as
smoking, obesity, hypertension, and diabetes through
lifestyle changes and medication management.
Collaboration:
Collaborate with the healthcare team to coordinate care,
monitor treatment effectiveness, and adjust interventions
as needed for optimal patient outcomes.
 Cardiac

Angina Pectoris

Education Dietary Recommendations for Angina

Smoking Cessation Decrease sodium and saturated fat intake.

Moderate Exercise Limit alcohol consumption.
Stress Management Increase fiber by consuming more fruits and vegetables.
Weight Management Choose lean protein sources like poultry, fish,
Regular Monitoring and legumes.
Dietary Changes Incorporate whole grains such as oats, brown rice, and
Medication Adherence whole wheat bread.
Symptom Recognition Avoid processed and fried foods high in trans fats.
Avoidance of Triggers Opt for healthy fats found in nuts, seeds, and avocados.
Regular Follow-up Minimize intake of sugary foods and beverages.
Maintain hydration by drinking plenty of water.
Monitor portion sizes to manage weight.
Consider consulting a registered dietitian for
personalized advice.
 Cardiac

Myocardial Infarction

What is
Myocardial Infarction is a deadly medical emergency where your
heart muscle begins to die because it isn’t getting enough blood
flow. A blockage in the arteries that supply blood to your heart
usually causes this.

Failure to promptly treat it can result in

cardiac arrest. Medical Emergency

Causes Diagnostics
Plaque Buildup: Cardiac Biomarkers:
Blockage in coronary arteries due to plaque Blood tests (such as troponin) to assess cardiac damage.
accumulation (atherosclerosis). Imaging Studies:
Plaque Rupture: Echocardiography: Ultrasound to visualize heart
Rupture of plaque leading to blood clot formation. structure and function.
Coronary Artery Spasm: Cardiac MRI: Detailed imaging to evaluate heart muscle
Constriction of coronary arteries, reducing blood flow. damage.
Rare Medical Conditions: Coronary Angiography: X-ray imaging to visualize
Uncommon disorders causing abnormal vessel coronary arteries for blockages.
narrowing. Stress Testing:
Trauma: Assess heart function under physical stress to detect
Injury resulting in tears or ruptures in coronary arteries. ischemia.
Obstruction Originating Elsewhere: Chest X-ray:
Blood clot or air bubble from another location blocking Detects abnormalities in heart size and lung congestion.
coronary artery. CT Angiography:
Electrolyte Imbalance: Non-invasive imaging to assess coronary artery
Disturbance in essential electrolyte levels affecting blockages.
heart function. Coronary Catheterization:
Eating Disorders: nvasive procedure to directly visualize and treat
Long-term conditions damaging heart tissue. blockages in coronary arteries.
Takotsubo or Stress Cardiomyopathy: Electrocardiogram (ECG/EKG):
Temporary weakening of heart muscle due to extreme Detects abnormal electrical activity in the heart.
stress.
Anomalous Coronary Arteries:
Congenital defect where coronary arteries are in
abnormal positions. NSTEMI:
Partial blockage of coronary artery.
Symptoms include chest discomfort, shortness of breath.
Diagnosis: ST depression on ECG, elevated cardiac
biomarkers.
Treatment: Medications, possible invasive procedures.

STEMI:
Complete blockage of coronary artery.
Sudden, intense chest pain, sweating.
Diagnosis: ST-segment elevation on ECG, elevated
cardiac biomarkers.
Treatment: Emergency reperfusion therapy
(thrombolytics, PCI), medications.
Both require urgent medical attention to minimize
heart damage.
 Cardiac

Myocardial Infarction

Symptoms Nursing Interventions

Chest pain or discomfort:
Ensure strict bedrest to minimize cardiac workload.
Often described as pressure, tightness, squeezing, or
Administer supplemental oxygen as ordered to improve
burning sensation in the chest.
oxygenation.
Shortness of breath:
Continuously monitor vital signs, including EKG, and
Difficulty breathing, especially with exertion or at rest.
assess lung sounds for any abnormalities.
Pain or discomfort in other areas:
Assess surgical site for signs of bleeding and monitor
Pain may radiate to the arms (usually left arm but can
for any complications.
be both), neck, jaw, back, or stomach.
Monitor laboratory results, especially cardiac enzymes,
Nausea or vomiting:
to evaluate cardiac damage.
Feeling sick to your stomach or vomiting may occur.
Assess and manage chest pain promptly, ensuring
Light-headedness or dizziness:
adequate pain relief and reporting any changes.
Feeling faint, light-headed, or dizzy.
Offer emotional support to alleviate anxiety and fear.
Sweating:
Educate patients on heart attack signs, medications,
Profuse sweating, often described as cold sweats.
and lifestyle adjustments.
Fatigue:
Administer prescribed medications, such as antiplatelet
Unusual tiredness or weakness, often without apparent
agents and beta-blockers.
cause.
Monitor fluid balance to prevent fluid overload or
Anxiety or fear:
dehydration.
Feeling of impending doom or extreme anxiety.
Monitor for complications like heart failure or
Palpitations:
dysrhythmias and collaborate with the healthcare
Sensation of irregular or rapid heartbeat.
team for optimal care.
Indigestion:
Uncomfortable sensation in the upper abdomen,
sometimes mistaken for heartburn.

Women may experience atypical symptoms, Treatment

including:
Immediate:
Severe fatigue
Nausea Morphine:
Shoulder or neck pain Alleviates pain and reduces myocardial oxygen demand.
Jaw pain
Back pain
Oxygen:
Augments oxygen supply to the heart tissue.
Shortness of breath
Nitrates:
Dilate coronary arteries, improving blood flow to the heart.

Stabilization & Prevention: Aspirin:

Inhibits platelet aggregation, preventing further clot
Heparin IV: formation.
Prevents clot formation and progression.
Beta blockers: Next (interventions/procedures):
Reduce heart rate and workload, improving oxygen supply.
Procedures:
ACE inhibitors:
PCI (Percutaneous Coronary Intervention):
Dilate blood vessels, reducing strain on the heart.
Restores blood flow via balloon angioplasty and stent
Calcium channel blockers:
placement.
Lower blood pressure and improve blood flow.
CABG (Coronary Artery Bypass Grafting):
Statins:
Re-routes blood flow around blocked arteries.
Lower cholesterol levels, reducing risk of further plaque buildup.
Medication:
Antiplatelets:
Thrombolytics (Alteplase): Dissolves clots obstructing
Prevent platelet aggregation and subsequent clot formation.
coronary arteries.
Additional:
Nitroglycerin:
Relieves chest pain by dilating coronary arteries.
Clopidogrel:
Inhibits platelet aggregation, reducing risk of clot formation.
Glycoprotein IIb/IIIa inhibitors:
Prevent platelet aggregation during PCI.
Angiotensin II receptor blockers (ARBs):
Vasodilate and reduce blood pressure, similar to AC
inhibitors.
 Cardiac

Cardiac Tamponade

HEALTHY HEART TAMPONADE

What is
This is a medical or traumatic emergency that happens when
enough fluid accumulates in the pericardial sac compressing the
heart and leading to a decrease in cardiac output and shock.

This condition impedes the heart's ability to efficiently pump

blood, resulting in decreased cardiac output.

PERICARDIUM FLUID/ BLOOD BUILD UP

Causes
Trauma:
Diagnostics
Blunt or penetrating chest injury causing pericardial
Echocardiography:
bleeding.
Provides real-time visualization of pericardial effusion
Medical Procedures:
and hemodynamic effects.
Complications from invasive cardiac interventions.
Chest X-ray:
Pericarditis:
May show an enlarged cardiac silhouette or a "water
Inflammation leading to fluid accumulation around the
bottle" appearance suggestive of tamponade.
heart.
Electrocardiogram (ECG):
Aortic Dissection:
May reveal electrical alternans, where the QRS complex
Tear in the aortic wall with blood leakage into the
height varies with each beat.
pericardium.
Computed Tomography (CT) or Magnetic
Cancer:
Resonance Imaging (MRI):
Metastasis to the pericardium causing fluid buildup.
Offers detailed anatomical assessment and helps
Myocardial Rupture:
dentify underlying causes.
Heart muscle tear leading to bleeding into the pericardial
Hemodynamic Monitoring:
sac.
Invasive procedures such as cardiac catheterization can
Anticoagulant Therapy:
measure pressures within the heart chambers, aiding in
Excessive bleeding due to blood-thinning medications.
diagnosis.
Pericardiocentesis:
Therapeutic and diagnostic procedure involving the
removal of pericardial fluid for analysis and pressure
Symptoms relief.
Shortness of breath.
Chest pain.
Rapid heartbeat (tachycardia).
Low blood pressure (hypotension).
Dizziness or lightheadedness.
Weakness or fatigue.
Anxiety or restlessness.
Confusion or altered mental status.
Cyanosis (bluish discoloration of the skin).
Elevated jugular venous pressure.
Pulsus Paradoxus

Decreased blood pressure (due to reduced cardiac

output).
Increased jugular venous pressure (JVP) (resulting from
fluid accumulation).
Diminished heart sounds (due to pericardial fluid
accumulation).
 Cardiac

Cardiac Tamponade

TREATMENT Nursing Interventions

Pericardiocentesis:
Continuous Monitoring:
Emergency removal of fluid from around the heart to
Monitor vital signs, including blood pressure, heart rate,
relieve tamponade.
and oxygen saturation, frequently.
Hemodynamic support:
Educate patient on signs of pericardial effusion
Administer fluids cautiously to optimize preload and Assessment:
cardiac output. Assess for signs of tamponade, such as hypotension,
Treat underlying cause, such as antibiotics for JVD, muffled heart sounds, and pulsus paradoxus.
pericarditis. Prompt Reporting:
Use volume expanders to increase intravascular volume. Report any changes in patient condition, especially
Consider vasopressors to support blood pressure if worsening symptoms or hemodynamic instability, to the
necessary. healthcare team.
Dobutamine may be used to improve cardiac Positioning:
contractility Position the patient in a semi-Fowler's position to improve
respiratory mechanics and reduce venous return.
Pericardial Window:
Oxygen Therapy:
Surgical creation of a permanent opening in the
Administer supplemental oxygen as prescribed to
pericardium to drain fluid and prevent recurrence.
optimize tissue oxygenation.
Oxygen Therapy:
Emotional Support:
Supplemental oxygen to support issue oxygenation.
Provide reassurance and emotional support to alleviate
Monitoring:
anxiety and promote comfort.
Continuous assessment of vital signs, cardiac function,
Collaboration:
and response to treatment.
Collaborate with the healthcare team to facilitate prompt
Inotropic Medications:
interventions such as pericardiocentesis or administration
Drugs such as dopamine or epinephrine to improve
of intravenous medications.
cardiac contractility if needed.
Education:
Cardiac Monitoring:
Educate the patient and family about the condition,
ECG monitoring to assess for arrhythmias and ischemia.
treatment plan, and signs of complications to promote
Pain Management:
understanding and adherence to therapy.
Addressing any discomfort or chest pain experienced
Pain Management:
by the patient.
Administer analgesics as prescribed to alleviate
Collaboration with Specialists:
discomfort and promote relaxation.
Involvement of cardiologists, cardiothoracic surgeons,
Documentation:
and intensivists for comprehensive care.
Accurately document all assessments, interventions, and
Patient Education:
patient responses to facilitate continuity of care and
Providing information about the condition, treatment
communication among the healthcare team.
plan, and signs of recurrence.

Pericardial effusion
Pericardial effusion is the abnormal accumulation of fluid in the pericardial sac surrounding the heart.
Chest pain:
Sharp or dull pain in the chest that may worsen with deep breathing or lying flat.
Shortness of breath:
Difficulty breathing, especially when lying down or during physical activity.
Palpitations:
Irregular or rapid heartbeat, often felt as fluttering or pounding in the chest.
Fatigue:
Generalized weakness or tiredness, even with minimal exertion.
Cough:
Persistent or worsening cough, sometimes accompanied by pink, frothy sputum.
Swelling:
Swelling of the legs, ankles, or abdomen due to fluid retention.
Dizziness or fainting:
Feeling lightheaded or dizzy, or experiencing episodes of fainting.
Anxiety:
Feeling of unease or apprehension, often related to difficulty breathing or chest discomfort.

Goal
To detect symptoms promptly to prevent their progression to tamponade.
 Cardiac

Cardiomyopathy

What is
Cardiomyopathy is a disease that affects your myocardium (heart
muscle). cardiomyopathy can make your heart stiffen, enlarge or EPICARDIUM
thicken and can cause scar tissue.
MYOCARDIUM
Middle muscular layer of
the heart (thickest layer)
responsible for contractility
Myocardium
The myocardium is the middle muscular layer of the heart. It is the thickest
layer which lies between the single-cell endocardium layer, and the outer
ENDOCARDIUM
epicardium, which makes up the visceral pericardium that surrounds and
protects the heart. The myocardium is composed of specialized muscle
cells called cardiomyocytes.

Impairs the pumping mechanism, resulting in decreased cardiac output.

Causes Risk factors

Unknown in many cases;
Family history of heart conditions
can be acquired or inherited.
Long-term high blood pressure
Acquired causes include: Heart-related conditions like previous heart attacks or
Long-term high blood pressure infections
Heart tissue damage from heart attacks Obesity
Chronic rapid heart rate Chronic alcohol or illicit drug use
Heart valve issues Certain chemotherapy drugs and radiation therapy
COVID-19 infection Other diseases like diabetes, thyroid disorders,
Certain infections causing heart inflammation hemochromatosis, amyloidosis, sarcoidosis, and
Metabolic disorders (obesity, thyroid disease, diabetes) connective tissue disorders.
Vitamin or mineral deficiencies (e.g., thiamin)
Pregnancy complications
Hemochromatosis (iron buildup in the heart)
Sarcoidosis (inflammatory cell lumps)
Amyloidosis (abnormal protein buildup)
Connective tissue disorders
Chronic alcohol consumption
Illicit drug use (cocaine, amphetamines, steroids)
Some chemotherapy drugs and radiation therapy for
cancer.

Symptoms
Breathlessness with activity or even at rest
Swelling of the legs, ankles and feet
Bloating of the abdomen due to fluid buildup
Cough while lying down
Difficulty lying flat to sleep
Fatigue
Heartbeats that feel rapid, pounding or fluttering
Chest discomfort or pressure
Dizziness, lightheadedness and fainting
 Cardiac

Cardiomyopathy

TYPES OF CARDIOMYOPATHIES

Dilated Cardiomyopathy Diagnostics

most common Physical Examination:
Assessment of heart sounds and signs of fluid overload.
Left ventricle becomes enlarged and ineffective at Electrocardiogram (ECG):
pumping blood. Detects abnormal heart rhythms.
Common in middle-aged individuals, more prevalent Echocardiogram:
in men. Provides detailed images of heart structure and function.
Most often caused by coronary artery disease or heart Chest X-ray:
attack, can also be genetic. Assesses heart size and detects lung fluid accumulation.
Cardiac MRI:
Offers detailed heart images, useful for identifying
underlying causes.
Cardiac Catheterization:
Causes of Dilated Cardiomyopathy: Measures heart pressures and assesses coronary arteries.
Blood Tests:
Coronary Artery Disease or Heart Attack Evaluate cardiac biomarkers and overall cardiac function.
Genetic Factors
Long-term High Blood Pressure
Chronic Rapid Heart Rate
Heart Valve Problems Treatment
Infections (such as viral myocarditis)
Metabolic Disorders (obesity, thyroid disease, diabetes) Medications:
Nutritional Deficiencies (e.g., thiamin) ACE inhibitors, beta-blockers, diuretics, and aldosterone
Pregnancy Complications antagonists to manage symptoms and improve heart
Hemochromatosis (iron buildup in the heart) function.
Chronic Alcohol Consumption Lifestyle Modifications:
Illicit Drug Use (cocaine, amphetamines, steroids) Limit salt intake, avoid alcohol and illicit drugs, maintain
Some Chemotherapy Drugs and Radiation Therapy a healthy weight, and participate in regular physical
for Cancer activity.
Implantable Devices:
Pacemakers or implantable cardioverter-defibrillators
Symptoms (ICDs) to manage heart rhythm abnormalities.
Cardiac Rehabilitation:
Fatigue and weakness Structured exercise programs supervised by healthcare
Shortness of breath, especially during exertion or when professionals.
lying flat Surgical Interventions:
Swelling of the ankles, feet, legs, or abdomen (edema) Heart valve repair or replacement, coronary artery bypass
Rapid or irregular heartbeat (arrhythmias) grafting (CABG), or left ventricular assist device (LVAD)
Dizziness or lightheadedness implantation.
Persistent cough or wheezing, especially when lying down Heart Transplantation:
Sudden weight gain due to fluid retention Considered for severe cases.
Chest discomfort or pressure Regular Follow-up Care:
Decreased exercise tolerance Monitor symptoms, adjust medications, and evaluate
Fainting or near-fainting episodes (syncope) heart function regularly.
Palpitations, sensation of fluttering or pounding in the
chest.

"Pathophysiology of Heart Failure“

Ventricular Dilation: Heart chambers enlarge due to weakened myocardium.
RAAS Activation: Low blood pressure triggers fluid retention via RAAS.
Fluid Overload: Increased volume leads to congestion in both circulations.
Combined Heart Failure: Symptoms of both right and left-sided failure manifest.
 Cardiac

Cardiomyopathy

Hypertrophic Cardiomyopathy: Diagnostics

most deadly Electrocardiogram (ECG):
To detect abnormal heart rhythms and patterns
Heart muscle thickens, making it harder for the heart to indicative of hypertrophic cardiomyopathy.
function. Echocardiogram:
Can develop at any age, severity may be higher if onset Provides detailed images of the heart's size, shape, and
is during childhood. function, allowing assessment of hypertrophy and other
Often familial, with a family history of the disease. structural abnormalities.
Linked to certain genetic mutations. Cardiac MRI (Magnetic Resonance Imaging):
Offers detailed images of heart structure and function,
useful for evaluating myocardial thickening and scarring.
Holter Monitor:
Causes A portable device that records heart rhythm over a
period (usually 24-48 hours) to detect arrhythmias.
Exercise Stress Test:
Genetic Mutations:
Measures heart rate, blood pressure, and ECG changes
Inherited genetic changes affecting heart muscle
during physical activity to assess symptoms and
proteins can lead to hypertrophic cardiomyopathy.
evaluate heart function.
Family History:
Genetic Testing:
Having relatives with the condition increases the risk of
Identifies genetic mutations associated with hypertrophic
developing it.
cardiomyopathy, especially in individuals with a family
Aging:
history of the condition.
Hypertrophic cardiomyopathy can develop as individuals
Cardiac Catheterization:
grow older.
Invasive procedure to measure pressures within the
High Blood Pressure:
heart chambers and assess coronary artery status, useful
Chronic hypertension can contribute to the development
for evaluating severe cases or planning interventions.
of hypertrophic cardiomyopathy.
Blood Tests:
Intense Athletic Training:
Including cardiac biomarkers (troponin, B-type natriuretic
Vigorous exercise, especially endurance sports, may
peptide) to assess heart muscle damage and overall
increase the likelihood of developing the condition.
cardiac function.
Other Conditions:
Diseases like diabetes and thyroid disorders, as well as
conditions such as amyloidosis, can also be associated
Treatment
with hypertrophic cardiomyopathy.
Medications:
Beta-blockers, calcium channel blockers, and
Symptoms disopyramide.
Septal Reduction Therapy:
Chest pain or discomfort, especially during exertion. Septal myectomy or alcohol septal ablation.
Shortness of breath, especially during physical activity Implantable Devices:
or when lying flat. Pacemakers or implantable cardioverter-defibrillators
Fatigue and weakness, often due to reduced blood flow (ICDs).
to the body. Lifestyle Modifications:
Palpitations, rapid or irregular heartbeat. Avoiding strenuous activity and certain medications.
Dizziness or lightheadedness, especially upon Genetic Counseling:
standing up. Assessing familial risk and providing family planning
Fainting or near-fainting episodes (syncope). guidance.
Heart murmurs, abnormal heart sounds detected during Regular Follow-up Care:
a physical examination. Monitoring symptoms and heart function.
Edema (swelling), particularly in the ankles, feet, or
abdomen. Avoid using the "3 D's": Avoid :
Arrhythmias, such as atrial fibrillation or ventricular Digoxin Strenuous activity.
tachycardia. Dilators (nitro) Intense exercise.
Sudden cardiac arrest, in severe cases. Diuretics Rapid position changes.
Straining (Valsalva maneuver).

Will exacerbate obstruction and symptoms.

 Cardiac

Cardiomyopathy

Restrictive Cardiomyopathy: Diagnostics

most deadly Echocardiogram:
Visualizes heart structure and function.
Heart muscle becomes stiff and less flexible, impairing Cardiac MRI:
blood filling between heartbeats. Provides detailed heart anatomy assessment.
Least common type, often seen in older individuals. Cardiac Catheterization:
Can be idiopathic or caused by systemic diseases like Measures heart chamber pressures.
amyloidosis. Blood Tests:
Evaluates cardiac biomarkers.
Electrophysiological Studies:
Assesses heart rhythm abnormalities.
Causes Imaging Tests:
Detects heart and lung abnormalities.
Infiltrative Diseases: Genetic Testing:
Conditions such as amyloidosis, sarcoidosis, and Identifies associated genetic mutations.
hemochromatosis where abnormal substances
accumulate in the heart muscle.
Fibrosis:
Scarring of the heart muscle due to previous myocardial Treatment
infarction, radiation therapy, or idiopathic fibrosis.
Storage Disorders: Medications:
Conditions like glycogen storage diseases or Fabry Diuretics, calcium channel blockers, and targeted
disease where abnormal substances accumulate within therapies.
heart cells. Lifestyle Modifications:
Connective Tissue Disorders: Salt restriction, alcohol limitation, and activity
Diseases such as scleroderma or systemic lupus management.
erythematosus that affect the connective tissue and may Management of Underlying Conditions:
lead to restrictive cardiomyopathy. Treating amyloidosis, sarcoidosis, or hemochromatosis.
Radiation Therapy: Symptom Management:
Previous exposure to radiation, particularly for the Addressing shortness of breath, fatigue, and palpitations.
treatment of cancer, can damage heart tissue and lead Monitoring and Follow-up:
to restrictive cardiomyopathy. Regular assessment of heart function and symptoms.
Idiopathic: Advanced Therapies:
In some cases, the cause of restrictive cardiomyopathy is Heart transplant or ventricular assist device for
unknown (idiopathic). severe cases.

Symptoms The heart muscle is too rigid and unyielding for

medications to exert a beneficial effect.
Shortness of breath, especially with exertion or when
lying flat.
Fatigue and weakness, often due to reduced cardiac
output.
Swelling in the ankles, legs, or abdomen (edema).
Palpitations, rapid or irregular heartbeat.
Chest pain or discomfort.
Difficulty breathing when lying flat (orthopnea) or
awakening at night feeling breathless (paroxysmal
nocturnal dyspnea).
Abdominal discomfort or swelling due to fluid
accumulation (ascites).
Reduced exercise tolerance.
Fainting or near-fainting episodes (syncope).
Symptoms of underlying diseases, such as weight loss
in amyloidosis or skin changes in scleroderma.
 Cardiac

Infective Endocarditis

What is Endocardium
The inflammation of the endocardium, the inner lining of The endocardium is a thin, smooth tissue that makes
the heart, as well as the valves that separate each of the up the lining of the chambers and valves of the heart.
four chambers within the heart.

Causes
Staphylococcus aureus:
Major cause, especially in prosthetic valve cases or
IV drug users.
Streptococci:
Particularly Streptococcus viridans, common from oral
cavity or skin. Artic Valve
Oral Cavity & Skin:
Sources of bacteria.
Pre-existing Heart Conditions:
Increase susceptibility.
Invasive Procedures:
Dental work, surgeries can introduce bacteria.
Prosthetic Heart Valves: Normal Artic Valve Area of infection of the artic valve caused
High risk, often infected by Staphylococcus and Streptococci. by bacterial endocorditis

Risk Factors Bacteria

Age: Endocarditis is more common in adults over 60.

Congenital Heart Defects: Certain defects raise
infection risk.
Implanted Devices: Devices like pacemakers can be Blockages in valve openings restrict the flow of blood
sites for infection. through the heart, impairing its ability to pump
Artificial Heart Valves: Prosthetic valves have a higher effectively. This reduced pumping efficiency results in a
risk of infection. decline in the amount of blood ejected from the heart
IV Drug Use: Dirty needles can lead to endocarditis. with each contraction, known as cardiac output.
Poor Dental Health: Bacteria from the mouth can enter
the bloodstream.
Damaged Heart Valves: Conditions like rheumatic fever
increase the risk.
Long-term Catheter Use: Increases the risk of infection.
Previous Endocarditis: A history of endocarditis Progression of Infective Endocarditis
increases the risk of recurrence.
Heart Surgery: Recent heart surgery can temporarily Bacterial or Fungal Invasion:
increase the risk of infection. Pathogens, whether bacteria or fungi, enter the
Heart Conditions: Conditions like hypertrophic bloodstream.
cardiomyopathy or mitral valve prolapse elevate the risk. Travel to Heart:
Certain Medical Procedures: Invasive procedures like They migrate through the bloodstream to reach the heart.
dental work or surgeries can introduce bacteria into the Attachment to Heart Tissue:
bloodstream. Upon arrival, pathogens adhere to damaged or
Compromised Immune System: Conditions like HIV/AIDS weakened heart tissue.
or undergoing chemotherapy weaken the immune Pathogen Proliferation:
system, making infection more likely. They begin to multiply and grow.
Chronic Illnesses: Conditions like diabetes or kidney Progressive Damage:
failure can increase susceptibility to infections. Over time, this proliferation leads to damage within
Skin Infections: Open wounds or skin infections can the heart.
provide entry points for bacteria.
Intravenous Therapy: Receiving intravenous
medications or fluids over a prolonged period can
increase infection risk.
Alcohol Abuse: Excessive alcohol consumption can
weaken the immune system and damage heart tissue,
increasing vulnerability to infection.
 Cardiac

Infective Endocarditis

Symptoms Treatment
Aching joints and muscles Surgery:
Chest pain when breathing Surgical removal of dead or infected tissue and repair or
Fatigue replacement of damaged heart valves may be necessary.
Flu-like symptoms (fever, chills) Antibiotic Therapy:
Night sweats Intravenous antibiotics are administered for several
Shortness of breath weeks to eliminate the infection. Treatment duration
Swelling in feet, legs, or belly depends on infection severity.
New or changed heart murmur PICC Line:
Some patients may require a peripherally inserted
Classical Signs: central catheter (PICC line) to continue intravenous
Unexplained weight loss antibiotics at home for up to four weeks or longer.
Blood in urine
Tenderness under left rib cage (spleen)
Janeway lesions (red or purple spots on feet or palms)
Osler nodes (painful bumps on fingers or toes) Education
Petechiae (tiny purple, red, or brown spots on skin, eyes,
or mouth) Infection Monitoring:
Fever: Persistent or recurrent fever is a common Stay alert for redness, swelling, or fever, and report any
symptom. changes promptly.
New Heart Murmur: A new or changed heart murmur Aseptic Technique:
may be present. Maintain cleanliness rigorously during PICC line care to
Peripheral Signs: These include clubbing of the fingers prevent infections.
and toes, which is the widening and rounding of the tips Complete Antibiotic Course:
of the digits. Ensure full completion of prescribed antibiotics to
Embolic Phenomena: These can lead to symptoms such maximize effectiveness and prevent recurrence.
as stroke, transient ischemic attacks (TIAs), or peripheral
embolization causing symptoms like acute limb
ischemia.
Splinter hemorrhages: Small clots lodged beneath the
Dental Care
nails.
Emphasize Oral Hygiene:
Roth spots: Tiny hemorrhages detected in the eye.
Educate patients on the significance of maintaining
good oral health.
Inform Dentist Pre-Procedure:
Diagnostic Advise patients to notify their dentist before undergoing
any invasive dental procedures.
Blood Culture:
Identifies germs in the bloodstream.
Guides antibiotic treatment.
Complete Blood Count:
Checks for signs of infection or anemia.
Echocardiogram:
Provides images of the heart's structure and function.
Can be standard (transthoracic) or transesophageal for
detailed pictures.
Electrocardiogram (ECG or EKG):
Measures heart's electrical activity.
Chest X-ray:
Assesses heart and lung condition.
CT Scan or MRI:
May be needed to check for infection spread to other
parts of the body.
 Cardiac

Infective Endocarditis

Nursing Interventions Signs to Monitor For:

Supplemental Oxygen: Pulmonary embolism:
Administer oxygen therapy as needed for adequate Chest pain, shortness of breath, rapid heart rate,
oxygenation. coughing up blood.
DVT Prevention: Flank pain (renal):
Implement measures to prevent deep vein thrombosis, Sudden or severe flank pain, fever, nausea, blood in urine.
such as mobilization and prophylactic anticoagulation. Stroke:
Antipyretics for Fever: Sudden weakness, numbness, confusion, trouble
Administer antipyretic medications and monitor fever speaking, difficulty walking.
closely. Abdominal pain (spleen):
Vital Signs Monitoring: Left upper abdominal pain, shoulder pain, signs of
Regularly assess vital signs, especially temperature, to internal bleeding.
detect changes indicating infection or deterioration. Neurological Deficits:
Heart Rhythm Monitoring: Changes in speech, vision, coordination, or
Continuously monitor heart rhythm for abnormalities. consciousness.
Signs of Heart Failure: Skin Changes:
Watch for signs such as dyspnea or edema. Look for petechiae, Janeway lesions, or Osler nodes.
Embolic Episodes: Neurovascular Checks:
Monitor for signs of embolic events and intervene Assess peripheral pulses and capillary refill to monitor
promptly. circulation.
Fluid Balance Management: Mental Status:
Monitor intake and output for hydration status. Observe for confusion, agitation, or altered level of
Nutritional Support: consciousness.
Assess and provide appropriate dietary interventions.
Pain Management:
Administer analgesics as needed for comfort.
Wound Care:
Monitor and dress wounds to prevent infection.
Patient Education:
Provide comprehensive education on the condition and
treatment plan.
Psychosocial Support:
Offer emotional support and counseling.
Medication Administration:
Administer prescribed medications and monitor effects.
Collaboration with Healthcare Team:
Communicate effectively with other providers for
coordinated care.
 Cardiac

Heart Failure

Spetum Left
What is ventricle Enlarged
This is a condition that develops when your heart ventricle
doesn't pump enoughblood for your body's needs.

Right
Leads to decreased cardiac output. ventricle

Causes
Normal Heart Heart Failure
Coronary Artery Disease (CAD) and Heart Attacks:
Narrowing or blockage of coronary arteries restricts blood
flow, leading to heart muscle damage.
Hypertension (High Blood Pressure):
Prolonged high blood pressure strains the heart, causing
Symptoms
it to weaken over time.
Heart Valve Disease: If you have heart failure, your heart can't supply enough
Malfunctioning heart valves disrupt blood flow, blood to meet your body's needs.
overworking the heart and potentially leading to failure. Shortness of breath with activity or when lying down.
Cardiomyopathy: Fatigue and weakness.
Structural abnormalities or damage to the heart muscle Swelling in the legs, ankles and feet.
impairs its ability to pump effectively. Rapid or irregular heartbeat.
Myocarditis: Reduced ability to exercise.
nflammation of the heart muscle, often triggered by Wheezing.
viral infections, can weaken the heart and contribute A cough that doesn't go away or a cough that brings up
to failure. white or pink mucus with spots of blood.
Congenital Heart Defects: Swelling of the belly area.
Structural abnormalities present at birth can affect heart Very rapid weight gain from fluid buildup.
function and increase the risk of failure. Nausea and lack of appetite.
Arrhythmias: Difficulty concentrating or decreased alertness.
Irregular heart rhythms disrupt the heart's pumping Chest pain if heart failure is caused by a heart attack.
efficiency, potentially leading to failure.
Other Medical Conditions:
Diseases like diabetes, thyroid disorders, and kidney
disease can indirectly weaken the heart and contribute
to failure.
Lifestyle Factors:
Unhealthy habits such as smoking, excessive alcohol
intake, and physical inactivity can increase heart
failure risk.
Medications and Substances:
Certain drugs or toxins can damage the heart muscle,
leading to heart failure over time.
 Cardiac

Heart Failure

Types Of Heart Failure

Right-sided heart failure Left-sided heart failure

Affects the right ventricle. Affects the left ventricle.
Results in fluid accumulation in the belly, legs, and feet, Results in blood backing up into the lungs.
leading to swelling (edema). Symptoms include:
Symptoms include: Dyspnea (shortness of breath) and SOB
Abdominal swelling. (shortness of breath).
Leg swelling. Crackles in the lungs.
Fluid retention. Fatigue.
Presence of pink, frothy sputum.

Heart failure with reduced Heart failure with preserved

ejection fraction (HFrEF), ejection fraction (HFpEF),
also called systolic heart failure also called diastolic heart failure

Left ventricle cannot contract effectively. Left ventricle cannot relax or fill properly.
Leads to inadequate blood pumping to the body. Causes difficulties in blood filling.
Symptoms may include: Symptoms may include:
Fatigue. Shortness of breath.
Shortness of breath. Fatigue.
Swelling in the legs and ankles. Swelling in the legs and ankles.
Reduced exercise tolerance

Diagnostics
<100: Normal
Blood Tests: 300+: Mild heart failure
To detect diseases affecting the heart and measure 600+: Moderate heart failure
specific proteins indicating heart failure. 900+: Severe heart failure
Chest X-ray:
Provides images of the lungs and heart condition.
Electrocardiogram (ECG or EKG): Ejection fraction measures the percentage of blood that
Records heart's electrical signals, indicating heart rhythm is pumped out of the left ventricle with each heartbeat.
abnormalities.
Ejection Fraction Measurement:
Determines the percentage of blood leaving the heart
with each contraction. 55-70% normal 40% normal
Exercise Tests or Stress Tests:
Evaluate heart response to physical activity.
CT Scan of the Heart:
Generates detailed cross-sectional images of the heart.
Heart MRI Scan:
Creates detailed images using magnetic fields and
radio waves.
Coronary Angiogram:
Identifies blockages in heart arteries using dye injected
through a catheter.
Myocardial Biopsy:
Removes small heart tissue samples to diagnose
certain heart muscle diseases causing heart failure.
Echocardiogram:
Uses sound waves to visualize heart structure, valves,
and blood flow.
 Cardiac

Heart Failure

HEART FAILURE MEDS Nursing Interventions

Supplemental Oxygen:
Administering supplemental oxygen as needed.
Medications High Fowler's Position:
A combination of medicines may be used to treat heart Positioning the patient in a high Fowler's position to
failure. The specific medicines used depend on the facilitate breathing.
cause of heart failure and the symptoms. Leg Elevation:
Elevating the legs to reduce edema.
Fall Risk Precautions:
Implementing precautions to prevent falls, particularly
due to orthostatic hypotension and fluid status changes.
ACE Inhibitors: Monitoring:
Relax blood vessels, lower blood pressure, and decrease Monitoring vital signs, heart rhythm, and lung sounds
strain on the heart. regularly.
Examples: enalapril, lisinopril, captopril. Daily weights to assess fluid retention.
Angiotensin II Receptor Blockers (ARBs): Strict intake and output measurements.
Provide similar benefits to ACE inhibitors. Dietary Management:
Options for those unable to tolerate ACE inhibitors. Encouraging a diet low in sodium (<2g/day) and fat.
Examples: losartan, valsartan, candesartan. Implementing fluid restriction as appropriate.
Angiotensin Receptor plus Neprilysin Inhibitors (ARNIs):
Combines two blood pressure drugs to treat heart
failure with reduced ejection fraction.
Example: sacubitril-valsartan. Avoid:
Beta Blockers: Over-the-counter drugs containing sodium.
Slow heart rate, lower blood pressure, and improve Fried and processed foods.
heart function. Canned vegetables, beans, packaged snacks, processed
Examples: carvedilol, metoprolol, bisoprolol. meats, sugary beverages, and high-sodium condiments.
Diuretics: Monitor k levels Normal: 3.5-5 Excessive alcohol consumption.
Increase urination to prevent fluid buildup in the body
and lungs.
Examples: furosemide (Lasix), bumetanide, torsemide.
Potassium-Sparing Diuretics:
Preserve potassium levels while still promoting diuresis.
ARBs are utilized when ACE inhibitors cannot be tolerated.
Examples: spironolactone, eplerenone.
Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors:
Originally for diabetes, now used to treat heart failure. Side Effects
Examples: canagliflozin, dapagliflozin, empagliflozin. Masks hypoglycemia:
Digoxin (Lanoxin): Conceals the symptoms of low blood sugar.
Helps the heart contract more effectively. Bronchospasm:
May reduce heart failure symptoms, particularly in Constriction of the airway muscles, leading to
those with heart rhythm issues. difficulty breathing.
Hydralazine and Isosorbide Dinitrate (BiDil): Bradycardia:
Combination relaxes blood vessels, aiding severe heart Abnormally slow heart rate.
failure symptoms.
Vericiguat (Verquvo):
Oral soluble guanylate cyclase (sGC) stimulator for
chronic heart failure. Always check BP before giving diuretics!
Reduces hospital stays and heart disease-related deaths.
Positive Inotropes:
Given intravenously to improve heart pumping and
To prevent digoxin toxicity, it's important to monitor
maintain blood pressure in severe cases.
potassium levels, as hypokalemia elevates the risk.
Long-term use linked to increased risk of death in some
cases.
Other Medications:
Nitrates for chest pain, statins for cholesterol, blood
thinners for clot prevention, as needed.
 Cardiac

Hypertension

When the heart pumps blood through the arteries,

What is the blood puts pressure on the artery walls. This is
Hypertension (high blood pressure) is when the pressure in your known as blood pressure.
blood vessels is too high (140/90 mmHg or higher).

marked by >2 events of bp >140/90

Factors Affecting Blood Pressure Readings:

Regulation of Blood Pressure through Vascular Tone
and Cardiac Output: Physical Activity:
Exercise or physical exertion can temporarily raise blood
Vasoconstriction: pressure.
Resistance: Stress:
Narrowing of blood vessels increases resistance to blood Emotional or mental stress can elevate blood pressure
flow. readings.
Cardiac Output: Diet:
Heart pumps harder to overcome increased resistance. High-sodium diets or excessive caffeine intake may
increase blood pressure.
Vasodilation: Smoking:
Resistance: Dilation of blood vessels reduces resistance Nicotine in cigarettes can cause a temporary spike in
to blood flow. blood pressure.
Blood Volume Output: Enhanced blood flow efficiency Alcohol:
may increase blood volume output. Excessive alcohol consumption can raise blood pressure.
Medications:
Impact on Blood Pressure: Certain medications, such as decongestants or NSAIDs,
Vasoconstriction tends to elevate blood pressure. can affect blood pressure.
Vasodilation tends to lower blood pressure. Temperature:
Extreme temperatures, especially hot weather, can
influence blood pressure readings.
Time of Day:
Blood pressure tends to be lower in the morning and
higher in the evening.
Position:
Blood pressure readings can vary depending on whether
a person is sitting, standing, or lying down.
Arm Position:
Systolic blood pressure (the first number) Incorrect arm positioning during measurement can
indicates how much pressure your blood is exerting affect blood pressure readings.
against your artery walls when the heart contracts. White Coat Effect:
Anxiety related to medical settings can lead to higher-t
Diastolic blood pressure (the second number) vhan-usual blood pressure readings.
indicates how much pressure your blood is exerting Cuff Size:
against your artery walls while the heart muscle is resting An improperly sized blood pressure cuff can yield
between contractions. inaccurate readings

BLOOD PRESSURE Stages SYSTOLIC mm Hg and/or DIASTOLIC mm Hg

(upper number) (lower number)

NORMAL LESS THAN 120 and LESS THAN 80

ELEVATED 120 – 129 and LESS THAN 80
HIGH BLOOD PRESSURE (HYPERTENSION) STAGE 1 130 – 139 or 80 – 89
HIGH BLOOD PRESSURE (HYPERTENSION) STAGE 2 140 OR HIGHER or 90 OR HIGHER
HYPERTENSIVE CRISIS (consult your doctor immediately) HIGHER THAN 180 and/or HIGHER THAN 120
 Cardiac

Hypertension

CAUSES/ RISK FACTORS

Primary Secondary
Non-Modifiable Risk Factors Adrenal Gland Tumors:
Age: Overproduction of hormones can elevate blood pressure.
Risk increases with advancing age. Congenital Heart Defects:
Family History: Structural abnormalities in blood vessels present at birth.
Genetics play a role; having close relatives with Medications:
hypertension increases risk. Certain drugs like cough and cold medicines, pain
Race/Ethnicity: relievers, birth control pills, and some prescription drugs.
African-Americans are at higher risk of developing Illegal Drugs:
hypertension. Stimulants like cocaine and amphetamines can increase
Gender: blood pressure.
Men are more likely to develop hypertension before age Kidney Disease:
55; after 55, women are more affected. Impaired kidney function affects blood pressure
Genetic Factors: regulation.
Certain genetic predispositions can influence blood Obstructive Sleep Apnea:
pressure regulation. Breathing disruptions during sleep can lead to elevated
blood pressure.
Modifiable Risk Factors Thyroid Problems:
Abnormal thyroid function can impact blood pressure
Dietary Habits: regulation.
High salt intake, low potassium intake, and excessive White Coat Hypertension:
alcohol consumption. Blood pressure rises due to anxiety in medical settings.
Obesity:
Excess body weight increases strain on the heart and
raises blood pressure.
Physical Inactivity:
Lack of regular exercise contributes to hypertension.
Stress:
Chronic stress can elevate blood pressure levels.
Smoking:
Nicotine in cigarettes constricts blood vessels, raising
blood pressure.
Chronic Conditions:
Diabetes, kidney disease, and sleep apnea can increase
hypertension risk.
Medication Use:
Certain medications, such as NSAIDs and steroids, can
raise blood pressure levels.
Socioeconomic Factors:
ower socioeconomic status is associated with a higher
risk of hypertension.
Sleep Quality:
Poor sleep patterns, including sleep deprivation or sleep
disorders, can contribute to hypertension.

Highest risk African Americans Age >65+ Family history

 Cardiac

Hypertension

Symptoms Treatment
severe headaches
Lifestyle Modifications:
chest pain
dizziness Dietary changes
difficulty breathing (e.g., low-sodium diet, increased fruits and vegetables).
nausea Regular exercise regimen.
vomiting Weight management.
blurred vision or other vision changes Limiting alcohol intake.
anxiety Smoking cessation.
confusion Medications:
buzzing in the ears
nosebleeds Antihypertensive medications, such as ACE inhibitors,
abnormal heart rhythm beta-blockers, calcium channel blockers, diuretics,
and angiotensin II receptor blockers (ARBs).
Frequently without symptoms, hypertension is often
referred to as the "Silent Killer" due to its covert nature. Regular Monitoring:
Routine blood pressure checks to assess effectiveness
If left untreated, hypertension can result in:
of treatment and adjust medication dosage if needed.
Stroke Kidney failure
Heart attack Heart failure
Comprehensive Management:
Collaborative approach involving healthcare
professionals (e.g., physicians, pharmacists, dietitians)
Diet Education for Hypertension: to tailor treatment plan to individual needs and monitor
progress over time.
Reduce Sodium Intake:
Limit processed and packaged foods.
Avoid adding salt while cooking or at the table.
Choose low-sodium alternatives when available.
Increase Potassium-Rich Foods:
Consume fruits (e.g., bananas, oranges) and vegetables
(e.g., spinach, sweet potatoes) rich in potassium.
Potassium helps counteract the effects of sodium on
blood pressure.
Emphasize Whole Foods:
Opt for whole grains, lean proteins, and fresh produce.
Minimize intake of refined carbohydrates and sugary
beverages.
Moderate Alcohol Consumption:
Limit alcohol intake to recommended guidelines
(e.g., one drink per day for women, two drinks per day for
men).
Maintain a Healthy Weight:
Aim for a balanced diet and regular physical activity to
achieve and maintain a healthy weight.
Monitor Portion Sizes:
Be mindful of portion sizes to prevent overeating and
excess calorie intake.
DASH Diet:
Consider following the Dietary Approaches to Stop
Hypertension (DASH) diet, which emphasizes fruits,
vegetables, whole grains, and low-fat dairy products
while reducing sodium intake.
Stay Hydrated:
Drink plenty of water throughout the day to stay
hydrated and support overall health.
Consult with a Dietitian:
Seek guidance from a registered dietitian or healthcare
professional for personalized dietary recommendations
tailored to individual needs and preferences.
 Cardiac

PAD vs PVD

PVD (peripheral vascular disease)

PAD (peripheral artery disease)
Peripheral vascular disease (PVD) is a blood circulation
Peripheral arterial disease (PAD) is a common condition disorder that causes the blood vessels outside of your
where a build-up of fatty deposits in the arteries restricts heart and brain to narrow, block, or spasm. This can
blood supply to leg muscles. It's also known as peripheral happen in your arteries or veins. PVD typically causes
vascular disease (PVD). pain and fatigue, often in your legs, and especially
during exercise. The pain usually improves with rest.

Symptoms of PAD (peripheral artery disease) Symptoms of PVD (Peripheral Vascular Disease)

Intermittent Claudication: Intermittent Claudication:

Leg pain while walking, alleviated by rest. Painful leg cramping during exercise, relieved by rest.
Severity: Bilateral Occurrence:
Pain intensity ranges from mild to severe. May affect one or both legs depending on artery location.
Bilateral Affliction: Skin Changes:
Both legs are often affected, with potentially differing Decreased temperature, thin, brittle, shiny skin on legs
pain severity. and feet.
Additional Symptoms: Pulse Weakness:
Hair Loss: On legs and feet. Weak pulses in legs and feet.
Leg Numbness or Weakness. Gangrene Risk:
Slow-Growing Toenails. Due to insufficient blood flow, leading to tissue death.
Non-Healing Ulcers: Particularly on feet and legs. Hair Loss:
Skin Changes: Such as paleness or blueness. Particularly noticeable on the legs.
Shiny Skin. Impotence:
Erectile Dysfunction: In men. In some cases.
Muscle Wasting: Noticed in the legs. Non-Healing Wounds:
Development: Especially over pressure points like heels or ankles.
Symptoms progress gradually over time; sudden Neurological Symptoms:
worsening may signify urgent medical attention. Numbness, weakness, or heaviness in affected muscles.
Rest Pain:
Burning or aching sensation, often in toes and at night.
Elevation Paleness:
Causes of Peripheral Arterial Disease (PAD):
Paleness observed when legs are raised.
Discoloration:
Atherosclerosis: Reddish-blue hue in extremities.
Build-up of fatty deposits (atheroma) in leg arteries. Mobility Limitation:
Fatty Deposits: Restricted movement due to symptoms.
Primarily composed of cholesterol and waste substances. Severe Pain:
Narrowed Arteries: Especially when arteries are severely narrowed or
Fatty deposits reduce artery diameter, restricting blocked.
blood flow. Toenail Changes:
Cardiovascular Disease (CVD): Thickened, opaque toenails.
PAD is a subtype of CVD due to its impact on blood
vessels.
Causes of Peripheral Vascular Disease (PVD):

Atherosclerosis:
Primary cause, plaque buildup inside artery walls.
Plaque Formation:
Reduces blood flow, oxygen, and nutrient supply to limbs.
Blood Clots:
Form on artery walls, further reducing vessel size and
blocking arteries.
Other Causes:
Injury: to arms or legs.
Muscle or Ligament Irregularities.
Infection.
Association with Coronary Artery Disease (CAD):
Often coexists with PVD.
 Cardiac

PAD vs PVD

Diagnosis of Peripheral Arterial Disease (PAD): Diagnosis of Peripheral Vascular Disease (PVD):

Medical History and Physical Examination: Angiogram:

Assessing risk factors, symptoms, and physical signs. X-ray imaging with contrast dye to detect artery
Ankle-Brachial Index (ABI) Test: blockage or narrowing, inserted via leg artery.
Measures blood pressure in ankles and arms to assess Ankle-brachial index (ABI):
circulation. Compares ankle to arm blood pressure to assess
Doppler Ultrasound: circulation health using Doppler ultrasound.
Uses sound waves to evaluate blood flow in arteries. Doppler ultrasound flow studies:
Segmental Pressure Measurements: High-frequency sound waves create images of blood
Assess blood pressure at different points along the legs. vessels, helping detect blockages.
Angiography: Magnetic resonance angiography (MRA):
X-ray imaging with contrast dye to visualize blood flow Detailed imaging of blood vessels using magnets and
in arteries. radio frequencies, with contrast dye injection.
MRI or CT Angiography: Treadmill exercise test:
Detailed imaging of blood vessels to identify blockages Monitors blood circulation during exercise by walking on
or narrowing. a treadmill.
Blood Tests: Photoplethysmography (PPG):
Evaluate cholesterol levels, glucose levels (for diabetes), Measures blood flow using a tiny cuff around the toe and
and other markers of cardiovascular health. infrared light sensor.
Exercise Testing: Pulse volume recording (PVR) waveform analysis:
Assess symptoms and blood flow changes during Calculates blood volume changes in legs, displayed as
physical activity. a waveform.
Skin Perfusion Pressure (SPP) Testing: Reactive hyperemia test:
Measures blood flow to assess wound healing potential Compares thigh and ankle blood pressure to assess
in chronic ulcers. circulation without treadmill use.
Toe-Brachial Index (TBI) Test:
Similar to ABI but measures blood pressure in toes to
assess circulation in smaller vessels.

Treatment for Peripheral Artery Disease (PAD): Treatment of Peripheral Vascular Disease (PVD):

Goals: Goals:
Manage symptoms to make exercise more comfortable. Halt disease progression and manage symptoms to
Improve artery health to reduce the risk of heart attack maintain activity.
and stroke Reduce risk of serious complications.
Lifestyle Changes: Lifestyle Modifications:
Quit smoking, the most crucial step. Regular exercise program, including walking.
Regular, scheduled exercise, especially supervised Balanced diet.
training. Weight loss if necessary.
Medications: Smoking cessation to improve blood flow and prevent
Cholesterol Drugs: Statins to lower bad cholesterol and worsening.
reduce plaque buildup. Medications:
Blood Pressure Drugs: Control hypertension to prevent Cilostazol or Pentoxifylline: Increase blood flow and
arterial stiffness. alleviate claudication symptoms.
Blood Sugar Control: Important for diabetic patients to Clopidogrel or Daily Aspirin: Reduce blood clotting.
manage PAD risk. Statins (e.g., Atorvastatin, Simvastatin): Lower high
Medications to Prevent Blood Clots: Aspirin or cholesterol levels.
clopidogrel to improve blood flow and prevent clotting. ACE Inhibitors: Lower high blood pressure.
Medications for Leg Pain: Cilostazol or pentoxifylline to Diabetes Medication: Control blood sugar levels if
increase blood flow and alleviate pain. diabetic.
Surgeries or Procedures: Surgical Options:
Angioplasty and Stent Placement: Opens clogged Angioplasty: Catheter inserted to inflate a balloon and
arteries using a balloon and sometimes a stent. open narrowed arteries; may include stent placement.
Bypass Surgery: Creates a path around blocked arteries Vascular Surgery: Creates bypass for blood flow using
using healthy blood vessels or synthetic ones. vein grafting around narrow areas.
Thrombolytic Therapy: Dissolves blood clots blocking
arteries.
 Cardiac

PAD vs PVD

Education for Peripheral Artery Disease (PAD): Education for Peripheral Vascular Disease (PVD):

Stop smoking to improve blood flow. Wear compression stockings to improve blood flow and
Avoid crossing legs to prevent circulation obstruction. reduce swelling.
Keep feet warm in cold temperatures to maintain Avoid prolonged sitting or standing to prevent blood
circulation. pooling.
Engage in regular exercise like walking for improved Elevate legs when resting to promote venous return and
circulation. reduce discomfort.
Follow a healthy diet rich in fruits, vegetables, and whole Engage in regular exercise and maintain a healthy diet
grains. to support cardiovascular health.
Manage stress with relaxation techniques to support Maintain a healthy weight to reduce strain on the
vascular health. vascular system and improve circulation.
MUSCULOSKELETAL
 Musculoskeletal

Musculoskeletal System

The musculoskeletal system involves the complex Throughout the lifespan it provides support and
interactions of muscles, bones, and connective protection and allows for movement, and this
tissues. provides a means for us to engage in life.

The musculoskeletal system is an intricate network of Tendons:

bones, muscles, cartilage, tendons, ligaments, and other Tough, fibrous tissues that connect muscles to bones,
connective tissues that provide support, stability, and enabling movement by transmitting the force
movement to the body. generated by muscles to the bones.
The musculoskeletal system includes:
Ligaments:
Bones: Strong bands of connective tissue that connect bones
The framework of the body, bones provide structure, to each other in joints, providing stability and
protect vital organs, and serve as attachment points preventing excessive movement.
for muscles. They also produce blood cells and store
Joints:
minerals like calcium.
Areas where two or more bones meet, allowing for
Muscle: movement and flexibility. Different types of joints
These tissues are responsible for movement by include hinge joints (e.g., elbow), ball-and-socket
contracting and relaxing. Skeletal muscles, attached to joints (e.g., shoulder), and pivot joints (e.g., neck).
bones by tendons, are under voluntary control and
move the body's parts. Other structures:
This system also includes structures like bursae
Cartilage: (fluid-filled sacs that cushion joints), synovial
A flexible connective tissue found in various parts of the membranes (which produce synovial fluid to lubricate
body, including joints, ears, and the nose. It provides joints), and fascia (connective tissue that surrounds
cushioning and reduces friction between bones. muscles and other structures).
 Musculoskeletal

Musculoskeletal System

MUSCLE FUNCTIONS SKELETAL FUNCTIONS

Movement: To sum up the above content, the five major functions

of the skeletal system are as follows
Muscles enable movement by contracting and
relaxing. Skeletal muscles, which are attached to Protection of Organs
bones, work together with bones and joints to The vital function of the skeletal system is to protect
produce various movements such as walking, the internal organs. The structures like the skull, rib
running, lifting, and bending. cage and vertebrae protect the brain, lungs and
spinal cord respectively.
Posture and Stability:
Muscles help maintain posture and stability by
Movement Production of
providing support to the skeleton. They work
A wider range of body Blood cells
continuously to keep the body upright against the
force of gravity, preventing collapse or slumping. movements is because The bone marrow is a
of the coordinated action site of haematopoiesis
Joint Stability: of the skeletal system, where the formation
Muscles surrounding joints provide stability and nervous system and of blood cells takes
support, helping to prevent dislocations and injuries muscles. place.
during movement. They contribute to the integrity
and function of joints, especially during activities that Storage of Minerals Support the body
involve weight-bearing or impact. Bones are a reservoir The bones and
of minerals like cartilages provide the
Heat Generation phosphorus and framework to
Muscle activity generates heat, which is essential for calcium. It also plays maintain the body
maintaining body temperature. During muscle an important role shape. Without these
contractions, heat is produced as a byproduct, Erythropoietin (renal skeletal components,
helping to regulate body temperature and keep it hormone) the body parts would
within a narrow range conducive to cellular function. stimulatesbone collapse.
Protection of Organs: marrow for RBC
Muscles provide protection to vital organs by production
surrounding them and absorbing impacts or shocks.
For example, the abdominal muscles protect the
internal organs of the abdomen.
Protects
Facilitation of Circulation:
internal organs
Contractions of skeletal muscles assist in venous
return, helping to propel blood back to the heart
against gravity. This action supports efficient
circulation and the delivery of oxygen and nutrients Stores and
to tissues throughout the body. releases fat
Respiration:
Muscles involved in breathing, such as the
diaphragm and intercostal muscles, facilitate the Produces
expansion and contraction of the chest cavity, blood cells
allowing air to flow in and out of the lungs during
inhalation and exhalation.
Expression:
Muscles of the face and neck are crucial for facial Stores and releases
expressions, communication, and non-verbal cues. minerals
They enable us to convey emotions, express feelings,
and communicate with others effectively. Facilitates movement

Supports the body

 Musculoskeletal

Musculoskeletal System

MUSCLE LAYERS

Muscle layers refer to the arrangement of muscle tissue within the body, typically categorized into three main
layers: superficial, intermediate, and deep. These layers can vary in thickness and composition depending on the
region of the body.

Superficial Layer: (EPIMYSIUM) Deep Layer;(ENDOMYSIUM)

These are the muscles closest to the body's Situated beneath superficial and intermediate
surface. layers, these smaller muscles often specialize in
They are typically larger and more accessible, precise movements and joint stabilization.
aiding in visible movements like flexion and
They support posture and movements initiated by
extension.
superficial muscles. Examples include spinal,
Examples include abdominal, chest, and upper pelvic, and deep limb muscles.
limb muscles.

Intermediate Layer: (PERIMYSIUM)

Positioned between superficial and deep layers,

These muscles may have more specific functions
related to fine motor control or stabilization.
Examples include certain forearm and thigh
muscles.

Structure of Skeletal Muscle

Blood vessel
Tendon Fascicle

Bone
Muscle fiber

Epimysium Perimysium Endomysium

Outermost layer Middle layer Innermost layer
Covers the Covers a bundle of Covers a single
entire muscle muscle fibers muscle fiber

Fascia Is Connective Tissue That Covers The Epimysium

 Musculoskeletal

Musculoskeletal System

TYPES OF CONNECTIVE TISSUES FOUND IN THE HUMAN BODY.

Shock
TENDON LIGAMENT CARTILAGE Absorber

Tendons are a type of dense Ligaments are also dense Cartilage is a type of flexible
connective tissue that connect connective tissues, but they connective tissue that covers
muscle to bone. They transmit connect bone to bone. the surface of bones at joints.
the forces generated by Ligaments provide stability to It acts as a cushion, reducing
muscle contraction to the joints by preventing excessive friction between bones during
bones, allowing movement of movement and maintaining movement, and provides
the skeletal system. proper alignment between structural support.
bones.
Muscle
Tendon Cartilage

Tendon

Ligament

Bone
Attachment

Remember Remember Remember

T for two types L for like to like C For Cap Of Bone

STRAIN A strain is an injury resulting from SPRAIN A sprain is an injury involving the
overstretching or tearing of muscles or overstretching or tearing of a
tendons, typically causing pain and ligament, often causing pain, swelling,
restricted movement. and instability in a joint.
 Musculoskeletal

Musculoskeletal System

Ossicles
Skull (inner ear) Shoulder
Appendicular Skeleton Girdle
Rib cage Hyoid bone
The appendicular skeleton
comprises the bones of the
limbs (arms and legs) and
their associated girdles
(shoulder and pelvic).
Vertebral
Column It facilitates movement and Arm
mobility, supporting the
attachment of muscles
responsible for limb
movement and locomotion.
Hand

Axial Skeleton

The axial skeleton consists

Pelvic
of the bones along the
Girdle
body's central axis, Leg
including the skull, vertebral
column, ribs, and sternum.
It provides structural
support, protection for vital
organs such as the brain
and spinal cord, and serves
as attachment points for
muscles involved in posture
and movement.

REMEMBER THE LAW OF ONE’S AND TWO’S

The Law of One’s The Law of Two’s

Also known as "General Law of One," it states that Also known as "Special Law of Two’s," it states that
muscles typically have one primary function or muscles typically have two primary functions or
action. actions.
Muscles often work in pairs or groups, with one
This means that most muscles primarily perform
muscle (agonist) responsible for the primary
one specific movement, such as flexion or
movement (e.g., flexion), and its antagonist muscle
extension, although they may contribute to
opposing this movement (e.g., extension).
secondary movements as well
This law highlights the reciprocal relationship
between muscles, ensuring coordinated and
balanced movement around joints.

ONE (Axial Skeleton) TWO (Appendicular Skeleton)

Skull Spine (vertebral column) Upper limbs (arms) Shoulder girdles (scapulae/clavicles)
Ribcage (ribs) Sternum Lower limbs (legs) Pelvic girdles (hip bones)
 Musculoskeletal

Types of Bone Marrow

WHAT IS BONE MARROW? THERE ARE TWO TYPES

Bone marrow is a nutrient-dense, spongy tissue located RED BONE MARROW
in the cavities of bones. Bone marrow is where blood
cells are produced and where stem cells are found. YELLOW BONE MARROW

RED BONE MARROW YELLOW BONE MARROW

Spongy bone
Red bone marrow is responsible for Yellow bone marrow consists
producing blood cells, including mainly of fat cells and serves as a
red blood cells, white blood cells, Red
storehouse for fat. It is found in the
and platelets. It is found in the bone medullary cavity of long bones,
spongy or trabecular bone and is marrow where red bone marrow is
primarily located in the flat bones Compact gradually replaced by yellow
(such as the sternum, ribs, pelvic Bone marrow as individuals age. While
bones, and skull) and the ends of yellow marrow does not actively
long bones (such as the femur and produce blood cells, it can convert
Spongy
humerus) in adults. Bone back to red marrow under certain
conditions, such as severe blood
loss or certain diseases.

Cancellous substance
Sponge bone
Yellow
bone Compact bone
Red Bone
marrow Blood Vessels Marrow

Red Bone
Marrow

Periosteum Yellow Bone Marrow Cartilage

Renal failure patients can't produce erythopoietinwhich

stimulates Red Bone Marrow, causing Anemia
 Musculoskeletal

Joints

DEFINITION
A joint, also known as an articulation or articular surface, is a connection that occurs between bones in the skeletal
system. Joints provide the means for movement.

TYPES OF JOINTS Example of hinge joints is the ankle, elbows, and

knee joints.
Here are the main types of joints in the human body: 3. SADDLE JOINTS
FIBROUS JOINTS: Saddle joint is the biaxial joint that allows the
These joints are connected by fibrous connective movement on two planes–flexion/extension and
tissue and allow for little to no movement. There are abduction/adduction.
three types: For Example, the thumb is the only bone in the
Sutures: Found only in the skull, sutures are human body having a saddle joint.
immovable joints that tightly bind the bones of
the skull together.
Syndesmoses: These joints have slightly more
flexibility than sutures and are connected by
ligaments, allowing limited movement. An Types Of Joints
example is the distal tibiofibular joint.
Gomphoses: These are peg-in-socket joints,
such as the connection between a tooth and its
socket in the jawbone. They provide limited
movement
CARTILAGINOUS JOINTS:
These joints are connected by cartilage and allow
for limited movement. There are two types:
Synchondroses: These joints are joined by Pivot Joint
hyaline cartilage and are immovable. An Hinge Joint
example is the epiphyseal plates of growing
long bones.
Symphyses: These joints are joined by
fibrocartilage and allow for slight movement.
Examples include the intervertebral discs and
the pubic symphysis.

Saddle Joint Conyloid Joint

SYNOVIAL JOINTS INCLUDE VARIOUS TYPES:

1. PIVOTAL JOINTS
In this type of joint, one bone has tapped into the other
in such a way that full rotation is not possible.
This joint aid in sideways and back-forth movement. Plane Joint
Ball And Socket
An Example of a pivotal joint in the Neck. Joint
2. HINGE JOINTS
Hinge joints are like door hinges, where only back and
forth movement is possible.
 Musculoskeletal

Joints

Types Of Joints
DEFINITION

4. GLIDING JOINTS GLIDING ONLY

Gliding joints are a common type of synovial joint.
It is also known as a plane or planar joint.
This joint permit two or more round or flat bones to
move freely together without any rubbing or
crushing of bones.
This joint is mainly found in those regions where the Pivot Joint
two bones meet and glide on one another in any of Hinge Joint
the directions.
Example The lower leg to the ankle joint and the
forearm to wrist joint are the two main examples of
gliding joints.

5. BALL AND SOCKET JOINTS MOST MOBILE

Here, one bone is hooked into the hollow space of
another bone. This type of joint helps in rotatory
movement. Saddle Joint Conyloid Joint
An Example include the shoulder and hip joints.

6. CONDYLOID JOINTS
Condyloid joints are the joints with two axes which
permit up-down and side-to-side motions. This
joint is also known as a condylar, or ellipsoid joint.
Example The condyloid joints can be found at the Plane Joint
base of the index finger, carpals of the wrist, elbow Ball And Socket
and the wrist joints. Joint

FUNCTION

WHAT DO JOINTS DO?

Joints support your body. They help you sit, stand and
move. Some joints provide structural support. Others
let you move. Depending on how much a joint moves,
it fits into one of three categories:
SYNARTHROSES:
Joints that don’t move at all. These joints provide
structural support.
AMPHIARTHROSES:
Joints with limited movement that give you a mix of
stability and some motion.
DIARTHROSES:
These are joints you can move freely in most
directions. These joints allow the most movement.
 Musculoskeletal

Musculoskeletal Assessment

DEFINITION IMPORTANCE OF A
MUSCULOSKELETAL ASSESSMENT
An assessment of the musculoskeletal system
includes collecting data regarding the
structure and movement of the body, as well The musculoskeletal system is an essential
the patient's mobility. component of human health.

In addition to providing the body with structure

and the means for movement, the musculoskeletal
ASK THE PATIENT: system acts as endocrine system,

Stimulated by exercise, interacting through

Do you use any assistive devices? (cane, biochemical signaling with other organs in
walker, brace, etc.) the body.
Have you had any recent falls?
Assesses the function and ability to perform
Do you need assistance performing any activities of daily living (ADL's)
daily tasks? (cooking, eating, bathing)

Eating

Transferring Dressing
Mobility

ACTIVITIES
OF DAILY
LIVING
(ADLS)
Toileting Personal
Continence Hygiene
 Musculoskeletal

Musculoskeletal Assessment

INSPECT PALPATE

Inspection involves visually examining the patient's Palpation involves using the hands to feel or touch
body for any abnormalities, deformities, swelling, various parts of the patient's body to assess for
discoloration, or other visible signs of injury or illness. tenderness, swelling, warmth, muscle tone, and other
tactile sensations.
For Example:
For Example:
During a musculoskeletal assessment, inspection In a musculoskeletal assessment, palpation may
may involve observing the alignment of joints, involve feeling for joint crepitus, assessing muscle
muscle bulk and tone, presence of scars or bruises, strength, locating tender points, or identifying bony
and any signs of inflammation or swelling. landmarks.
Postural & Overall Stance: Palpating Muscles & Joints for Warmth,
Swelling, or Tenderness:
Observing the alignment of the head, shoulders, Using hands to feel for abnormal warmth, swelling, or
spine, pelvis, and lower extremities while the patient tenderness in muscles and joints, which may indicate
is standing or sitting to identify any deviations from inflammation, injury, or infection.
normal anatomical alignment.
Perform Passive ROM:
Gait & Balance while Walking/Standing: Gently moving the patient's joints through their full
Assessing the patient's coordination, stability, and range of motion while they remain relaxed, assessing
weight-bearing distribution while they walk or stand, for any restrictions, pain, or stiffness, which helps
including observations of stride length, step evaluate joint integrity and mobility.
symmetry, arm swing, foot placement, and balance
maintenance. Assess Muscle Strength:
Applying resistance to the patient's muscles while they
Curvature of Spine: contract, assessing their ability to generate force,
Visual assessment of the spine from various angles which helps evaluate muscle function and detect
to detect abnormalities such as sideways curvature weakness or imbalances.
(scoliosis), excessive rounding of the upper back
(kyphosis), or excessive inward curvature of the
lower back (lordosis).
STRENGTH SCALE
Pain with Active Range of Motion (ROM):
Observing for signs of pain, discomfort, or restriction 0. No Contraction:
while the patient actively moves their joints through No muscle contraction or movement is observed,
their full range of motion, indicating possible indicating complete paralysis or inability to generate
inflammation, injury, or dysfunction in the affected any muscle force.
joint or surrounding structures. 1. Trace Contraction:
A minimal flicker or trace of muscle contraction is
palpable or observed, but there is no joint movement
against gravity.
RANGE OF MOTION (ROM) 2 . Poor Contraction:
The muscle can move the joint with gravity eliminated
(in a horizontal position), but cannot overcome
The extent of movement possible at a joint in
gravity to move against it.
various directions.
3 .FAIR CONTRACTION:
Active ROM (Range of Motion):
The muscle can move the joint against gravity but
Movements of a joint performed by the patient with some resistance provided by the examiner,
using their own muscles, indicating the extent indicating moderate strength.
and direction of movement achievable
4 .Good Contraction:
voluntarily. The muscle can move the joint against gravity and
Passive ROM (Range of Motion): provide moderate resistance when the examiner
Movements of a joint facilitated by an external applies force, indicating strong muscle strength.
force without the patient's muscular 5. Normal Contraction:
contraction, assessing the full extent and The muscle can move the joint against gravity and
direction of joint movement without the withstand maximum resistance provided by the
patient's active effort. examiner, indicating normal or full muscle strength.
 Musculoskeletal

Musculoskeletal Assessment

FACTORS AFFECTING
PHYSICAL MOBILITY

Nerve Degeneration: Impairs nerve function, leading to weakness, numbness, or loss of sensation and coordination.

Diabetes: Can cause peripheral neuropathy, affecting sensation and motor function in the extremities.
Multiple Sclerosis: Affects the central nervous system, leading to muscle weakness, spasticity, and
coordination problems.
Stroke: Damages brain tissue, resulting in muscle weakness, paralysis, balance issues, and coordination
difficulties.
Aging: Naturally leads to a decline in muscle strength, flexibility, balance, and coordination.
Sedentary Lifestyle: Lack of physical activity contributes to muscle weakness, stiffness, reduced flexibility, and
overall deconditioning.
Recent Surgery: Impairs mobility temporarily due to pain, weakness, or limitations in movement during the
recovery period.
Pain: Hinders mobility by causing discomfort, reducing range of motion, and limiting physical activity.
Obesity or Malnutrition: Excessive weight or poor nutrition can exacerbate joint stress, reduce muscle strength,
and impair overall physical health.
Fractures/Injury: Causes pain, swelling, limited mobility, and functional impairment until healing is complete.
Bone Degeneration (Osteoarthritis): Leads to joint pain, stiffness, reduced range of motion, and functional
limitations.
Sedative Medications: Can cause drowsiness, dizziness, or muscle weakness, affecting mobility and balance.
Muscle Atrophy: Loss of muscle mass and strength due to disuse, injury, or neurological conditions reduces
mobility and functional capacity.

Other factors unrelated to mobility, such as orthostatic hypotension or shortness of breath, can also impact a
patient's ability to safely move around.
 Musculoskeletal

Musculoskeletal Assessment

TYPES OF MOVEMENT Types of movement

Flexion: bending the elbow or knee results in flexion
at those joints.
Extension: Straightening the elbow or knee from a
bent position demonstrates extension.
Abduction: raising the arms or spreading the Flexion Extension
fingers away from the body demonstrates
abduction.
Flexion
Adduction: Bringing the arms back down to the Extension
sides or bringing the fingers together demonstrates
adduction

Think the limb is being abducted from the body

Rotation: Rotation involves turning a body part

around its axis.
Flexion
Extension
Internal Rotation brings a body part closer to
the midline of the body, while
External Rotation moves it away from the
midline. Examples include rotating the head
from side to side or turning the shoulder inward
or outward.
Circumduction: the movement of the arm when
performing a windmill motion. Extension

Elevation: shrugging the shoulders demonstrates

elevation of the scapulae.
Depression: Lowering the shoulders after shrugging Rotation
them demonstrates depression of the scapulae.
Protraction: sticking out the jaw or pushing the
shoulders forward demonstrates protraction.
Retraction: Pulling the jaw back or squeezing the
shoulder blades together demonstrates retraction. Abduction

Hyperextension: is the abnormal or excessive

extension of a joint beyond its normal range of Flexion
motion, thus resulting in injury.
Excursion Extension
Circum
Lateral
Abduction duction
Rotation
Circumduction: It involves the sequential
combination of flexion, adduction, extension, and Medial
abduction at a joint. Rotation

Excursion: is the side to side movement of the

mandible.
Lateral excursion moves the mandible away
from the midline, toward either the right or
left side.
Medial excursion returns the mandible to its
resting position at the midline.
 Musculoskeletal

Musculoskeletal Assessment

MOVEMENTS OF THE JOINTS

Type of Joint Movement Example

Pivot Uniaxial joint; allows rotational Atlantoaxial joint (C1–C2

movement vertebrae articulation); proximal
radioulnar joint

Hinge Uniaxial joint; allows Knee; elbow; ankle;

flexion/extension movements interphalangeal joints of fingers
and toes

Condyloid Biaxial joint; allows Metacarpophalangeal (knuckle)

flexion/extension, joints of fingers; radiocarpal joint
abduction/adduction, and of wrist; metatarsophalangeal
circumduction movements joints for toes

Saddle Biaxial joint; allows First carpometacarpal joint of the

flexion/extension, thumb; sternoclavicular joint
abduction/adduction, and
circumduction movements

Plane Multiaxial joint; allows inversion Intertarsal joints of foot;

and eversion of foot, or flexion, superior-inferior articular process
extension, and lateral flexion of articulations between vertebrae
the vertebral column

Ball-and-socket Multiaxial joint; allows Shoulder and hip joints

flexion/extension,
abduction/adduction,
circumduction, and medial/lateral
rotation movements
 Musculoskeletal

Acute Compartment Syndrome

Compartment Syndrome

Contain

COMPARTMENT SYNDROME Blood vessels

Nerves
Muscles

Pressure
Compartment syndrome happens when there’s too much pressure
around your muscles. The pressure restricts (reduces) the flow of blood,
fresh oxygen and nutrients to your muscles and nerves. Compartment Blood flow cut off

syndrome is extremely painful. Tissuet damage due to

hypoxia (lack of oxygen)

ACUTE COMPARTMENT SYNDROME

Acute compartment syndrome occurs when the pressure within a
muscle compartment rises to dangerous levels, compromising blood
flow to the muscles and nerves within that compartment.

LEADS TO
Acute compartment syndrome occurs when the pressure within a muscle compartment rises to dangerous levels,
compromising blood flow to the muscles and nerves within that compartment.

Muscle and Nerve Damage: Prolonged elevation of pressure within the muscle compartment can result in
compression and damage to the muscles and nerves within that compartment. This can lead to muscle
weakness, loss of sensation, and impaired function.
Tissue Necrosis: Insufficient blood flow caused by increased compartment pressure can lead to tissue ischemia
(lack of oxygen) and necrosis (tissue death). Severe tissue necrosis may require surgical debridement or
amputation.
Limb Loss: In extreme cases, where compartment syndrome is not promptly diagnosed and treated, the lack of
blood flow and severe tissue damage may necessitate amputation of the affected limb to prevent
life-threatening complications such as systemic infection (sepsis).
Chronic Pain and Disability: Even with successful treatment, some individuals may experience chronic pain,
weakness, or disability due to residual muscle and nerve damage. Rehabilitation and physical therapy may be
necessary to regain function and mobility.
Infection: Compartment syndrome increases the risk of infection due to compromised tissue integrity and
impaired immune response. Infections can lead to further tissue damage, systemic complications, and
prolonged recovery.
Contractures: Scar tissue formation and muscle fibrosis resulting from tissue damage may lead to
contractures, where the affected muscles and joints become permanently shortened, limiting range of motion
and function.
Systemic Complications: Severe cases of acute compartment syndrome can lead to systemic complications
such as rhabdomyolysis (breakdown of muscle tissue), electrolyte imbalances, acute kidney injury, and even
multi-organ failure.
Pain: Increased pressure within the muscle compartment leads to intense pain that may be disproportionate to
the injury or trauma.
Neurovascular impairment (from compressed nerves): Compression of nerves within the compartment can
result in neurovascular impairment, leading to sensory deficits, motor weakness, and potential tissue damage
due to ischemia (lack of blood flow).
Decreased blood flow (from compressed blood vessels): Elevated compartment pressure compresses blood
vessels, impeding blood flow to the muscles and tissues within the affected compartment.
 Musculoskeletal

Acute Compartment Syndrome

CAUSES SYMPTOMS DIAGNOSTICS

Trauma Severe Pain: Pain that Clinical Assessment: The healthcare
Tight Bandages or Casts is out of proportion to provider evaluates the patient's
the injury, persistent, symptoms, medical history, and physical
Strenuous Exercise and not relieved by rest examination findings. Key indicators
Burns or pain medication. It include severe pain out of proportion to
Vascular Injury may feel deep, EARLY the injury, paresthesia, pallor, paralysis or
throbbing, or intense. SIGN weakness, pulselessness, and pressure
Crush Injuries: can lead sensation.
Paresthesia: Abnormal
to muscle damage,
sensations such as Compartment Pressure Measurement:
bleeding, and swelling
tingling, numbness, or Direct measurement of compartment
within the affected
pins and needles pressures using a handheld device called
compartment, resulting in
sensation in the a manometer can help confirm the
compartment syndrome.
affected limb or area diagnosis. Pressures are typically
IV Infiltration: Infiltration due to nerve measured in the affected compartment
of intravenous fluids or compression or and compared to diastolic blood pressure
medications into muscle ischemia. to calculate the perfusion pressure.
compartments,
Pallor: Pale or dusky
particularly in areas with
skin coloration in the NORMAL: 0-10 MMHG
limited blood supply, can
affected area due to
cause tissue irritation, ELEVATED: >20 MMHG
decreased blood flow
inflammation, and
and tissue perfusion.
swelling, contributing to EMERGENT: >30 <40% BAD MMHG
increased compartment Paralysis or
pressure. Weakness: Loss of Imaging Studies: Although not always
muscle function, necessary for diagnosis, imaging studies
Reperfusion Injury:
weakness, or difficulty such as magnetic resonance imaging
Re-establishment of blood
moving the affected (MRI) or computed tomography (CT)
flow to a previously
limb or area due to scans may be used to assess for muscle
ischemic muscle
nerve compression or and nerve damage, confirm the presence
compartment, such as
muscle ischemia. of compartment syndrome, and rule out
after surgical correction of
vascular occlusion or Pulselessness: other causes of symptoms (e.g., fractures,
treatment of frostbite, can Diminished or absent soft tissue injuries).
result in reperfusion injury peripheral pulses distal Serial Examinations: Serial clinical
and compartment to the affected area assessments and compartment pressure
syndrome. due to compromised measurements may be performed to
blood flow and arterial monitor changes in symptoms and
Snakebites LATE
compression. SIGN compartment pressures over time,
Complications of Pressure Sensation: especially in cases where the diagnosis is
Intravenous Drug Use Increased pressure or uncertain or if conservative management
Fractures tightness in the is being considered.
affected compartment, Intra-compartmental Pressure
described as a feeling Monitoring: In some cases, particularly in
of fullness, tightness, or critically ill patients or those with multiple
Most Common
swelling that worsens injuries, intra-compartmental pressure
Cause Tibial Fractures
with passive stretching monitoring systems may be used to
of the muscles. continuously monitor compartment
pressures and guide management
decisions.
Near-infrared Spectroscopy (NIRS):NIRS
Remember The 6 P's is a non-invasive technique used to
assess blood flow and tissue oxygenation
in muscle compartments.
 Musculoskeletal

Acute Compartment Syndrome

TREATMENT COMPLICATIONS
Pain Management: Use opioid analgesics and Rhabdomyolysis: Breakdown of muscle tissue
NSAIDs to alleviate pain and inflammation. leads to release of myoglobin, causing acute
Intravenous Fluids: Administer IV fluids to kidney injury.
maintain hydration and improve limb perfusion. Tea-Colored Urine: Urine discoloration due
Elevation of Limb: Elevate the affected limb to to presence of myoglobin.
heart level to reduce swelling and enhance Muscle Pain: Severe muscular discomfort
blood flow. due to tissue damage.
Muscle Weakness: Reduced muscle
strength and function as a result of
PROCEDURES damage.
Gangrene: The death and decay of body tissue,
Fasciotomy: Perform surgical fasciotomy to typically resulting from insufficient blood supply
relieve pressure by making incisions in the fascia to the affected area. It can lead to tissue
surrounding the affected compartment. necrosis, infection, and potentially limb loss if not
Amputation: Consider limb amputation in promptly treated.
severe cases with irreversible tissue damage or
Red/Purple/Black Skin: Skin discoloration
systemic complications.
indicating tissue necrosis.
Continuous Monitoring: Monitor compartment
Sores or Blisters: Ulceration or vesicle
pressures, perfusion, and clinical status
formation on the skin.
post-procedure for complications and ongoing
management. Foul-Smelling Wound: Malodor from
necrotic tissue breakdown.

NURSING INTERVENTIONS
Assessment and Monitoring: Regularly assess and monitor the patient's pain level, neurovascular status,
and signs of compartment syndrome, such as swelling, pallor, paresthesia, and pulselessness.
Pain Management: Administer prescribed analgesics, such as opioids or NSAIDs, to alleviate pain and
discomfort.
Elevation: Elevate the affected limb at heart level to reduce swelling and improve venous return.
Frequent Neurovascular Checks: Perform frequent neurovascular assessments to monitor for changes in
sensation, motor function, and peripheral pulses.
Asses:
Documentation: Document assessments, interventions, and patient responses accurately and promptly Pulse
in the medical record. Color
Collaboration: Collaborate with the healthcare team to facilitate prompt diagnosis and treatment, Cap refill
including consultation with a surgeon for potential fasciotomy. Temperature
Sensation
Patient Education: Educate the patient and family about the signs and symptoms of compartment Movement
syndrome, the importance of timely reporting of symptoms, and the rationale for treatment interventions.
Emotional Support: Provide emotional support and reassurance to the patient and family members,
addressing concerns and providing information about the condition and treatment plan.
Prevention of Complications: Monitor for potential complications such as rhabdomyolysis, acute kidney
injury, or gangrene, and intervene promptly if signs or symptoms occur.
Prevention of Pressure Ulcers: such as frequent repositioning, skin assessment, and the use of
pressure-relieving devices.
Fluid Management: Monitor fluid intake and output closely, ensuring adequate hydration while avoiding
fluid overload.
Preoperative Preparation: including obtaining consent, ensuring proper patient positioning, and
providing emotional support.
Postoperative Care: Provide postoperative care for patients undergoing fasciotomy, including wound
care, pain management, and monitoring for complications such as infection or delayed wound healing.
 Musculoskeletal

Degenerative Disc Disease

On affected limb no:

AVOID BP measurements
Blood draws
Restrictive Clothing: IV lines
Clothing that is tight or constrictive, potentially
limiting blood flow and exacerbating swelling
or pressure within muscle compartments.
Tight Casts or Bandages: DEGENERATIVE DISC DISEASE
Casts or bandages applied too tightly, leading
to compression of muscle compartments and
potential development of compartment Degenerative disc disease refers to the
syndrome. progressive breakdown of the intervertebral
discs, which act as cushions between the
Placing Limb Above or Below Heart Level: vertebrae in the spine.
Positioning the affected limb either above or
below heart level, which can disrupt blood flow
dynamics and worsen swelling or pressure
within muscle compartments.
INTERVETEBRAL DISCS
Intervertebral discs are fibro cartilaginous
structures located between adjacent vertebrae
in the spine, providing cushioning, flexibility, and
support to the spinal column.

If damage or wear gets severe enough can cause

Compression Of Spinal Nerves

Normal disc

Degenerative disc
Disc begins to become brittle
and wear away

Bulging disc
Disc becomes flattened &
slightly pushes out

Herniated disc
Outer layer of disc cracks &
inner disc contents leak out

thinning disc
Inner contents of disc lose
fluid, reducing "sponginess"

osteophyte formation
IBone spurs develop on
vertebrae, compressing disc
 Musculoskeletal

Degenerative Disc Disease

RISK FACTORS
Aging: As individuals grow older, the intervertebral discs naturally lose hydration, elasticity, and height, making
them more susceptible to degeneration.
Genetics
Occupation: Jobs that place strain on the spine, such as construction work or heavy manual labor, may
accelerate disc degeneration over time.
Smoking: Smoking reduce blood flow to the intervertebral discs, impairing their ability to receive nutrients and
repair damage.
Obesity
Poor Posture: Maintaining poor posture, such as slouching or sitting for prolonged periods without adequate
support.
Trauma: Previous spinal injuries or trauma, such as fractures or herniated discs.
Lack of Physical Activity: Sedentary lifestyle and lack of regular exercise can weaken the muscles supporting
the spine
Nutrition: Poor diet lacking essential nutrients, such as calcium, vitamin D, and antioxidants
Other Medical Conditions: Certain medical conditions, such as osteoporosis, rheumatoid arthritis, and spinal
deformities, can increase the risk of degenerative disc disease.

SYMPTOMS

Depend On Location & Severity

Most Common
Back Pain
Radiating Pain:
Numbness and Tingling: Numbness, tingling, or pins-and-needles sensations (paresthesia) may occur in the
affected region or radiating down the arms or legs due to nerve compression or irritation.
Muscle Weakness:
Stiffness:
Pain Aggravation:
Pain Relief:
Decreased Range of Motion:
Pain Flare-ups: Episodes of acute pain or flare-ups may occur intermittently, triggered by exacerbating factors
such as physical exertion, trauma, or changes in weather.
Pain Distribution: The pattern and distribution of pain may vary depending on the location and severity of disc
degeneration, as well as individual factors such as posture, activity level, and overall health.
 Musculoskeletal

Degenerative Disc Disease

DIAGNOSTICS
Medical History and Physical Examination:
Imaging Studies:
X-rays: X-ray images of the spine can help identify structural changes, such as narrowing of disc space, bone
spurs (osteophytes), or vertebral misalignment (scoliosis).
MRI (Magnetic Resonance Imaging): GOLD STANDARD
MRI scans provide detailed images of the spine and can visualize the intervertebral discs, spinal cord, nerve
roots, and surrounding soft tissues. MRI can reveal disc degeneration, disc herniation, nerve compression, and
other spinal abnormalities.
CT (Computed Tomography): CT scans may be used to assess bony structures of the spine, such as vertebral
fractures or osteophytes, and can provide additional detail in certain cases.
Diagnostic Tests:
Discography: Discography involves injecting contrast dye into the intervertebral discs followed by imaging
studies (such as CT or MRI) to evaluate disc structure and identify painful discs.
Electromyography (EMG) and Nerve Conduction Studies: EMG and nerve conduction studies may be used to
assess nerve function and identify nerve compression or dysfunction.
Clinical Assessment Tools: Various clinical assessment tools and questionnaires may be
Patient lies on back
used to evaluate pain intensity, functional impairment, and quality of life, helping to assess
with legs straight
the impact of degenerative disc disease on daily activities and well-being.
Raises one leg at a
Specialized Tests: In some cases, specialized tests or consultations may be recommended,
time between 30-60
such as consultations with a spine specialist, pain management physician, or orthopedic
degrees
surgeon, to further evaluate and manage the condition.
Electromyography (EMG): Diagnostic test evaluating muscle and nerve electrical activity, Pain= Positive Test
used to detect nerve irritation or damage. May Indicate Disc
Straight Leg Raise Test: A maneuver to assess nerve irritation or compression by elevating Herniation
the straightened leg, often indicating issues like herniated discs or sciatica.

MEDICATIONS PROCEDURES

Pain Management: Laminectomy:

Medications like NSAIDs or muscle relaxants. Removal of a small portion of the vertebral bone called
Steroid injections for inflammation reduction. the lamina to relieve pressure on the spinal cord or
Topical treatments for localized relief. nerves caused by spinal stenosis or other conditions.
Physical Therapy: Diskectomy:
Exercise programs to strengthen muscles. Surgical removal of part or all of a herniated or
Manual therapy for muscle tension relief. damaged intervertebral disc to alleviate pressure on
Modalities like heat or ultrasound for pain relief. adjacent nerves and spinal structures, relieving pain
Lifestyle Modifications: and other symptoms.
Maintaining proper posture. Foraminotomoy:
Weight management to reduce strain.
Widening of the opening (foramen) through which nerve
Quitting smoking to improve blood flow.
roots exit the spinal canal to alleviate compression and
Supportive Measures: relieve symptoms associated with nerve root
Ergonomic support with chairs or cushions. impingement, such as pain, numbness, or weakness.
Orthotic devices like lumbar belts.
Alternative Therapies: Osteophyte Removal:
Acupuncture for pain relief. Surgical removal of bone spurs or osteophytes, which are
Chiropractic care for spinal alignment. bony outgrowths that can develop along the edges of
vertebral bones due to degenerative changes in the spine.
Surgical Intervention: This procedure helps relieve pressure on nerves and
Considered if conservative treatments fail. spinal structures and may be performed in conjunction
Options include discectomy or spinal fusion. with other spinal surgeries.
 Musculoskeletal

Degenerative Disc Disease

NURSING INTERVENTIONS
Preoperative Preparation:
Educate the patient about the procedure, including risks, benefits, and expected outcomes.
Ensure informed consent is obtained.
Assess and address the patient's anxiety or concerns.
Collaborate with the surgical team to prepare the patient physically and emotionally for the procedure.
Assess & Manage Pain
Intraoperative Support:
Assist with patient positioning to ensure proper alignment and access to the surgical site.
Provide emotional support and reassurance to the patient throughout the surgical process.
Ensure the operating room environment is conducive to patient comfort and safety.
Pain Management:
Administer pain medications as prescribed to alleviate discomfort and promote comfort.
Implement non-pharmacological pain relief measures such as positioning, relaxation techniques, or distraction.
Mobility and Rehabilitation:
Collaborate with physical therapists to develop a rehabilitation plan tailored to the patient's needs and
surgical outcomes.
Provide assistance with mobility aids or adaptive equipment as needed to facilitate safe movement
and independence.
ROM Exercises:
Range of motion (ROM) exercises are typically prescribed postoperatively to promote joint flexibility,
prevent stiffness, and facilitate rehabilitation.
Assess Bladder & Bowel Function:
Assessing bladder and bowel function is important postoperatively, especially after spinal surgery, to
monitor for potential complications such as urinary retention or bowel dysfunction and intervene as
needed.
Frequent Neurovascular Checks if Patient Had Spinal Surgery:
This is part of postoperative monitoring to assess neurological function, circulation, and sensation in the
extremities after spinal surgery.

PATIENT EDUCATION

Maintain Neutral Spinal Alignment:

Keeping the spine in a neutral position during activities to
minimize stress on the spinal structures and promote proper
alignment and posture.
Alternate Heat & Cold Therapy:
Using both heat and cold therapy alternatively to manage pain,
reduce inflammation, and promote relaxation in the muscles and
soft tissues surrounding the spine.
Heat for spasms &
Low impact exercise (walking, swimming, yoga) ice for inflammation
/swelling
 Musculoskeletal

Fractures

DEFINITION
A fracture is a break or a crack in a bone. A fracture occurs when force exerted against a bone is stronger than the
bone can structurally withstand.

OPEN VS. CLOSED

OPEN FRACTURE CLOSED FRACTURE

(COMPOUND FRACTURE) (SIMPLE FRACTURE)

In an open fracture, the broken bone penetrates In a closed fracture, the broken bone does not
through the skin, creating an external wound penetrate the skin, and there is no external
that exposes the bone and surrounding tissues wound
to the outside environment. The fractured bone remains within the soft
This type of fracture carries a higher risk of tissues, and there is no direct communication
infection due to the open wound. with the outside environment.

OPEN CLOSE
 Musculoskeletal

Fractures

COMPLETE VS. INCOMPLETE

COMPLETE FRACTURE INCOMPLETE FRACTURE

In a complete fracture, the bone is broken into In an incomplete fracture, the bone is partially
two or more separate pieces, causing a cracked or broken, but the fracture does not
complete disruption of the bone continuity. extend completely through the bone, leaving
This type of fracture may require realignment some portion of the bone intact.
(reduction) to restore proper bone alignment Incomplete fractures are often seen in children
and healing. and may be more stable than complete
fractures, sometimes requiring less aggressive
treatment.

COMPLETE INCOMPLETE
 Musculoskeletal

Fractures

TYPES OF FRACTURES

Transverse fracture: a fracture line that runs

horizontally across the bone shaft.
Oblique fracture: a fracture line that runs
diagonally across the bone shaft
Spiral fracture: a fracture characterized by a
spiral-shaped break, often caused by twisting
forces. Oblique
Transverse Spiral
Comminuted fracture: a fracture where the DIsplaced
bone breaks into three or more fragments.
Greenstick fracture: a type of incomplete
fracture seen in children, where the bone bends
and partially breaks, resembling a green stick
being bent.
Impacted fracture: a fracture where one
fragment of bone is driven into another, often
seen in compression injuries.
Impacted fracture: a fracture where one
fragment of bone is driven into another, often
seen in compression injuries.
Avulsion fracture: a fracture caused by the
pulling or tearing away of a piece of bone at the
site of attachment of a ligament or tendon.
Compression fracture: a fracture characterized
by the collapse or compression of the bone,
often seen in vertebrae due to osteoporosis or
trauma. Comminuted Greenstick Impacted

Stress fracture: a hairline crack in the bone

caused by repetitive stress or overuse,
commonly seen in athletes or individuals
engaged in repetitive activities.
Pathological fracture: a fracture occurring in
weakened or diseased bone, often due to
conditions such as osteoporosis, cancer, or
infection.

No
Fracture

Avulsion
Fracture
Pathological
Fracture
 Musculoskeletal

Fractures

CAUSES

Trauma: Fractures commonly result from physical injuries or trauma to the bone, which may occur due to
various accidents, falls, or direct blows to the body.

Car Accidents: High-impact collisions or accidents involving motor vehicles can exert significant force on the
body, leading to fractures of the bones, especially those in the extremities or the spine.

Falls: Falls from heights or slips and trips can cause fractures, particularly in the wrist, hip, or vertebrae,
depending on the impact and landing position.

Weakened Bones: Conditions such as osteoporosis, which leads to decreased bone density and strength,
can increase the risk of fractures even with minimal trauma or normal activities of daily living.

Osteoporosis: Osteoporosis is a medical condition characterized by weakened and porous bones, making
them more susceptible to fractures, especially in the spine, hips, and wrists.

Cancer: Certain types of cancer, particularly those that metastasize to the bones or affect bone density, can
weaken the bone structure and increase the risk of pathological fractures.

Sudden Twisting Motions: Sports injuries or sudden twisting movements can exert torsional forces on the
bones, leading to fractures, particularly in weight-bearing joints or areas prone to stress fractures.

SYMPTOMS

Pain
Swelling
Bruising: Bruising or discoloration may develop around the fractured bone
Deformity
In some cases, fractures can cause visible deformity or abnormal alignment of the affected limb or joint.
Limited Mobility:
Fractures often restrict movement and mobility of the affected limb or joint. Patients may experience
difficulty moving the injured area or performing activities that require normal range of motion
Tenderness: patients may experience increased sensitivity or pain when pressure is applied to the injured
area.
Numbness or Tingling: Fractures near nerves or blood vessels may cause numbness, tingling, or a
pins-and-needles sensation in the affected limb or extremity.
Visible Bone:
In open fractures, where the broken bone penetrates through the skin, the fractured bone may be visible or
palpable
Difficulty Bearing Weight:
Fractures involving weight-bearing bones, such as the leg or pelvis, may cause difficulty bearing weight on
the affected limb or joint.
Crepitus: Fractures may produce a grating or crackling sensation called crepitus when the broken bone
fragments rub against each other during movement.
 Musculoskeletal

Fractures

TREATMENT Splint, cast, brace, or sling

Immobilization: For stable fractures, immobilization using splints, casts, braces, or slings may be employed to
keep the broken bones in proper alignment and prevent further injury during the healing process.
Reduction (Realignment): Reduction refers to the process of restoring the alignment of the fractured bone
fragments to their normal position. This can be achieved through closed reduction or open reduction.
Closed Reduction: This non-surgical approach involves manually manipulating the bone fragments
externally to realign them. It is typically performed under sedation or anesthesia.
Open Reduction: In cases where closed reduction is not feasible or the fracture is complex, open reduction
may be necessary. This involves surgically accessing the fracture site through an incision to directly
visualize and manipulate the bone fragments into proper alignment.
Physical Therapy: Once the acute phase of healing has passed, physical therapy and rehabilitation
programs may be initiated to improve mobility, strength, and range of motion in the affected limb or joint,
facilitating recovery and return to functional activities.
Traction: Traction applies a pulling force with weights or pulleys to realign and immobilize fractured bones,
commonly used for pain reduction and alignment in long bone or hip fractures before further treatment.
Fixation: Fixation involves stabilizing the fractured bone fragments to maintain alignment and facilitate
healing. This can be achieved through external or internal fixation methods.
External Fixation: External fixation involves the placement of pins, wires, or screws into the bone above
and below the fracture site, which are then attached to an external frame outside the body. This stabilizes
the fracture externally while allowing for adjustments as needed.
Internal Fixation: Internal fixation involves surgically implanting hardware such as pins, screws, plates, or
rods directly into the bone to stabilize the fracture internally. This method provides rigid fixation and is
often used for complex or unstable fractures.
 MUSCULOSKELETAL

FRACTURES

COMPLICATIONS

FAT EMBOLISM OSTEOMYELITIS COMPARTMENT SYNDROME

A complication where a clot, Infection of the bone and Occurs when pressure builds
often from bone marrow, surrounding tissues, usually up within a muscle
travels through the caused by bacteria entering compartment due to bleeding
bloodstream and blocks the bone through a wound or or swelling, leading to
circulation, leading to bloodstream. Symptoms decreased blood flow and
symptoms such as mental include pain, fever, and potential nerve and tissue
status changes, rapid swelling at the site of infection, damage. Symptoms include
breathing (tachypnea), and commonly seen in long bone pain, pallor (pale skin), loss of
tiny red or purple spots on the fractures. pulse, numbness or tingling
skin (petechiae). (parasthesia), decreased
Pain: Persistent or
temperature (poikilothermia),
localized pain in the
and paralysis if severe.
Common In. Long Bone. affected bone, often
Fractures exacerbated by Pain: Intense pain 6 P'S
movement or pressure. disproportionate to the
Mental Status Changes: Example: A patient with injury, often described as
Alterations in cognitive osteomyelitis in the tibia severe and out of
function or consciousness, may experience severe, proportion to the physical
such as confusion, throbbing pain in the findings.
disorientation, or agitation, lower leg. Pallor: Pale or whitened
often indicating impaired appearance of the skin
brain function due to Fever: Elevated body
due to restricted blood
reduced oxygen supply temperature above the
flow and decreased
from compromised normal range, typically
oxygenation.
circulation. indicating an
inflammatory response to Pulselessness: Absence of
Tachypnea: Abnormally the infection. a palpable pulse in the
rapid breathing rate, affected area due to
Example: A patient with
characterized by increased compromised arterial
osteomyelitis may
respiratory rate above blood flow.
develop a fever with
normal levels, which may Parasthesia: Tingling,
temperatures exceeding
occur as the body attempts numbness, or abnormal
100.4°F (38°C).
to compensate for decreased sensations in the affected
oxygenation caused by Swelling at Site: area due to nerve
impaired blood flow. Inflammation and swelling compression or damage.
around the infected area, Poikilothermia: Inability of
Petechiae: Tiny red or caused by the body's
purple spots on the skin the affected limb to
immune response to the regulate its temperature,
caused by small bleeds bacterial invasion.
beneath the skin's surface, resulting in a feeling of
Example: Osteomyelitis in coldness or reduced
typically appearing as
the jawbone may present warmth compared to the
pinpoint-sized dots and
with facial swelling, surrounding tissues.
indicating the presence of
tenderness, and redness Paralysis: Loss of motor
small blood vessel damage
at the affected site. function or weakness in
or bleeding, often seen in
fat embolism syndrome. the affected area, which
may occur if the condition
progresses and nerve
damage becomes severe.
 MUSCULOSKELETAL

FRACTURES

DIAGNOSIS & TESTS

X-rays
X-rays usually confirm whether a person has a broken bone and where any loose bony pieces may be. Other
diseases of the bone can also show up on an x-ray, such as osteoporosis and Paget's disease.
BMD Test
One of the first tests a healthcare professional will order is a bone mineral density (BMD) test. Results from a BMD
test (usually of the hip, spine, wrist, or heel bone) can show if you have osteoporosis or weaker bones.
All women 65 years of age and older should have a BMD test to check bone strength. It is not clear whether men
need a routine BMD, since men have a lower risk of osteoporosis than women do. Men need to talk to their
healthcare professional about whether to get a BMD.
FRAX Tool
The FRAX tool has been developed to predict the risk of a fracture. It offers a personalized score to predict the
10-year risk of a person having a major fracture. The tool combines your individual risk factors for fractures and
your bone density scores. You may need to talk about this tool with your healthcare professional.
Additional Imaging
Additional Imaging
If the x-ray does not show a fracture but your healthcare provider still thinks you might have one, other imaging
tests may be necessary such as:
Magnetic resonance imaging (MRI)
Computed tomography (CT) scan

NURSING INTERVENTIONS
Apply Sterile Dressing to Open Fractures:
Apply sterile dressing to open fractures to minimize the risk of infection and provide wound protection
Immobilization:
Assist with the application of splints, casts, braces, or traction devices to immobilize the fractured limb or
area, promoting proper alignment and stability for healing.
Monitor Vital Signs, Respiratory Rate, and Signs of Shock:
Monitor vital signs, including respiratory rate, and assess for signs of shock, such as rapid pulse, hypotension,
or altered mental status, which may occur in severe fractures.
Pain Management:
Administer prescribed pain medications and implement non-pharmacological pain management
techniques to alleviate discomfort and promote patient comfort.
Keep NPO in Case of Surgery:
Maintain the patient nothing by mouth (NPO) status if surgical intervention is anticipated, to prevent
aspiration and ensure readiness for anesthesia.
Log Roll if Suspect Spinal Cord Injury (SCI):
Use a log roll technique to safely move and transfer patients with suspected spinal cord injury, minimizing
movement of the spine to prevent further damage.
Psychosocial Support:
Provide emotional support and reassurance to patients experiencing pain, anxiety, or fear related to the
fracture, and facilitate communication with the healthcare team to address concerns and promote coping
mechanisms.
Follow PRICE:
Implement PRICE protocol to manage pain and reduce swelling. Protection Rest Ice PRICE
Compression Elevation
 Musculoskeletal

Gout

DEFINITION
The accumulation
Gout is an inflammatory of uric acid Uric Acid crystals
arthritis characterized by leads to the
sudden and severe joint pain formation of
due to the accumulation of crystals within the
URIC ACID crystals in the joints. joints,
resulting in pain
and swelling.

URIC ACID
Uric acid is a metabolic
byproduct formed during the filtered through inflammatory
breakdown of purines, which kidneys & Synovial Fluid
are compounds found in excreted through
certain foods and body urine
tissues, through the process of
digestion.

SYMPTOMS OF GOUT

Characterized By Gout Attacks (Worsening Of Symptoms) & Remissions (Disappearance Of Symptoms)

Gout Attacks and Remissions:

Gout is characterized by episodes of acute symptoms, known as gout attacks, during which
symptoms worsen, including sudden swelling and pain in the affected joint. These attacks are
followed by periods of remission, during which symptoms disappear or significantly improve.
Sudden Swelling and Pain in the Joint:
During a gout attack, there is a rapid onset of swelling and intense pain in the affected joint, often
leading to significant discomfort and limited mobility.
Symptoms at Night:
MOST
Gout attacks frequently occur at night and can awaken the patient from sleep, causing distress
COMMON
and disrupting normal sleep patterns.
IN BIG TOE
Acute Pain Worsening Throughout the Day:
The pain experienced during a gout attack tends to worsen as the day progresses, reaching peak
intensity in some cases. This worsening pain can make daily activities increasingly challenging.
Inability to Tolerate Pressure on the Area:
During a gout attack, the affected joint becomes extremely tender and sensitive to touch, making
it difficult for the individual to tolerate any pressure on the area, such as from clothing or bedding

CHRONIC CASES CHRONIC CASES

Chronic cases of gout refer to long-term or recurring Tophi are white or yellowish nodules that develop
episodes of the condition where uric acid crystals under the skin, commonly found in joints, fingers,
accumulate in joints, leading to persistent inflammation toes, and outer ears, resulting from the
and damage. Repeated attacks leading to permanent accumulation of uric acid crystals.
joint damage as uric acid crystals form TOPHI, causing
swelling and deformity.
 Musculoskeletal

Gout

CAUSES RISK FACTOR MEDICATIONS

Having high urate levels. Overweight or obesity. Some medications can

Having a family history of gout. Metabolic syndrome, a name increase your risk of
Being male. for a group of conditions that developing gout, such as:
Having menopause. include high blood pressure,
Diuretics, which help your
Increasing age. high blood sugar, abnormal
body eliminate excess fluid.
Drinking alcohol. cholesterol levels, and excess
Low-dose aspirin.
Drinking sugar-sweetened body fat around the waist.
Niacin, a vitamin, when taken
beverages, such as soda. Chronic kidney disease, a
in large amounts.
Having an unhealthy diet and condition that develops when
Cyclosporine, which is an
eating foods that are rich in your kidneys are damaged
immunosuppressant for
purines (usually from animal and cannot filter blood the
people who have organ
sources), a substance that way they should.
transplants and treats some
breaks down into urate. High blood pressure.
autoimmune diseases.
Conditions that cause your
cells to turn over rapidly, such
as psoriasis or some cancers.
Rare genetic conditions
(Kelley- Seegmiller syndrome
or Lesch-Nyhan syndrome)
that lead to increased urate.

DIAGNOSTICS

Gout can typically be diagnosed definitively during an acute flare-up when uric acid crystals are present in the
affected joint.
Diagnostics for gout typically involve a combination of clinical evaluation, laboratory tests, and imaging studies.
Common diagnostic methods include:
Joint Aspiration (Arthrocentesis): Analysis of synovial fluid obtained from the affected joint to identify the
presence of uric acid crystals under a microscope. Finding needle-shaped crystals confirms the diagnosis
of gout.
Blood Tests (blood uric acid level): Measurement of serum uric acid levels. Elevated uric acid levels
(hyperuricemia) are suggestive of gout, although not all individuals with hyperuricemia develop gout, and
some may have normal levels during an acute attack.

NORMAL (FEMALE): 2.5-6.2 MG/DL NORMAL (MALE): 4.5-8 MG/DL

Imaging Studies:
X-rays: To detect joint damage, erosions, or tophi in chronic cases of gout.
Ultrasound: To Visualize Urate Deposits (Tophi) In Soft Tissues Or Around Joints.
Synovial Fluid Analysis. Analysis of synovial fluid will reveal the presence of uric acid crystals, aiding in the
diagnosis of gout.
Clinical Evaluation: Assessment of symptoms such as joint pain, swelling, redness, and tenderness, as well
as the pattern of attacks and response to treatment, aids in diagnosing gout.
Joint Examination: Physical examination of the affected joint to assess for characteristic signs of gout, such
as warmth, swelling, and limited range of motion.
 Musculoskeletal

Gout

TREATMENT
For Acute Attacks:
Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen to reduce pain and inflammation.
Colchicine to relieve pain and reduce inflammation, often used if NSAIDs are not tolerated.
Corticosteroids like prednisone for severe cases or when NSAIDs and colchicine are ineffective.

NO GRAPEFRUIT! CAN CAUSE TOXICITY

For Prevention:
Lifestyle modifications: Including dietary changes (low-purine diet), weight management, and avoiding alcohol.
Medications:
Xanthine oxidase inhibitors (e.g., allopurinol, febuxostat) to reduce uric acid production.
Uricosuric agents (e.g., probenecid) to increase uric acid excretion.
Pegloticase or rasburicase for refractory cases.
Prophylactic colchicine or NSAIDs during initiation of urate-lowering therapy to prevent acute attacks.

NO ASPIRIN INCREASE URIC ACID LEVELS

 Musculoskeletal

Gout

NURSING INTERVENTIONS
Pain Management:
Administer prescribed analgesics (NSAIDs, colchicine) as directed for pain relief during acute attacks.
Monitor pain levels and response to treatment, adjusting interventions as needed.
Assessment:
Assess and document joint pain, swelling, and mobility limitations.
Monitor for signs of inflammation or complications such as tophi formation.
Fluid Intake:
Encourage adequate fluid intake (2-3 L/ day) to promote uric acid excretion and prevent kidney stone formation.
Joint Protection:
Teach proper joint protection techniques to minimize stress on affected joints.
Provide assistive devices such as splints or braces for joint support, if necessary.
Monitoring:
Monitor serum uric acid levels and renal function tests.
Assess for medication side effects and complications of gout therapy.

Referral:
Refer patients to physical therapy for joint mobilization exercises and rehabilitation, if indicated.
Collaborate with other healthcare professionals, such as rheumatologists or orthopedic specialists, for
comprehensive management.
Referral:
Refer patients to physical therapy for joint mobilization exercises and rehabilitation, if indicated.
Collaborate with other healthcare professionals, such as rheumatologists or orthopedic specialists, for
comprehensive management.
Nutritional Guidance:
Collaborate with dietitians to develop personalized low-purine diet plans.
Educate patients on foods to avoid or limit, such as HIGH-PURINE FOODS and alcohol.

HIGH-PURINE FOODS EDUCATION

TO AVOID
Organ meats: Liver, kidneys, and sweetbreads. Provide patient education on gout triggers,
dietary modifications (low-purine diet), and
Red meat: Beef, pork, and lamb.
lifestyle changes.
Seafood: Anchovies, sardines, mussels, scallops, Educate patients on medication adherence,
and trout. including dosage, frequency, and potential side
Shellfish: Shrimp, crab, lobster, and oysters. effects.
Game meats: Venison, rabbit, and duck.
Processed meats: Bacon, sausage, and deli meats.
Certain vegetables: Spinach, asparagus,
mushrooms, and cauliflower (although these are
not as high in purines as meats and seafood).
Alcohol: Beer and spirits, especially beer, which
contains purine-rich brewer's yeast.
 Musculoskeletal

Osteo Arthritis Vs Rhematoid Arthritis

OSTEO ARTHRITIS VS. RHEMATOID ARTHRITIS

OSTEO ARTHRITIS OA RHEMATOID ARTHRITIS RA

Osteoarthritis Can Damage Any Joint, The Rheumatoid Arthritis Affects The Lining Of Your
Disorder Most Commonly Affects Joints In Your Joints, Causing A Painful Swelling That Can
Hands, Knees, Hips And Spine. Eventually Result In Bone Erosion And Joint Deformity.

Osteoarthritis Rheumatoid Arthritis

Degenerativ Autoimmune
Disease Disease

Affects mostly Affects Seen

weight bearing Systemically
joints
Bone
Bone ends Thinned Erosion
rub together cartilage Swollen inflamed
synovial membrane

RISK FACTORS RISK FACTORS

Older age: Risk increases as you get older. Your sex. Women are more likely than men
Female sex: Women are more susceptible, to develop rheumatoid arthritis.
though the reason is unclear. Age. Rheumatoid arthritis can occur at any
Obesity: Excess weight stresses joints and age 20-50, but it most commonly begins in
promotes inflammation. middle age.
Joint injuries: Past injuries, even if healed, Family history. If a member of your family
can raise risk. has rheumatoid arthritis, you may have an
increased risk of the disease.
Repeated stress on the joint: Repetitive
strain can lead to osteoarthritis. Smoking. Cigarette smoking increases your
risk of developing rheumatoid arthritis,
Genetics: Inherited factors can predispose particularly if you have a genetic
individuals to the condition. predisposition for developing the disease.
Bone deformities: Malformed joints or Smoking also appears to be associated with
defective cartilage increase risk. greater disease severity.
Certain metabolic diseases: Conditions like Excess weight. People who are overweight
diabetes and hemochromatosis heighten appear to be at a somewhat higher risk of
susceptibility. developing rheumatoid arthritis.
 Musculoskeletal

Osteo Arthritis Vs Rhematoid Arthritis

SYMPTOMS OF OA

Pain. Affected joints might hurt during or after movement.

Stiffness. Joint stiffness might be most noticeable upon awakening or after being inactive.
Tenderness. Your joint might feel tender when you apply light pressure to or near it.
Loss of flexibility. You might not be able to move your joint through its full range of motion.
Grating sensation. You might feel a grating sensation when you use the joint, and you might hear popping or
crackling.
Bone spurs. These extra bits of bone, which feel like hard lumps, can form around the affected joint.
Swelling. This might be caused by soft tissue inflammation around the joint

NODES & DEFORMITIES

Bouchard's nodes are bony growths that Bouchard's nodes are bony growths that
develop on the middle joints of the fingers develop on the middle joints of the fingers
in osteoarthritis. think b for below in osteoarthritis. think b for below

THINK B FOR BELOW THINK H FOR HIGH

SYMPTOMS OF RA
Tender, warm, swollen joints: Joints are painful to touch, feel warm, and appear visibly swollen due to inflammation.
Morning stiffness and stiffness after inactivity: Joints feel stiff, especially in the morning or after periods of rest,
making movement difficult.
Fatigue, fever, and loss of appetite: Generalized feelings of tiredness, elevated body temperature, and reduced
desire to eat may accompany the joint symptoms.

NODES & DEFORMITIES

Swan-neck Boutonniere Ulnar drift
Hyperextension of the proximal Flexion of the proximal Gradual deviation of fingers
interphalangeal (PIP) joint. interphalangeal (PIP) joint. towards the little finger side.
Flexion of the distal Hyperextension of the distal Common in rheumatoid arthritis.
interphalangeal (DIP) joint. interphalangeal (DIP) joint. Results from weakening of
Resembles the shape of a swan's Resembles a buttonhole supporting tissues.
neck. (boutonniere). Causes joint instability and
Commonly seen in conditions like Commonly associated with impaired hand function.
rheumatoid arthritis. conditions like rheumatoid
Can impair hand function and arthritis.
grip strength. Impairs finger function and
dexterity.
 Musculoskeletal

Osteo Arthritis Vs Rhematoid Arthritis

DIAGNOSTICS DIAGNOSTICS

X-rays: Show joint space narrowing and bone Diagnostics for rheumatoid arthritis include
spurs, not cartilage. Physical examination for joint tenderness and
MRI: Provides detailed images of bone and soft swelling.
tissues, including cartilage, helpful for complex
Blood tests for rheumatoid factor, anti-CCP
cases.
antibody, CRP, and ESR.
Imaging studies like X-rays, ultrasound, and
TREATMENT MRI to assess joint damage.
Synovial fluid analysis for inflammation.
Acetaminophen: Relieves mild to moderate Applying clinical criteria, such as ACR criteria,
pain, but overdose can harm the liver. to confirm diagnosis based on symptoms.
NSAIDs: Over-the-counter options like
ibuprofen and naproxen, or stronger
prescription versions, can help but may cause
TREATMENT
side effects.
Treatment for rheumatoid arthritis includes:
Topical NSAIDs: Applied to the skin, they have
Medications:
fewer side effects and can also alleviate pain.
Duloxetine: An antidepressant also approved to NSAIDs (Nonsteroidal anti-inflammatory
treat chronic pain, including osteoarthritis pain. drugs): Relieve pain and reduce inflammation.
Corticosteroid injections: Reduce inflammation DMARDs (Disease-modifying antirheumatic
in ligaments and tendons. drugs): Slow down the progression of
Glucosamine: Slows degeneration of cartilage.
rheumatoid arthritis.
Topical analgesics (capsicum gel): Provide pain
Biologics: Target specific parts of the immune
relief when applied to the skin over the affected
system to reduce inflammation.
joint
Corticosteroids: Provide short-term relief by
Osteotomy is a surgical procedure to correct reducing inflammation and suppressing the
bone alignment or length, often used for immune system.
conditions like osteoarthritis to relieve pain and Physical Therapy: Exercises to improve joint
improve joint function. function.
Joint Protection: Using assistive devices and
braces.
Lifestyle Changes: Maintaining a healthy
weight and regular exercise.
Surgery: Joint replacement in severe cases.
Alternative Therapies: Acupuncture and dietary
supplements.

Synovectomy is a surgical removal of inflamed

synovial tissue in a joint, often done to alleviate pain
and reduce inflammation in conditions like
rheumatoid arthritis.
 Musculoskeletal

Osteo Arthritis Vs Rhematoid Arthritis

EDUCATION
Plan periods of rest with activity.
Utilize assistive devices for daily tasks.
Manage weight to reduce stress on joints.
Alternate between heat and cold therapy.
Perform range of motion (ROM) exercises regularly.
Attend physical therapy (PT) and occupational therapy (OT) sessions.
Engage in low-impact exercises like walking and swimming.
Incorporate strength training exercises.
Rest irritated joints to prevent further inflammation and damage.
Use ergonomic tools and equipment to minimize joint strain during daily activities.
Practice relaxation techniques to manage stress, which can exacerbate symptoms.
Stay hydrated to maintain joint lubrication and overall health.
Maintain a balanced diet rich in anti-inflammatory foods, such as fruits, vegetables, and omega-3 fatty acids.
Avoid smoking and limit alcohol consumption, as these habits can worsen inflammation and joint damage.
Stay informed about new developments in rheumatoid arthritis management and treatment options.
Communicate openly with healthcare providers and seek regular check-ups to monitor disease progression
and adjust treatment as needed.
 Musculoskeletal

Osteomyelitis

Chronic Osteomyelitis Acute Osteomyelitis

Periosteal
Periosteal Involucrum thickening/reaction
DEFINITION Thickening

Osteomyelitis is an inflammation or swelling of bone tissue

that is usually the result of an infection. Bone infection may
occur for many different reasons and can affect children
or adults.

Most Common Cause Is Staphylococcus Aureus

Pus Edostreal
Cloaca Pus Sequestrum scalloping
Sclerosis
CAUSED BY

E. coli: Commonly found in the intestines and can infect bones through the bloodstream.
Pseudomonas: A type of bacteria that can cause osteomyelitis, particularly in people with weakened immune
systems or chronic wounds.
Salmonella: Often associated with foodborne illness, Salmonella bacteria can also spread to bones and cause
osteomyelitis.
Streptococcus: A group of bacteria that includes various species, some of which can lead to bone infections like
osteomyelitis.
Staphylococcus aureus: One of the most common causes of osteomyelitis, often acquired through skin wounds
or surgery.
Mycobacterium tuberculosis: Can cause tuberculosis osteomyelitis, typically affecting the spine (Pott's disease)
but can also involve other bones.
Enterococcus faecalis: Found in the gastrointestinal tract, it can occasionally lead to osteomyelitis, especially in
individuals with underlying health conditions.
Haemophilus influenzae: Once a common cause in children, vaccination has reduced its prevalence, but it can
still cause osteomyelitis in some cases.

RISK FACTORS

Risk factors for osteomyelitis include:

Open Wounds: Such as compound fractures, surgical incisions, or deep cuts, which provide pathways for
bacteria to enter the bone.
Poor Blood Circulation: Conditions like peripheral arterial disease or diabetes can impair blood flow to bones,
making them more susceptible to infections.
Weakened Immune System: Due to conditions like HIV/AIDS, cancer, or immunosuppressive medications,
which decrease the body's ability to fight off infections.
Recent Surgery or Trauma: Surgical procedures involving bones or joints and traumatic injuries can introduce
bacteria into the bone.
Chronic Medical Conditions: Such as diabetes, kidney failure, or sickle cell disease, which can increase the risk
of infections.
Intravenous (IV) Drug Use: Sharing needles or using contaminated injection equipment can introduce bacteria
directly into the bloodstream.
Prosthetic Devices: Implants, artificial joints, or other prosthetic devices can become infected and lead to
osteomyelitis.
Age: Children and older adults may be at higher risk due to immune system differences or underlying health
conditions.
Malnutrition: Inadequate nutrition weakens the immune system and impairs the body's ability to fight infections.
Peripheral Vascular Disease: Decreased blood flow to the extremities can impair the body's ability to deliver
immune cells and antibiotics to the infected bone
 Musculoskeletal

Osteomyelitis

SYMPTOMS (< 6 WEEKS) PAIN

CHARACTERISTICS
Symptoms of acute osteomyelitis may include:
Localized
Severe Pain: Intense and localized pain in the affected bone, often
Constant
worsening with movement or pressure.
Fever Pulsating
Swelling and Redness. Worsens With Movement
Limited Mobility
Fatigue: Feeling tired or lethargic, especially as the body fights off the
infection.
Symptoms of chronic osteomyelitis may include:
Mild Pain:
Persistent or intermittent pain in the affected bone
Intermittent Fever:
Occasional low-grade fever or recurrent fevers, especially during
periods of acute exacerbation.
Swelling and Drainage:
Bone Deformity
Generalized Symptoms:
Nonspecific symptoms like fatigue, weight loss, and malaise may
occur, particularly in cases of chronic, systemic infection

SYMPTOMS (< 6 WEEKS) SEQUESTRA

Symptoms of acute osteomyelitis may include: Necrotic bone fragment that
Persistent Pain: forms due to lack of blood flow
Constant or intermittent pain in the affected bone, often worsening at becomes seperated from
night or with activity. healthy bone
Swelling and Tenderness:
Pus Drainage:
Pus or discharge from sinus tracts (channels) near the affected bone.
Fever
Fatigue
Restricted Movement:
Skin Changes:
Redness, warmth, or ulceration overlying the affected bone.
Bone Deformity
Development of Sequestra:
Formation of dead bone fragments (sequestra) within the affected
bone, leading to persistent infection and impaired healing.
 Musculoskeletal

Osteomyelitis

COMPLICATION: SEPSIS
Sepsis is a life-threatening complication of osteomyelitis, characterized by widespread inflammation and organ
dysfunction due to bacterial spread from the infected bone into the bloodstream.
Monitor for:
Altered Level of Consciousness (LOC).
Decreased Blood Pressure (BP), Increased Heart Rate (HR), Elevated Respiratory Rate (RR), and Elevated
Temperature (Temp), which may indicate systemic inflammation and sepsis.
Elevated levels of lactic acid and procalcitonin, which are markers of tissue hypoperfusion and systemic infection,
respectively.

DIAGNOSTICS
Diagnosis of osteomyelitis involves:
Physical examination: Your doctor checks for tenderness, swelling, or warmth around the affected bone and
may use a dull probe to assess underlying bone proximity, especially in foot ulcers.
Blood tests: Elevated white blood cell levels and other markers indicate infection, helping identify the causative
germ.
Imaging tests: X-rays may show bone damage, while MRI and CT scans provide detailed images of bones and
surrounding tissues.
Bone biopsy: Identifies the specific germ causing the infection, guiding antibiotic treatment. It can be done
through open surgery or with a needle under local anesthesia and imaging guidance.
LABS :
Elevated ESR (Erythrocyte Sedimentation Rate): An increased ESR indicates inflammation in the body, which is
commonly seen in osteomyelitis.

>20 MM/HR = INFLAMMATION

Elevated CRP (C-Reactive Protein): CRP is another marker of inflammation, and elevated levels are indicative of
an acute inflammatory response, often seen in osteomyelitis.

>3 MG/DL = INFLAMMATION

Elevated WBC (White Blood Cell Count): An elevated WBC count suggests the presence of infection, as the
body's immune system responds to the pathogen.

Inflammatory Markers
 Musculoskeletal

Osteomyelitis

TREATMENT Patient Might Go Home With PICC Line

Medication
IV antibiotics: These are the primary treatment for osteomyelitis and are typically administered intravenously for
a period of 4-6 weeks or longer, depending on the severity of the infection and response to treatment.
Antipyretics: These are medications used to reduce fever, which may accompany osteomyelitis as the body's
immune response to the infection.
NSAIDs (Nonsteroidal Anti-Inflammatory Drugs): These are pain relievers commonly used to manage discomfort
and inflammation associated with osteomyelitis.

Procedures
Debridement: This surgical procedure involves cleaning and removing any damaged or dead bone tissue from
the affected area.
Debridement helps to eliminate the source of infection and promote healing.
Hyperbaric oxygen therapy: This promotes tissue healing and helps combat infection by enhancing the body's
natural immune response.
Sequestrectomy: Removing the sequestrum helps eliminate the source of infection and allows healthy bone
tissue to regenerate.
Amputation: Amputation is considered as a last resort when all other treatment options have been exhausted.
Wound Care: Proper wound care, including dressing changes and wound irrigation, helps prevent further infection
and promotes tissue healing.
Bone Grafting: In cases of extensive bone loss, bone grafts may be used to fill defects and promote bone
regeneration.

NURSING INTERVENTIONS
ASSESS
PULSE
Frequent Neurovascular Checks: Assessing circulation, sensation, and movement to
monitor for any neurovascular compromise. COLOR
Elevate Extremity: Elevating the affected limb to reduce swelling and promote CAP REFILL
circulation. TEMPERATURE
Monitor Vital Signs (VS): Regularly assessing temperature, heart rate, blood pressure, SENSATION
and respiratory rate for signs of systemic infection or deterioration. MOVEMENT
Monitor for Infection: Observing the wound site for signs of infection, such as
redness, swelling, warmth, or drainage.
Wound Care: Performing wound care using sterile technique to prevent
contamination and promote healing.
Pain Management: Administering prescribed pain medications and implementing
comfort measures to alleviate discomfort.
Patient Education: Providing education on wound care, antibiotic therapy, signs of
infection, and the importance of adherence to treatment.
Nutritional Support: Ensuring adequate nutrition to support healing and immune
function, including dietary counseling or supplementation as needed.
Psychosocial Support: Offering emotional support, counseling, and referrals to
resources for patients and their families coping with the challenges of chronic
infection and treatment.
Coordination of Care: Collaborating with the interdisciplinary healthcare team to
ensure comprehensive and coordinated care, including scheduling appointments,
arranging consultations, and facilitating discharge planning.
 Musculoskeletal

Osteoporosis

DEFINITION
Osteoporosis is a bone disease that develops when bone mineral density and bone mass decreases, or when the
structure and strength of bone changes. This can lead to a decrease in bone strength that can increase the risk of
fractures (broken bones).
OSTEOPOROSIS IS IRREVERSIBLE

Osteoclasts exhibit accelerated bone breakdown

compared to Osteoblasts' rebuilding capacity.

Gradual decline in bone density leads to

Osteopenia, characterized by reduced bone
density.

Continued decrease in bone density heightens the

risk of Fragility Fractures, posing a significant
threat to the patient's skeletal integrity.
HEALTHY OSTEOPOROSIS SEVERE
BONE OSTEOPOROSIS

SYMPTOMS KEY FACTORS IN BONE HEALTH

Back pain, caused by collapsed vertebrae or Calcium: Essential for bone structure and
spinal fractures. remodeling, serving as a main component in
Loss of height over time, resulting from bones.
compression fractures in the spine. Vitamin D: Facilitates the absorption of calcium,
Stooped posture or curvature of the spine crucial for maintaining bone density.
(kyphosis). Parathyroid hormone (PTH): Stimulates the
Fractures occurring with minimal trauma or release of calcium into the bloodstream when
force, known as fragility fractures, most levels are low.
commonly in the wrist, hip, or spine. Estrogen: Supports bone health by promoting
Bone fractures that heal slowly or poorly. osteoblast activity, aiding in bone formation.
Kyphosis AKA Dowager's Hump: Kyphosis is Calcitonin: Inhibits bone breakdown by
sometimes referred to as Dowager's Hump, osteoclasts, helping to maintain bone density.
especially when it occurs in older individuals as
a result of osteoporosis-related vertebral
compression fractures.
USUALLY IN HIPS WRISTS SPINE
 Musculoskeletal

Osteoporosis

RISK FACTORS
Age: Risk increases with advancing age, particularly after menopause in women.
Gender: Women are more prone to osteoporosis than men.
Family history: Having a family history of osteoporosis increases the risk.
Low body weight or BMI: Being underweight or having a low body mass index (BMI) is a risk factor.
Hormonal factors: Low estrogen levels in women and low testosterone levels in men increase the risk.
Diet: Poor nutrition, low calcium intake, and vitamin D deficiency contribute to bone loss.
Sedentary lifestyle: Lack of weight-bearing exercise can lead to bone loss.
Smoking: Tobacco use is associated with decreased bone density.
Excessive alcohol consumption: Heavy alcohol consumption can weaken bones.
Certain medications: Prolonged use of corticosteroids, thyroid medications, and some cancer treatments can
increase the risk.
Medical conditions: Conditions such as rheumatoid arthritis, gastrointestinal disorders, and hormonal disorders
can affect bone health.
Previous fractures: Having a history of fractures increases the risk of future fractures.
Ethnicity: Caucasian and Asian individuals are at higher risk compared to other ethnic groups.

DIAGNOSTICS
Dual-energy X-ray absorptiometry (DXA or DEXA scan): Measures bone mineral density (BMD) at specific
sites, such as the hip and spine, to assess bone strength and risk of fractures.
GOLD STANDARD
Quantitative ultrasound (QUS): Uses sound waves to measure bone density at peripheral sites like the heel or
shin.
0-1: NORMAL -1 TO -2.5: OSTEOPENIA < -2.5: OSTEOPOROSIS

Blood tests: Assess levels of certain markers related to bone turnover, such as serum calcium, phosphate,
alkaline phosphatase, and vitamin D.
FRAX tool (Fracture Risk Assessment Tool): Calculates the 10-year probability of a major osteoporotic fracture
or hip fracture based on clinical risk factors and BMD measurements.
X-rays: Can detect fractures or signs of bone loss, although they may not show osteoporosis until significant
bone density loss has occurred.
Other imaging techniques: Magnetic resonance imaging (MRI) or computed tomography (CT) scans may be
used to evaluate bone health in specific cases.

Labs
Vitamin D levels: Assessing serum levels of vitamin D, which plays a crucial role in calcium absorption and
bone health.
Parathyroid hormone (PTH): Measuring PTH levels helps evaluate calcium metabolism and bone turnover.
Estrogen levels: Evaluating estrogen levels, particularly in postmenopausal women, as estrogen deficiency
can accelerate bone loss.
Calcium levels: Monitoring serum calcium levels, which are essential for bone mineralization and overall bone
health.
ALL REGULATE
CALCIUM LEVELS
 Musculoskeletal

Osteoporosis

TREATMENT NURSING INTERVENTIONS

Medication: Fall prevention: Assessing the home environment for potential

Calcium Supplements (Calcitonin): hazards, recommending modifications, and educating patients on
Administered to replenish calcium safe mobility techniques.
levels in bones. Medication management: Educating patients on the proper
Vitamin D Supplements: Prescribed administration and potential side effects of prescribed
to facilitate calcium absorption. osteoporosis medications.
Bisphosphonates (Alendronate): Nutrition counseling: Recommending a diet rich in calcium and
Medications prescribed to slow vitamin D, or referring patients to a dietitian for personalized
down bone breakdown. dietary advice.
Estrogen: Hormone therapy used to Exercise promotion: Encouraging regular weight-bearing and
prevent calcium loss from bones. resistance exercises to improve bone strength and reduce
Selective Estrogen Receptor fracture risk.
Modulators (SERMs): Drugs like Pain management: Assessing and addressing any pain
raloxifene can help prevent bone associated with fractures or osteoporosis-related complications
loss. through pharmacological and non-pharmacological
Denosumab: An injection that interventions.
reduces bone breakdown. Regular monitoring: Monitoring bone mineral density, medication
Teriparatide: A synthetic form of efficacy, and adherence, as well as assessing for any signs of
parathyroid hormone that disease progression or complications
stimulates bone formation.
Fall precautions: high risk for fractures
Procedures
Call bell in reach: Ensuring that patients have access to a call bell
Joint Replacement: Surgical
within easy reach allows them to quickly summon assistance if
intervention to replace a damaged
needed, reducing the risk of falls.
joint with a prosthetic.
Bed alarm: Implementing a bed alarm alerts healthcare providers
Reduction with Fixation: Surgical
when a patient attempts to get out of bed unsupervised, allowing
realignment and stabilization of
for timely intervention to prevent falls.
fractures.
Assist with ambulation: Providing assistance with ambulation,
Vertebroplasty/Kyphoplasty:
such as using a gait belt or providing supervision during walking
Minimally invasive procedures to
activities, helps to support patients and minimize the risk of falls.
stabilize vertebral fractures.
Physical Therapy: Utilized to
improve strength, flexibility, and
balance, reducing the risk of falls
and fractures.
 Musculoskeletal

Osteoporosis

EDUCATION
Protein: Encouraging higher protein intake to support bone strength and repair.
Calcium: Advising increased consumption of calcium-rich foods for optimal bone density.
Vitamin D: Stressing the importance of adequate sunlight exposure and dietary sources of vitamin D for calcium
absorption.
Smoking Cessation
Avoid Caffeine & Alcohol
Weight Bearing Exercises
Good Body Mechanics: Teaching proper posture and movement techniques to prevent falls and fractures.
Adequate Sunlight (Vitamin D)
Medication management: Educate patients about the importance of adhering to prescribed medications, such
as calcium supplements or vitamin D supplements, to support bone health and prevent osteoporosis.
Fall prevention strategies: Teach patients to keeping pathways clear of hazards, using assistive devices when
needed, and practicing balance exercises, to reduce the risk of fractures associated with falls.
Regular screening
GASTROINTESTINAL
 Gastroıntestınal
Gastrointestinal

GI System Overview

What is the immune system?

The gastrointestinal tract is part of the digestive system.

Also called alimentary tract and digestive tract.
Passageway of the digestive system that leads from the
mouth to the anus. Mouth
The GI tract contains all the major organs of the
digestive system. Esophagus
The organs that food and liquids travel through when
they are swallowed, digested, absorbed, and leave the
body as feces. These organs include the mouth, pharynx
(throat), esophagus, stomach, small intestine, large
intestine, rectum, and anus.
The gastrointestinal tract is part of the digestive system.
Also called alimentary tract and digestive tract.

Liver
Stomach
Functions
Pancreas
Gallbladder
Digestion, absorption, excretion, and protection.
Breaks down food into simple nutrients such as
carbohydrates, fats and proteins. Large
Small
Digestive system breaks down and absorbs nutrients Intestine
Intestine
from the food and liquids you consume to use for
important things like energy, growth and repairing cells.
Excrete waste products of digestion

Anus

Organs work together in digestive system

Mouth: The mouth is the beginning of the digestive tract. In fact, digestion starts before you even take a bite. Your
salivary glands get active as you see and smell that pasta dish or warm bread.
Esophagus: Located in your throat near your trachea (windpipe), the esophagus receives food from your mouth when
you swallow.
Stomach: The stomach is a hollow organ, or "container," that holds food while it is being mixed with stomach enzymes.
Small intestine: Made up of three segments — the duodenum, jejunum, and ileum — the small intestine is a 22-foot long
muscular tube that breaks down food using enzymes released by the pancreas and bile from the liver.
Pancreas: The pancreas secretes digestive enzymes into the duodenum that break down protein, fats and
carbohydrates.
Gallbladder: The gallbladder stores and concentrates bile from the liver, and then releases it into the duodenum in the
small intestine to help absorb and digest fats.
Colon: The colon is responsible for processing waste so that emptying your bowels is easy and convenient.
Rectum: The rectum is a straight, 8-inch chamber that connects the colon to the anus.
Anus: The anus is the last part of the digestive tract. It is a 2-inch long canal consisting of the pelvic floor muscles and
the two anal sphincters (internal and external).
 Gastroıntestınal
Gastrointestinal

Types of Digestion

TYPES of DIGESTION

Digestion is a form of catabolism or breaking down of substances that involves two separate processes:
mechanical digestion and chemical digestion.

1. Mechanical Digestion 2.Chemical Digestion

Mechanical digestion /Physical Process: Chemical digestion:

It involves the physical breakdown of food It involves a series of chemical reactions to digest the food
molecules into a smaller, absorbable form. which occurs inside the stomach under the action of gastric
juices and enzymes.
It begins in the mouth with chewing.
This also starts in the mouth with salivary amylase that starts
The tongue and the teeth play the most
the process of carbohydrate breakdown.
important roles here in moving the food
around and chewing. Chemical digestion continues throughout the digestive
system with gastric acid in the stomach, and pancreatic and
other enzymes in the small intestine.

UPPER GI TRACT FUNCTIONS Nasal Cavity

The upper GI tract includes your food pipe

(esophagus), stomach, and the first part of
your small intestine (the duodenum). Oral Cavity
The upper GI tract is responsible for starting
digestion and preparing it for the lower GI Glottis (closed)
tract to process and absorb nutrients.
Trachea

Esophagus
Lung
Mouth / Oral cavity Sphincter

Breathing.
Stomach
Talking.
Chewing. Pharynx & esophagus
Tasting.
Swallowing. The esophagus is a muscular tube that connects the
pharynx (throat) to the stomach.
Eating.
The esophagus contracts as it moves food into the stomach.
Drinking
Esophagus is to transport food entering the mouth through
Converts the foods we eat into their the throat and into the stomach.
simplest forms, like glucose (sugars), amino
acids (that make up protein) or fatty acids This function begins at the very beginning of the esophagus,
(that make up fats). following some taste buds located on the organ, at the
upper esophageal sphincter
 Gastroıntestınal
Gastrointestinal

Types of Digestion

Fundic region
Stomach Oesophagus

Reservoir, Lower oesophageal

Acid secretion, sphincterhagus

Enzyme secretion Stomach

Cardiac region
its role in gastrointestinal motility. body

In the stomach, cells lining the gastric pits secrete Pyloric

enzymes that break down food proteins.
The acidic environment of the stomach favors the Oesophagus
neutralization of most ingested pathogens.
The muscles in the stomach wall perform vigorous Cardiac region Rugae
churning that supports mechanical digestion.
Cardiac region

The lower gastrointestinal tract

Large
Small
Digestion, absorption, excretion, and protection. Intestine
Intestine
Breaks down food into simple nutrients such as
carbohydrates, fats and proteins.
Digestive system breaks down and absorbs nutrients
from the food and liquids you consume to use for
important things like energy, growth and repairing cells. Appendix

Excrete waste products of digestion Rectum

Small intestine

The small intestine is part of your digestive system. It makes up part of the
long pathway that food takes through your body, called the
gastrointestinal (GI) tract.
Duodenum: The duodenum is the first part of the small intestine that
the stomach feeds into.
Jejunum: The remaining small intestine lays in many coils inside the
lower abdominal cavity.
Ileum: The ileum is the last and longest section of the small intestine.

Function:
Systematically breaks food down.
Absorbs nutrients.
Extracts water.
Moves food along the gastrointestinal tract.
 Gastroıntestınal
Gastrointestinal

Accessory Digestive Organs

Transverse
Large intestine colon

Ascending
Reabsorption of water and mineral ions such as sodium and chloride. colon Descending
Formation and storage of faeces. colon
Maintaining a resident population of over 500 species of bacteria
that are mostly beneficial to the digestion.
Bacterial fermentation of indigestible materials inside the colon.
Absorbs nutrients. Appendix

Extracts water.
Rectum
Moves food along the gastrointestinal tract.

Anus
Rectum
The area where
sood waste is stored The waste from digestion (stool, or poop) leaves the body through the
anus when you have a bowel movement.
Anus facilitates bowel movements.
Anal sphincter
muscles Nerves and muscles surrounding anus coordinate to tell you when
The area where you need to poop, while allowing you to hold it in until you’re able to
sood waste is stored reach a toilet.
When you’re ready, these nerves and muscles coordinate again to
push poop out of your body.

Anus The mucous lining in your anus secretes mucus to lubricate the
passage and help your poop pass smoothly through.
The external opening
of the rectum

LIVER
Accessory digestive organs

The accessory organs include the teeth, tongue, and glandular

organs such as salivary glands, liver, gallbladder, and pancreas.
The main functions of the GI system include ingestion and digestion
GALL
of food, nutrient absorption, secretion of water and enzymes, and PANCREAS
BLADDER
excretion of waste products.

Hepatic Liver
vein Function:
Liver
Bile production and excretion.
The liver filters all of the blood
in the body and breaks down Excretion of bilirubin, cholesterol, hormones, and drugs.
poisonous substances, such
Metabolism of fats, proteins, and carbohydrates.
as alcohol and drugs.
Portal Enzyme activation.
vein The liver also produces bile, a
fluid that helps digest fats and Storage of glycogen, vitamins, and minerals.
carry away waste.
Gallbladder Hepatic Synthesis of plasma proteins, such as albumin, and
artery The liver consists of four lobes, clotting factors.
which are each made up of
Blood detoxification and purification.
eight sections and thousands
Common of lobules.
bile duct
 Gastroıntestınal
Gastrointestinal

Accessory Digestive Organs

Pancreas Functions of the Pancreas: A healthy pancreas produces the

Gallbladder correct chemicals in the proper quantities, at the right times,
It is an organ of the to digest the foods we eat.
digestive system and of
Exocrine Function:
the endocrine system. Lobules
The pancreas contains exocrine glands that produce
The exocrine pancreas
enzymes important to digestion.
produces enzymes that
help to digest food, These enzymes include trypsin Lipase Digests fats
particularly protein. and chymotrypsin to digest
Amylase Digests carbs
proteins; amylase for the
The endocrine pancreas
digestion of carbohydrates; Protease Digests protein
makes the hormone
and lipase to break down fats.
insulin, which helps to
control blood sugar levels. Pancreatic
duct Endocrine Function:
The endocrine component of the pancreas consists of islet
cells (islets of Langerhans)
Gallbladder
That create and release important hormones directly into
The gallbladder is a sac located under the liver. the bloodstream.

It stores and concentrates bile produced in the liver.

Bile aids in the digestion of fat and is released from
the gallbladder into the upper small intestine in
response to food (especially fats). Gallbladder Function:
To store and concentrate bile.
To respond to intestinal hormones (such as
Bile helps with cholecystokinin) to empty and refill its bile stores.
Common
hepatic duct digestion. It breaks To contribute to regulating the composition of bile
Gallstone blocking down fats into fatty (the percentage of water, bile salts and more)
the cystic duct acids, which can
be taken into the To control the flow of bile into the small intestine.
Galbladder body by the To contract, secreting bile into the biliary tract and
digestive tract. duodenum (the first section of the small intestine)
Inflamed
galbladder
mucosa Gallstone blocking
the common bile duct
Layers of the gallbladder: The epithelium—a thin
Gallstones layer of cells that lines the inside of the gallbladder.
To duodenum
The lamina propria a layer of connective tissue;
when this layer is combined with epithelium, it
forms the mucosa (a membrane that lines body
Structure The gallbladder is divided into three sections, cavities and covers organs)
The fundus the large rounded base which stores The muscularis a layer of smooth muscle tissue
the bile juices, the fundus comprises the distal (far that enables the gallbladder to contract to release
end) portion of the gallbladder, which is angled, bile into the bile duct.
causing it to face the abdominal wall.
The perimuscular a fibrous connective tissue
The body the part of the gallbladder that begins to layer, that surrounds the muscularis.
taper into the neck.
The serosa a smooth membrane that forms the
The neck the area where the gallbladder continues outer covering of the gallbladder.
to taper, becoming narrow as it joins the cystic duct
 Gastroıntestınal
Gastrointestinal

Digestion Process

Digestion Process

The digestive system breaks down food into simple nutrients such as carbohydrates, fats and proteins.

Functions of the Digestive System: 3 phases of digestion:

Ingestion,
The cephalic phase, The gastric phase, The intestinal phase,
Propulsion,
Mechanical or physical digestion, Phases of gastric secretion
Chemical digestion,
Secretion,
Absorption,
Defecation.

Cephalic phase Gastric phase Intestinal phase

1.Ingestion

The process of absorbing The process of taking food, drink, or another substance
information. into the body by swallowing or absorbing it.

Ingestion can be referred to as an organism's consumption of a substance.

In the case of human beings, when the food is taken in from the mouth and then
masticated and swallowed for further processing, it is called ingestion.
It takes place by absorbing substances by cell membranes in single-celled organisms.

2.Propulsion Contraction Bolus

Propulsion is the movement of food along the digestive tract.

A
The major means of propulsion is peristalsis, a series of alternating contractions
and relaxations of smooth muscle.
B
That lines the walls of the digestive organs and that forces food to move forward.
C

Propulsive Movements Chyme is propelled through the small intestine by Involuntary contractions
peristaltic waves toward the anus at a velocity of (0.5 - 2 cm / sec), faster in the that move food through
proximal intestine and slower in the terminal intestine. digestive tract
 Gastroıntestınal
Gastrointestinal

Digestion Process

Chemical Digestion Mechanical

of proteins Digestion
3.Mechanical Digestion
Acid
Mechanical digestion involves physically breaking down food substances into
(Hydrochloric)
smaller particles to more efficiently undergo chemical digestion.
Pepsin
The role of chemical digestion is to further degrade the molecular structure of
(Enzyme)
the ingested compounds by digestive enzymes into a form that is absorbable
into the bloodstream.
Muscular
contractions
Gastric juices
(Peristalsis)

Examples of mechanical digestion?

Mastication Peristalsis Segmentation Mechanical digestion begins in your mouth with chewing,
then moves to churning in the stomach and segmentation
Mechanical digestion, which begins in the mouth with
in the small intestine.
chewing or mastication and continues with churning
and mixing actions in the stomach. Peristalsis is also part of mechanical digestion.

4.Chemical Digestion

Chemical digestion uses certain enzymes to break down nutrients, such as carbohydrates, proteins, and fats, into
smaller molecules.
This occurs so a person can absorb these molecules into the bloodstream.
The process occurs in the mouth, stomach, and small intestine.

What is the immune system?

Enzyme Category Enzyme Name Source Substrate Product

Free fatty acids, and

Salivary Enzymes Salivary Enzymes Salivary Enzymes Salivary Enzymes
mono - and diglycerides

Disaccharides and
Salivary Enzymes Salivary Amylase Salivary Amylase Polysaccharides
trisaccharides

Fatty acids and

Gastric Enzymes Gastric lipase Chief cells Triglycerides
monoacylglycerides

Gastric Enzymes Pepsin* Chief cells Proteins Peptides

Brush Border Enzymes α-Dextrinase Small Intestine αD-Dextrins Glucose

 Gastroıntestınal
Gastrointestinal

Digestion Process

5.Absorption 6.Defecation

The products of digestion, including vitamins, minerals, This is the process of removing indigestible waste
and water, which cross the mucosa and enter the products from your body in the form of feces or urine.
lymph or the blood (Absorption).
Feces are formed in your large intestine and
eliminated through your anus.

Types of Absorption:
This complex function requires coordination between
Active transport, Passive diffusion, the gastrointestinal, nervous, and musculoskeletal
systems.
Facilitated diffusion, Endocytoses.
Exocrine Function:
The parasympathetic defecation reflex
The intrinsic myenteric defection reflex
This is the point where nutrients are able to pass
through the cell membranes in the lining of the small
intestine and into the capillaries of your blood and
lymph systems.

Blood vessel with

Intestinal wall blood en route to
the liver
Rectum

Muscle
Layers

Villi Exterior Exterior

sphincter sphincter

Circular folds

Interior sphincter
 Gastroıntestınal
Gastrointestinal

GI System Assessment

GI System Assessment

Assessment order: GI Assessment: A thorough assessment of the abdomen provides

I Inspection I Inspection Order is valuable information regarding the function of a
changed to patient's gastrointestinal (GI) and genitourinary (GU).
P Palpation P Palpation
avoid altering Empty bladder
P Percussion P Percussion bowel sounds
Lie in supine position with pillow under the head
A Auscultation A Auscultation

The nursing assessment of the genitourinary system generally focuses on bladder function. Ask
about urinary symptoms, including,
Urinary frequency,
Urinary urgency.
Dysuria is any discomfort associated with urination and often signifies a urinary tract infection.

Assessment Expected Findings Unexpected Findings

Symmetry of shape Flat or rounded Asymmetry Distension Scars

and color contour
Inspection Wounds Visible peristalsis
No visible Intact skin Colostomy Pulsations Skin breakdown
lesions

Hypoactive bowel sounds

Auscultation Presence of non proactive bowel sounds Hyperactive bowel sounds
Absent bowel sounds

Absence of pain or tenderness Pain on palpation Rigidity

Palpation
Absence of masses Guarding Rebound
tenderness

Clear, pale yellow urine

Genitourinary Absence of pain, urgency, frequency,
or retention
 Gastroıntestınal
Gastrointestinal

GI System Assessment

1. Focused GI history

Abdominal pain
The location and description of abdominal pain is critical to help localize the cause. Use your SOCRATES mnemonic
and think about where and when the pain is occurring. For example:
Biliary colic - colicky right upper quadrant pain after meals.
Diverticulitis - acute left iliac fossa pain +/- diarrhea and fever.
Peptic ulcer disease - chronic epigastric pain +/- reflux symptoms.

Dysphagia
Determine the onset of dysphagia (e.g. sudden or gradual), whether it is related to the initiation of swallowing.

Heartburn
Classically described as a burning retrosternal discomfort that may be associated with a bad taste at the back of
the mouth.

Change in bowel habit

There are several aspects to consider when asking about a change in bowel habit:
Onset - acute, subacute, chronic (> 6 weeks).
Consistency - loose, hard.
Frequency - how many times a day or week.
Additional features - blood or mucus present.
Associated symptoms - any abdominal pain.

Bleeding
The two cardinal presentations of gastrointestinal disease are upper GI bleeding and lower GI bleeding that should
always needs to be investigated. It can be a red flag sign for cancer.
Upper GI bleeding - hematemesis (vomiting bright red blood or ‘coffee ground’ material), melaena (jet black
stool from digested blood).
Lower GI bleeding - passing bright red blood or altered blood. Blood may be seen on wiping with toilet paper,
mixed with the stool, or just blood.

Jaundice
It is usually be obvious from the yellowing of the sclera and skin. Dark urine and pale stool: due to absence of
breakdown products of bilirubin in the faeces and more being reabsorbed into the circulation previous episodes of
jaundice?
Painless or painful: painless jaundice concerning for malignancy
Surgical history
Any known liver disease

Past medical history

Drug history
Enquire about any previous gastrointestinal or liver disease.
Make sure you ask about all medications
Age of diagnosis (e.g. Crohn’s at 17 years old) including over the counter as NSAIDs
Treatment for condition (e.g. Azathioprine) can precipitate GI bleeding.

Any complications (e.g. hospital admission with acute flare 2/12 ago)
Previous investigations (e.g. colonoscopies, gastroscopies, or imaging) Could be early sign of
Last follow-up & recommendations (e.g. known to an IBD team?) malignancy or other GI disorder
 Gastroıntestınal
Gastrointestinal

GI System Assessment

2. Inspection 3. Auscultation

The patient is placed supine on sequence of quadrants Start in RLQ & move
an examining table or bed. clockwise.
Auscultation. In abdominal examination Lightly palpate the abdomen by pressing into the skin about 1
auscultation is performed before palpation, centimeter beginning in the RLQ. Continue to move around the
as palpation may alter the bowel sounds. abdomen in a clockwise.
Bulges(a rounded swelling which distorts an
otherwise flat surface.)
Palpation. ... Esophagus Stomach
Duodenum Pancreas
Percussion.
Liver
Masses(a large body of matter with no Gall bladder Spellen
definite shape.) Descending colon kidney

Hernias
Rectal Examination.
Skin muscle
Enlarged veins cecum appendix Ovary/Adnexa
Spider nevi ureters testicle psoas muscle

Inguinal Region.

Auscultation of the abdomen is performed for detection of altered Four quadrants:

bowel sounds, rubs, or vascular bruits.
Right upper quadrant (RUQ),
Normal peristalsis creates bowel sounds that may be altered or absent
Left upper quadrant (LUQ),
by disease.
Right lower quadrant (RLQ),
Irritation of serosal surfaces may produce a sound (rub) as an organ
moves against the serosal surface. Left lower quadrant (LLQ).

Abdominal Could mean:

Classifying bowel sound
Assessment Intestinal activity has slowed.
Normal bowel sounds: 5–30 bowel
sounds per minute (about 2 sounds Ileus
every 5 seconds). Peritonitis
Right Upper Left Upper
Hypoactive bowel sounds: Sounds Constipation
Quadrant Quadrant
RUQ LUQ are normal during sleep. They also
occur normally for a short time after Ischemic bowel disease
the use of certain medicines and
after abdominal surgery(< 5 bowel
Right Lower Left Lower
Quadrant Quadrant sounds per minute).
RUQ LUQ Hyperactive bowel sounds: There is Could mean:
an increase in intestinal activity. This Crohn disease. Bowel obstruction
may happen with diarrhea or after
eating. Diarrhea. Malabsorption
Absent: No bowel sounds. Food allergy. Infectious enteritis.
GI bleeding. Ulcerative colitis.
 Gastroıntestınal
Gastrointestinal

GI System Assessment

4. Percussion
Percussion of the abdomen is performed to check liver size, spleen size, and any abnormal gas collections.
DULLNESS: Soft, muffled, thud- like tone
Hear elsewhere may indicate tumor or mass
Heard over fluid & solid structures (full bladder or liver
The size of the liver is estimated by determining the span of liver dullness by percussion.
This is performed by percussing just below the breast in the midclavicular line.
TYMPANY:
High pitched, drum-like sound
Heard over air filled structures (large intestine)

If ascites present:
Tympany
Percussion of the green
section shifts from a dull
note to a tympanic note Tympany
Right Lateral Recumbent
after the patient
changes from supine to Supine Dullness
lateral decubitus
position.
Left Lateral Recumbent

5. Palpation
Light palpation:
Palpation of the abdomen involves using the Is used to feel abnormalities that are on the surface. Use the
flat of the hand and fingers, front of your finger to gently press down into the area of the
Not the fingertips to detect palpable organs, body about 1-2cm.

Abnormal masses, or tenderness No tenderness should be felt

on light or deep palpation
Palpate clockwise Deep palpation:

Again, an orderly approach is necessary to Is used to feel internal organ and masses. Use the front of your
prevent oversights. finger to firmly press down into the area of body 4-5 cm.

Use light, gentle, and dipping motions Light ballottement:

Warm the palms before One should begin in the Is used to detect fluid in body part Use the front of your finger
right upper quadrant with palpation of the liver. to apply light rapid pressure at the location.
Deep ballottement:
Is used to detect fluid in body part Use the front of your finger
to apply light rapid pressure at the location.

Five steps to palpating of the abdomen include:

Wash and warm your hands,
Contraindicated if suspected: patients with suspected
Communicate with the patient and palpate
the most painful area last, Abdominal aortic aneurysm, Tender spleen,

Palpate with light pressure then deep pressure, Appendicitis, Kidney transplant

Palpate all four quadrants, Kidney transplant Abdominal aortic aneurysm

Use a one- or two-handed technique. Tumor Polycystic kidney disease.

 Gastroıntestınal
Gastrointestinal

GI System Assessment

DIAGNOSTICS

GI endoscopy and colonoscopy

x-ray exam
Upper GI Series (barium swallow or barium meal) ...
Gastroscopy....
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Small bowel series
Endoscopic Ultrasound. ...
pH Monitoring.
Esophagogastroduodenoscopy (EGD):
Esophageal/Gastric Manometry.
Anorectal manometry.
Guaiac test: stool sample to test for blood
Gastric manometry. ...
Magnetic resonance cholangiopancreatography (MRCP).
 Gastroıntestınal
Gastrointestinal

Cholecystitis
Gallbladder

Hepatic duct

Cystic duct

CHOLECYSTITIS Duodenum Gallstones

Liver
inflammation of the gallbladder. It happens when a Gall bladder
digestive juice called bile gets trapped in your gallbladder. becomes inflamed
or blocked and bile Gallbladder
chole cyst Itis cannot exit properly
Normal
Bile Membranous sac Inflammation galbladder

The gallbladder is a small, pear-shaped organ on the Inflamed

right side of the belly (abdomen), beneath the liver. galbladder

The gallbladder holds a digestive fluid (bile) that's

released into the small intestine. Gallstone

Swollen mucosa
Bile helps:
With digestion.
It breaks down fats into fatty acids,
In patients with liver failure or chronic
Which can be taken into the body by the digestive tract. liver conditions such as cirrhosis,
hepatitis (liver inflammation) or
Bile contains: Mostly cholesterol.
perforation, trauma, and drug-induced
Absorb fat soluble vitamins liver injury, the risks of developing
sepsis, multiple organ failure (MOF),
Carry waste (including billirubin) out of liver
and sepsis-induced death are higher
Bile acid deficiency that leads to fat malabsorption may cause than those risks in patients without
weight loss if you have trouble digesting enough calories. intrinsic liver diseases.

Risk factors: Cholecystitis Diagnosis: The doctor will examine you, ask a few
having gallstones is the main risk questions about your symptoms, and probably order some tests.
factor for developing cholecystitis. Detail when your symptoms started.
Woman older than 50 Have you felt this way before?
Man older than 60 Describe how severe your pain is.
Overweight Talk about whether anything makes your pain better or worse.
Have diabetes Imaging tests These may include:
Pregnant X-ray of your belly, which will show your internal organs, bones,
Crohn's disease and tissues

End-stage kidney disease Ultrasound, to check blood flow

Heart disease CT scan, which gives doctors a more detailed look at organs,
muscles, and bones than an X-ray can
Hyperlipidemia (when your blood
has too many lipids in it) HIDA scan, which checks how your gallbladder squeezes and if bile
is blocked. You get a shot of a chemical, and then a scanner
Sickle cell disease traces it as it moves through your body.
Quick weight loss PTC, which uses a dye injected into your liver to show how bile is
moving through your body
Remember the 5 F’s:
ERCP, which uses a long, flexible tube threaded down your throat,
Family History Forty or older through your stomach, and into your small intestine. It has a light
and camera at the end. This test also uses a dye to check how bile
Female Fertile (pregnant) is flowing through your system.
Fat (obesity)
 Gastroıntestınal
Gastrointestinal

Cholecystitis

Symptoms Prevention

Symptoms of cholecystitis may include: You can reduce your risk of cholecystitis by taking the
following steps to prevent gallstones:
Severe pain in your upper right or center abdomen
The fundus
Pain that spreads to your right shoulder or back
Rapid weight loss can increase the risk of gallstones.
Tenderness over your abdomen when it's touched
Maintain a healthy weight
Nausea
Being overweight makes you more likely to develop
Vomiting
gallstones.
Fever Will get worse
To achieve a healthy weight, reduce calories and
after a fatty meal
Yellow skin or eyes (jaundice) increase your physical activity.
Severe RUQ/epigastric pain Hold a deep Maintain a healthy weight by continuing to eat well
breath while and exercise.
Tachycardia
palpating the right
Maintain a healthy weight
Steatorrhea (fatty stools) subcostal area
Diets high in fat and low in fiber may increase the
Positive Murphy's Sign
risk of gallstones.
Bowel movements that are loose and light-colored
To lower your risk, choose a diet high in fruits,
vegetables and whole grains.

Treatments
Gallbladder inflammation
Fasting. You may not be allowed to eat or drink at first in
order to take stress off your inflamed gallbladder.
Can be caused by:
Fluids through a vein in your arm.
Gallstones.
This treatment helps prevent dehydration.
Tumor.
Antibiotics to fight infection.
Bile duct blockage.
Pain medications. ...
Infection. AIDS and certain viral infections can
Procedure to remove stones. trigger gallbladder inflammation.
Antiemetic for nausea Severe illness.
Gallbladder drainage.
ERCP: Diagnostic & remove gall stones
T-tube: placed in common bile duct to drain bile
Lithotripsy: non-surgical procedure to break up stones

Complications

Cholecystitis can lead to a number of serious complications, including:

Infection within the gallbladder. If bile builds up within your gallbladder, causing cholecystitis, the bile may become
infected.
Death of gallbladder tissue. Untreated cholecystitis can cause tissue in the gallbladder to die (gangrene). It's the most
common complication, especially among older people, those who wait to get treatment and those with diabetes. This can
lead to a tear in the gallbladder, or it may cause your gallbladder to burst.
Torn gallbladder.
A tear (perforation) in your gallbladder may result from gallbladder swelling, infection or death of tissue.
 Gastroıntestınal
Gastrointestinal

Biliary Obstruction

Biliary Obstruction
Billiary duct
obstruction Gallstone blocking
common bile duct
Blockage of the bile duct system leading to impaired bile flow from
the liver into the intestinal tract.
Bile is a substance that contains bile salts, bilirubin, and cholesterol
Gallbladder
Continuously synthesized in the liver hepatocytes.

Gallstone

Symptoms: Most commonly caused by

Gall Stones
Pancreas
Pruritus — or itchy skin
Pain in your upper right abdomen
Gall stones are formed due to
Duodenum
Fever impaired metabolism of bile &
get stuck in bile duct causing
Clay-colored stool
inflammation
Dark colored urine Complications of Biliary Obstruction:

Nausea and vomiting Infection

Causes of biliary obstruction: Liver disease
Tiredness and fatigue
Cholelithiasis or gallstones. Jaundice
Weight loss
Cancer. Diabetes
Loss of appetite
Injury during surgery. Pancreatitis
Pruritus
Choledochal cysts. Vitamin deficiency
Elevated AST/ALT & billirubin
Chronic pancreatitis. Gastrointestinal problems
Gallbladder swelling

NURSING INTERVENTIONS

Pain Management: Administer prescribed analgesics

as ordered and monitor the patient's response to pain
relief, adjusting medications as needed.
NPO preoperatively
NGT insertion (for gastric decompression)
IV fluids for hydration
Infection Control: ... Low-Fat Foods:
Dietary Guidance: ... Leafy greens like kale, spinach, arugula.
Health Promotion: Vegetables like broccoli, cauliflower, cabbage, and mushrooms.
Monitor Vs & electrolytes Fruits, beans and legumes and sweet potatoes.
Monitor T-tube site & drainage Whole grains including farro, bulgur, spelt, quinoa.
Prepare for surgery, if indicated. White fish, chicken breast, low-fat dairy and egg whites.
 Gastroıntestınal
Gastrointestinal

Pancreatitis

Gallbladder

Pancreatitis
Bile duct
Pancreatitis is inflammation in your pancreas. Pancreatitis Gallstones

Inflammation causes swelling and pain. Inflamed

tissue

Pancreas

Occurs due to autodigestion of pancreas:

Small
Pancreatitis is the inflammation and intestine
autodigestion of the pancreas. Autodigestion
describes a process whereby pancreatic
enzymes destroy its own tissue leading to
inflammation. Pancreas is involved in digestion and regulating your blood
sugar.
It makes digestive enzymes (like amylase) and hormones (like
Types of pancreatitis: insulin).

There are two types of pancreatitis: Acute and It delivers digestive enzymes to your small intestine through the
Chronic. pancreatic duct.

Acute pancreatitis:
Acute pancreatitis is a temporary condition.
Pancreas Functions :
It happens when pancreas is attempting to
recover from a minor, An exocrine gland runs the length of your pancreas. It produces
enzymes that help to break down food (digestion). Pancreas
Short-term injury. releases the following enzymes:
Chronic pancreatitis: Lipase: Works with bile (a fluid produced by the liver) to break
down fats.
Chronic pancreatitis is a long-term,
progressive condition. Amylase: Breaks down carbohydrates for energy.
It doesn’t go away and gets worse over time. Protease: Breaks down proteins.

The pancreas It is an organ of the digestive system and of the endocrine system.
has two main functions: Pancreas performs two main functions:

Exocrine function: Produces substances (enzymes) that Endocrine function: Sends out hormones that control
help with digestion (lipase, amylase, protease). the amount of sugar in your bloodstream.

Endocrine system? Endocrine system?

The endocrine system consists of glands that release The exocrine system consists of glands that make
hormones into your blood. substances that travel through a duct (tube). Besides the
pancreas, the exocrine system includes:
These glands control many of body’s functions.
Besides the pancreas, endocrine system includes the: Prostate. Salivary glands.
Adrenal glands. Pineal gland. Mammary glands. Sebaceous (oil) glands.
Hypothalamus. Pituitary gland. Mucous membranes. Sweat glands.
Ovaries and testes. Thymus. Lacrimal glands (tear glands).
Parathyroid and thyroid gland.
 Gastroıntestınal
Gastrointestinal

Pancreatitis

PATHOPHYSİOLOGY

Self-digestion of the pancreas caused by its own proteolytic enzymes, particularly trypsin, causes acute pancreatitis.
Entrapment: Gallstones enter the common bile duct and lodge at the ampulla of Vater.
Obstruction: The gallstones obstruct the flow of the pancreatic juice or causing reflux of bile from the common bile
duct into the pancreatic duct.
Activation: The powerful enzymes within the pancreas are activated.
Inactivity: Normally, these enzymes remain in an inactive form until the pancreatic secretions reach the lumen of the
duodenum.
Enzyme activities: Activation of enzymes can lead to vasodilation, increased vascular permeability, necrosis, erosion,
and hemorrhage.
Reflux: These enzymes enter the bile duct, where they are activated and together with bile, back up into the
pancreatic duct, causing pancreatitis.

Risk Factors Diagnostics

Pancreatitis Risk Factors A pancreas blood test looks for elevated levels of pancreatic enzymes
in blood.
Several things can cause you to have a
greater chance of having this condition, CT scan or MRI
including:
Glucose test (pancreas is still producing insulin effectively).
Heavy drinking (four or more
Stool elastase test (pancreas is making enough digestive enzymes).
alcoholic drinks per day).
Fecal fat analysis (excess fat in poop, a sign of fat malabsorption).
Vaping.
Blood tests (nutritional status and have enough fat-soluble vitamins
Gallstones.
in your blood).
Cholecystitis.
ERCP
Cystic Fibrosis.
A biopsy. in which doctor uses a needle to remove a small piece of
ERCP (can cause trauma to tissue from pancreas to be studied
pancreatic duct).
Labs
High levels of triglycerides.
High Lipase & Amylase High Glucose Low Calcium
Having a family history of
High WBC High Bilirubin Low Platelets
pancreatitis.
Pancreatitis Risk Factors: WBC count of 10,000–25,000 is present in 80%
Excessive alcohol use.
of patients. Hb may be lowered because of bleeding.
Cigarette smoking.
Urinalysis: Glucose, myoglobin, blood, and protein may be present.
Obesity. People with a body mass
Urine amylase: Can increase dramatically within 2–3 days after onset
index of 30 or higher are at
of attack.
increased risk of pancreatitis.
Stool: Increased fat content (steatorrhea) indicative of insufficient
Diabetes.
digestion of fats and protein.
Family history of pancreatitis.
 Gastroıntestınal
Gastrointestinal

Pancreatitis

Acute Pancreatitis Chronic Pancreatitis

Condition where the pancreas becomes inflamed Prolonged abdominal pain with intermittent pain-free
(swollen) over a short period of time acute pancreatitis periods, weight loss, Relief of abdominal pain when
start to feel better within about a week and have no leaning forward.
further problems.
Chronic pancreatitis causes:
Acute pancreatitis causes include:
Cystic fibrosis
Drinking lots of alcohol
Family history of pancreas disorders
Gallstones
Gallstones
Autoimmune diseases
High triglycerides
Infections
Longtime alcohol use
Medications
Medications
Metabolic disorders
In about 20% to 30% of cases, the cause of chronic
Surgery pancreatitis is unknown.
Trauma to the belly area
In up to 15% of people with this type, the cause is Symptoms of chronic pancreatitis.:
unknown.
Indigestion and pain after eating.
Symptoms of acute pancreatitis:
Loss of appetite and unintended weight loss.
Moderate to severe pain in the upper part of your belly
Fatty poops that leave an oily film in the toilet.
that goes into your back. Eating may make it worse,
especially foods high in fat. Lightheadedness (from low blood pressure).
Fever Diarrhea and weight loss because your pancreas isn’t
releasing enough enzymes to break down food
Higher heart rate
Upset stomach and vomiting
Nausea and vomiting
Fatty, oily stools that smell especially bad and leave a
Swelling and tenderness in the belly
film in the toilet.
Epigastric LUQ pain that radiates to back
Dark urine (from excessive bile)
Tetany (from hypocalcemia)
Turner sign (bruising on flank) Chronic inflammation leads to fibrosis of pancreas
Cullen sign (bruising around navel) tissue leading to inability to produce digestive enzymes.

Acure pancreatitis

Complications of Turners
Acute pancreatitis: Complications of chronic pancreatitis:

Necrosis and infection. Exocrine pancreatic insufficiency

Pancreatic pseudocysts. Cullens (EPI), malabsorption and malnutrition.

Chronic pancreatitis. Hypoglycemia, hyperglycemia and Type 1 diabetes.

Chronic pain.
Increased risk of pancreatic cancer.
 Gastroıntestınal
Gastrointestinal

Pancreatitis

ARDS
Complications?
acute respiratory distress syndrome (ARDS).
This condition can have severe complications, including:
A serious lung condition that causes low blood oxygen
Diabetes if there’s damage to the cells that make insulin.
Fluid builds up inside the tiny air sacs of the lungs, and
Infection of pancreas. surfactant breaks down
Kidney failure. Cause of ARDS is
Weight lose. Sepsis, Shortness of breath
Acute respiratory distress syndrome (ARDS). Restlessness
Malnutrition if your body can’t get enough nutrients from Tachycardia
the food you eat because of a lack of digestive enzymes.
Serious and widespread infection of the bloodstream.
Blockage of the bile ducts.
Pancreatic necrosis, when tissues die because your
pancreas isn’t getting enough blood.
Pseudocysts, when fluid collects in pockets on your Peritonitis
pancreas. They can burst and become infected. Peritonitis is a redness and swelling (inflammation) of
Pancreatic cancer. the lining of your belly or abdomen.

Peritonitis. This lining is called the peritoneum. It is often caused

by an infection from a hole in the bowel or a burst
Malnutrition. With both acute and chronic pancreatitis. appendix.
Breathing problems. Acute pancreatitis can cause Rigid board-like abdomen
changes in how the lungs work, causing the level of
oxygen in the blood to fall to dangerously low levels. Rebound tenderness
Fever

Can lead to sepsis if not treated promptly!

TREATMENT

Medical Management: Management of pancreatitis is directed towards relieving symptoms and preventing or treating
complications.
Pain management: Adequate administration of analgesia (morphine, fentanyl, or hydromorphone) is essential during
the course of pancreatitis to provide sufficient relief and to minimize restlessness, which may stimulate pancreatic
secretion further.
Antibiotics for infection
ERCP: Diagnostic & remove gall stones.
Intensive care: Correction of fluid and blood loss and low albumin levels is necessary to maintain fluid volume and
prevent renal failure.
Antiemetic's for nausea
Antacids: decrease acid production
Respiratory care: Aggressive respiratory care is indicated because of the high-risk elevation of the diaphragm,
pulmonary infiltrates and effusion, and atelectasis.
Respiratory care: Aggressive respiratory care is indicated because of the high-risk elevation of the diaphragm,
pulmonary infiltrates and effusion, and atelectasis.
 Gastroıntestınal
Gastrointestinal

Pancreatitis

Surgical Management
There are several approaches available for surgery. The major surgical procedures are the following:
Side-to-side pancreaticojejunostomy (ductal drainage). Indicated when dilation of pancreatic ducts is associated
with septa and calculi. This is the most successful procedure with success rates ranging from 60% to 90%.
Caudal pancreaticojejunostomy (ductal drainage). Indicated for uncommon causes of proximal pancreatic ductal
stenosis not involving the ampulla.
Pancreaticoduodenal (right-sided) resection (ablative) (with preservation of the pylorus) (Whipple procedure).
Indicated when major changes are confined to the head of the pancreas. Preservation of the pylorus avoids usual
sequelae of gastric resection.
Pancreatic surgery.

Nursing Assessment
NURSING INTERVENTIONS
Nursing assessment of a patient with pancreatitis
Performing nursing interventions for a patient with
involves:
pancreatitis needs expertise and efficiency.
Assessment of current nutritional status and
Relieve pain and discomfort. The current
increased metabolic requirements.
recommendation for pain management in this
IV fluids for hydration population is parenteral opioids including morphine,
hydromorphone, or fentanyl via patient-controlled
Opioid analgesics for pain
analgesia or bolus.
Monitor for hyperglycemia
Improve breathing pattern. The nurse maintains the
Monitor VS & electrolytes patient in a semi-Fowler’s position and encourages
frequent position changes.
Assessment of respiratory status.
Improve nutritional status. The patient receives a diet
Assessment of fluid and electrolyte status. high in carbohydrates and low in fats and proteins
Assessment of sources of fluid and electrolyte loss. between acute attacks.
Assessment of abdomen for ascites. Maintain skin integrity. The nurse carries out wound
care as prescribed and takes precautions to protect
NPO at least 24 hrs (eating stimulates enzymes!) intact skin from contact with drainage
NGT insertion (for gastric decompression)
EVALUATION
Give pancreatic enzymes before meals.
Evaluation of a successful plan of care for a patient with
Diet Low fat Low sugar No alcohol pancreatitis should include:
Relieved pain and discomfort.
Improved nutritional status.
Improved respiratory function.
Improved fluid and electrolyte status.
 Gastroıntestınal
Gastrointestinal

Inflammatory Bowel Disease

Inflammatory bowel disease

Similarities
Inflammatory bowel disease (IBD) is a group of Have flare ups Increase risk of colon cancer
disorders that cause chronic inflammation (pain and
swelling) in the intestines. Ulcers Cause inflammation
BD includes Crohn’s disease and ulcerative colitis Remissions

Types of IBD
Crohn’s disease and ulcerative colitis are the main types of IBD. Types include:
Crohn’s Disease: Causes pain and swelling in the digestive tract. It can affect any part from the mouth to the anus. It
most commonly affects the small intestine and upper part of the large intestine.
Ulcerative Colitis: Causes swelling and sores (ulcers) in the large intestine (colon and rectum).
Microscopic colitis: Causes intestinal inflammation that’s only detectable with a microscope.

Complications: IBD symptoms include:

Anal fistula (tunnel that forms under the skin Abdominal (belly) pain.
connecting an infected anal gland and the anus).
Diarrhea (sometimes alternating with constipation) or
Anal stenosis or stricture (narrowing of the anal canal urgent need to poop (bowel urgency).
where stool leaves the body).
Gas and bloating.
Anemia (low levels of red blood cells) or blood clots.
Loss of appetite or unexplained weight loss.
Kidney stones.
Mucus or blood in stool.
Liver disease, such as cirrhosis and primary sclerosing
Upset stomach.
cholangitis (bile duct inflammation).
Rarely, IBD may also cause:
Malabsorption and malnutrition (inability to get enough
nutrients through the small intestine). Fatigue.
Osteoporosis. Fever.
Perforated bowel (hole or tear in the large intestine). Itchy, red, painful eyes.
Toxic megacolon (severe intestinal swelling). Joint pain.
Nausea and vomiting.
Skin rashes and sores (ulcers).
Causes IBD: Vision problems.
Researchers are still trying to determine why some people
develop IBD. Three factors appear to play a role:
Genetics: As many as 1 in 4 people with IBD have a
family history of the disease.
Immune system response: The immune system
typically fights off infections. In people with IBD, the
immune system mistakes foods as foreign substances.
It releases antibodies (proteins) to fight off this threat,
causing IBD symptoms.
Environmental triggers: People with a family history of
IBD may develop the disease after exposure to an
environmental trigger. These triggers include smoking,
stress, medication use and depression.
 Gastroıntestınal
Gastrointestinal

Inflammatory Bowel Disease

Crohn’s disease VS Ulcerative colitis

Crohn’s disease is a chronic (lifelong) autoimmune abnormal reactions of the immune system cause
condition that inflames and irritates your digestive tract, inflammation and ulcers on the inner lining of your
most commonly your small and large intestines (colon) large intestine.

Crohn's causes pain in the lower right abdomen. UC includes pain in the lower left abdomen,

Inflammation with Crohn's disease is often patchy, Inflammation in ulcerative colitis is usually continuous,
with so-called "skip lesions" (intermittent regions of typically involving the rectum, with involvement extending
inflamed bowel). proximally (to sigmoid colon, ascending colon, etc.).

Affects full thickness of bowel wall Affects mucosa layer of bowel wall

Continuous Distributions Discontinuous

Crohn’s Disease Ulcerative Colitis

Common Crohn’s disease signs and Signs and Symptoms:

symptoms: Diarrhea (may or may not be bloody).
Abdominal pain or cramps. Tenesmus (feeling like you have to poop but being
Chronic diarrhea (watery stool). unable to).

Loss of appetite and weight loss. Mild abdominal (belly) cramping or tenderness.

Bloody stool (rectal bleeding). Later, you may also have symptoms of moderate to
severe UC, including:
Mouth ulcers or pain in your mouth or gums.
Frequent bowel movements or episodes of diarrhea
Fever and fatigue (tiredness that doesn’t improve (four or more episodes daily).
with rest).
Blood, mucus or pus in your stool.
Abscesses of infections around your anal canal.
Severe belly cramping.
Crohn’s can also cause symptoms in body parts
outside of your digestive tract, including: Fatigue (extreme tiredness).

Arthritis or joint pain. Sudden weight loss.

Rashes. Nausea.

Eye inflammation, such as uveitis and episcleritis. Fever.

Kidney stones. Dehydration

Osteoporosis (loss of bone mass). Joint pain or soreness

Skin tags (usually around your anus). Canker sores

Inflammation in your bile ducts Eye pain when you look at a bright light
Too few red blood cells, called anemia
 Gastroıntestınal
Gastrointestinal

Inflammatory Bowel Disease

Complications of Crohn’s disease? Complications of ulcerative colitis

Crohn’s disease can cause complications that may Anemia
require more treatment or, possibly, surgery.
Colon cancer
Abscesses: Infected pus-filled pockets that form in
Osteoporosis: The inflammation can spread to your
your digestive tract or abdomen.
bones and joints, causing bone weakening or
Anal fissures: Small tears in your anus that cause pain, osteoporosis.
itching and bleeding.
Primary sclerosing cholangitis: Inflammation that
Fistulas: An abnormal tunnel-like opening that spreads to your liver can cause primary sclerosing
connects two body parts that don’t normally connect. cholangitis, a condition that causes liver scarring. The
damaged tissue can prevent your liver from working as
Bowel obstructions
it should.
Malnutrition
Growth and development issues in children: UC can
Anemia: Low blood cell counts. Approximately 1 in 3 limit a child’s colon function, so they can’t absorb key
people with Crohn’s disease have anemia. nutrients needed for growth and development.
Crohn’s disease can also increase your risk of colon Dehydration
cancer and blood clots.
Perforation: A hole in your colon (perforation) is a
medical emergency, requiring immediate treatment.
Severe bleeding
Toxic megacolon: Severe inflammation can cause
your colon to stop working.

Risk factors of Crohn’s disease? Risk factors

Risk factors include: Anyone can get ulcerative colitis, but your risk is greater
based on your:
Age: a large percentage of people are diagnosed in
their late teens through early 30s. Age: Most people get diagnosed between 15 and 30
years old or when they’re older than 60.
Genes: IBD runs in families in about 20% of Crohn’s
disease diagnoses. Genes: IBD runs in families in about 20% of Crohn’s
disease diagnoses.
Smoking: Smoking cigarettes increases risk.
Race and ethnicity
Appendectomy
Genetics
Location: People living in developed countries and
urban areas have a higher risk than those living in Gut microbiome: Your gut microbiome consists of
less developed countries and rural areas. bacteria, viruses and fungi in your digestive system.
Stress: Your body’s stress response may contribute
to flares.
 Gastroıntestınal
Gastrointestinal

Inflammatory Bowel Disease

Diagnosis and Tests Diagnosis and Tests

Lab tests: check a sample of fluid or tissue for Tests and procedures include:
microscopic signs of disease.
Blood tests: Your blood can show signs of anemia,
Blood test: A blood test checks your blood cell counts which may mean you have bleeding in your colon or
and blood chemistry for signs of Crohn’s. A high white rectum. Blood tests can also help providers rule out
blood cell count may indicate inflammation or other causes of your symptoms, like an infection.
infection. Low levels of red blood cells indicate anemia,
Stool samples: Signs of infection, parasites (tiny
common with Crohn’s disease.
organisms that can live in a person’s body) and
Stool test: This test checks a stool (poop) sample for inflammation can show up in your poop.
bacteria or parasites. It can rule out infections that
Imaging tests: Your healthcare provider may need a
cause chronic diarrhea.
picture of your colon and rectum. You may need a
Computed tomography (CT) scan: A CT scan creates specialized type of X-ray called a barium enema to
images of your digestive tract using X-rays. reveal signs of inflammation in your colon.
Magnetic resonance imaging (MRI) A CT scan: (computed tomography scan).
Colonoscopy MRI: (magnetic resonance imaging) can show signs of
inflammation in your colon, especially with moderate
Upper endoscopy: A provider passes an endoscope
and severe UC.
through your mouth and into your throat.
An X-ray: can show complications like megacolon or
Capsule endoscopy: You swallow a small plastic
perforation.
capsule with a light and a camera that takes pictures
as it moves through your digestive tract. Endoscopic test: To diagnose UC include colonoscopy
and sigmoidoscopy.

Treatment Treatment
Steroids: Corticosteroids and budesonide calm Medications for UC include:
inflammation in the short term but are rarely
Aminosalicylates:
appropriate for long-term symptom management.
sulfasalazine for mild to moderate ulcerative colitis.
Anti-inflammatory medications: 5-aminosalicylates
are anti-inflammatory medicines used mainly for you’re allergic to sulfa. They can prescribe a sulfa-free
ulcerative colitis. They provide limited benefits for aminosalicylate instead, such as mesalamine.
people with Crohn’s.
Corticosteroids.
Immunomodulators: Immunomodulators work by
Immunosuppressants: These medicines include 6
changing how your immune system works. Types
mercaptopurine , azathioprine or methotrexate.
called immunosuppressants calm your immune
response. Examples include azathioprine and Biologics: Biologics treat moderate to severe ulcerative
methotrexate. colitis by calming parts of your immune response.
Medications like infliximab , adalimumab , golimumab ,
Biologics: Biologics target proteins that cause your
certolizumab pegol vedolizumab and ustekinumab
immune system to have an excessively activated
are biologics.
immune response.
Janus kinase (JAK) inhibitors (small molecule
Small molecule advanced therapies: Pills called
drugs): Drugs like tofacitinib stop one of your body’s
JAK-inhibitors also reduce the immune response and
enzymes (chemicals) from triggering inflammation
treat Crohn’s. Upadacitinib is the only one currently
approved by the U.S. Federal Drug Administration (FDA).
Antibiotics. Only cure is: Protocolectomy (+ permanent ileostomy)
Antidiarrheal medication: Ileoanal anastomosis (no ostomy)
Pain: There are several therapies used to help with
pain related to Crohn’s disease.
 Gastroıntestınal
Gastrointestinal

Inflammatory Bowel Disease

Prevention Prevention
You can’t prevent Crohn’s disease, but you can ease Tips for avoiding common triggers include:
symptoms and reduce flare-ups by:
Managing stress:
Stopping smoking;
Avoid NSAIDs: For pain relief or a fever, use
Avoiding medications that can trigger flare-ups: acetaminophen (Tylenol®) instead of NSAIDs like
These include some types of NSAIDs (nonsteroidal Motrin® and Advil®. NSAIDs can worsen ulcerative colitis
anti-inflammatory drugs). symptoms.
Avoiding foods that may trigger unwanted Avoid foods that trigger flare-ups.
symptoms
Lactose intolerance: can be an issue for some. If this is
the case, you may need to avoid dairy. You may need
to avoid carbonated beverages.
Eating foods that work for you with meals spread out.
Caring for your mental health.

Types of Crohn’s disease include: Types of Ulcerative Colitis

Ileocolitis: Inflammation in your lower small intestine The type of ulcerative colitis you have depends on where
and part of your large intestine. Ileocolitis is the most it is in your body:
common type of Crohn’s disease.
Ulcerative proctitis: is usually the mildest form. It’s only
Colitis: Inflammation in the lining of your large in the rectum, the part of your colon closest to your
intestine. anus. Rectal bleeding may be the only sign of the
disease.
Ileitis: Swelling and inflammation in your small intestine
(ileum). Proctosigmoiditis happens in your rectum and the
lower end of your colon (you may hear the doctor call
Gastroduodenal: Inflammation and irritation that
it the sigmoid colon).
affects your stomach and the top of your small
intestine (the duodenum). Left-sided colitis causes cramps on that side of your
belly. You’ll also have bloody diarrhea, and you might
Jejunitis: Patchy areas of inflammation in the upper
lose weight without trying.
half of your small intestine (the jejunum).
Pancolitis often affects your entire colon. It can cause
Perianal disease: A portion of people have
severe bouts of bloody diarrhea, belly cramps, pain,
inflammation around the anus, which can cause
fatigue, and major weight loss.
fistulas and abscesses.
Acute severe ulcerative colitis is rare. It affects your
entire colon and causes severe pain, heavy diarrhea,
bleeding, and fever.

EDUCATION EDUCATION
Which Foods Should I Avoid With a Crohn's Disease: Foods to avoid if you have ulcerative colitis?
Alcohol (mixed drinks, beer, wine). Lactose products, such as milk and cheese.
Butter, mayonnaise, margarine, oils. Red meat and processed meat.
Carbonated beverages. Alcohol.
Coffee, tea, chocolate. Carbonated drinks.
Corn. Sugar alcohols, such as those found in sugar-free
products like chewing gum, mints, and candies.
Dairy products (if lactose intolerant)
Insoluble fibers, such as in broccoli and whole nuts.
Fatty foods (fried foods)
High fat foods.
Foods high in fiber.
 Gastroıntestınal
Gastrointestinal

Diverticular Disease

Diverticolosis
Diverticular disease

What is it?
Diverticular disease are related digestive conditions
that affect the large intestine (colon).
In diverticular disease, small bulges or pockets
(diverticula) develop in the lining of the intestine. Diverticutitis
Diverticulitis is when these pockets become inflamed
or infected.

Symptoms of diverticular disease

include:
Pain in the lower left side of your tummy
(abdomen) – a small number of people
get pain on the right side.
Tummy pain that gets worse after you
eat, and gets better after you poo or
fart.
Constipation. Risk factors for diverticulosis:

Diarrhea. Obesity

Blood in your poo. Smoking

Bloating. Alcohol
Diet
Age
Diabetes mellitus
Hyperlipidemia
Hypertension
Hypothyroidism
Nonsteroidal anti-inflammatory drug
Physical activity
Polycystic kidney disease
 Gastroıntestınal
Gastrointestinal

Diverticular Disease

Diverticulosis VS Diverticulitis

Diverticulosis is the condition of having small pouches Diverticulitis is the infection or inflammation of
or pockets in the inside walls of intestines. pouches that can form in your intestines.
They develop when the inside lining of your intestines These pouches are called diverticula. Undigested food
pushes into weak spots in the outer wall. or stool gets trapped in pouches.
This usually happens gradually over time.

inflamed pouch
Most Common Site: Sigmoid Colon

Diverticula

Symptoms: Symptoms of diverticulitis include:

Symptoms of diverticulosis. Usually asymptomatic until Sharp pain, often located at a specific point – for
complications develop. example, in the lower left half of the abdomen

Abdominal pain and bloating. Fever

Constipation and diarrhoea. Distension (bloating) of the abdomen

Flatulence. Nausea and vomiting.

Blood in the faeces – this is usually minor, but bleeding Abdominal tenderness.
can sometimes be heavy if a diverticulum gets Severe llq pain
inflamed or is near a blood vessel.
Bloating
Anaemia from repeated bleeding may occur.
Constipation or diarrhea.
 Gastroıntestınal
Gastrointestinal

Diverticular Disease

Risk factors Risk factors

Obesity Hyperlipidemia Several factors may increase your risk of developing
diverticulitis:
Diabetes mellitus Hypertension
Aging: The incidence of diverticulitis increases with age.
Physical activity Hypothyroidism
Obesity: Being seriously overweight increases your
Smoking Immunosuppression
odds of developing diverticulitis.
Age Medications
Smoking: People who smoke cigarettes are more likely
Diet Polycystic kidney disease than nonsmokers to experience diverticulitis.
Lack of exercise: Vigorous exercise appears to lower
your risk of diverticulitis.
Diet high in animal fat and low in fiber: A low-fiber diet
in combination with a high intake of animal fat seems
Complications: to increase risk, although the role of low fiber alone isn't
clear.
Intestinal obstruction.
Certain medications: Several drugs are associated
Abscess: Untreated, diverticulitis may lead to an with an increased risk of diverticulitis, including steroids,
abscess (a ball of pus). opioids and nonsteroidal anti-inflammatory drugs, such
Fistula as ibuprofen.
Gastrointestinal perforation
Bleeding
Peritonitis: Perforation can lead to peritonitis (infection
of the membranes that line the abdominal cavity and Complications:
abdominal organs). This complication is potentially life
About 25% of people with acute diverticulitis develop
threatening.
complications, which may include:
Peritonitis
An abscess: Which occurs when pus collects in the
Constipation pouch.
Abdominal pain A blockage: In your bowel caused by scarring.
Haemorrhage: Diverticula can be the source of An abnormal passageway (fistula): Between sections
haemorrhage. When bleeding occurs. of bowel or the bowel and other organs.
Bloating Peritonitis: Which can occur if the infected or inflamed
pouch ruptures, spilling intestinal contents into your
Distended abdomen abdominal cavity. Peritonitis is a medical emergency
Fever and requires immediate care.
Phlegmon
Vomiting
Perforation: A weakened pocket of bowel wall may
rupture.
 Gastroıntestınal
Gastrointestinal

Diverticular Disease

Diagnosis and Tests Diagnosis and Tests

Tests to confirm the diagnosis of diverticular disease Exams might include:
include:
Physical exam: A provider will check your vital signs,
Medical history: Including dietary habits. palpate (feel) your abdomen and listen to your bowel
sounds. They may insert a gloved finger into your anus
Physical Examination: Including rectal examination.
(digital rectal exam).
Colonoscopy
Blood test: A blood test can show if you have an
Barium enema: A special contrasting dye flushed into infection or significant internal bleeding.
the bowel via the anus and x-rays are taken.
Stool test: A stool test may show signs of infection or
CT scan: To detect abscesses outside the bowel lining. gastrointestinal (GI) bleeding.
Blood tests: To check for signs of infection. Imaging tests: Such as a CT scan, a barium enema, a
flexible sigmoidoscopy or a colonoscopy.
Stool tests: To check for the presence of blood in the
faeces or the presence of infections, which may mimic
the symptoms of diverticulosis and diverticulitis.

Patients often find out they have diverticulosis through

routine colonoscopy.

Treatment Treatment
A gradual switch to a diet with increased soluble No eating or drinking: Intravenous fluids are given to
fibre: (green vegetables, oat bran and fiber rest the bowel.
supplements such as psyllium).
Antibiotics
Short-term use of laxatives to treat and prevent
Pain-relieving medication
constipation may be advised.
Surgery: if the weakened sections of bowel wall have
Elective surgery is performed to remove seriously
ruptured or become obstructed, or if the attack of
affected bowel segments when symptoms are
infection fails to settle.
disabling.
NPO (to rest bowel)
Probiotics
Colostomy
One antibiotic (rifaximin) has been successful in
randomised trials for those with more severe The long-term use of a mild antibiotic: This is often
symptoms of diverticular disease. necessary to prevent further attacks, but is generally
not recommended.
 Gastroıntestınal
Gastrointestinal

Diverticular Disease

Prevention Prevention
Eat fruits, vegetables, beans, and whole grains To help prevent diverticulitis:
every day.
Exercise regularly: Exercise promotes normal bowel
Drink plenty of fluids. function and reduces pressure inside your colon. Try to
exercise at least 30 minutes on most days.
Get at least 2½ hours of moderate to vigorous
exercise a week. Eat more fiber
Take a fibre supplement (such as Benefibre or Drink plenty of fluids
Metamucil) every day if needed.
Avoid smoking: Smoking is associated with an
Schedule time each day for a bowel movement. increased risk of diverticulitis.

EDUCATION EDUCATION
During flare up Recovery & maintenance
Avoid hard-to-digest foods Antibiotics, pain control
Nuts, corn, popcorn, and seeds Recommend surgery.
NPO to rest bowel if severe A liquid diet,
Clear liquids for 2-3 days Resting
Fluid diet and physical rest Psyllium supplements
Prescribe antibiotics, Adequate hydration.
Possibly antispasmodics,
Pain medications
 Gastroıntestınal
Gastrointestinal

GERD vs. Gastritis vs. PUD

GERD GASTRITIS PUD

Gastroesophageal reflux disease Inflammation of the lining of the Peptic Ulcer Disease
stomach
Is a digestive disorder that Peptic ulcers are open sores
affects the ring of muscle The inflammation of gastritis is that develop on the inside lining
between your esophagus and most often the result of infection of your stomach and the upper
stomach. with the same bacterium that portion of small intestine.
causes most stomach ulcers or
This ring is called the lower The most common symptom of
the regular use of certain pain
esophageal sphincter (LES). a peptic ulcer is stomach pain.
relievers.
Peptic ulcers include:
Gastric ulcers that occur on the
Gastritis inside of the stomach.
Risk Factors: Duodenal ulcers that occur on
Being overweight or obese. Esophagus the inside of the upper portion
of your small intestine
Pregnancy. (duodenum).
Ulcer
Delayed emptying of the
stomach (gastroparesis).
Stomach Ulcer
Diseases of connective tissue
such as rheumatoid arthritis, Esophagus
scleroderma, or lupus.
Smoking. Ulcer
Inflamed stomach linine
Certain foods and drinks, Duodenal Ulcer
including chocolate and fatty
or fried foods, coffee, and Risk Factors that increase your Duedanum
alcohol. risk of gastritis include:
Stomach
Large meals. Bacterial infection.

Eating too soon before bed. Regular use of pain relievers.

Certain medications, including Older age.

aspirin. Excessive alcohol use. Risk for peptic ulcers:
Coughing and other breathing Stress. Drinking too much alcohol.
problems.
Cancer treatment. Regular use of aspirin,
Heartburn. ibuprofen, naproxen, or other
Your own body attacking cells nonsteroidal anti-inflammatory
Hiatal hernia. in your stomach. drugs (NSAIDs)
Other diseases and conditions. Smoking cigarettes or chewing
Long term NSAID use. tobacco.
Being very ill, such as being on
a breathing machine.
Radiation treatments.
Stress.
 Gastroıntestınal
Gastrointestinal

GERD vs. Gastritis vs. PUD

Symptoms: Symptoms: Symptoms:

Acid regurgitation (retasting Loss of appetite or feeling full Burning stomach pain
your food after eating) soon after eating.
Feeling of fullness, bloating or
Difficulty or pain when Stomach pain and bloating belching
swallowing
If you have a bleeding ulcer, Intolerance to fatty foods
Sudden excess of saliva you may find:
Heartburn
Dyspepsia (heartburn) Black blood in your poop
Vomiting or vomiting blood —
(melena)
Epigastric pain which may appear red or black
Black blood in your vomit
Chronic sore throat Dark blood in stools, or stools
(coffee ground emesis.
that are black or tarry
Laryngitis or hoarseness
Nausea or recurrent upset
Trouble breathing
Inflammation of the gums stomach
Feeling faint
Cavities Abdominal bloating
Nausea or vomiting
Regurgitation while supine Abdominal pain
Unexplained weight loss
Bitter taste in mouth Vomiting
Appetite changes
Bad breath Indigestion
A recurrent or chronic cough Burning or gnawing feeling in
the stomach between meals or
Chest pain (seek immediate
at night
medical help)

Diagnosis: Diagnosis: Diagnosis:

Several tests may be used to Upper endoscopy. An Endoscopy exam
diagnose GERD including: endoscope, a thin tube
CT scan (computed
containing a tiny camera, is
X-ray of the upper digestive tomography scan)
inserted through your mouth
system
and down into your stomach to CBC: if actively bleeding
Endoscopy (examines the look at the stomach lining.
Urea breath test: assess for H.
inside of the esophagus)
The doctor will check for Pylor
Ambulatory acid (pH) test inflammation and may perform
EDG Test
(monitors the amount of acid in a biopsy .
the esophagus) Urea breath test
Blood tests. The doctor may
Esophageal impedance test perform various blood tests, Stool test.
such as checking your red
EGD GI series X-ray exam
blood cell count to determine
pH testing. whether you have anemia.
Endoscopy Urea breath test: assess for
presence of H. Pylori
Manometry: assess ability of
esophagus to squeeze food Fecal occult blood test (stool
down test). This test checks for the
presence of blood in your stool,
a possible sign of gastritis.
 Gastroıntestınal
Gastrointestinal

GERD vs. Gastritis vs. PUD

Complications Complications Complications

Inflammation of the tissue in the May include trusted source: Internal bleeding: While most
esophagus (esophagitis). people with ulcers won’t have
Anemia
Stomach acid can break down bleeding, this is the most
tissue in the esophagus, Deficiencies in vitamin b12, common complication that can
causing inflammation, bleeding, vitamin d, folic acid, vitamin c, occur.
and sometimes an open sore zinc, calcium, and magnesium
Perforation: An ulcer that is
(ulcer). Esophagitis can cause
Bleeding in the stomach continuously eroded by acid
pain and make swallowing
can eventually become a hole
difficult. Perforation inside the stomach
in the stomach or intestinal wall
Narrowing of the esophagus Peptic ulcers
Obstruction: An ulcer in the
(esophageal stricture). Damage
Chronic atrophic gastritis, pyloric channel, the narrow
to the lower esophagus from
which causes the loss of cells in passageway that leads from
stomach acid causes scar
the gastric glands . the stomach into the
tissue to form. The scar tissue
duodenum,
narrows the food pathway, Achlorhydria, which prevents
leading to problems with the stomach from producing Stomach cancer: Some gastric
swallowing. the acid it needs to digest food ulcers can become malignant
properly over time.
Precancerous changes to the
esophagus (Barrett esophagus). Perforation of the stomach
Damage from acid can cause
changes in the tissue lining the Cancers such as
lower esophagus. adenocarcinoma

Treatment Treatment Treatment

Lifestyle changes to treat GERD Treatment for gastritis usually Medications. Peptic ulcer
include: involves: medications include:
Elevate the head of the bed 6-8 Taking antacids and other Antibiotics. If you have an H.
inches drugs (such as proton pump pylori or other bacterial
inhibitors or H-2 blockers) to infection, your healthcare
Lose weight
reduce stomach acid provider will prescribe some
Stop smoking combination of antibiotics to kill
Avoiding hot and spicy foods
the bacteria.
Decrease alcohol intake
If the gastritis is caused by
Common antibiotics for H. pylori
Limit meal size and avoid heavy pernicious anemia, B12 vitamin
infection include:
evening meals shots will be given.
Doxycycline
Do not lie down within two to Eliminating irritating foods from
three hours of eating your diet such as lactose from Metronidazole
dairy or gluten from wheat.
Decrease caffeine intake Clarithromycin
Avoid theophylline (if possible) Amoxicillin
Cytoprotective agents. These
medicines help to coat and
protect your gastrointestinal
lining while it heals. They
include:
Sucralfate
Misoprostol
 Gastroıntestınal
Gastrointestinal

GERD vs. Gastritis vs. PUD

Medications to treat your Antibiotics and other Misoprostol.

symptoms. medications to treat H. pylori.
Bismuth subsalicylate.
Antacids: these drugs can help Finding alternative medications
Histamine receptor blockers (H2
neutralize acid in the for conditions you’ve been
blockers). These drugs reduce
esophagus and stomach and treating with NSAIDs.
stomach acid by blocking the
stop heartburn.
Addiction treatment services for chemical that tells your body to
H2 blockers: for chronic reflux alcohol use disorder or cocaine produce it. They include:
and heartburn, the doctor may addiction.
Famotidine
recommend medications to
Targeted drugs for
reduce acid in the stomach.. Cimetidine
autoimmune diseases.
Proton pump inhibitors (ppis): Nizatidine
Proton pump inhibitors
also known as acid pumps,
Proton pump inhibitors (PPIs).
these drugs block a protein H2 Antagonists
These drugs help reduce
needed to make stomach acid.
stomach acid and also coat
Ppis include dexlansoprazole
and protect your mucous lining
Prokinetics: in rare cases, these to promote healing. PPIs
drugs help your stomach include:
empty faster so you don’t have
Esomeprazole
as much acid left behind.
Dexlansoprazole.
They may also help with
symptoms like bloating, nausea, Lansoprazole
and vomiting.
Omeprazole
Procedures
Pantoprazole
Nissen fundoplication: wrapping
fundus around lower Rabeprazole
esophagus NSAID alternatives.

Causes of gastritis include: If actively bleeding ulcer

Radiation therapy (mucositis Cauterization: stop bleeding
Chemotherapy. IV fluids: maintain fluid volume
Bile reflux: A backflow of bile into Blood products
the stomach from the bile tract
(that connects to the liver and
gallbladder)
Infections caused by bacteria
and viruses
 Gastroıntestınal
Gastrointestinal

GERD vs. Gastritis vs. PUD

Diet and Lifestyle Changes: Prevention: Prevention: peptic ulcer disease

are to:
Avoid foods and beverages Maintaining good hygiene
triggers: Stay away from foods habits. Find and eradicate H. pylori.
that can relax the LES, including Most people who have an H.
Taking good care of your
chocolate, peppermint, fatty pylori infection aren’t aware of it
mental health.
foods, caffeine, and alcoholic
Use NSAIDs only as directed. If
beverages. Eat smaller Eating smaller meals more
you’re in the habit of managing
servings:. slowly and regularly.
daily aches and pains with
Eat slowly: Take your time at Quitting smoking, if you smoke. NSAIDs, make sure you aren’t
every meal. taking more than the
Avoiding or limiting alcohol and
recommended dose.
Chew your food thoroughly: caffeine
Stop smoking:
Elevate your head:
Stay at a healthy weight:
Wear loose clothes:
Acupuncture:

Types of GERD Types of gastritis Types of peptic ulcers?

Stage 1: You can have acute gastritis or Duodenal ulcers account for
chronic gastritis. almost 80% of peptic ulcers.
Mild GERD. Minimal acid reflux
occurs once or twice a month. Acute gastritis is sudden and Stomach ulcers; account for
temporary. The conditions that almost 20% of peptic ulcers.
Stage 2:
cause it are also acute.
Esophageal ulcer. Chronic acid
Moderate GERD. Symptoms are
Chronic gastritis is a long-term reflux , stomach acid rising into
frequent enough to require
condition, though you may not esophagus.
prescription acid reflux
notice it all the time (or at all). It
medication, which is typically Jejunal ulcer. ulcer in jejunum,
tends to develop gradually, as
taken daily. the middle part of your small
a result of another chronic
intestine, as a side effect of
Stage 3: condition.
surgery connecting your
Severe GERD. Erosive gastritis means the stomach to your jejunum
thing that’s causing your (gastrojejunostomy).
Stage 4:
gastritis is actually eating away
Precancer or cancer. at your stomach lining, leaving
wounds (ulcers). It’s often a
chemical, like acid, bile, alcohol
or drugs.
Nonerosive gastritis doesn’t
leave erosive changes but may
cause irritation, such as
reddening of the stomach
lining.
 Gastroıntestınal
Gastrointestinal

GERD vs. Gastritis vs. PUD

EDUCATION

Lifestyle Modifications Avoid

Do not lie down within two to three hours of eating Baked goods, like cupcakes and pastries, which are
Decrease caffeine intake often high in hydrogenated fat
Adequate hydration Cheese, including cheese sauces
Avoid theophylline (if possible) Cream soups
Smoking cessation Citrus fruits
Weight management Carbonated beverages
Elevate the head of the bed 6-8 inches Carbonated beverages
Lose weight Chocolate, which is rich in caffeine
Stress management Dairy desserts, like ice cream, custard, pudding, and
milkshakes
Probiotics
Fatty red meats, which are harder to digest.
Eat smaller and more frequent meals
Fried food
Eat slowly to allow time to digest
Peppermint
Avoid the consumption of food or drink in the 2 hours
before bedtime Overeating
Avoid the consumption of alcohol Fast food
Alcohol
Potato chips and other processed snacks
Chili powder and pepper (white, black, cayenne)
Fatty meats such as bacon and sausage
Cheese
 Gastroıntestınal
Gastrointestinal

Gastrointestinal Bleed

Gastrointestinal (GI) bleeding is a sign of a disorder in the digestive tract.

The blood often shows up in stool or vomit but isn't always obvious.
Stool may look black or tarry. Bleeding can range from mild to severe and can be life-threatening.

Mallory-Weiss tear Esophageal varices

Types of GI bleeds:
Gastric ulcer
Acute: Sudden, severe bleeding that’s a sign of a medical emergency. Hemorrhagic gastritis
Duodenal ulcer
Chronic: To treat and prevent constipation may be advised.
Ischmenic
Occult: Bleeding is not visible as it is microscopic, but you can see bowel
disease
signs of GI blood loss (such as low blood counts) on laboratory testing.
Intussus
Overt: Visible signs of a GI bleed, including abnormal colors or ception

substances in your feces (poop). You may also vomit blood. Angiody-
splasia Inflammatory
Obscure: When standard endoscopy testing does not reveal a source boweh disease

of GI bleeding. Colonic
carcinoma

Diverticulosus
Meckel diverticulum

Rectosigmoid carcinoma
Symptoms of GI Bleeding: Anal fissure
Hemorrhoids
Vomiting blood,
Which might be red or might be dark brown and look
like coffee grounds.
Causes of GI bleeding:
Black, tarry stool.
Angiodysplasia.
Rectal bleeding, usually in or with stool.
Benign tumors and cancer.
With occult bleeding, you might have:
Colitis.
Lightheadedness.
Colon polyps.
Difficulty breathing.
Diverticular disease.
Fainting.
Esophageal varices. Esophageal varices can cause GI
Chest pain. bleeding.
Abdominal pain. Esophagitis. The most common cause of esophagitis is
gastroesophageal reflux (GERD)
Gastritis. infections
Acute bleeding symptoms: Crohn’s disease
You may go into shock if you have acute bleeding. Acute serious illnesses
bleeding is an emergency condition. Symptoms of shock
include: severe injuries

Drop in blood pressure Hemorrhoids or anal fissures.

Little or no urination Mallory-Weiss tears.

A rapid pulse Peptic Ulcers.

Unconsciousness

Chronic bleeding symptoms:

Occult bleeding Inflammation
Shortness of breath Disease such as colorectal cancer
Develop anemia if you have chronic bleeding
 Gastroıntestınal
Gastrointestinal

Gastrointestinal Bleed

UPPER GI bleed LOWER GI bleed

Bleeding within the intraluminal gastrointestinal tract Any bleeding that occurs distal to the ligament of
from any location between the upper esophagus to Treitz is lower GI bleeding. This condition range from
the duodenum at the ligament of Treitz. scant bleeding to massive hemorrhage.
Bleeding occurs in the lining of esophagus, stomach or Bleeding occurs in the large intestine or rectum.
duodenum.

Cause Cause
Crohn's disease Diverticular disease. This involves the development of
small, bulging pouches in the digestive tract, called
Esophageal cancer
diverticulosis..
Abnormal blood vessels. At times abnormal blood
Inflammatory bowel disease (IBD).
vessels, small bleeding arteries and veins may lead to
bleeding. Proctitis. Inflammation of the lining of the rectum can
cause rectal bleeding.
Esophageal varices
Tumors.
Esophagitis
Anal fissures
Gastritis
Colon polyps
Growths. Though rare, upper GI bleeding can be
caused by cancerous or noncancerous growths in the Colorectal cancer
upper digestive tract.
Colon polyps. Small clumps of cells that form on the
Gastrointestinal stromal tumor (GIST) lining of your colon can cause bleeding. Most are
harmless, but some might be cancerous or can
GERD (Chronic Acid Reflux)
become cancerous if not removed.
Liver cancer
Crohn's disease.
Pancreatic cancer
Diverticulitis and diverticulosis
Hiatal hernia. Large hiatal hernias may be associated
Hemorrhoids. These are swollen veins in your anus or
with erosions in the stomach, leading to bleeding
lower rectum, such as varicose veins.
Peptic ulcers
Anal fissures. An anal fissure is a small tear in the thin,
Stomach cancer moist tissue that lines the anus

Symptoms Symptoms
Black or tarry stool. Bright red blood in vomit.
Paleness Dizziness or faintness.
Dizziness Feeling tired.
Bright red blood in vomit. Paleness.
Cramps in the abdomen. Shortness of breath.
Dark or bright red blood mixed with stool. Tachycardia
Dizziness or faintness. Paleness
Feeling tired. Dizziness
Paleness. Cramps in the abdomen.
Shortness of breath. Dark or bright red blood mixed with stool.
Vomit that looks like coffee grounds Black or tarry stool
Weakness
 Gastroıntestınal
Gastrointestinal

Gastrointestinal Bleed

Risk factors for upper GI bleeding: Risk factors for lower GI bleeding:
Upper gi bleeding, NSAID medicines
Anticoagulant use, Lack of timely screening for colon cancer and polyps
High-dose nonsteroidal anti-inflammatory drug use, Use of alcohol and smoking
Older age. Conditions that lead to the development of
angioectasias
Peptic ulcer bleeding,
Gastritis, esophagitis,
Variceal bleeding

Blood vessel
Complication: Hypovolemic Shock
Red bloodcells
Hypovolemic shock is an emergency condition in
which severe blood or other fluid loss makes the heart
unable to pump enough blood to the body.
This type of shock can cause many organs to stop
working.

Hypovolemic shock complications: White blood cell

Rapid breathing
Confusion plasma

Clammy skin
Sweating
Anxiety
Decreased or no urine output
Pale skin color
Symptoms of shock include:
Weakness or fatigue.
Gastrointestinal losses
Dizziness or fainting.
Other organ damage
Cool, clammy, pale skin.
Renal losses
Nausea or vomiting.
Tachycardia
Not urinating or urinating a little at a time.
Unconsciousness
A gray or bluish tinge to lips or fingernails.
Death
Changes in mental status or behavior, such as
Heart attack
anxiousness or agitation.
Hypotension
Unconsciousness.
Skin losses
Rapid pulse.
Brain damage
Rapid breathing.
Chest pain
Drop in blood pressure.
Weakness
Enlarged pupils.
Show less
 Gastroıntestınal
Gastrointestinal

Gastrointestinal Bleed

Complications Prevention

A gastrointestinal bleed To help prevent a GI bleed:

can cause:
Limit your use of nonsteroidal anti-inflammatory drugs.
Anemia
Limit your use of alcohol.
Shock
If you smoke, quit.
Death
If you have GERD, follow your health care team's instructions for treating it.
Respiratory distress
Heart attack
Infection
Nursing Interventions

Manage the bleeding.

TREATMENT
Correct the underlying cause.

Bleeding can be treated with medicine or a procedure Rest the bowel.

during a test. Administer oxygen as prescribed.
Reduce levels of stomach acid. Maintain hydration.
Protonix infusion: low acid to prevent further ulceration Transfuse blood products.
Isotonic fluids (NS or LR Reverse anticoagulation.
Help your blood clot. Administer medications as ordered.
Vitamin K: promote clotting Administer oxygen as needed
Relieve swelling. Stop NSAIDs, Aspirin & blood thinners
Continuous infusion therapy with a proton pump Maintain 2 large bore IV's
inhibitor (PPI) such as pantoprazole or esomeprazole
Make sure type & screen is current
Isotonic fluids (NS or LR)
Fall precautions
Treat a bleeding peptic ulcer during an upper
endoscopy or to remove polyps during a colonoscopy. (may have orthostatic hypotension from bleeding)

Diagnosis and Tests

Blood tests check for signs of GI bleeds, such as anemia, using a sample of your blood.
Fecal occult blood test (FOBT) is a lab test that checks for signs of blood in a poop sample.
CT scan
GI X-rays, take images of your upper or lower digestive tract to check for signs of a bleed or other conditions.
Upper endoscopy, is a procedure to examine symptoms of an upper GI bleed. It uses a long tube with a camera and
light at the tip (endoscope).
Balloon enteroscopy; is like an endoscopy. It uses long tubes and a camera. Tiny balloons at the endoscope tip inflate
to help providers examine hard-to-reach small bowel.
Colonoscopy or sigmoidoscopy, is a procedure to examine signs of a lower GI bleed.
Angiography is an imaging study that uses dye to make the GI tract’s blood vessels easier to see.
Capsule endoscopy involves swallowing a pill-sized camera. As it travels along the GI tract, it takes pictures. You
eliminate the camera through a bowel movement.
Radionuclide scan involves receiving a substance with safe levels of radioactive material.
 Gastroıntestınal
Gastrointestinal

Hepatitis

Nursing Assessment
In this section, we will cover subjective and
The first step of nursing care is the nursing assessment, objective data related to GI bleeding.
During which the nurse will gather physical, psychosocial,
Review of Health History:
emotional, and diagnostic data.
Assess for GI bleeding.

Review of Health History: Monitor for symptoms of shock.

Ask the patient about the current and past GI bleeding incidents. Perform an abdominal examination.

Review the patient’s medical history. Monitor the vital signs.

Review the patient’s medication regimen. Diagnostic Procedures

Assess the patient’s general symptoms related to GI bleeding Review serum lab values.

Portal hypertension Alcohol abuse Ulcers Obtain a sample for a stool exam.

H. pylori infection Smoking Assist with endoscopy.

Hepatitis
Hepatitis is an inflammation of the liver that is caused by a variety of
infectious viruses and noninfectious agents leading to a range of health
problems, some of which can be fatal.
Hepat It is
Liver Inflammation

Hepatitis can be caused by: Symptoms of hepatitis include:

Immune cells in the body attacking the liver. Pain or bloating in the belly area
Infections from viruses (such as hepatitis A, Dark urine and pale or clay-colored stools
hepatitis B, or hepatitis C), bacteria, or parasites.
Fatigue Loss of appetite
Liver damage from alcohol or poison.
Low grade fever Nausea and vomiting
Medicines, such as an overdose of acetaminophen.
Itching Weight loss
Fatty liver.
Jaundice (yellowing of the skin or eyes)

Memory Trick

Acute Hepatitis (Hep A & E) Chronic Hepatitis - Hep b, c & d (all consonants)
Immune cells in the body attacking the liver. inflammation of the liver that lasts at least 6
months.
Infections from viruses (such as hepatitis A,
hepatitis B, or hepatitis C), bacteria, or parasites. All transmitted through blood & body fluids.
Liver damage from alcohol or poison.
Medicines, such as an overdose of acetaminophen.
Fatty liver.
 Gastroıntestınal
Gastrointestinal

Hepatitis

Type Hepatitis A
Inflammation of the liver that can cause mild to severe illness.

Transmission: Diagnostics: Treatment:

It is spread primarily when a Detection of HAV-specific Stay hydrated.
person ingests the virus from immunoglobulin G (IgM)
Stay in bed,
food, drinks, or objects antibodies in the blood.
Avoid substances that stress
That have been contaminated Blood test.
your liver.
by small amounts of stool from
Liver function tests
an infected person; Keep in touch
IgM= active infection
Sex with an infected person,
+ IgG= past infection
It involves anal-oral contact;
(recovered)
Through injection drug use.
Reverse transcriptase
polymerase chain reaction
(RT-PCR) to detect the hepatitis
A virus

Symptoms: Causes: Risk factors:

Clay- or gray-colored stool Drinking contaminated water Travel or work in areas of the
world where hepatitis A is
Loss of appetite Eating food washed in
common
contaminated water
Low-grade fever
Live with another person who
Eating raw shellfish from water
Dark urine has hepatitis A
polluted with sewage
Joint pain Are a man who has sexual
Being in close contact with a
contact with other men
Yellowing of the skin and the person who has the virus —
whites of your eyes (jaundice) even if that person has no Have any type of sexual
symptoms contact with someone who has
Intense itching
hepatitis A
Having sexual contact with
someone who has the virus Are HIV positive
Are homeless
Use any type of recreational
Prevention: drugs
Hep A Vaccine
Hand hygiene
 Gastroıntestınal
Gastrointestinal

Hepatitis

Type Hepatitis B
Viral infection attacking the liver causing acute and chronic disease.

Transmission: Diagnostics: Treatment:

Spread when blood, semen, or Blood tests. Blood tests can Chronic hepatitis B can be treated
other body fluids from a person detect signs of the hepatitis B with medicines. ACUTE Supportive
infected with the virus enters virus in your body and tell your chronic Anti-virals
the body of someone who is provider whether it's acute or
Adefovir dipivoxil (Hepsera)
not infected. chronic.
Entecavir (Baraclude)
Childbirth, sex, IV drug use. + Anti-HBS= past infection
(recovered) Interferon alfa (Intron A)
Liver ultrasound. A special Lamivudine (3tc, Epivir A/F, Epivir
ultrasound called transient HBV, Heptovir).
electrography can show the
Pegylated Interferon
amount of liver damage.
Telbivudine.
Liver biopsy.
Tenofovir alafenamide
+ HBsAg= active infection.
These tablets are taken 6 to 12
months.
These tablets are taken 6 to 12
Symptoms: Causes:
months.
Fever Sharing needles and other
Tenofovir
injecting drug equipment
Loss of appetite
Sharing razors, toothbrushes or
Nausea and vomiting
nail clippers
Abdominal pain.
Sexual contact (either
Risk factors:
Weakness and fatigue heterosexual or homosexual)
Sex.
Joint pain Tattooing with unsterilized
needles and equipment Sharing needles. .
Dark-colored urine.
Close family contact with Accidental needle
Light or clay-colored poop.
someone who has hepatitis B
Mother to baby.
Blood transfusion
Hepatitis B doesn’t spread
through kissing, food or water,
shared utensils, coughing or
sneezing, or through touch.

Prevention:
Use condoms every time you have sex. Don’t share chewing gum, and don’t pre-chew food for
a baby.
Hep B Vaccine
Make certain that any needles for drugs, ear piercing
Wear gloves when you clean up after others, especially
or tattoos -- or tools for manicures and pedicures are
if you have to touch bandages, tampons, and linens.
properly sterilized.
Cover all open cuts or wounds.
Clean up blood with one part household bleach and 10
Don’t share razors, toothbrushes, nail care tools, or parts water.
pierced earrings with anyone.
 Gastroıntestınal
Gastrointestinal

Hepatitis

Type Hepatitis C
Viral infection attacking the liver causing acute and chronic disease.

Transmission: Diagnostics: Treatment:

Spread through contact with Albumin level Medications. ACUTE Supportive
blood from an infected person. chronic Anti- virals. Sofosbuvir
Liver function tests
Sharing needles or other Ledipasvir/ sofosbuvir
Prothrombin time
equipment used to prepare
Simeprevir
and inject drugs. Liver biopsy
Paritaprevir/
Childbirth, sex, IV drug use. Transient electrography using
ultrasound ombitasvir/ritonavir/ dasabuvir
+ Anti-HCV Daclatasvir
Magnetic resonance Elbasvir / grazoprevir
electrography (MRE)
Sofosbuvir/ velpatasvir
Most common Glecaprevir / pibrentasviR
among iv drug use
Sofosbuvir / velpatasvir
Voxilaprevir

Symptoms: Causes:
Pain in the right upper Inject street drugs or share a
abdomen needle with someone who has Risk factors:
HCV
Abdominal swelling due to fluid People who got donated blood
(ascites) Have been on long-term kidney or organ transplants.
dialysis
Clay-colored or pale stools Sexual partners of anyone
Have regular contact with blood diagnosed with hepatitis C
Dark urine infection.
at work (such as a health care
Fatigue worker)
People with HIV infection.
Fever Have unprotected sexual contact
Men who have sex with men.
with a person who has HCV
Itching Sexually active people about to
Were born to a mother who had
Jaundice start taking medicine to prevent
HCV
HIV, called pre-exposure
Loss of appetite prophylaxis or PrEP.
Received a tattoo or acupuncture
Nausea and vomiting with needles that were not
Anyone who has been in prison.
disinfected properly after being
used on another person
Received an organ transplant
Prevention: from a donor who has HCV

Stop using illegal drugs. If you Share personal items,

use illegal drugs, seek help. Received a blood transfusion
Hand hygiene
Sharp precautions
Be careful about body piercing and tattooing. For piercing or tattooing, look for a shop that's known to be clean.
No vaccine
Practice safer sex.
 Gastroıntestınal
Gastrointestinal

Hepatitis

Type Hepatitis D
Only occurs in people who are also infected with the hepatitis B virus. Causing acute and
chronic disease.

Transmission: Diagnostics: Treatment:

Spread when blood or other The diagnosis is based on signs Pegylated interferon alpha is
body fluids from a person and symptoms and confirmed the generally recommended
infected with the virus enters with a blood test treatment for hepatitis D virus
the body of someone who is infection.
+ Anti-HDV
not infected.
ACUTE Supportive chronic
+ HDAg (Hep D antigen)
Touch the open sores of Anti-virals
someone who has the virus PCR (polymerase chain reaction)
The first potentially effective
test in a pathology laboratory.
Occurs in conjuction with drug Bulevirtide (BLV)
Hepatitis B Positive serology indicates
previous exposure to hepatitis D
virus while PCR testing is used to
confirm the presence of the virus.
Remember b & d Risk Factors:
are best buds
Have hepatitis B
Are a man who has sex with
other men
Symptoms: Causes:
Often receive blood
Yellow skin and eyes (jaundice) This can happen two ways: transfusions
Stomach upset Co-infection: You can contract Use injectable or intravenous
HBV and HDV at the same time (IV) drugs, such as heroin
Pain in your belly
Super-infection: You can get Have hepatitis B
Throwing up
sick with hepatitis B first, then
Inject drugs
Fatigue later come down with HDV
Have sex with someone who
Not feeling hungry has hepatitis B or D
Joint pain Have HIV and hepatitis B
Dark urine Are a man who has sex with
Light-colored stool other men

Prevention:
Hand hygiene
Exclusion of people with hepatitis D from childcare,
Wear gloves if you have to touch someone else’s open
preschool, school and work is not necessary.
wound or sore.
Hepatitis B vaccination will prevent infection with
Don’t share chewing gum, and don’t pre-chew food for
hepatitis D. Don’t share needles if you inject drugs.
a baby.
If you already have hepatitis B, you can lower your risk
Make certain that any needles for drugs, ear piercing
of HDV. This means:
or tattoos -- or tools for manicures and pedicures are
Keep personal items like your toothbrush and razor properly sterilized.
separate.
Clean up blood with one part household bleach and 10
Hep B Vaccine parts water.
 Gastroıntestınal
Gastrointestinal

Hepatitis

Type Hepatitis E
A liver disease caused by the hepatitis E virus (HEV)and acute only.

Transmission: Diagnostics: Treatment:

Transmitted via the fecal-oral Doctor will use a blood test These steps can help ease your
route, principally via symptoms:
Stool test to diagnose hepatitis E.
contaminated water.
Rest
+ Anti-HEV
Contaminated food & water
Eat healthy foods
Drink lots of water
most common in 3rd Avoid alcohol
world countries

Symptoms: Causes: Risk Factors:

Mild fever Hepatitis E virus spreads through The most common source of HEV
poop. infection is contaminated
Feeling very tired
Contaminated drinking water Uncooked/undercooked pork or
Less hunger
deer meat.
Drink or eat something that has
Feeling sick to your stomach
been in contact with the stool of
Throwing up someone who has the virus.
Belly pain
Dark pee
Light-colored poop
Skin rash or itching
Joint pain
Yellowish skin or eyes

Prevention:
Don’t drink water or use ice that you don’t know is clean.
Don’t eat undercooked pork, deer meat, or raw shellfish.
Wash your hands with soap and water after you use the bathroom,
Full cook food
Hand hygiene
No vaccine.
 Gastroıntestınal
Gastrointestinal

Hepatitis

SYMPTOMS EDUCATION
Pain or bloating in the belly area. Wash your hands after going to the bathroom,
changing diapers, and touching garbage or dirty
Dark urine and pale or clay-colored stools.
clothes.
High level of ammonia and bilirubin
Wash your hands before preparing food and eating.
Fatigue. Get the hepatitis A vaccine
Low grade fever. Do not share personal hygiene products
Dark urine Get the vaccines for hepatitis A and hepatitis B.
Clay-colored stools Use a condom during sex.
Itching. Eat small, frequent meals
Jaundice Adequate rest (to allow liver to heal)
Abdominal discomfort Don't share needles to take drugs.
Jaundice (yellowing of the skin or eyes) Practice good personal hygiene such as thorough
hand-washing with soap and water.
Loss of appetite.
Don't use an infected person's personal items.
Nausea and vomiting.
Avoid liver toxic meds (Acetaminophen + Aspirin
Vaccines can prevent certain serious or deadly
infections.

NURSING INTERVENTIONS FOR HEPATITIS

Practice proper hand hygiene, isolation precautions, and appropriate use of personal protective equipment (PPE) can
help prevent the spread of hepatitis to others.
Encourage rest, adequate fluid intake, and eating small frequent meals to prevent nausea (low protein and fat).
Avoid alcohol and use medications with care.
 Gastroıntestınal
Gastrointestinal

Cirrhosis

Cirrhosis is severe scarring of the liver. This serious condition can be caused by many forms of liver diseases and
conditions, known as End Stage liver disease once at this stage damage is irreversible!

Stages of Cirrhosis Function of the Liver? Healthy Liver

Compensated and Filtration. Healthy liver, at left, shows no signs of scarring

decompensated cirrhosis.
Digestion.
Compensated cirrhosis:
Metabolism and
doesn't necessarily look or
Detoxification.
feel sick. Their symptoms of
the disease may be mild or Makes albumin
nonexistent even though
Detoxifies the body
the liver is severely scarred.
Metabolizes nutrients &
Decompensated cirrhosis:
drugs
Will feel and appear sick as
their liver is struggling to Protein synthesis. Healthy Liver
function.
Storage of vitamins and
minerals.
To make and secrete bile Cirrhosis
and to process and purify
the blood containing newly In cirrhosis, at right, scar tissue replaces
absorbed nutrients that are healthy liver tissue.
coming from the small
intestine.
Liver processes this blood & Build up of scar tissue prevents liver from
Healthy Liver breaks down, balances, functioning normally (becomes hard & stiff
and creates the nutrients from scarring).

Also connects to the hepatic

portal vein Blood vessel that
carries blood from GI tract,
spleen, gall bladder &
pancreas to the liver

Compensated cirrhosis
Cirrhosis Liver
(Stage three liver disease)

Cirrhosis is scarring (fibrosis) of the liver

caused by long-term liver damage.
The scar tissue prevents the liver working
properly.
Cirrhosis is sometimes called end-stage
liver disease because it happens after
other stages of damage from conditions
Decompensated cirrhosis
That affect the liver, such as hepatitis.
(Stage four liver disease)
 Gastroıntestınal
Gastrointestinal

Cirrhosis

Causes DIAGNOSTICS

Causes Include: Tests may include:

Long-term alcohol abuse. Blood tests. A panel of liver function tests can show
signs of liver disease and liver failure. These measure
Ongoing viral hepatitis (hepatitis B, C and D).
liver products like liver enzymes, proteins and bilirubin
Nonalcoholic fatty liver disease levels in your blood.
Hemochromatosis, a condition that causes iron Albumin & calcium (bind together)
buildup in the body.
Low Platelets
Autoimmune hepatitis,
Low PT/PTT & INR
Destruction of the bile ducts caused by primary biliary
Blood tests may also indicate specific diseases or
cholangitis.
known side effects, like reduced blood clotting.
Hardening and scarring of the bile ducts caused by
Imaging tests. Imaging tests like an abdominal
primary sclerosing cholangitis.
ultrasound,
Wilson's disease
CT scan or MRI can show the size, shape and texture of
Cystic fibrosis. your liver.
Alpha-1 antitrypsin deficiency. Electrography uses ultrasound or MRI technology to
measure the level of stiffness or fibrosis in your liver.
Poorly formed bile ducts, a condition known as biliary
atresia. Liver biopsy. A liver biopsy is a minor procedure to take
a small tissue sample from your liver to test in a lab.
Inherited disorders of sugar metabolism, such as
galactosemia or glycogen storage disease.
Alagille syndrome, a genetic digestive disorder.
Infection, such as syphilis or brucellosis.
Medications, including methotrexate or isoniazid.v

Risk factors

Drinking too much alcohol. Cystic fibrosis Toxins & hepatotoxic drugs
Being overweight. Biliary Cirrhosis (damage to biliary ducts) Having viral hepatitis
 Gastroıntestınal
Gastrointestinal

Cirrhosis

Symptoms
Fatigue.
Easily bleeding or bruising. Cancer

Loss of appetite. Cirrhosis

Nausea. Fatty

Swelling in the legs, feet or ankles, called edema. Fatty

Healthy
Weight loss. Liver
Itchy skin.
Yellow discoloration in the skin and eyes, called
jaundice.
Fluid accumulation in the abdomen, called ascites
Spiderlike blood vessels on the skin.
Redness in the palms of the hands.
Pale fingernails, especially the thumb and index finger.
Early signs
Feeling tired or weak.
Clubbing of the fingers, in which the fingertips spread
out and become rounder than usual. Itching of the skin.
For women, absence of or loss of periods not related to Fatigue
menopause.
Hepatomegaly
For men, loss of sex drive, testicular shrinkage or breast
Poor appetite.
enlargement, known as gynecomastia.
Losing weight without trying.
Confusion, drowsiness or slurred speech.
Nausea and vomiting.
Mild pain or discomfort over the liver in the upper right
side of the abdomen, or belly.
Late signs Muscle loss and weakness.
Yellow discoloration of the skin (jaundice) Muscle cramps.
Splenomegaly
Caput medusa (enlarged veins on abdomen)
Fluid retention with abdominal distension (ascites) Prevention
Leg swelling (edema) Lower your risk of cirrhosis by taking these steps to care for
Bleeding & easily bruised your liver:

Portal hypertension Eat a healthy diet: Choose a diet that's full of fruits and
vegetables.
Confusion (encephalopathy)
Maintain a healthy weight
Jaundice
Reduce your risk of hepatitis: Sharing needles and
Ascites having unprotected sex can increase your risk of
Bleeding from abnormal blood vessels hepatitis B and C.
 Gastroıntestınal
Gastrointestinal

Cirrhosis

Complications: Hepatic encephalopathy is brain dysfunction caused by

liver dysfunction. “Encephalopathy” is brain dysfunction, and
General toxicity, feeling ill, tired and foggy. “hepatic” means liver-related.
Reduced immunity, healing and recovery. High ammonia level in body causes toxic effects to brain.
Fluid leakage from your veins, causing swelling in It can affect your:
your body.
Mood and personality.
Hormonal imbalances and deficiencies.
Behavior and impulse control.
Hepatic encephalopathy
Memory, concentration and thinking.
Digestive difficulties, malabsorption and
malnutrition. Severe AMS

Mild cognitive impairment and motor dysfunction. Asterixis (flapping hand when extended

Life-threatening complications of cirrhosis and Consciousness, lucidity and sleep patterns.

portal hypertension can include: Coordination and motor functions.
Gastrointestinal varices and gastrointestinal
bleeding.
Spontaneous bacterial peritonitis.
esophageal varices IS Dilated submucosal distal esophageal
Kidney failure (hepatorenal syndrome). veins connecting the portal and systemic circulations.
Esophageal varices Risk factors:
Respiratory failure (hepatopulmonary syndrome). High risk for hemorrhage
Chronic liver failure. High portal vein pressure..
Liver cancer. Large varices.
No NGT tubes
No straining
Red marks on the varices
Severe cirrhosis or liver failure
Continued alcohol use
 Gastroıntestınal
Gastrointestinal

Cirrhosis

TREATMENT: Dietary changes:

Lifestyle changes Malnutrition is common in people with cirrhosis, so it's

important you eat a healthy, balanced diet to help you get all
If you have cirrhosis, there are several lifestyle the nutrients you need.
changes you can make to reduce your chances
of further problems and complications. These Cutting down on salt can help reduce the chance of swelling in
include: your legs, feet and tummy caused by a build-up of fluid.

Avoid alcohol The damage to your liver can mean it's unable to store
glycogen, which is a type of fuel the body needs for energy.
Quit smoking
When this happens, your muscle tissue is used for energy
Lose weight if you're overweight or obese between meals, which leads to muscle loss and weakness. This
Do regular exercise to reduce muscle loss means you may need extra calories and protein in your diet.

Practice good hygiene to reduce your chance Eating healthy snacks between meals, or having 3 or 4 small
of getting infections. meals each day, rather than 1 or 2 large meals, may help.

Procedures Medicines:
Paracentesis: drain fluid in peritoneum (ascites) To ease the symptoms of cirrhosis, such as:
Liver transplant Diuretics, which are used in combination with a low-salt diet to
reduce the amount of fluid in body, which helps with swelling
(edema)
Lactulose: low ammonia
Bleeding Precautions
Albumin: low scites & edema: Causes loss of ammonia through
Use a soft toothbrush and nonabrasive stool & deemed effective when patients mental status improves
toothpaste.
Medicine to help with high blood pressure in the main vein that
Avoid using toothpicks and dental floss. takes blood to the liver (portal hypertension)
Avoid rectal suppositories,. Prescription creams to ease skin itching
Avoid the Valsalva maneuver
Electric razor
Monitor for bloody stools
 Gastroıntestınal
Gastrointestinal

Acute Liver Failure

Acute liver failure

Cirrhosis is severe scarring of the liver. This serious condition can be caused by many forms of liver diseases and
conditions, known as End Stage liver disease once at this stage damage is irreversible!

Acute Liver Failure Causes

Loss of liver function that occurs quickly in days or May cause:

weeks usually in a person who has no preexisting liver
The overuse of certain drugs or toxins, like
disease.
acetaminophen
It's most commonly caused by a hepatitis virus or
Viral infections, such as Hepatitis A,D,E B.
drugs, such as acetaminophen.
Loss of appetite
Budd-Chiari syndrome (clot blocks hepatic veins)
Medical Emergency Wilson’s disease (elevated copper levels)
Vomiting blood
Chronic liver disease (CLD) is a progressive
Blood in the stool
deterioration of liver functions for more than six
months, which includes synthesis of clotting factors, Extreme tiredness
Other proteins, detoxification of harmful products of pregnancy).
metabolism, and excretion of bile.
Disorientation (confusion and uncertainty)..
Bleeding.

For diagnosis must have Shock

Changes in mental status.
& onset: <26 WEEKS
Acute liver failure is characterized by: Musty or sweet breath odor.
(unless reactivation
jaundice, of hepatitis or Movement problems...
Wilson's disease)
Coagulopathy,
Encephalopathy.
SYMPTOMS
Acute liver injury (LOW LFT)
Confirm the diagnosis by finding prolongation of INR Bleeding.
and clinical manifestations of encephalopathy in
patients with hyperbilirubinemia and elevated Changes in mental status.
aminotransferase levels. Musty or sweet breath odor.
Movement problems.
Loss of appetite.
Complications General feeling of being unwell.
Liver failure can affect many of your body’s organs. Jaundice.
Acute liver failure can cause such complications as
Jaundice (yellowing of your skin and eyes).
Sepsis Risk of infection,
Hepatic Encephalopathy
Electrolyte deficiencies
Ascites
Bleeding
Extreme tiredness.
Hypoglycemia: Liver stores glycogen
Disorientation (confusion and uncertainty).
Cerebral edema: Due to elevated ammonia
Fluid buildup in your abdomen and extremities (arms
Without treatment, both acute and chronic liver and legs).
failure may eventually result in death.
 Gastroıntestınal
Gastrointestinal

Acute Liver Failure

DIAGNOSTICS LAB Values in Acute

Liver Failure
Diagnoses liver failure based on your symptoms, your
medical history and the results of tests (blood tests, Prothrombin time/INR Lactate Increased
urine tests, abdominal imaging).
Blood cultures: assess for infection Hemoglobin& platelets Low

CT scan/ MRI ultrasound Liver function tests (AST, ALT, Elevated

Laboratory tests to confirm the presence and severity alkaline phosphatase, GGT)
of liver failure include liver enzyme and bilirubin levels
and INR Total bilirubin & ammonia Elevated

Treatment NURSING INTERVENTIONS

Find & treat underlying cause! Will need ICU management
Treatment includes changes to your diet and lifestyle, Reduce the development of complications.
including:
Encourage the patient to act on alcohol dependency
Avoiding alcohol or medications that can harm your
Achieve the ideal weight.
liver.
Q1 neuro checks
Eating less of certain foods, including red meat,
cheese and eggs. Continuous VS & heart monitoring
Weight loss and management of metabolic risk Control viral hepatitis. ..
factors, including high blood pressure and diabetes
Prepare for possible intubation
Cutting down on salt in your diet (including not
Bleeding precautions.
adding salt to food).
Manage the symptoms.
For acute (sudden) liver failure, treatment includes:
Improve malnutrition.
Intravenous (iv) fluids to maintain blood pressure.
Anticipate the possibility of TPN use.
Medications such as laxatives or enemas to help flush
toxins (poisons) out. Keep HOB elevated 30 degrees
Blood glucose (sugar) monitoring. Your provider will Manage pain.
give you glucose if your blood sugar drops.
ICP monitoring
You may also receive a blood transfusion if you are
bleeding excessively, or a breathing tube to help you I&O
breathe.
MEDICATIONS
Caused by acetaminophen overdose is treated with a GRADES of ENCEPHALOPATHY
medication called acetylcysteine.
Encephalopathy is a group of conditions that cause
Antidotes (e g, penicillin g, silibinin, brain dysfunction. Brain dysfunction can appear as:
Activated charcoal, n- acetylcysteine) Confusion,
Ffp or vitamin k for bleeding Memory loss,
Lactulose: low ammonia Personality changes
Osmotic diuretics (e g, mannitol) barbiturate agents Coma in the most severe form.
(e g, pentobarbital, thiopental)
Procedures
Emergent liver transplant (in severe cases)
 Gastroıntestınal
Gastrointestinal

Acute Liver Failure

Four Grades of Encephalopathy

Grade Characteristics

Grade I Changes in behaviour with minimal change in level of consciousness.

Grade II Gross disorientation, drowsiness, possibly asterixis, inappropriate

behaviour.

Management

Consider listing for transplant and transfer to tertiary referral center

Consider CT to rule out other causes
Avoid stimulation (can raise intracranial pressure) and sedatives
Monitor and treat any infection
Consider lactulose (thought to play a role in reducing ammonia load thereby preventing worsening
of encephalopathy)

Grade III Marked confusion, incoherent speech, sleeping most of the time but
rousable to vocal stimuli

Grade IV Comatose, unresponsive to pain, decorticate or decerebrate posturing

Management

Intubation and sedation

Head elevation
Consider ICP monitor if listed for transplant
Treat seizures
Mannitol and hyperventilation only if herniation imminent or severe raised ICP
Barbiturates for refractory raised ICP
 Gastroıntestınal
Gastrointestinal

Bowel Obstruction

Bowel obstruction A bowel obstruction is a partial or complete blockage

of small intestine or large intestine (bowels).
What is it?
Bowel obstruction (blockage) is when food and liquids
can't move through your intestines (gut).
It can be caused by many things, most commonly
tumors such as bowel cancer, or other health
conditions, such as hernias and adhesions.

Blockage can be partial or complete

Partial: Bowel is partly blocked and some faeces (poo)

can still get through.

Complete: Bowel is partly blocked and some faeces

(poo) can still get through medical emergency. 1
2

medical emergency

If blood flow to your intestine is completely and 1 Large intestine 2 Small intenstine
suddenly blocked, intestinal tissue can die
(gangrene).
A hole through the wall of the intestines (perforation).
A perforation and shock can develop, which can
cause the contents of the intestine to leak into the
abdominal cavity.
This may cause a serious infection (peritonitis)
 Gastroıntestınal
Gastrointestinal

Bowel Obstruction

EDUCATION

1. Mechanical BOWEL OBSTRUCTION

The obstruction occurs when the lumen of the bowel becomes either partially or completely blocked.
Physical blockage in bowel preventing movement

Adhesions or scar tissue that Intussusception (telescoping of one segment of bowel

form after surgery into another)

The blood supply might be when one part of the bowel

compromised, and the bowel slides into
tissues might die.
The next, much like the pieces
This is a life-threatening of a telescope.
situation.
When this "telescoping" happens: The flow of fluids and
The small bowel constantly moves digested food and
food through the bowel can get blocked. The intestine
stomach juices forward from the stomach to the colon.
can swell and bleed.

Gallstones (rare)
Foreign body
Gallstone ileus is one of the
rarest forms of all mechanical If the ingested foreign body
bowel obstructions and is a causes obstruction or injury,
complication of cholelithiasis. presenting symptoms:

Diarrhea
Volvulus Constipation
Volvulus occurs when a loop Vomiting
of intestine twists around itself
and the mesentery that Hematemesis
supplies it, causing a bowel Deceased appetite Can include abdominal pain
obstruction.

Hernias Tumors blocking the intestines

Inguinal or femoral hernias. Tumors that block the intestines.
These hernias can trap a Scar tissue or adhesions (bands of scar
portion of the intestine, tissue that bind tissue together)
causing a blockage.
That form after surgery to the small or
Symptoms of a bowel obstruction may include: Severe large intestines.
abdominal pain. Damage to the intestine from radiation

Impacted Stool
Cause of lower gastrointestinal tract obstruction lagging
behind stricture for diverticulitis and colon cancer. Tumors
 Gastroıntestınal
Gastrointestinal

Bowel Obstruction

2.Functional bowel obstruction

There is no physical blockage, however, the bowels are not moving food through the digestive tract.
Muscles & nerves not working properly & disrupt peristalsis.

The large and small bowels move in coordinated contractions. Some people refer to nonmechanical obstructions
Trusted Source as dynamic or paralytic ileus causes of nonmechanical bowel obstructions include:

Scarring from abdominal or pelvic surgery Nerve and muscle disorderstrusted source such as
parkinson’s disease
Diabetes
Severe infection or illness
Electrolyte imbalances
General anesthesia
Hypothyroidism
Certain pain relief medications
Hirschsprung’s disease

Some conditions and events increase the risk of a bowel obstruction occurring, such as:

Cancer, especially in the abdomen Previous abdominal or pelvic surgery, which may
increasetrusted source the risk of adhesions
Crohn’s disease
Radiation therapy
Ulcerative colitis

Stages of Bowel Small bowel obstruction Large bowel obstruction

Obstructions Severe pain in your belly. Crampy abdominal

Complete obstructions: pain that comes
Severe cramping sensations in your belly.
and goes.
Severe bowel obstruction can Throwing up.
entirely block part of the Loss of appetite.
intestine. Feelings of fullness or swelling in your belly.
Lower abdominal
Partial obstructions: Severe fluid & electrolyte imbalances cramping

A partial bowel obstruction is Metabolic alkalosis Abdominal

typically less severe. These distention
Loud sounds from your belly.
obstructions block some, but Vomiting fecal
not all, of the intestine. Feeling gassy, but being unable to pass gas.
matter (late sign)
Pseudo obstruction: Constipation (being unable to pass stool)
Constipation.
Intestinal pseudo-obstruction is nausea and vomiting
Vomiting.
a rare condition Trusted Source Diarrhea
that causes the symptoms of Inability to have a
bowel obstruction without the Bloating bowel movement
presence of a blockage. or pass gas.
Cramping
Swelling of the
Decreased appetite abdomen.
Inability to pass
stools or gas
Key Points
Severe pain
Hyperactive BS above blockage Abdominal swelling
Hypoactive BS below blockage
 Gastroıntestınal
Gastrointestinal

Bowel Obstruction

DIAGNOSTICS TREATMENT
Medical history partial obstructions may resolve without surgery
treatment may include:
Physical examination: They may use a stethoscope to
listen for bowel sounds that signal an obstruction. Intravenous (IV) fluids: You may need IV fluids and
electrolytes to treat dehydration.
Blood tests: A blood test checks for signs of infection.
Electrolyte levels can show if you have severe Nasogastric tube: You may need a nasogastric tube
dehydration. to suction out fluids and air backed up from the
blockage.
Endoscopy: in which a doctor uses a special camera
to look inside the gut Medications: Anti-emetics to prevent nausea and
vomiting and pain relievers to keep you more
CT scans
comfortable.
Abdominal x-ray: Assess for presence of gas or fluid
Antibiotics: For infection.
X-rays
Medication: Opioids can lead to constipation. If this
contrast enemas occurs, laxatives and stool softeners can help.
Barium enema X-ray: A barium enema X-ray is an Bowel rest
X-ray of your colon
NGT placement: For gastric decompression.
Colon resection: Removal of part of the colon.
Surgery
NURSING INTERVENTIONS
Schedule surgery immediately.
Administer pain medications as ordered. NURSING ASSESSMENT
Start fluid resuscitation. Determine the patient’s general symptoms
Monitor the output.
Abdominal distension Vomiting
Ostomy care + education (also contact wound care RN)
Bloating Constipation
Emotional support
Nausea Assess the patient’s pain level
Provide comfort measures.
Assess nonverbal Assess changes in vital signs
Cluster nursing care with pain medication. pain cues
Decompress the bowel.
Assess for changes in bowel habits. Determine the risk
Prepare for surgery. factors. Assess for risk factions in pediatric patients.
Intestinal decompression, and bowel rest.
Intussusception Congenital atresia
Monitoring of the patient's hydration status.
Pyloric stenosis
Measure the patient's abdominal girth every 4 hours to
observe the progress of an obstruction. Obtain a thorough history

Hernias Inflammatory bowel disease

EDUCATION ABG's VS & heart monitoring

Try eating smaller meals more often throughout the day. Cancer Initiate antibiotics
preoperatively
Chew your food very well. I&O
Previous abdominal surgery
Try to chew each bite until it is liquid. Monitor the output.

Avoid dried fruits, nuts and seeds. Decompress the bowel.

Strain fruit and vegetable juices and soups. Start fluid resuscitation.

Low fiber 6-8 weeks Manage the Pain and Nausea

Avoid foods that cause gas

Avoid wholegrain, high fibre breads and cereals
RENAL & URINARY
 Renal / Urinary

Renal System Overview

Renal functions:
The renal system, also known as the URINARY SYSTEM, is a
complex network of organs responsible for maintaining
the body's fluid and electrolyte balance, as well as Pneumonic: WAVE
eliminating waste products from the blood.
Waste:
Filtration: Removal waste products like urea, creatinine,
and toxins.
Kidneys receive 20-25% of all blood pumped by the
Excretion: Elimination of waste products.
heart.
Kidneys filter 8 liters of blood in an hour. Acid/Base:
Only one donated kidney is enough to substitute both Regulation: by excreting acid and generating
failed kidneys. bicarbonate.

Kidneys continue performing until they have lost 75 – Electrolyte balance: Regulate it for proper nerve
80% of their functionality. and muscle functions.

Involve in active Vitamin D production, that is Volume:

necessary for calcium absorption in body. Fluid balance: It controls fluid volume in the body.
Blood pressure: By regulating fluid volume.

Nephron Endocrine:
Hormone production: It produce several hormones,
including erythropoietin & renin.
The nephron, a microscopic tube within the kidney, is the
Vitamin D activation: It activate vitamin D for bone
functional unit responsible for filtering blood, balancing
health.
fluids, and removing waste products from the body.

Each kidney contains approximately one million

nephrons. Human kıdney
Kidneys are a special filter system of body

Renal capsule
Functions of Nephron with parts: Renal coretex
Pneumonic: GRIP-SACT Renal medulla
G: Glomerulus - Filtration
R: Reabsorption - Proximal tubule Renal artery
I: Ions - Loop of Henle
P: Potassium - Distal tubule
S: Secretion - Distal tubule Renal veın
A: Acid-base balance - Distal tubule Renal pelvıs
C: Concentration of Urine- Collecting duct
T: Transport of urine- Collecting duct
Ureter
 Renal / Urinary

Urinary Assessment

Renal functions: 2. Reabsorption:

Urine is formed in NEPHRONE. It consists of 4 steps: Essential substances are reabsorbed from the filtrate.
Pneumonic: FRASE
These are returned to the bloodstream, ensuring that
F-Filtration Ra-Reabsorption valuable components are not lost in the urine.
S-Secretion E-Excretion

3. Secretion:
1. Filtration:
Certain substances are actively transported from the
blood into the renal tubules to be added to the urine.
Blood flows into the GLOMERULUS through the afferent
arteriole and undergoes filtration there.

GFR: The GLOMERULAR FILTRATION RATE (GFR) refers to

the volume of fluid that is filtered by the glomerulus of 4. Excretion:
the kidney per unit of time.
GFR Normal vale: 90-120 mL/min per 1.73 m². The concentrated urine is then excreted from the body
through the ureters, stored in the bladder, and eventually
eliminated through the urethra.

Renin-Angiotensin- Na+ & water

Aldosterone System RAAS Blood flow to kidneys
retention in
Kidney sensors detect combination with
BP initiates the RAAS system vasoconstriction
WHAT IS IT…? blood pressure

It is a multi-organ & complex hormonal

system that plays a crucial role in regulating
blood pressure, fluid balance, and electrolyte
levels in the body.
Angiotensinogen
Key Components of RAAS Vasoconstriction
Renin
Kidney
Sensors: Juxtaglomerular apparatus (JGA) in the
kidneys macula densa in the distal tubules.
Effector: Juxtaglomerular cells. Angiotensin I
ACE
Vessels
Signaling cascade:
Renin Angiotensin I
Angiotensin II
Target effects:
Lung
Angiotensin II Vasoconstriction Aldosterone
release ACE is angiotensin
Aldosterone: Adrenal gland
converting
Sodium and water reabsorption enzyme released
by lungs
Negative feedback Kidney
Positive feedback

Aldosterone Reabsorption of
NaCl and H2O
 Renal / Urinary

Urinary Assessment

Typical urine production

Ureters
Adult urine output is 800 to 1500 ml of urine per/day.
Average rate of approximately 25 to 30 ml/hr.
Infants-750 ml/24 hours. Urine
Bladder
Normally urine is STERILE (germ-free) & is composed of water, salts and
waste product. Smooth muscle
Urethra

Urine colors with their interpretation

Bright yellow Pale Yellow or clear Purple

Very Good
An excess of Healthy and Porphyria, a rare
vitamin B hydrated metabolic disorder
Good

Orange Red Brown

Fair
Dehydration Blood in urine Certain antipsyhotic
Light Dehydrated drugs
Certain drugs Eating beetroot or
and medications blackberries Certain antibiotics
(e.g. Rifampin,
Dehydrated Phenytoin
pyridium)
Sennoside laxatives
Dietary factors, Green
Very Dehydrated
such as eating
lots of carrots Drugs containing phenol Biliverdin, a bile pigment
Severe Dehydrated Some antidepressants Certain infections
Dyes in food

Normal lab values for urinary assessment

GFR (Glomerular filtration Rate) Stage of chronic kidney disease GFR % of kidney
function
It measure of the amount of blood
that passes through the glomeruli Stage 1 Kidney demaged with normal 90 or higher 90-100%
per minute. kidney function

Normal GFR values: 90 to 120

mL/min/1.73 m². Kidney demaged with mild 89 to 60 89-60%
Stage 2 loss of kidney function
Age-specific variations: GFR naturally
decreases with age. Low GFR indicates
low urine excretion & accumulation of MIld to moderate loss of 59 to 45 59-45%
Stage 3a kidney function
wastes & toxins in the body.

Moderate to severe loss of 44 to 30 44-30%

Interpreting GFR results Stage 3b kidney function

Stage 4 Severe loss of kidney function 29 to 15 29-15%

Your GFR number tells you how much kidney
function you have. As kidney disease gets
worse, the GFR number goes down. Stage 5 Kidney failure less than 15 less than 15%
 Renal / Urinary

Urinary Assessment

Creatinine
Creatinine is a result of muscle tissue Role of creatınıne İn renal assessment
breakdown normal creatinine values ın urıne
24-hour collection:
High Creatinine Low Creatinine
Males: 955-2,936 mg/day
Kidney disease/CKD Low muscle mass
Females: 601-1,689 mg/day
Dehydration Pregnancy
In blood High-protein diet Liver disease
Males: 0.6 to 1.1 mg/dL (for males normal
Heart failure Low dietary intake of proteins
value varies from 1.1 to 1.2 mg/dl).
Creatinine supplements
Females: 0.5 to 1.1 mg/dL
Muscular dystrophy & ıncreased muscle mass
Infants: >0.2 mg/dL
Person with one kidney: >1.8 to 1.9 mg/dL

BUN (blood urea nitrogen)

A product of protein metabolism: High BUN Low BUN

Hıgh values show kıdney dısease Kidney disease & urine obstruction Liver impairment
Low values show lıver dısease Dehydration Excessive fluid intake

Normal BUN Values: Liver impairment Insufficient dietary intake

Generally: 7-20 mg/dL (milligrams per Too much intake of protein

deciliter). GI bleeding
Age-specific variations: Levels naturally
decrease with age.
Children: 7-20 mg/dL Adults: Males: 8-24 mg/dL Females: 6-21 mg/d

Normal urine values

Specific gravity Urine osmolality
A measure of the concentration of solutes (dissolved Measures the number of dissolved particles (osmoles) per
particles) in urine. Normal range: 1.005 to 1.030. kg of water in urine.
Higher than 1.030: indicate dehydration or It is a more precise measure of urine concentration but
excessive protein in the urine & concentrated urine. not a part of routine urinalysis.
Lower than 1.005: may indicate over-hydration, It is measured to determine any abnormalities.
diabetes, or certain kidney diseases & indicates
dilute urine. Normal urine osmolality values:
Water has specific gravity=1. Adults: 50 to 1200 milliosmoles per kg(mOsm/kg)
As the specific gravity (SG) of urine decreases, it Children: 300 to 1200 mOsm/kg
approaches that of water.
Interpretation of Results:
Specific gravity reflects the overall "weight" of particles Higher than 300= Concentrated Lower than 300= Dilute
in urine, while osmolality only counts the actualnumber
of individual particles.
 Renal / Urinary

Urinary Assessment

pH: acid-base balance of urine (distinct from blood pH).

Normal range: 4.5 to 8.0
Lower than 4.5: Indicate metabolic acidosis, certain kidney diseases, or excessive intake of vitamin C.
Higher than 8.0: Indicate metabolic alkalosis, UTIs, or kidney stone.

Protein:
Normal range: Less than 50 mg/dL.
Higher than 150 mg/dL: May indicate kidney damage, preeclampsia, or multiple myelom.

Ketones:
Negative: Normal.
Positive: Indicate uncontrolled diabetes, diabetic ketoacidosis, or starvation.

Bilirubin:
Must be absent in urine If present indicates liver impairement, Bile duct problems, Gilbert's syndrome.

Nitrites:
Indicator of Urinary tract infection.

Red blood cells (RBCs):

Normal range: Less than 3 per hpf.
Higher than 3 per hpf: May indicate hematuria, caused by UTIs & tumor.

Glucose:
Negative: Normal.
Positive: Indicate diabetes, gestational diabetes, or certain metabolic disorders.
 Renal / Urinary

Urinary Assessment

Urinary Assessment Tests and Associated Terminology

Terminology Description Relevance to Urine Assessment Tests

Absence of urine production

Anuria Indicates severe kidney dysfunction
Urine output <50 mL/day

Decreased urine output. Urine Suggests decreased kidney function, dehydration, or

Oliguria
output <20 mL/hour or 400 mL/day other issues

Hemorrhagic urine (appearance Can be detected through urinalysis dipsticks, microscopic

Hematuria
of blood) examination, or cystoscopy

Elevated levels of protein in Can indicate kidney damage or other conditions

Proteinuria
the urine

May be linked to sleep disorders, medications, or

Nocturia Excessive urination at night
underlying health conditions

Dysuria Pain during urination Can be caused by UTIs, bladder stones, or inflammation

Urgency Abrupt and intense urge to urinate Described by the patient

Requiring more frequent urination Reported by the patient and evaluated with bladder diary,
Frequency
than usual pad tests, or urodynamic studies.

Reported by the patient and evaluated with bladder diary,

Incontinence Impaired bladder function
pad tests, or urodynamic studies.
 Renal / Urinary

Acute Kidney Injury

Acute Kidney Injury

What is it? Categories of AKI

Renal: Damage within the
Akı formerly known as acute renal faılure a sudden and kidney structure.
rapid decline in kidney function that is reversible . It
develops over hours or days leads to the accumulation of Prerenal: Marked decrease
waste, fluids, and disruptions in electrolyte balance may in renal blood flow.
result in chronic kidney disease, which becomes irreversible Postrenal: obstruction of
without prompt treatment. urine outflow.

Feature Pre-renal Intra-renal Post-renal

Type Injury precedıng kidney Direct ınjury to the kidneys. Injury following the
damage & reduced blood kidneys blockage
Very severe.
flow to kidneys.
Urine refluxes into
the kidneys.

Cause of Injury Severe & sudden reduction Infections & inflammation: Blockage of urine flow
in BP (Hypotension) due to glomerulonephritis, lupus
Renal stones
shock, hypovolemia, blood nephritis.
loss, dehydration. Cervical cancer
Drugs & toxins: nephrotoxins
Reduced cardiac output, (antibiotics including Meatal stenosis
heart failure, Myocardial gentamycin & vancomycin, CT
infarction. scan dyes), heavy metals, Retroepritoneal
recreational drugs. fibrosis
Vascular occlusion, tumor,
emboli. Injury: Rhabdomyolysis (release Tumors
of myoglobin due to damaged Benign prostatic
tissue that cause injury to hyperplasia
kidneys).
Prostate cancer
Acute tubular necrosis
Stroke
Autoimmune disease
Reduced blood supply
Small vessel vasculitis

Symptoms Decreased urine output, thirst, Edema, confusion, blood in urine, Painful urination,
fatigue. difficulty urinating. urinary tract infections,
bladder fullness.

Diagnosis Blood tests, urinalysis, Blood tests, urinalysis, kidney biopsy. Imaging tests, urinalysis,
ultrasound. catheterization.

Prognosis Often reversible with prompt More variable, depends on severity May be reversible if
treatment. of injury. blockage removed early.
 Renal / Urinary

Acute Kidney Injury

Phase Urine Output Diagnosis Complications Symptoms Duration

Initiation Normal or Slightly vary from Reduced urine output Few or no Hours to
Initial injury slightly normal symptoms days
Fluid overload
decreased
Electrolyte imbalances
Metabolic acidosis

Oliguric / Significantly Electrolyte Uremia Nausea, vomiting, Days to

Anuric decreased imbalances fatigue, confusion, weeks
Glomerulus not Increased risk of
(<400 ml/day) swelling
functioning Specific gravity infections
appropriately Bun & creatinine High Serum Creatinine
Edema High blood urea
nitrogen
Hypertension
Electrolyte disturbance
Metabolic acidosis

Initiation Significantly Specific gravity Fluid overload Improved Days to

Kidneys are increased symptoms, but fluid weeks
Lab values Electrolyte
flushing out (>2liters/day) and electrolyte
beginning to imbalances
fluid & waste. imbalances
correct
Acute tubular possible
necrosis

Recovery Normal Returning to Incomplete Gradual Weeks to

Returning to Normal recovery improvement of months (or
normal symptoms longer)
gradually Cardiovascular
sometimes
complications
persists
Long-term leading to
health issues CKD
 Renal / Urinary

Acute Kidney Injury

Susceptibilities for AKI Treatment

Elderly Find & treat underlyıng cause
Addressing the source of inadequate blood flow (prerenal)
Diabetes
Stopping or modifying medications that could be harming
Chronic kidney disease
the kidneys (intrarenal)
Dehydration or volume depletion
Relieving blockages in the urinary tract (postrenal)
Chronic disease (heart, liver)
Fluid management and electrolyte balance
Female gender & anemia
DIALYSIS if kidney function is severely compromised
Cancer
Medications: Diuretics, Antihypertensive, Sodium Bicarbonate

Main Pathogenesis of AKI Nursing Interventions

Elderly Monitoring vital signs, urine output, and laboratory values
closely.
Diabetes
Providing adequate hydration and electrolyte balance.
Chronic kidney disease
Administering medications as prescribed.
Dehydration or volume depletion
Managing pain and nausea.
Chronic disease (heart, liver)
Preventing infections and skin breakdown.
Female gender & anemia
Educating patients and families about AKI and its
Cancer
management.
 Renal / Urinary

Chronic Kidney Disease

What is it? Causes

It is a gradual and irreversible decline in kidney function Diabetes mellitus (type 1 & 2)
over time. Damage is measured by GFR calculation. Long term
High blood pressure
damage
Autoimmune diseases

Symptoms Glomerulonephritis (inflammation of the kidney

filters).
Polycystic kidney disease (genetic cysts in
Early stages (often symptom-free) kidneys).
Later stages (when symptoms may appear) Prolonged use of certain medications(
nephrotoxic drugs).
General:
Urinary tract infections (repeated, untreated).
Fatigue and weakness
Congenital kidney abnormalities.
Loss of appetite
Elder age (lose of organs’ functions with time).
Trouble sleeping
Impaired cognitive function
Itchy and dry skin
Urea crystals on skin (uremic frost) Diagnosis
High blood pressure
Swelling in hands, feet, and ankles(uremic frost or Imaging Studies:
pruritus)
Ultrasound CT scan or MRI
Shortness of breath
Laboratory Tests:
Muscle cramps
Metallic taste Urinalysis: It checks for abnormalities in urine,
such as the presence of protein or blood.
Pruritis
Metabolic acidosis Evaluation of Ions & Electrolytes:

Urinalysis: (K), (Cl), (Ca), (P), (HCO3)

Urinary:
Foamy urine Urine test: (Na), (K), (Cl), (Ca)

Increased urination at night HGB, HCT: (decrease levels Show CKD)

Decreased urination Evaluation of Ions & Electrolytes: It estimates the

glomerular filtration rate (GFR).
Blood in the urine

Advanced stage: Blood sample 24 hour urine

Heart disease & arrhythmias taken sample collected
Stroke
Creatine
Bone disease
Anemia First specimen is discarded
Specimen kept on ice
 Renal / Urinary

Chronic Kidney Disease

Stage GFR (ml/min /1.73m²) Description Potential complications

Mild damage,
1 > 90 normal or May progress to later stages.
increased GFR

Mild to moderate Few symptoms, but increased risk of

2 60-89
decrease in GFR progression.

Moderate decrease May show some symptoms, increased risk of

3a 45-59
in GFR complications.

3b 30-44 Moderate to severe Symptoms become more noticeable, higher risk

decrease in GFR of complications.

Severe decrease in Significant symptoms, dialysis or transplant may

4 15-29
GFR be needed.

5 < 15 or dialysis Kidney failure Dialysis or transplant required.

Stages of CKD

Stage 1 Stage 2 Stage 3 Stage 4 Stage 5

 Renal / Urinary

Chronic Kidney Disease

Treatment

Manage underlying cause: treat diabetes, high blood pressure, etc.

Medications:, ESAs, phosphate binders, statins, sodium bicarbonate.

Epoetin alpha: RBC production.

Calcium gluconate: potassium quickly.
Antihypertensive: ACE inhibitors, ARBs.
Diuretics: excess fluid.

In the case of DANGEROUSLY high potassium levels, administer intravenous D50 and regular insulin to rapidly reduce
potassium.

Kayexalate: potassium

Diet: Low-protein, low-sodium, low-potassium diet to reduce workload on kidneys.

Lifestyle changes: Smoking cessation, weight management, exercise.
Dialysis: Filters waste products and fluid from blood when kidneys fail.
Kidney transplant: Replacing diseased kidneys with healthy ones.

Contraindications

High sodium ıntake Magnesium containing NSAIDs

Excessive protein ıntake antacids (TUMS) Tobacco and smoking
High phosphorus foods Excessive fluid ıntake High oxalate foods
Potassium-rich foods Alcohol Uncontrolled blood sugar levels

Nursing Interventions

Monitor vital signs, laboratory values, and fluid balance.

Educate patients about CKD and manage self-care.
Provide emotional support and address concerns.
Prevent and manage complications like anemia, bone disease, and malnutrition.
Prepare patients for dialysis or transplant if needed.
Diet

Sodium Potassium Phosphate Protein Limit fluids

 Renal / Urinary

Benign Prostatic Hyperplasia

BPH also known as benign prostatic hypertrophy, is a Benign Prostatic

non-cancerous enlargement of the prostate gland. An Normal Prostate Enlargement (BPH)
enlarged prostate exerts pressure on the bladder and
urethra, resulting in obstruction of urinary flow.

Benign: Not cancerous. Urine

Prostatic: Prostate gland. Prostate Urine Enlarged
Hyperplasia: An abnormal increase in the number Urethra Prostate
of cells.

Causes Symptoms
Age: common in older men >50 Frequent urination: Needing to urinate more often than usual,
especially at night (nocturia).
Family history
Urgency: Feeling a sudden, strong need to urinate.
Hormonal changes: particularly an
increase in estrogen & Hesitancy: Difficulty starting urination.
dihydrotestosterone (DHT)
Weak stream: Having a weak or slow urine stream.
Obesity
Dribbling: Leaking urine after urination.
Lack of physical activity
Incomplete emptying of bladder.
Medical conditions such as diabetes
Urinary tract infections (UTIs): Increased risk of UTIs due to urine
and heart disease retention.
Erectile dysfunction All manifestations arising from PARTIAL OBSTRUCTION of urinary flow.
Ethnicity

Diagnosis
Digital rectal exam (DRE): Doctor palpate the prostate through the rectum to check for size and consistency.
Prostate-specific antigen (PSA) test: A blood test to measure the level of PSA, a protein produced by the prostate.

Level >4 may indicate BPH.

An elevated PSA can indicate prostate cancer, it can also be caused by BPH further testing is required.

Urinalysis: A test to check for signs of infection or blood in the urine.

Uroflowmetry: A test that measures the strength and volume of urine flow.
Cystoscopy: A thin, lighted tube is inserted into the urethra to view the bladder and urethra.
 Renal / Urinary

Benign Prostatic Hyperplasia

Treatment

Medications:
Alpha-Blockers: Tamsulosin, Alfuzosin, Doxazosi
Relax the muscles in the prostate and bladder neck & improve urine flow.

5-Alpha Reductase Inhibitors: Finasteride, Dutasteride

Inhibits the conversion of testosterone to reduce prostate size.

Phosphodiesterase-5 (PDE-5) Inhibitors:

Tadalafil, in addition to treating erectile dysfunction, can also improve lower urinary tract symptoms associated
with BPH.
Antispasmodics, such as oxybutynin, reduce spasms that lead to constriction.

Invasive procedures:
Prostatic Urethral Lift (PUL): implants to elevate enlarged prostate tissue, enhancing urine flow.
Open Prostatectomy.
Transurethral Incision of the Prostate (TUIP): It relieves urethral pressure by creating minor incisions in the prostate.
Transurethral needle ablation (TUNA): It employs radiofrequency to eliminate excess prostate tissue.
TURP (Transurethral Resection of Prostate): It involves surgically removing a portion of the prostate.

Post-TURP, continuous bladder irrigation is performed using a three-way catheter, infusing saline to prevent or
remove clots.
The objective of TURP is to achieve a drainage color of light pink.

Adjust the rate of continuous bladder irrigation (CBI) to:

Increase if the output is red or contains clots.
Decrease the rate if the output is clear.
In the event of expected obstruction, discontinue cbı and perform ırrıgatıon.

Note:
Monitor output closely.
Comparing it to the infused saline.
If output is less than the amount infused, It suggests obstruction-check for kinks and irrigate if needed.
 Renal / Urinary

Benign Prostatic Hyperplasia

Nursing Interventions

Assessment of urinary symptoms, including frequency, urgency, nocturia.

Timed voiding schedule.
Fluid Management to avoid excessive consumption, especially before bedtime.
Encourage fluid intake to prevent UTI.
Bladder Training to help improve bladder control and reduce urinary urgency.
Monitoring for complications such as UTIs.
Minimize exposure to substances that can irritate the bladder, such as caffeine.
Insert a Foley catheter following the established facility protocol for cases of urinary retention.

Remember:
Inserting the catheter may POSE CHALLENGES in the presence of a large prostate.
Avoid forceful insertion of catheter to prevent potential trauma.
Consider consulting urology for possible placement of a coude catheter.
 Renal / Urinary

Urinary Tract Infection

What is it? Pyelonephritis

(kidney infection)
It is an microbial infection involving any part of the urinary
system, including the bladder, urethra, ureters, and kidneys.
Ureter infection
The most common type of UTI is a bladder infection
(cystitis)UTIs are usually caused by bacteria.
Cystitis
Most commonly Escherichia coli (E. coli)Generally found in (Bladder Infection) Urethritis (Urethra infection)
the bladder (cystitis) & can.
travel up the urinary tract serious infection Lower UTIs
(PYELONEPHRITIS) UTIs usually initiate in the lower regions and
ascend upwards.

Risk factors Symptoms Diagnosis

Having sexual intercourse Frequent and urgent need to Patient history and symptom
urinate assessment.
Using spermicides
Pain or burning sensation Urinalysis to detect signs of
Having a history of UTIs
during urination infection & presence of
Having a urinary tract blockage: bacteria, leukocytes, bloods,
Cloudy or foul-smelling urine
nitrites.
Renal calculi Lower or discomfort
Urine culture & sensitivity to
Associated with BPH abdominal pain
identify the specific causative
Neurological damage Fever and chills microorganism.

Holding urine for extended Hematuria (blood in urine) Prioritize obtaining cultures
periods before administering
Elderly patients may include:
antibiotics.
Diabetes Involuntary urination Imaging studies may be
Pregnancy Apathy conducted in severe or
recurrent cases.
Menopause Sudden cognitive
More common in females impairment
(shorter length and closer
proximity urethras to the
rectum)
Poor hygiene
Prolonged use of urinary
catheters
 Renal / Urinary

Urinary Tract Infection

Comparison of urinary tract ınfection (UTI) types

Have the patient face away & exposing Patient’s back. Place hand over the costovertebral
angle (below the 12th rib between the spine).

Type of Site of Main Cause Common Detection Prevalence Prognosis

UTI Infection Symptoms Method

Cystitis Bladder Bacteria Frequent urination, Urine test, Most common Excellent with
(usually E. coli). burning pain, cloudy urine culture. type, especially prompt
urine, pelvic pain. in women. treatment.

Urethritis Urethra Bacteria, Burning pain during Urine test, STI More common Good with
(tube sexually urination, discharge, testing. in women, appropriate
carrying transmitted urgency affects sexual treatment.
urine out). infections (STIs). function.

Pyelonephritis Kidneys Bacteria Fever, chills, nausea, Urine test, More serious, Excellent with
(Complıcatıon ascending vomiting, flank pain, urine culture, requires prompt
Of utıs) from bladder CVA tenderness blood test. hospitalization. treatment, risk
bloody urine of kidney
damage if
untreated.

Asymptomatic Bladder Bacteria Usually detected Urine test, Common in Usually no

Bacteriuria present, during routine urine culture pregnant treatment
no symptoms tests women and needed,
older adults monitor for UTI
development

Assess CVA tenderness by:

Have the patient face away & exposing Patient’s back.
Place hand over the costovertebral angle (below the 12th rib between the spine).
Gently thump the hand with the fist of the opposite hand.
Observe the patient's response for any signs of tenderness or pain.
 Renal / Urinary

Urinary Tract Infection

How to prevent UTIs Treatment Nursing Interventions

Drink plenty of fluids Antibiotics: Educating patients about UTIs
(Take culture sample 1st) and how to prevent them
Urinate frequently
Trimethoprim / Encouraging patients to drink
Empty bladder completely
sulfamethoxazole plenty of fluids
when urinate
Nitrofurantoin Helping patients to empty their
Wipe from front to back after
bladder completely when they
using the toilet. Ciprofloxacin (Cipro) urinate
Avoid using SPERMICIDES. Levofloxacin (Levaquin) Providing perineal care
Urinate after sexual intercourse Amoxicillin-clavulanate Administering antibiotics as
Wear cotton underwear & (Augmenti) prescribed
loose-fitting clothing Pyridium alleviates urinary Monitoring patients for signs
Refrain from douching urgency and pain (urine and symptoms of
may turns orange) complications
Limit caffeine and alcohol
intake Urinary Alkalinizers (cranberry
supplements)
Complete the entire prescribed
antibiotic course Increased Fluid Intake
Pain killers: ibuprofen,
acetaminophen
If a catheter is in place,
remove it.
 Renal / Urinary

Glomerulonephritis

What is it?
It is an inflammation of the Inflammation of the
glomeruli the small filtering units in GLOMERULONEPHRITIS
glomeruli and of the
the kidneys(nephrons) responsible small blood vessels
Cortex
for removing waste and excess
Major Pyramid
fluids from the blood.
calyces
Role of Glomeruli: Minor
Filtration of Blood calyces
Renal
Fibrous
Selective Permeability pelvis
capsule
Maintaining Blood Pressure Ureter
Normal kidney Glomerulonephrıtıs
Formation of Ultrafiltrate
GFR Regulation

Symptoms:
Causes
Excessive Fluid Accumulation
A beta-hemolytic streptococcus (GABHS) infection is a common
cause of Poststreptococcal glomerulonephritis (PSGN) Oliguria
Blood in the urine (hematuria) (Brown,
Sequence of events leading to PSGN:
tea-colored urine)
Triggering Infection Protein in the urine (proteinuria), causing
foamy urine
Immune Response
Hypervolemia
Immune Complex Formation Swelling (edema) in legs, ankles, and face
(Abs deposit in the glomeruli & bind to the GBM forming Fatigue
complex).
Reduced urine output
Shortness of breath
Complement Activation
(leading to inflammation and damage to the GBM). Hypertension
JVD
Kidney Damage
Crackles Fluid is backing up because
leading to hematuria, proteinuria, decreased urine output.
Dyspnea glomeruli are not working to
filter out excess fluids

Other Causes

Primary:
Infectious agents: VZV, HIV, EBV
Sepsis
Epstein-Bar
Secondary:
An autoimmune disease: High blood pressure
SLE, vasculitis Certain medications: (NSAIDs)
or antibiotics
Diabetes
A genetic disorder: Alport
Cirrhosis syndrome
 Renal / Urinary

Glomerulonephritis

Diagnosis
Urine tests: to examine blood, protein, or white blood cells in the urine.
Blood tests: to assess creatinine & BUN ( ) and eGFR ( ), electrolyte imbalances, WBCs ( ),anemia.
Imaging tests: CT scans or MRI scans.
Kidney biopsy
ASO (antistreptolysin) titer: to measure antibodies against streptococcal infections.
Throat culture: to identify GABHS in cases of suspected PSGN (+ group A hemolytic strep).

Treatment
Addressing the underlying cause & protect kidneys against additional harm.

Medications:
Blood Pressure Control: BP Immunosuppressants: Inflammation
Diuretics: Excess fluid Antibiotics: To treat infection

Procedure:
Plasmapheresis involves removing antibody complexes through filtration
Dialysis or Kidney Transplant for chronic cases

Nursing Interventions Dietary Management:

Monitoring and Assessment: Limit fluids
Vital signs Low-protein, low-sodium diet
Intake and output Monitor potassium and phosphorus levels
Weight
Medication Management:
Laboratory tests: BUN, Cr Administer medications as prescribed
Symptoms: fatigue, edema, dyspnea Monitor for side effects

Patient Education and Support:

Fluid Management:
Treat strep infections early
Restrict fluid intake
About infection prevention practice
Monitor for signs of dehydration and overhydration
Monitor for signs of infection
 Renal / Urinary

Nephrotic Syndrome

WHAT IS IT?
It is a collection of symptoms that manifest in reaction to
structural impairment of the glomeruli.

It marked by the presence of excessive protein in the urine,

low levels of protein in the blood. Damage to the glomerular filtration barrier,
typically in podocytes
Albumin regulates
Unlike glomerulonephritis, which involves mild protein oncotic pressure &
loss due to inflammation of the glomeruli Proteinuria mainly Albumin
keeps fluid from
leaking into tissues
Hypoalbuminemia

Causes Decreased plasma oncotic pressure

Primary Causes:
(Result from intrinsic issues within the kidneys) Hyperlipidemia
Examples include:
IgA nephropathy Minimal Change Disease (changes
Alport syndrome to glomeruli; cause unknown)
Treatment
Focal segmental glomerulosclerosis (FSGS Medications:
Diuretics to reduce edema
Secondary Causes:
Statins to manage HYPERLIPIDEMIA
(Arise from underlying systemic conditions affecting
(ACE) inhibitors to control BP and reduce proteinuria
the kidneys)
Immunosuppressive Therapy
Examples include: Corticosteroids to reduce inflammation
Infections (streptococcal, viral), HIV Albumin & plasma: edema
Autoimmune diseases (lupus nephritis) Diet: A low-salt, low-protein diet
Diabetes mellitus Plasmapheresis: procedure that removes protein from the blood.
Hypertension Kidney transplant
CHF
Vasculitis (e.g., granulomatosis with polyangiitis)
NSAIDs (nephrotic drugs)
Nursing Interventions
Monitor Fluid Balance:
Daily weights to assess fluid retention &
abdominal circumference
Symptoms
Foamy urine due to protein in the urine (proteinuria) Dietary Management:
Swelling (edema especially around eyes, face, abdomen, Low-sodium diet to control edema.
and legs) due to albumin Moderate protein intake.
Periorbital (around eyes) Periorbital edema Medication Administration:
Peripheral edema Puffy pale face Administer prescribed medications, monitor for side effects.
scites Lips may be swollen
Education:
High cholesterol/Hyperlipidemia Educate the patient about the importance of
Low blood albumin Medication adherence
Fatigue Dietary restrictions ( sodium, moderate protein, limit fluids)
Weight gain Regular follow-up
Aneroxia Avoid NSAID's
Assessment of Edema & skin integrity:
Regularly assess and document the extent of edema
Diagnosis Assess for skin breakdown
Urinalysis: Albumin increases risk of pressure ulcers
Presence of heavy proteinuria (>2+) Q2 turning
Elevate edematous extremities
Blood Tests:
Serum albumin levels. Triglycerides Monitoring for Complications:
Lipid profile. Cholesterol Watch for signs of
Blood urea nitrogen (BUN) and creatinine BUN/ Cr Infections
albumin GFR Thrombosis
Other complications
24 hour urine sample: Protein > 3.5 g/Dl
Imaging Studies:
Ultrasound, CT scan, or MRI to assess kidney structur
 Renal / Urinary

Renal Calculi

NEPHROLITHIASIS UROLITHIASIS
WHAT IS IT? Location of renal stones
It is commonly known as KIDNEY STONES, Kidneys (nephrolithiasis)
are hard deposits of minerals and salts
that form in the kidneys. Bladder
Ureters (urolithiasis)
Urethra

5 TYPES of STONES
CALCIUM OXALATE URIC ACID STRUVITE
CALCIUM PHOSPHATE CYSTINE

Type
Prevalence Composition Appearance Causes Frequency Symptoms Treatment
of Stone

Calcium Most Calcium Spiky, rough, High oxalate & Varies with Back pain, Medication,
oxalate common oxalate yellow or brown calcium intake diet and other blood in lithotripsy,
(80%) low fluid intake factors urine, surgery
Overactive thyroid nausea,
gland IBD due vomiting
to impaired
fat absorption

Uric acid 5-10% Uric acid Yellow or orange, High purine More common Similar to Medication,
irregular intake (red meat, in men, people calcium dietary
seafood) with gout oxalate changes,
Dehydration stones hydration
Gout Type-II diabetes

Less highly Smooth, white or UTIs with bacteria Associated Similar to Antibiotics,
Struvite common alkaline urine gray, "coffin-lid" that split urea with UTIs calcium sometimes
(10-15%) producing shape (Bacteria elevate oxalate surgery
Magnesium, urine pH, creating stones,
ammonium, conditions conducive fever, foul-
phosphate to ammonia formation) smelling
urin

Cystine Cystine Cystine White, hexagonal Cystinuria Rare, affects Similar to Medication,
Rare (less (genetic disorder) both men calcium hydration,
than 2%) and women oxalate surgery
stones

Diagnosis Symptoms
Imaging (KUB): Renal Colic:
CT scan, ultrasound, or X-rays for stone visualization Severe pain in the back or sid (Aching flank discomfort
Urinalysis: suggesting the presence of a stone in the renal pelvis)
Identifies crystals, blood(RBC, WBC), bacteria, & Hematuria
abnormal pH Dysuria
Oliguria
Blood Tests:
Frequent Urination
To assess kidney function and BMP, CBC & uric acid
Nausea and Vomiting: Due to pain intensity.
Ultrasound or CT scan Cloudy or Foul-Smelling Urine: Indicates infection
Fever and chills (with struvite stones)
Intravenous pyelogram (IVP):
Decreased urine output
X-ray images are captured periodically as the contrast
dye travels through the urinary tracTo assess kidney
function and BMP, CBC & uric acid
 Renal / Urinary

Renal Calculi

Treatment Nursing Interventions

Medications: Pain Assessment and Management: Monitor and address
Depending on stone type (e.g., allopurinol for uric pain promptly.
acid stones) Fluid Monitoring: Ensure adequate hydration
Monitoring vital signs and signs of infection & dehydration
Pain Management: Strain Urine: helps in determining stone composition
Analgesics (e.g., NSAIDs) for pain relief. Encouraging Ambulation: to help promote the movement
Opioid analgesics: for severe pain of stones
Hydration: Medication Administration
Increased fluid intake Postoperative Care
Medical Expulsion Therapy:
alpha-blockers to facilitate stone passag
Dietary Changes: Patient EDUCATION
Adjustments based on stone composition Education: Promote dietary modifications and lifestyle changes.
Procedure: Diet Modifications:
Extracorporeal Shock Wave Lithotripsy (ESWL): Limit Oxalate-Rich Foods beets, chocolate, tea, nuts,spinach.
non-invasive method that employs shock waves Watch for High-Purine Foods organ meats, anchovies, sardines,
to fragment kidney stones and some legume.
Percutaneous Nephrolithotomy (PCNL): Reduce Sodium Intake processed foods, canned soups.
small incision is made in the back to remove Moderate Animal Protein red meat, poultry, fish, and eggs.
or break up the stones Limit Vitamin C Supplements.
Ureteroscopy

Comparison of Glomerulonephritis, Renal Calculi, and Nephrotic Syndrome

Feature Glomerulonephritis Renal Calculi (Kidney Stones) Nephrotic Syndrome

Set of symptoms caused by
Inflammation of the Hard deposits of minerals and
Definition damaged glomeruli leading
glomeruli (kidney filters). salts in the kidneys.
to protein loss in urine.

Causes Infections, autoimmune Dehydration, diet, medical Primary (minimal change

diseases, medications, conditions, medications, disease, FSGS), secondary
genetic factors. family history. (diabetes, lupus).

Symptoms Blood in urine, swelling, high Severe pain in the flank or Protein in urine, swelling, high
blood pressure, fatigue, back, blood in urine, nausea, cholesterol, low blood
decreased urine output. vomiting, frequent urination. albumin, fatigue, foamy urine.

Diagnosis Urine tests, blood tests, Urine tests, blood tests, Urine tests, blood tests, kidney
kidney biopsy. imaging tests (X-ray, CT scan, biopsy.
ultrasound).

Treatment Medications, lifestyle Medication, lithotripsy Medications, diet,

changes, dialysis, (shockwave treatment), plasmapheresis, transplant.
transplant. surgery.

Complications Kidney failure, high blood Infection, kidney damage, Increased risk of infection,
pressure, heart disease. bleeding. blood clots, malnutrition.

Prognosis Varies depending on the Most stones pass on their Depends on the underlying
type and severity, own, larger stones may cause, some cases are
some cases resolve on require intervention. treatable, others require
their own, others ongoing management.
require long-term
management.
 Renal / Urinary

Hemodialysis

WHAT IS IT? Hemodialysis Process Frequency

Usually done thrice
Hemodialysis is a medical procedure that filters waste Patient Preparation weekly.
products and excess fluids from the blood when the Procedure Time
kidneys are unable to perform this function adequately Vascular Access Establishment Sessions typically
Act as “ARTIFICIAL KIDNEY”. last 3-5 hours.
Connection to Hemodialysis Machine
Blood Circulation through Dialyzer
REMEMBER "HEAR A BRUIT, FEEL A THRILL" Filtration of Waste and Fluids Heparin is introduced
into the bloodstream
Assessment Of Patency: Return of Purified Blood to Patient during dialysis to reduce
the likelihood of
Palpation: Monitoring and Adjustments clot formation
Feel for a THRILL (vibration) over the access site,
indicating blood flow. Disconnection and Post-Dialysis Care
Auscultation:
Listen for a BRUIT (swishing sound) using a stethoscope.
Complication
Blood flow measurement:
Measure blood flow rate through the access using Disequilibrium syndrome:
specialized equipment Solutes are eliminated too rapidly, resulting in
an increase in intracranial pressure (ICP)
If either is missing during the assessment,
inform the physician promptly Observe for:
Agitation and disorientation Queasiness & emesis
Headache
Hemodialysis Access Types
Feature Arteriovenous Fistula (AV Fistula) Graft Catheter

Surgical connection between Surgical placement of Insertion of thin tube into large
Creation method synthetic tube connecting vein (superior venacava),
artery and vein in arm
artery and vein usually in neck or chest

Durability Most durable, lasts for years Less durable (2-3 years), Least durable, requires
may need replacement frequent replacement

Infection risk Lowest risk Moderate risk Highest risk

Blood flow Best blood flow Good blood flow Variable blood flow

Suitability Preferred option for most patients Alternative for those Used for temporary or
unsuitable for fistula immediate access

Maturation Span 8-12 weeks 2-3 weeks immediate

Complications Stenosis Infection Infection

Thrombosis Stenosis or Thrombosis Thrombosis
Aneurysm Formation Pseudoaneurysm Formation Catheter Dysfunction
Steal Syndrome Graft Failure Exit Site Infection

Diagram Vein expanded Mixed AV blood Artery Internal jugular

due to increased Arteriovenous Vein
blood pressure Artery Arteriovenous graft

Nursing Interventions Post-Dialysis Care: Precautions for Arm with Vascular Access
Check access site for bleeding
Pre-Dialysis Assessment:
or infection. Refrain from taking blood pressure readings
Vital signs, weight, Avoid blood draws from the arm
Daily weight
and fluid status Do not wear tight clothing on the arm
Patient Education: Fluid and Electrolyte Management:
Avoid sleeping on the arm with access.
Importance of adhering to Monitor levels and adjust as needed.
Refrain from carrying heavy bags
dietary and fluid restrictions. Withhold medications before the Avoid wearing constricting jewelry
Monitoring during Dialysis: commencement of dialysis
Regularly assess vital signs
and fluid balance.
Avoid medications that lower blood pressure, including diuretics and
anti-hypertensives, to mitigate the risk of hypotension during dialysis
 Renal / Urinary

Peritoneal Dialysis

WHAT IS IT? Hemodialysis Process

A renal replacement therapy that uses the peritoneum, a Catheter Insertion
membrane lining the abdominal cavity, as a natural filter to
remove waste products and excess fluids from the body.
Instillation of Dialysis Solution

NOTE: Dwell Time (Solution in Peritoneal Cavity)

The procedure is replicated several times throughout the day
Conducted every day of the week, with the dwell time determined Drainage of Dialysate
by the physician's instructions
Cycles Repeated (Continuous Ambulatory
Peritoneal Dialysis - CAPD) or Automated
Peritoneal Dialysis (APD)
Types of Peritoneal Dialysis
Exit Site Care and Catheter Securement
Aspect Continuous Automated
Ambulatory Peritoneal
Peritoneal Dialysis Dialysis (APD)
(CAPD) Access:
Manual exchanges Automated machine Permanent catheter, usually Tenckhoff catheter,
Connection surgically inserted into the peritoneal cavity.
performed by performs exchanges,
the patient usually overnight. Insertion site is typically positioned 3-5 cm below
the umbilicus.
Frequency Multiple manual Nightly cycles with It may require 1 month after insertion to heal and
exchanges throughout the machine mature before becoming ready for use in
the day. handling exchanges. peritoneal dialysis

Dwell Time Typically 4-6 hours Multiple short cycles

per exchange during with shorter dwell times,
the day. often 1-2 hour
Awareness Guidelines
Nursing Training patients Educating patients on Practice effective hand hygiene before and after
Involvement for self-administration. machine use and dialysis and whenever touching the site.
troubleshooting. Store supplies in a hygienic and dry location.
Ensure the site is kept clean and dry on a daily basis.
Regularly inspect the site for any signs of issues

Nursing Interventions
Monitoring vital signs, fluid balance, and weight. Complications
Providing patient education and support.
Assisting with catheter care and preventing infection. Peritonitis:
Daily weights Infection in the abdominal cavity, requiring
Warm dialysate solution before administering prompt treatment
Always use sterile technique while accessing site Abdominal pain
Managing complications and responding to emergencies, Tenderness
monitor color of drainage of outflow Swelling or distention
Fever
Cloudy peritoneal dialysis effluent
Tachycardia
Shortness of breath:
As a result of quick infusion or excess filling of
the abdomen
Crackles
Difficulty breathing (Dyspnea)
Rapid breathing (Tachypnea)
 Renal / Urinary

Peritoneal Dialysis

Differences btw types of dialysis

Aspec Hemodialysis Peritoneal Dialysis

Requires vascular access (arteriovenous
Access Uses the peritoneal membrane as a natural filter.
fistula, graft, or central venous catheter).
Can be performed at home or in a
Location Typically performed in a dialysis center or hospital.
healthcare setting.

Frequency Usually done thrice weekly. More frequent exchanges, often daily.

Continuous process, with exchanges

Procedure Time Sessions typically last 3-5 hours
taking several hours throughout the day.

Uses a dialysate solution that is infused and

Dialysate Specialized fluid with electrolytes is used.
drained multiple times.

Nursing Trains and educates patients for

Involvement Administers dialysis under direct supervision.
self-administration. Regular follow-ups are crucial
Hypotension, muscle cramps, infection,
Complications Peritonitis, catheter-related problems, hernias.
access-related issues

Greater mobility; can perform exchanges

Mobility Limited mobility during the session. independently

Vascular Requires regular assessment and care Care of the catheter site is crucial to
Access Care of access site prevent infections.

Fluid and Diet Strict fluid and diet control required. Generally more liberal fluid and diet control.
Control

Training Nurses provide care during sessions; Extensive training for patients and their
Requirements patient participation is passive. caregivers. Active patient involvement
Often more expensive due to the need for a Can be more cost-effective, especially with
Cost
dedicated facility and specialized equipment. home-based options.

Suitability for Well-suited for home use, offering greater

Home Use Possible but less common.
independence
ENDOCRINE
 Endocrine

Endocrine System Overview

Introduction

The endocrine system is made up of glands that make hormones.

Hormones are the body's chemical messengers.
They carry information and instructions from one set of cells to another.
The endocrine system influences almost every cell, organ, and function of our bodies.
Secrete hormones to maintain homeostasis throughout the body.

Function Types of endocrine cells

Metabolism. Growth and Three types of endocrine cells;
Homeostasis ,such development.
Alpha cells which secrete glucagon,
as blood pressure Sexual function.
and blood sugar Beta cells which secrete insulin,
Reproduction.
regulation. Delta cells which inhibit the secretion on
Sleep-wake cycle.
Fluid and glucagon and insulin:
Mood.
electrolyte
balance and body
temperature.

Pineal Gland
Pituitary Gland

Thyroid and
Parathyroid Glands
Thymus

Pancreas
Ovary Andrenal Glands
( In Female)

Placenta
Testicle
(During Pregnancy)
( In Male)
 Endocrine

Endocrine System Overview

Hypothalamus Causes
Head injuries,.
The hypothalamus is a structure deep within
Brain infection.
your brain.
Brain tumor
The hypothalamus is an area of the brain
that produces hormones that control: Body Significant weight loss caused by eating
temperature. Heart rate. Hunger. Mood disorders, such as bulimia or anorexia.
Brain surgery.
Radiation therapy and chemotherapy
Birth defects involving the brain or
Hormones Released: hypothalamus.
1. Corticotropin-Releasing Hormone: This Inflammatory disease including multiple
hormone is responsible for the regulation sclerosis
of metabolic and immune response. Some genetic disorders, such as growth
2. Thyrotropin Releasing Hormone: It triggers hormone deficiency
the pituitary gland to release a
thyroid-stimulating hormone which plays a
major role in the functioning of organs of Function:
the body such as heart, muscles, etc.
3. Gonadotropin-Releasing Hormone: It Body temperature.
stimulates the pituitary gland to release Its main function is maintaining the body’s
several reproductive hormones. internal balance- homeostasis.
4. Oxytocin: It is involved in several processes It also connects the endocrine and the
such as lactation, childbirth, regulating nervous system.
sleep cycles, maintaining body
temperature. Hypothalamus stimulates or inhibits many
of the body’s activities in order to maintain
5. Dopamine, Dopamine is the “feel-good” homeostasis, such as regulating body
hormone. It gives you a sense of pleasure temperature, appetite and body weight,
6. Somatostatin: This hormone is also known heart rate and blood pressure, etc.
as Growth Hormone Inhibiting Hormone.
Blood pressure Sleep
It regulates the endocrine system and Hunger and thirst. Appetite and
affects the neurotransmission and cell Sense of fullness thirst control.
proliferation by interacting with G-protein when eating. Blood pressure
coupled receptors. and heart rate.
Mood.
Sex drive.
Control Center
 Endocrine

Endocrine System Overview

Fornix of
Hippocampus
Symptoms Of
Thalamus Hypothalamus Dysfunction
Hyphothalamus
High blood pressure or low blood pressure.
Optic Chalsm
Pons Water retention or dehydration.
Anterior Pitiuitary Weight loss or weight gain with or without
Posterior Pitiuitary changes in appetite.
Muscle loss and weakness.
Pineal Gland Trouble sleeping (insomnia).
Infertility
Pineal gland, also Body temperature fluctuations.
called the pineal Poor bone health.
body or epiphysis
cerebri, is a tiny Delayed puberty.
gland in brain. Frequent need to pee.
That’s located
beneath the back
part of the corpus
callosum Pituitary Gland
Master Gland
Function :
The pituitary is a small, pea-sized gland.

receive information about the state of the It is found at the base of your brain, in line
light-dark cycle from the environment. with the top of nose.

Convey this information by the production

and secretion of the hormone melatonin.

Hypothalamus
Hormones Released: Posterior
Lobe
Pituitary Stalk
Melatonin released in response to darkness
hence the name, “hormone of darkness”.
provides a circadian and seasonal signal to
the organisms in vertebrates. Anterior Lobe
 Endocrine

Endocrine System Overview

Hormones Released:
Anterior Pituitary Posterior Pituitary
growth hormone which regulates growth Oxytocin which is involved in childbirth
Thyroid stimulating hormone (TSH) which and breastfeeding
tells the thyroid gland to make hormones Vasopressin(Antidiuretic hormone (ADH)
Prolactin which controls breast milk which helps control the amount of salt
production and water in body.

Adrenocorticotrophic hormone (ACTH)

which tells the adrenal glands to make These hormones affect your:
hormones Metabolism Reproduction
Follicle stimulating hormone (FSH) which Blood pressure Other vital
is involved in the reproductive system body functions.

Testosterone Thyrotropin
Function :
It regulates growth, metabolism, and
reproduction through the hormones that
it produces.
Parathyroid The posterior lobe produces two
hormones, vasopressin and oxytocin.
The production of these hormones is
either stimulated or inhibited by chemical
messages sent from the hypothalamus to
the pituitary.

Parathyroid

The parathyroid is comprised of 4 small

Function : glands embedded in the posterior aspect
of the thyroid gland.
Produce parathyroid hormone,
which plays a key role in the regula-
tion of calcium levels in the blood.
Precise calcium levels are important Hormones Released:
in the human body, since small
changes can cause muscle and
Parathyroid hormone (PTH) levels are
nerve problems.
mainly controlled by a feedback loop of
calcium levels in your blood to your
Two pairs of parathyroid are located on the parathyroid glands.
back of the thyroid gland
 Endocrine

Endocrine System Overview

Function :
Thymus Production and maturation of immune cells;
including small lymphocytes that protect
the body against foreign antigens.
The thymus is the source of cells that will
live in the lymphoid tissues and supports
their maturation and proper function.

Hormones Released:
Thymus Thymopoietin: fuels the production of T-cells
and tells the pituitary gland to release
Small gland in the lymphatic system that hormones.
makes and trains special white blood cells Thymosin and thymulin: help make
called T-cells. specialized types of T-cells.
Thymic humoral factor: keeps your immune
system working properly

FUNCTION
 Endocrine

Endocrine System Overview

Adrenal Glands Function:

A small gland that makes steroid hormones, Adrenal glands produce hormones that help
adrenaline, and noradrenaline. Regulate your Blood pressure,
metabolism, Response to stress
Immune system, and other essential
Adrenal functions.
Cortex
Right
Adrenal Gland
Aldosterone (Mineral Corticoids)
Adrenal
Medulla Steroid hormones that regulate salt
and water balances.
Androgens (Sex Hormones)
Left Androgens are crucial for male sexual
Adrenal Gland and reproductive function.
Left Kidney They are also responsible for the
development of secondary sexual
characteristics in men, including facial
and body hair growth and voice change.
Androgens also affect bone and muscle
development and metabolism.

Hormones Released:
Adrenal Medulla
Adrenal Cortex
FUNCTION
The adrenal medulla is responsible for
producing catecholamine, or adrenaline-
The adrenal cortex produces a handful of type hormones such as epinephrine and
hormones necessary for fluid and electrolyte norepinephrine.
(salt) balance in the body such as cortisol,
androgen and aldosterone. The adrenal Adrenaline (Epinephrine)
cortex also makes small amounts of sex Plays an essential role in Cognitive
hormones Function
The regulation of arous-
Glucocorticoids Cortisol: al Stress
Increase the availability of blood glucose Reactions
Attention
to the brain.
Noradrenaline (Norepinephrine)
Cortisol acts on the liver, muscle, adipose Norepinephrine has more of an effect on
tissue, and pancreas. your blood vessels.

Both play a role in your body's natural

fight-or-flight response to stress and have
important medical uses as well.
 Endocrine

Endocrine System Overview

Pancreas Testes
It is an organ of the digestive system and of The testes are 2 small organs that are
the endocrine system. found inside the scrotum.

Stomatch
Stomatch

Galbladder Pancreas

Duodenum
FUNCTION
Normal Testos

Function: Function:
Pancreatic diet emphasizes small, frequent, Testes is producing and storing sperm.
nutrient-dense meals including lean protein,
They're also crucial for creating testosterone
fruits and vegetables, and whole grains, and
and other male hormones called androgens.
FUNCTION
discourages alcohol and greasy foods.
The pancreas sends insulin into the blood.
Testes get their ovular shape from tissues
known as lobules.
Insulin helps open cells throughout the body
to let glucose in, giving the cells the energy
they need.

Hormones Released:
Hormones Released: Testosterone is an important hormone
during male development and maturation
Insulin. This hormone is made in cells of the for developing muscles, deepening the voice,
pancreas known as beta cells. and growing body hair
Glucagon. Alpha cells make up about 20% of
the cells in your pancreas that produce
hormones.
Gastrin and amylin. Gastrin is primarily
made in the G cells in your stomach, but
some is made in the pancreas, too.
 Endocrine

Endocrine System Overview

Ovaries
Function:
The ovaries are two small,
walnut-shaped organs. The ovaries have two main reproductive functions in the body.
They are found in the They produce oocytes (eggs) for fertilisation and they produce
lower part of the the reproductive hormones, estrogens, progesterone and
abdomen (belly). androgens

Hormones Released:
The ovaries have two main reproductive functions in the body. Estrogen
They produce oocytes (eggs) for fertilisation and they produce Progesterone
the reproductive hormones. Androgens

Fallopian Tube

Cervix
Fallopian
Tube
Vagina
Uterus
 Endocrine

Hormone Functions

1 - Hypothalamus
The hypothalamus is a small region of the Causes and Risk Factors
brain. It’s located at the base of the brain,
near the pituitary gland. Certain genetic conditions, such as
growth hormone deficiency
Surgery involving the brain
Congenital irregularitie
Autoimmune conditions
Function:
Head injuries
Important functions, including:
Regulating body temperature
Managing sexual behavior Symptoms
Maintaining daily physiological cycles
Regulating emotional responses Insomnia Delayed onset of puberty
Releasing hormones Infertility Dehydration
Controlling appetite Short stature Frequent urination

Hypothalamic Dysfunction
Hypothalamic dysfunction plays a role in many conditions, including:

Diabetes insipidus. If the hypothalamus does not produce and release enough vasopressin,
the kidneys can remove too much water. This causes increased urination and thirst.
Prader-Willi syndrome. This is a rare, inherited disorder that causes the hypothalamus to
not register when someone is full after eating.
Hypopituitarism. This disorder occurs when the pituitary gland does not produce enough
hormones. While it’s usually caused by damage to the pituitary gland, hypothalamic
dysfunction can also cause it.
Gigantism. Gigantism occurs when the pituitary gland produces too much growth hormone.
It typically affects children and adolescents.
Acromegaly. Acromegaly is also caused by the pituitary gland producing excess growth
hormone.
 Endocrine

Hormone Functions

Hormone Functions
Hypothalamic dysfunction plays a role in many conditions, including:

Corticotrophin-releasing hormone (CRH).

CRH is involved in the body’s response to both physical and emotional stress.
It signals the pituitary gland to produce a hormone called adrenocorticotropic hormone
(ACTH) ACTH triggers the production of cortisol, an important stress hormone.
Gonadotropin-releasing hormone (GnRH).
Production of GnRH causes the pituitary gland to produce important reproductive hormones,
follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
Thyrotropin-releasing hormone (TRH).
Production of TRH stimulates the pituitary gland to produce thyroid-stimulating hormone
(TSH).
TSH plays an important role in the function of many body parts, such as the muscles, heart,
and gastrointestinal tract.
Somatostatin.
Somatostatin works to stop the pituitary gland from releasing certain hormones, including
growth hormones and TSH.
Oxytocin
This hormone controls many important behaviors and emotions, such as sexual arousal,
trust, recognition, and maternal behavior.
It’s also involved in some functions of the reproductive system, such as childbirth and lacta-
tion. Learn more about oxytocin.
Vasopressin
Also called antidiuretic hormone (ADH).
vasopressin regulates water levels in the body.
When vasopressin is released, it signals the kidneys to absorb water
 Endocrine

Hormone Functions

2 - Thyroid
Thyroid is a small, butterfly-shaped gland
Hypothyroidism
located at the front of your neck under (underactive thyroid). T3 T4 TSH
your skin.
Hypothyroidism (underactive thyroid)
happens when your thyroid doesn’t produce
1. Thyroxine (T4): This is the primary hormone and release enough thyroid hormones.
your thyroid makes and releases
2. Triiodothyronine (T3): Your thyroid produces
lesser amounts of T3 than T4, but it has a Causes
much greater effect on your metabolism
than T4. Hashimoto’s disease, an autoimmune
disease
3. Reverse triiodothyronine (RT3): Thyroid
makes very small amounts of RT3, which Thyroiditis (inflammation of the thyroid).
reverses the effects of T3. Iodine deficiency.
4. Calcitonin: This hormone helps regulate the A nonfunctioning thyroid gland
amount of calcium in your blood.

Hyperthyroidism
Decrease calcium level . Think calcitonin
(overactive thyroid). T3 T4 TSH
brings calcium into the bone

Hyperthyroidism (overactive thyroid)

happens when your thyroid produces and
Function: releases more thyroid hormones than
your body needs
How your body Body temperature
uses energy Brain development
(metabolism).
Mental activity Causes
Heart rate
Skin and bone Graves’ disease, an autoimmune condition.
Breathing maintenance
Digestion Thyroid nodules.
Fertility
Thyroiditis (inflammation of the thyroid).
Postpartum thyroiditis (inflammation of the
thyroid that happens after giving birth).
Symptoms Excess iodine in your blood

Slow or rapid heart rate.

Unexplained weight loss or weight gain.
Difficulty tolerating cold or heat.
Depression or anxiety.
Irregular menstrual periods.
 Endocrine

Hormone Functions

Goiter (enlarged thyroid)

Goiter is an enlargement of your thyroid gland

1. Simple goiters: These goiters develop when your thyroid gland doesn’t make enough
hormones to meet your body's needs
2. Endemic goiters: These goiters occur in people who don't get enough iodine in their diet

Thyroid cancer

Thyroid cancer is cancer that begins in your thyroid tissues

1. Papillary: Up to 80% of all thyroid cancer cases are papillary.

2. Follicular: Follicular thyroid cancer accounts for up to 15% of thyroid cancer diagnoses.

3. Medullary: About 2% of thyroid cancer cases are medullary. It’s often caused by a gene mutation.
4. Anaplastic: About 2% of thyroid cancer cases are anaplastic.
 Endocrine

Hormone Functions

3 - Pituitary
The pituitary gland can be
The pituitary is a small, pea-sized gland. It is divided into two different parts:
found at the base of your brain, in line with the anterior and posterior lobes.
the top of your nose.

Pituitary Gland Disorders Anterior lobe

N
Growth hormone. Growth hormone
Pituitary tumors. Pituitary tumors are regulates growth and physical
usually noncancerous. However, they often development. It can stimulate growth in
interfere with the release of hormones. almost all of your tissues. Its primary
They can also press against other areas of targets are bones and muscles.
your brain, leading to vision problems or
Thyroid-stimulating hormone. This
headaches.
hormone activates your thyroid to release
Hypopituitarism. This condition causes thyroid hormones. Your thyroid gland and
your pituitary gland to produce very little the hormones it produces are crucial for
or none of one or more of its hormones. metabolism.
This can affect things like growth or
Adrenocorticotropic hormone. This
reproductive system function.
hormone stimulates your adrenal glands to
Acromegaly. pituitary gland produces too produce cortisol and other hormones.
much growth hormone. This can lead to
Follicle-stimulating hormone.
excessive growth, especially of your hands
Follicle-stimulating hormone is involved
and feet. It’s often associated with pituitary
with estrogen secretion and the growth of
tumors.
egg cells in women. It’s also important for
Diabetes insipidus. This can be caused by sperm cell production in men.
a problem with the release of vasopressin.
Luteinizing hormone. Luteinizing hormone
It’s usually due to a head injury, surgery, or
is involved in the production of estrogen in
a tumor.
women and testosterone in men.
Cushing’s disease. The pituitary gland
Prolactin. Prolactin helps women who are
releases too much adrenocorticotropic
breastfeeding produce milk.
hormone in people with this condition. This
can lead to easy bruising, high blood Endorphins. Endorphins have
pressure, weakness, and weight gain. pain-relieving properties and are thought
to be connected to the “pleasure centers”
Hyperprolactinemia. In this condition, your
of the brain.
blood contains an unusually high amount
of prolactin. Enkephalins. Enkephalins are closely
related to endorphins and have similar
Traumatic brain injury. This involves a
pain-relieving effects.
sudden blow to your brain.
Beta-melanocyte-stimulating hormone.
This hormone helps to stimulate increased
pigmentation of your skin in response to
exposure to ultraviolet radiation.
 Endocrine

Hormone Functions

Symptoms Posterior Lobe

Headaches Hormones stored in the posterior lobe include:
Weakness or fatigue
High blood pressure Vasopressin
Unexplained weight gain This is also called antidiuretic hormone.
Trouble sleeping It helps your body conserve water and prevent dehydration.

NUF
Oxytocin
This hormone stimulates the release of breast milk.
It also stimulates contractions of the uterus during labor.
 Endocrine

Hormone Functions

4 - Pineal
The pituitary is a small, pea-sized gland. It is
Symptoms
found at the base of your brain, in line with
the top of your nose. Seizures Nausea and
Memory issues. vomiting.
The pineal gland was commonly called
Headaches. Vision changes.
the “third eye”
Its location deep in the center of the brain
Its connection to light via the circadian
rhythm and melatonin secretion. 5 - Thymus
Many spiritual traditions believe it serves
Thymus is a small gland in the lymphatic
as a connection between the physical
system that makes and trains special
and spiritual worlds
white blood cells called T-cells. The T-cells
help your immune system fight disease
and infection.

Function:
Pineal gland is to receive information Pimary Function
about the state of the light-dark cycle
from the environment Primary function: is maturing T cells, or T
Convey this information by the production lymphocytes. These are white blood cells
and secretion of the hormone melatonin. responsible for fighting infections.

The thymus produces an array of

hormones. Some of these, like thymulin
and Thymosin, regulate immune cell
Hormones Released: production.
Melatonin. The thymus Trusted Source is an essential
part of the immune system. Without it, the
Melatonin also interacts with biologically immune system cannot function properly.
female hormones. Research has shown
that it helps in regulating menstrual cycles. The thymus also synthesizes hormones
such as insulin and melatonin.
Regulates sleep-wake cycles.
Melatonin: a sleep-regulating hormone
Melatonin can also protect against that comes from the pineal gland
neurodegeneration, which is the
progressive loss of function of neurons. Insulin: a blood sugar regulating hormone
made by the pancreas
Growth hormone: a growth-regulating
hormone from the pituitary gland
Pineal gland Disorders Prolactin: a breast-development hormone
from the pituitary gland
Pineal gland tumors.
Injuries that affect the pineal gland.
Pineal gland calcification.
 Endocrine

Hormone Functions

6 - Parathyroid 8 - Adrenal Glands

The parathyroid glands lie just behind the Adrenal glands, also known as suprarenal
thyroid glands in the neck. The parathyroid glands, are small, triangle-shaped glands
glands (light pink) produce parathyroid that are located on top of each of your
hormone two kidneys.
Which increases levels of calcium in the
blood.
PTH inhibits osteoblast activity and Cortisol:
stimulates osteoclast activity leading to Cortisol is a glucocorticoid hormone that
bone breakdown and calcium release. plays several important roles.
It helps control your body’s use of fats,
proteins and carbohydrates.
Parathyroid Hormone (PTH) levels are
mainly controlled by a feedback loop of It also suppresses inflammation, regulates
calcium levels in your blood to your your blood pressure, increases blood sugar
parathyroid glands. and helps control your sleep-wake cycle

Aldosterone:
Aldosterone is a mineralocorticoid hormone
7 - Ovaries that plays a central role in regulating blood
pressure and the levels of sodium and
One of a pair of female glands in which the potassium (electrolytes) in your blood.
eggs form and the female hormones
estrogen and progesterone are made. DHEA and androgenic steroids:
Estrogen: These hormones are weak male
hormones, meaning they don’t have
1. Estrogen stimulates the growth and
much biologic impact.
activities of female secondary sex organs.
2. It stimulates the development of Adrenaline (epinephrine) and
developing ovarian follicles, the noradrenaline (norepinephrine):
emergence of female secondary sex traits
These hormones are known as the “fight or
(e.g., the high pitch of voice, etc.), and the
flight” hormones and are called
development of the mammary gland.
catecholamine.
3. Estrogens are also involved in the
increasing your heart rate and force of
regulation of female sexual behavior.
heart contractions.
Progesterone: Increasing blood flow to your muscles and
brain and assisting in glucose metabolism.
1. Progesterone is a hormone that helps with
pregnancy.
Steroid hormones:
2. Progesterone also increases the production
Help to control metabolism, inflammation,
of alveoli (milk-storing sac-like structures)
immune system functions, salt and water
and milk secretion in the mammary
balance.
glands.
 Endocrine

Hormone Functions

9 - Pancreas
The pancreas is an elongated, tapered Symptoms
organ located across the back of the belly,
behind the stomach. It makes: Symptoms of pancreas problems may include:
Enzymes to help with digestion (exocrine Abdominal pain.
system). Back pain.
Hormones to control the amount of sugar Blurred vision.
in your bloodstream (endocrine system).
Dark urine or light-colored, greasy stools.
Fatigue.
Extreme thirst or frequent urination.
Disorders Nausea or vomiting.
Tingling in your hands or feet.
The following disorders can affect the pancreas: Unexplained weight loss.
Type 1 diabetes: Type 1 diabetes
occurs when your pancreas doesn’t
produce insulin.
Type 2 diabetes: Type 2 diabetes
occurs when your body makes insulin Hormones Released:
but doesn’t use it correctly.
Hyperglycemia (high blood sugar): 1. Insulin. This hormone is made in cells of
Hyperglycemia happens when your the pancreas known as beta cells.
body produces too much glucagon. 2. Glucagon. Alpha cells make up about 20%
This results in high blood sugar levels. of the cells in your pancreas that produce
Hypoglycemia (low blood sugar): hormones.
Hypoglycemia occurs when your body 3. Gastrin and amylin. Gastrin is primarily
produces too much insulin. It causes made in the G cells in your stomach, but
low blood sugar levels. some is made in the pancreas, too.
Pancreatitis: Pancreatitis happens
when enzymes start to work in the
pancreas before they reach the
duodenum.
Pancreatic cancer: Cancerous cells in
the pancreas cause pancreatic
cancer. Pancreatic cancer can be
difficult to detect and treat.
 Endocrine

Hormone Functions

10 - Testes
The testes — also called testicles — are two Disorders
oval-shaped organs in the male
reproductive system. Hypogonadism: Your testicles don’t pro-
They’re contained in a sac of skin called the duce enough of the hormones you need.
scrotum. Klinefelter syndrome: This genetic condi-
The scrotum hangs outside the body in the tion happens when a person is born with
front of the pelvic region near the upper two copies of the X chromosome and one
thighs. copy of the Y chromosome.
Infertility: This refers to being unable to
impregnate a partner. Your testicles may
not produce any or enough sperm,
Function:

The main function of the testes is

producing and storing sperm.
They're also crucial for creating Symptoms
testosterone and other male hormones
called androgens. signs or symptoms of conditions related to
Testes get their ovular shape from tissues your testes?
known as lobules.
Pain in your scrotum and/or testicles.
Lobules are made up of coiled tubes
surrounded by dense connective tissues. A lump or swelling on your testicle.
Discoloration of the skin on your scrotum.
An abnormal feeling of warmth in the area.
Blood in your semen.
Hormones released: Pain in your lower abdomen.

Testosterone is the key male sex hormone.

Its functions include regulating fertility,
muscle mass, fat distribution, and red blood
cell production.
The testes also make these other hormones:
Inhibin B: Serum levels of this protein are
related to testicular volume and sperm
counts in adults.
Anti- Mullerian hormone: This hormone is
important to the development of internal
male reproductive organs.
Insulin-like factor 3: This hormone helps
testicles descend into the scrotum from the
abdomen and to continue to develop in the
scrotum.
Estradiol: This hormone is important in
making sperm.
 Endocrine

Hormone Functions

Adrenal Cortex Adrenal Cortex Functions:

The adrenal cortex makes up a large part
CORTISOL
of your adrenal gland.
Cortisol is a glucocorticoid hormone
The cortex is the outer part of your adrenal produced by the zona fasciculate that plays
gland. It releases hormones that support several important roles in the body.
your well-being.
It helps control the body’s use of fats.
It consists of three layers: Proteins and carbohydrates.
1. Zona Glomerulosa (outer layer). Suppresses inflammation.
2. Zona Fasciculate (middle layer). Regulates blood pressure.
3. Zona Reticularis (innermost layer). Decrease bone formation.
Increases blood Sugar.

ALDOSTERONE
Controls blood sugar levels. Produced by the zona glomerulosa plays
Supports the breakdown of carbohydrates, a central role in regulating blood
proteins and fats (metabolism). pressure and certain electrolytes
Regulates blood pressure. (sodium and potassium).
Suppresses inflammation. Mineralocorticoids increases Sodium
Regulates your sleep-wake cycle.
DHEA AND ANDROGENIC STEROIDS
Raises glucose levels when the body is
Produced by the zona reticularis are weak
under stress.
male hormones.
They are precursor hormones that are
Adrenal Gland converted in the ovaries into female
hormones (estrogens) and in the testes
Capsule into male hormones
Increase Sex hormones

Blood
Vessels
Remember the 3s’s
Blood Cortex
Vessels
FUNCTION
The adrenal glands sit on top
of each kidney like a cap
 Endocrine

Addison's vs Cushing's

Addison's Cushing's

Addison's disease, also called adrenal Cushing disease (also called Cushing's
insufficiency (hyposecretion). disease or hypercortisolism) occurs when
your body makes too much cortisol, a
Uncommon illness that occurs when the
hormone related to the body's
body doesn't make enough of certain
stress response
hormones.
In Addison's disease, the adrenal glands
make too little cortisol and, often, too little
of another hormone, aldosterone. Remember in cushing's
there's a cushion of steroids
Remember in addison's you
need to add steroids
Causes

Tumor in the outer part of the adrenal

Causes gland called an adrenal adenoma
Chronic stress and poor stress manage-
causes of Addison’s disease include: ment can cause Cushing disease
Adrenal hyperplasia (enlarged adrenal
Cancer glands)
Take anticoagulants (blood thinners)
Have chronic infections like tuberculosis Cushing syndrome is caused by having too
Had surgery to remove any part of your much cortisol in the body. Cortisol is a
adrenal gland hormone that is made in the adrenal glands.
It helps the body respond to stress and plays
Have an autoimmune disease, like type
many other important roles, including:
1 diabetes or Graves’ disease
Bleeding (hemorrhaging) into your
Controlling blood pressure.
adrenal glands.
Reducing inflammation.
Surgical removal of your adrenal
glands. Helping the heart and blood vessels work
correctly.
Amyloidosis
Controlling blood sugar.
Tuberculosis
Helping the body use food for energy.
 Endocrine

Addison's vs Cushing's

Symptoms Symptoms

Everything is low (except the 2 p's) Everything is high & big (except potassium)
Symptoms
Symptoms may include:
Symptoms of Cushing syndrome can vary
Extreme fatigue depending on the level of extra cortisol.
Low periods (amenorrhea) Common Symptoms of Cushing Syndrome
High pigmentation (bronze skin) Weight gain in the trunk, with thin arms and
High potassium ( Na= K) legs.
Weight loss and loss of appetite Weight gain in the face. This is sometimes
Areas of darkened skin called moon face.
Low sodium (salt cravings) A fatty lump between the shoulders. This may
be referred to as a buffalo hump.
Low weight (weight loss)
Pink or purple stretch marks on the stomach,
Low blood pressure, even fainting hips, thighs, breasts and underarms.
Salt craving Thin, frail skin that bruises easily.
Low blood sugar, also called hypo- Areas of darkened skin
glycemia high sodium
Nausea, diarrhea or vomiting high weight (weight gain)
Low blood pressure Slow wound healing.
Low blood sugar Acne
Abdominal pain Low potassium (highNa= lowK)
Irritability or depression Symptoms women with Cushing syndrome
may experience
Lack of energy
Thick, dark hair on the face and body. This
Sleep disturbances
condition is called hirsutism.
Irritability Periods that are irregular or that stop.
Low hair (alopecia) Symptoms men with Cushing syndrome
Depression may experience
High pigmentation (bronze skin) Lower sex drive.
Body hair loss or sexual issues in Reduced fertility.
some people Problems getting an erection.
Extreme weakness. Other possible symptoms of Cushing
Severe pain in your lower back, belly syndrome
or legs. Emotions that are hard to control.
High blood pressure.
Infections.
Skin darkening.
Bone loss, which can lead to broken bones.
Stunted growth in children.
 Endocrine

Addison's vs Cushing's

Complication: Treatment

Addisonian crisis secondary to adrenal An addisonian crisis is a medical

insufficiency can be difficult to diagnose in emergency. Treatment typically includes IV:
acutely ill patients as the initial presentation Corticosteroids
is usually nonspecific with symptoms of: Saline solution
Fatigue Back pain Sugar
Weakness Diarrhea IVF resuscitation
Nausea Dizziness IV hydrocortisone
Vomiting Hypotension
Abdominal pain Syncope

Complications
Bronze Without treatment, Cushing syndrome can
Hypoglycemia
Pigmentation cause complications, including:
of Skin Bone loss, also called osteoporosis,
Postural
Hypotension which can lead to broken bones.
Changes in High blood pressure, also called
Distribution hypertension.
of Body Hair Type 2 diabetes.
Serious or multiple infections.
GI Disturbances Weight Loss Loss of muscle mass and strength.

Fat Pads
Weakness Red Cheeks (Bufalo Humps)

Bruise
Easily
Abdominal
Monitor for Addison's Disease? Stretch Mark

If Addison's disease is suspected, blood tests Pendulous

will be carried out to measure Abdomen
Thin Arm
The levels of A low sodium and Legs
sodium high potassium
Potassium and or low cortisol
cortisol in your body level may indi-
Severe hypotension cate Addison's
disease
Profound fatigue
 Endocrine

Addison's vs Cushing's

Risk factors Risk factors

A history of having a disease or surgery ACTH-producing pituitary adenoma.

that affects the pituitary gland or the Pituitary adenomas are tumors that grow
adrenal glands. in the pituitary gland.
Certain genetic changes that affect the Buffalo hump (fat pad on back of neck)
pituitary or adrenal glands. These include Thin extremities
gene changes that cause the inherited Easy bruising & petichiae
disease congenital adrenal hyperplasia.
Slow wound healing (high risk of infection)
Other autoimmune endocrine conditions,
Ectopic ACTH-producing tumor. ...
such as hypothyroidism or type 1 diabetes.
Adrenal gland tumors or disease. ...
A traumatic brain injury.
Familial Cushing syndrome.
High risk of fractures (brittle bones/
osteoporosis from high steroid levels

Diagnosis
Diagnosis
Blood tests diagnose Addison’s disease?
Blood to be tested for the following: the following tests:
a low level of the hormone aldosterone Blood tests:
a high level of adrenocorticotrophic Tests to measure the levels of sodium,
hormone (ACTH) potassium, cortisol and ACTH in your blood.
a low level of glucose (sugar used for
ACTH stimulation test:
energy)
This test measures your adrenal glands’
positive adrenal antibodies (antibodies
response after you’re given a shot of
designed to attack the adrenal gland)
artificial ACTH.
Synacthen stimulation test
Insulin-induced hypoglycemia test:
.
Thyroid function test This test measures blood sugar
(glucose) levels before and after the
injection of fast-acting insulin,
Computed tomography (CT scan);
Computed tomography is an imaging
test that uses computers to combine
many X-ray images into
cross-sectional views.
 Endocrine

Addison's vs Cushing's

Treatment Treatment

Watch for signs of too many steroids Chemotherapy:

(will lead to cushing's) Chemotherapy is necessary if a tumor’s
cancerous and has spread to other parts
Hydrocortisone, prednisone or methyl- of your body.
prednisolone (Medrol) to replace cortisol.
Medications. Adding drugs that reduce
These hormones are given on a schedule
cortisol or taking away drugs that can
to act like the changes in cortisol levels the
cause Cushing syndrome.
body goes through over 24 hours.
Fludrocortisone acetate to replace aldo- Radiation:
sterone. Surgery on a pituitary tumor may not be
If you’re taking fludrocortisone, your possible. In those cases, you might have to
provider might tell you to increase your salt go through a six-week period of radiation.
intake, especially in hot and humid weather
and after vigorous exercise. Hypophysectomy:
Is the surgical removal of the hypophysis
Other treatment recommendations (pituitary gland).
include:
It is most commonly performed to treat
Carry a medical alert card and bracelet at tumors, especially craniopharyngioma
all times. tumors.
Keep extra medicine handy. Surgery:
Carry a glucocorticoid injection kit.
Surgically removing pituitary tumors,
Stay in contact with your care provider. adrenal tumors and ectopic tumors
Have yearly checkups. is effective.

Adrenalectomy:
is a surgical procedure to remove the
Diet adrenal gland if it is cancerous and/or
producing too much hormone.

Diet plays an important role in managing

the symptoms of Addison’s disease. A
high-sodium diet can be beneficial for
those with insufficient aldosterone levels.
Grapefruit or high-fiber foods can interfere
with corticosteroids
Need extra calcium and vitamin D
supplementation to counter the risk for
osteoporosis.
 Endocrine

Diabetes Mellitus

Diabetes, a chronic condition, is diagnosed and monitored with blood glucose testing.
Diabetes mellitus (DM) is a disease of inadequate control of blood levels of glucose.

Glucose Transport

After eat a meal, any

Insulin is released from the The pancreas detects
carbohydrates you've eaten
beta cells in your pancreas this rise in blood glucose
are broken down into
in response to rising glucose and starts to secrete
glucose and passed into the
in your bloodstream. insulin
bloodstream.

Once the cell unlocks, Insulin also Insulin is like a Blood glucose
glucose enters and is helps the key that helps increases this
Converted into two body store unlock your cells rise in blood
molecules of pyruvate, each any extra and allows sugar triggers
of which contains three glucose. glucose (sugar) the pancreas to
carbon atoms. For each in your blood to secrete insulin
molecule of glucose, two move into your into the
molecules of ATP are cells where it is bloodstream.
hydrolyzed to provide used for energy Insulin travels
energy to drive the early through the
steps circulatory
system to the
body's cells

1.Between meals 2.Sugar-rich meals 3.After insulin secretion

Glucose Glucose Glucose

SGLT1 SGLT1 Glut2 SGLT1

Glut2

Glut2

Glucose Glucose
Glucose

Glut2 Glut2 Glut2

Glucose Glucose Glucose Insuline

Blood
 Endocrine

Diabetes Mellitus

Type 1 Type 2

Type 1 diabetes is a condition in which your Type 2 diabetes is a lifelong disease that
immune system destroys insulin-making keeps your body from using insulin the way
cells in your pancreas. These are called it should.
beta cells. The pancreas does not produce enough
Body breaks down the food you eat into insulin a hormone that regulates the
glucose (sugar) movement of sugar into the cells.
Which is body’s main source of energy. And cells respond poorly to insulin and
take in less sugar.
Glucose enters your bloodstream.
Cells become resistant to insulin and
Which signals your pancreas to release glucose can't enter, causing glucose to
insulin. glucose stays in the bloodstream get stuck in the blood
causing high blood sugar.
Insulin helps glucose in your blood enter
your muscle, fat and liver cells.

Causes
Genes.
Causes
Weight gain
Metabolic syndrome. People with insulin
Dehydration Weight loss.
resistance often have a group of conditions
Genetics Diabetic including high blood sugar, high blood
Family history ketoacidosis (DKA). pressure, and high cholesterol and
triglycerides.
If your body can't get enough glucose for
fuel, it breaks down fat cells instead. Too much glucose from your liver. When
your blood sugar is low, your liver makes
Damage to your body. and sends out glucose.
Over time, high glucose levels in your blood Sedentary lifestyle
can harm the nerves and small blood Bad communication between cells.
vessels in your eyes, kidneys, and heart. Sometimes, cells send the wrong signals or
Usually diagnosed in childhood don't pick up messages correctly.
Hyperlipidemia. elevated level of lipids like
cholesterol and triglycerides in your blood.
Remember childhood comes
Broken beta cells. If the cells that make
1st for type 1
insulin send it out at the wrong time, your
blood sugar gets thrown off.
 Endocrine

Diabetes Mellitus

Symptoms

Symptoms are Abrupt 3 p's Symptoms are gradual

Symptoms of Type 1 diabetes include:

Polyuria (High Urination)
Excessive thirst. Vaginal yeast
Condition where the body urinates more Frequent urination, infections.
than usual and passes excessive including frequent Fruity-smelling
Abnormally large amounts of urine each full diapers in breath.
time you urinate. infants and Nausea and
bedwetting in vomiting.
Kidney’s trying to excrete glucose via
children.
urination Abdominal
Excessive hunger. (stomach) pain.
Unexplained weight Rapid breathing.
loss.
Polydypsia (High thirst) Confusion.
Fatigue
Drowsiness.
Blurred vision.
Excessive thirst. Loss of
Slow healing of consciousness.
Excess thirst is an abnormal urge to drink
cuts and sores.
fluids at all times.
It's a reaction to fluid loss in body.
Hypothalamus increasing thirst because
blood is concent.

Symptoms of type 2 diabetes

Polyphagia (High Hunger)
Increased thirst. Slow-healing sores.
Feeling of extreme, insatiable hunger. Frequent urination. Frequent infections.
It's a symptom of certain health conditions. Increased hunger. Numbness or
It's a reaction to fluid loss in body. Unintended weight tingling in the
loss. hands or feet.
Eating typically doesn't make polyphagia
go away, except in the case of low blood Fatigue Areas of darkened
sugar (hypoglycemia). skin.
Blurred vision.
Due to limited entry of glucose into the cells
 Endocrine

Diabetes Mellitus

Risk Factors Risk Factors

Some factors that can raise your risk for Factors that may increase the risk of type 2
type 1 diabetes include: diabetes include:
1. Family history. Anyone with a parent or 1.Weight. Being overweight or obese is a
sibling with type 1 diabetes has a slightly main risk.
higher risk of developing the condition. 2. Fat distribution. Storing fat mainly in the
2. Genetics. Having certain genes increases abdomen, rather than the hips and thighs
the risk of developing type 1 diabetes. indicates a greater risk.
3. Geography. The number of people who 3. Inactivity. The less active a person is, the
have type 1 diabetes tends to be higher greater the risk
as you travel away from the equator. 4. Family history.
4. Age. Type 1 diabetes can appear at any 5. Blood lipid levels. An increased risk is
age, but it appears at two noticeable associated with low levels of high-density
peaks. lipoprotein (HDL) cholesterol the "good"
cholesterol — and high levels of
triglycerides.
6. Age. The risk of type 2 diabetes increases
with age, especially after age 35.
7. Prediabetes. Prediabetes is a condition in
which the blood sugar level is higher than
normal, but not high enough to be classi-
fied as diabetes
8. Pregnancy-related risks. The risk of devel-
oping type 2 diabetes is higher in people
who had gestational diabetes when they
were pregnant and in those who gave birth
to a baby weighing more than 9 pounds (4
kilograms).
9. Polycystic ovary syndrome. Having poly-
cystic ovary syndrome — a condition
characterized by irregular menstrual
periods, excess hair growth and obesity
 Endocrine

Diabetes Mellitus

Treatment Treatment

Everyone with type 1 diabetes needs to use Management of type 2 diabetes includes:
insulin shots to control their blood sugar. Healthy eating.
When your doctor talks about insulin, Regular exercise.
they’ll mention three main things: Physical activity
"Onset" is how long it takes to reach your Weight loss.
bloodstream and begin lowering your Possibly, diabetes medication or
blood sugar. insulin therapy.
"Peak time" is when insulin is doing the Blood sugar monitoring.
most work in terms of lowering your blood
sugar. Diabetes medications
"Duration" is how long it keeps working Metformin (Fortamet, Glumetza, others)
after onset. Sulfonylureas help the body secrete more
Several types of insulin are available. insulin
Glinides stimulate the pancreas to secrete
Rapid-acting starts to work in about 15 more insulin.
minutes. It peaks about 1 hour after you
take it and continues to work for 2 to 4 Thiazolidinediones make the body's tissues
hours. more sensitive to insulin.
Regular or short-acting gets to work in DPP-4 inhibitors help reduce blood sugar
about 30 minutes. It peaks between 2 and 3 levels but tend to have a very modest
hours and keeps working for 3 to 6 hours. effect.
Intermediate-acting won’t get into your GLP-1 receptor agonists are injectable
bloodstream for 2 to 4 hours after your medications that slow digestion and help
shot. It peaks from 4 to 12 hours and works lower blood sugar levels.
for 12 to 18 hours. Insulin therapy.
Long-acting takes several hours to get into Some people who have type 2 diabetes
your system and lasts about 24 hours. need insulin therapy. In the past, insulin
therapy was used as a last resort.
Type 1 diabetes management include:

Insulin.
Blood glucose (sugar) monitoring.
Carbohydrate counting.
 Endocrine

Diabetes Mellitus

Diagnosis

Normal fasting Target glucose

Blood glucose test : Age

glucose without range for type 1
diabetes diabetes
Blood glucose test to check the amount of at bedtime
sugar in your blood.
They may ask you to do a random test Adults and
(without fasting) and a fasting test (no children 70-100 mg/dL 90-150 mg/DL
food or drink for at least eight hours before
13-19
the test).
If the result shows that you have very high
blood sugar, it typically means you have Children
70-100 mg/dL 100-180 mg/DL
Type 1 diabetes 6-12
Drink 75g glucose drink
Test blood sugar in 2 hours.
Children
Glycosylated hemoglobin test (A1c): 70-100 mg/dL 110 to 200 mg/DL
under 6
If blood glucose test results indicate that you
have diabetes, your healthcare provider may
do an A1c test. This measures your average
blood sugar levels over three months.

Antibody test:
This blood test checks for autoantibodies
to determine if you have Type 1 or Type 2
diabetes.
Urinalysis: A urinalysis (also known as a
urine test) is a test that examines the visual,
chemical and microscopic aspects of your
urine (pee).
Arterial blood gas: An arterial blood gas
(ABG) test is a blood test that requires a
sample from an artery in your body to
measure the levels of oxygen and carbon
dioxide in your blood.
hba1c: measures average blood sugar
over past 3 months

Normal < 110 mg/dl

 Endocrine

Diabetes Mellitus

Diabetic Foot Care

Impaired Sensation
causes major sensory loss for all sensory modalities with ataxia of lower and even upper
limbs and loss of thermal sensation.(neuropathy)
Impaired perfusion
Excess blood sugar decreases the elasticity of blood vessels and causes them to narrow,
impeding blood flow. (high glucose damages vessels)
Causes high risk of injury, infection & slow wound healing leading to infection

Education

Inspect your feet daily. Consider using an antiperspirant on the

Bathe feet in lukewarm, never hot, water. . soles of your feet.
Be gentle when bathing your feet. Never walk barefoot. Not even at home!
Moisturize your feet but not between your Take care of your diabetes. Keep your
toes. blood sugar levels under control.
Cut nails carefully Do not smoke. Smoking restricts blood flow
in your feet.
Never treat corns or calluses yourself.
Get periodic foot exams.
Wear clean, dry socks. Change them daily.
Consider socks made specifically for
patients living with diabetes.
Wear socks to bed. If your feet get cold at
night, wear socks.
Shake out your shoes and feel the inside
before wearing.
Keep your feet warm and dry.
 Endocrine

Diabetes Mellitus

Sick Day Rules Complications

Continue taking your insulin and diabetes Cardiovascular disease. Diabetes can put
pills as usual. you at higher risk of blood clots, as well as
Test your blood sugar every 4 hours and high blood pressure and cholesterol. These
keep track of the results. can lead to chest pain, heart attack, stroke,
or heart failure.
Drink extra calorie-free liquids, and try to
eat as you normally would. Skin problems. People with diabetes are
more likely to get bacterial or fungal
Substitute sick day foods if can’t tolerate
infections. Diabetes can also cause blisters
regular food (Ex: popsicles & jello)
or rashes.
Weigh yourself every day.
Gum disease. A lack of saliva, too much
Losing weight without trying is a sign of plaque, and poor blood flow can cause
high blood glucose. mouth problems.
Check your temperature every morning Pregnancy problems. Women with type 1
and evening. A fever may be a sign of diabetes have a higher risk of early
infection. delivery, birth defects, stillbirth, and
preeclampsia.
Retinopathy. This eye problem happens in
about 80% of adults who have had type 1
diabetes for more than 15 years.
Notify HCP immediately if : Kidney damage. About 20% to 30% of
people with type 1 diabetes get a condition
BG <70 after eating
called nephropathy
Unable to tolerate food or drink
Retinopathy the leading cause of
Ketones are positive preventable blindness. It is caused by
BG >240 damage to the blood vessels of the
light-sensitive tissue at the back of the eye
(retina).
Hearing impairment. Hearing problems
are more common in people with diabetes.
Sleep apnea. Obstructive sleep apnea is
common in people living with type 2
diabetes.
 Endocrine

Hypoglycemia Vs Hyperglycemia

Dysregulation of glucose
Blood sugar dysregulation refers to abnormalities or inconsistencies in the
body's ability to maintain optimal levels of glucose (sugar) in the blood.
Proper blood sugar regulation is crucial for a range of physiological functions.
Including energy production, hormonal balance, and cellular health.

Glucose Function
Function of glucose in the cell is to produce energy instantly by catabolism.
Glucose is the most common substrate and it yields two molecules of ATP directly from
substrate-level phosphorylation.
Insulin facilitates the uptake of glucose and amino acids from the bloodstream.

Insulin Function Glucagon function

Insulin is a peptide hormone secreted by the Help regulate your blood glucose
β cells of the pancreatic islets of Langerhans (sugar) levels.
Maintains normal blood glucose levels by Glucagon increases your blood sugar level
facilitating cellular glucose uptake, Prevents it from dropping too low, whereas
Regulating carbohydrate, lipid and protein insulin, another hormone, decreases blood
metabolism sugar levels.
Promoting cell division and growth through
its mitogenic effects.
Stimulates glycogen
breakdown
Glucagon

Chemical energy 0
Pancreas
Glycogen Glucose

Liver Insulin
Glycolysis Stimulates glucose
Electron (hydrogen) formation
KREBS Transport system Stimulates glucose
Glucose > Pyruvic acid CYCLE uptake from food

Tissue cells

H20

2 ATP 36
C02
 Endocrine

Hypoglycemia Vs Hyperglycemia

Hypoglycemia Hyperglycemia
(Low Blood Sugar) (Low Blood Sugar)
Hypoglycemia happens when the level of Hyperglycemia is the technical term for high
sugar (glucose) in your blood drops below blood glucose (blood sugar). High blood
the range that’s healthy for you. It’s also glucose happens when the body has too
called low blood sugar or low blood glucose. little insulin or when the body can't use
insulin properly.
<70 mg/ dL >200 mg/ dL

Causes Causes

Causes can include: Skip or forget your insulin or oral

glucose-lowering medicine.
Medications. Taking someone else's oral
diabetes medication accidentally is a Eat too many grams of carbohydrates for
possible cause of hypoglycemia. the amount of insulin you took, or eat too
many carbs in general
Excessive alcohol drinking.
Have an infection
Some critical illnesses. Severe liver
illnesses such as severe hepatitis or Are sick
cirrhosis, severe infection, kidney disease, Illness, stress or infection
and advanced heart disease can cause Poor diet (lots of sweets, salt & fat)
hypoglycemia.
Are under stress
Long-term starvation. Hypoglycemia can
Become inactive or exercise less than usual
occur with malnutrition and starvation
.glycogen stores your body needs to
create glucose are used up.
Insulin overproduction. A rare tumor of
the pancreas can cause it.
Hormone deficiencies. Certain adrenal
gland and pituitary tumor disorders can
result in an inadequate amount of certain
hormones that regulate glucose
production or metabolism.
 Endocrine

Hypoglycemia Vs Hyperglycemia

Symptoms Symptoms

"Cool & clammy need some candy" "If skin is dry, sugar's high"

Shaking or trembling. Early signs and symptoms

Weakness. Recognizing early symptoms of
Sweating and chills. hyperglycemia can help identify and treat it
Extreme hunger (polyphagia) right away. Watch for:
Faster heart rate. Frequent urination
Dizziness or lightheadedness. Increased thirst
Confusion or trouble concentrating. Blurred vision
Anxiety or irritability. Feeling weak or unusually tired
Color draining from your skin (pallor).
Tingling or numbness in your lips, tongue or Later signs and symptoms
cheeks. If hyperglycemia isn't treated, it can cause
Signs of severe hypoglycemia include: toxic acids, called ketones, to build up in the
Blurred or double vision. blood and urine. This condition is called
ketoacidosis. Symptoms include:
Slurred speech.
Shakiness Fruity-smelling breath
Obtunded Dry mouth
Clumsiness or difficulty with coordination. Abdominal pain
Being disoriented. Nausea and vomiting
Seizures. Shortness of breath
Loss of consciousness. Confusion
Restless sleep. Loss of consciousness 3 p's
Sweating through your pajamas or sheets.
Crying out during sleep.
Polyuria
Having nightmares.
Polydypsia
Obtunded (can lead to coma!)
Polyphagia
 Endocrine

Hypoglycemia Vs Hyperglycemia

Complications Complications

Untreated hypoglycemia can lead to: Long-term complications

Coma Keeping blood sugar in a healthy range can

Falls help prevent many diabetes-related
complications. Long-term complications of
Injuries
hyperglycemia that isn't treated include:
Greater risk of dementia in older adults
Fast heartbeat Cardiovascular disease
Dizziness Nerve damage (neuropathy)
Sweating Kidney damage (diabetic nephropathy)
Blurry vision or kidney failure
Fatigue Damage to the blood vessels of the retina
(diabetic retinopathy) that could lead to
Irritability blindness
Difficulty concentrating Feet problems
Shaking Bone and joint problems
Paresthesia Teeth and gum infections
Confusion
Emergency complications
Loss Of Consciousness
Clumsiness If blood sugar rises very high or if high
blood sugar levels are not treated.
Seizures
it can lead to two serious conditions.
Slurred speech
Pallor Diabetic ketoacidosis. This condition
Shakiness develops when you don't have enough
insulin in your body.

Hyperosmolar hyperglycemic state.

 Endocrine

Hypoglycemia Vs Hyperglycemia

Risk Factors Risk Factors

Taking too much insulin. Many factors can contribute to hypergly-

cemia, including:
Not eating enough carbs for how much
insulin you take. Not using enough insulin or other diabetes
Timing of when you take your insulin. mevdication
The amount and timing of physical activity. Not injecting insulin properly or using
Drinking alcohol. expired insulin
How much fat, protein, and fiber are in your Not following your diabetes eating plan
meal. Being inactive
Hot and humid weather. Having an illness or infection
Unexpected changes in your schedule. Using certain medications, such as steroids
Spending time at a high altitude. or immunosuppressants
Going through puberty. Being injured or having surgery
Menstruation. Experiencing emotional stress, such as
family problems or workplace issues

Prevention Prevention

Monitor your blood sugar. Follow your diabetes meal plan. If you take
Don't skip or delay meals or snacks. insulin or oral diabetes medication, be
consistent about the amount and timing of
Measure medication carefully and take it
your meals and snacks.
on time.
Monitor your blood sugar.
Adjust your medication or eat additional
snacks if you increase your physical Carefully follow your health care
activity. provider's directions for how to take your
medication.
Eat a meal or snack with alcohol, if you
choose to drink. Adjust your medication if you change
your physical activity.
Record your low glucose reactions.
Carry some form of diabetes identification
so that in an emergency others will know
that you have diabetes.
 Endocrine

Hypoglycemia Vs Hyperglycemia

Diagnosis Diagnosis

Check your blood sugar. with a blood glucose Your health care provider sets your target
meter (glucometer). blood sugar range. For many people who
have diabetes, Mayo Clinic generally
A CGM could be a helpful tool in identifying recommends the following target blood
and preventing low blood sugar. sugar levels before meals:
health care provider will want to know : Between 80 and 120 milligrams per deciliter
(mg/dL) (4.4 and 6.7 millimoles per liter (m
What were your signs and symptoms? mol /L)) for people age 59 and younger
What is your blood sugar level when who have no medical conditions other than
you're having symptoms? . diabetes
Do your symptoms disappear when blood Between 100 and 140 milligrams per decili-
sugar levels increase? ter (mg/dL) (5.6 and 7.8 milli moles per liter
(m mol /L)) for:

People age 60 and older.

Those who have other medical condi-
tions, such as heart, lung or kidney
disease.
People who have a history of low blood
sugar (hypoglycemia) or who have
difficulty recognizing the symptoms of
hypoglycemia.

Home blood sugar monitoring

Routine blood sugar monitoring with a
blood glucose meter is the best way to be
sure that your treatment plan is keeping
your blood sugar within your target range
Hemoglobin A1C test
During an appointment, your health care
provider may conduct an A1C test.
 Endocrine

Hypoglycemia Vs Hyperglycemia

Treatment—The "15-15 Rule" Treatment

The 15-15 rule—have 15 grams of Home treatment

carbohydrate to raise your blood glucose
Talk to your health care provider about
and check it after 15 minutes. If it’s still
managing your blood sugar.
below 70 mg/dL, have another serving.
Understand how different treatments can
Repeat these steps until your blood
help keep your glucose levels within your
glucose is at least 70 mg/dL.
target range.
Once blood glucose is back to normal, eat
Your health care provider may suggest
a meal or snack to make sure it doesn’t
the following:
lower again.
Get physical. Regular exercise
This may be:
Take your medication as directed.
Glucose tablets (see instructions)
Follow your diabetes eating plan.
Gel tube (see instructions)
Adjust your insulin doses.
4 ounces (1/2 cup) of juice or regular soda
(not diet) Emergency treatment for severe
1 tablespoon of sugar, honey, or corn syrup hyperglycemia
Hard candies, jellybeans, or gum- If you have signs and symptoms of diabetic
drops—see food label for how many to ketoacidosis or hyperosmolar hyperglycemic
consume state, you may be treated in the emergency
Treat severe low blood sugar room or admitted to the hospital.
If someone has very low blood sugar (a Assess for signs of DKA or HHNS
severe hypo) and becomes unconscious:
HHS can cause a person to experience
Do not give them any food or drink as they hallucinations, confusion, drowsiness, loss
will not be able to swallow safely. of vision, or a coma.
Put them into the recovery position. DKA is associated with high levels of
Give them a glucagon injection straight ketones in the blood.
away, if one is available and you know how
to use it. Treatment usually includes:
If they start to recover within 10 minutes of Fluid replacement. You'll receive fluids —
having a glucagon injection and can usually through a vein (intravenously)
swallow safely, give them some food or until your body has the fluids it needs.
drink that will raise their blood sugar. Electrolyte replacement. Electrolytes are
Stay with them until they're fully recovered. minerals in your blood that are necessary
for your tissues to work properly.
Call MD immediately Insulin therapy. Insulin reverses the
processes that cause ketones to build up
CARBOHYDRATE SOURCE in your blood. Along with fluids and
electrolytes.
Fruits Rice Dextrose Gel
Oats Orange Juice
Jello Bread
 Endocrine

Hypoglycemia Vs Hyperglycemia

Education Avoid DIET

Know the symptoms of hypoglycemia and Fried foods and other foods high in
when you are at risk for it, such as during saturated fat and trans fat.
exercise or when you are sick. Foods high in salt, also called sodium.
Always carry glucagon kit & fast acting carb Sweets, such as baked goods, candy, and
Check your blood glucose often when you ice cream.
are at risk for hypoglycemia. Beverages with added sugars, such as
Hypoglycemia can develop quickly, and it juice, regular soda, and regular sports or
can be dangerous if it is not treated right energy drinks.
away. High sodium
Eat a well balanced diet. Skipping meals

Hypoglycemia can mimic

the effects of alcohol! Recommended DIET
NUT Fish
EGG Fruits & vegetables
Education Whole grains Low fat dairy
Sugar Leafy green
Instruct the patient about the importance
Fiber-rich foods Lean meats &
of increasing physical activity to reduce
Meat protein
glucose levels.
Monitor your blood sugar. ...
Don't skip or delay meals or snacks. ...
Measure medication carefully and take it
on time. ...
Adjust your medication or eat additional
snacks if you increase your physical
activity. ...
Eat a meal or snack with alcohol, if you
choose to drink.
Educate the patient on the need for tightly
controlled glucose levels of 70 to 130 mg/dl
before meals and less than 180 mg/dl 2
hours after eating.
 Endocrine

DKA Vs HHNS

Diabetic ketoacidosis (DKA) is associated with hyperglycemia and ketoacidosis,

whereas hyperosmolar hyperglycemia state (HHS) mainly has severe
hyperglycemia and hyperosmolarity.
DKA is typically seen in people with type 1 diabetes, whereas HHS is typically seen
in people with type 2 diabetes.
These conditions cause an unsafe high blood glucose level, dehydration, and
electrolyte changes

Hyperglycemic Hyperosmolar
Diabetic Ketoacidosis (DKA) Vs Nonketotic Syndrome(HHNS)
Develops when your body doesn't have
enough insulin to allow blood sugar into It involves very high blood sugar levels and
your cells for use as energy. can be life threatening.
Blood sugar gets too high, your kidneys try
Metabolic acidosis: buildup of acid in to excrete excess sugar through urination.
the body due to kidney disease or kidney When this happens, it’s known as
failure hyperglycemia.
Severe hyperglycemia: polyuria, If you do not drink enough to replace the
polydipsia, and weight loss. fluid you’ve lost, blood sugar levels get
Ketone production: Ketones are formed even higher and your blood becomes more
when there is not enough sugar or concentrated. This is called
glucose to supply the body's fuel needs. hyperosmolarity.
Very little insulin available to move glucose
Mainly occurs in into cells
type 1 diabetics
Mainly occurs in
The fat is broken down by the liver into a type 2 diabetics
fuel called ketones.
Ketones are normally produced by the liver
when the body breaks down fat after it has The pancreas pumps out more insulin to
been a long time since your last meal. get blood sugar into cells.
These ketones are normally used by the Over time, cells stop responding to all that
muscles and the heart. insulin they've become insulin resistant.
The pancreas keeps making more insulin to
try to make cells respond.
Eventually, the pancreas can't keep up, and
blood sugar keeps rising.
 Endocrine

DKA Vs HHNS

Differences between DKA and HHS include :

Markers DKA HHS

Most commonly affects Most commonly

People affected. people with affects people with
Type 1 diabetes. Type 2 diabetes.

Develops quickly — Develops more slowly

Time to develop. — usually within days
often within 24 hours.
to weeks.

Usually above Higher than

Blood sugar level.
250 mg/dL. 600 mg/dL.

Urine or
Present. Trace or none.
blood ketones.

Blood pH level. 7.3 or lower. Higher than 7.3.

Mortality rate. About 1% to 8%. About 10% to 20%.

 Endocrine

DKA Vs HHNS

Causes Causes

Missing insulin doses and diabetes Illness

mismanagement. If you miss doses of Stress
insulin or other medications a lot, or if your
Cardiovascular (heart and blood vessel)
doctor prescribed the wrong dose, etc.
issues:
Timing of diabetes diagnosis. People who
Very high blood sugar levels from
don’t know they are diabetic and people
undiagnosed or unmanaged diabetes
who just found out that they have diabetes
are more likely to get DKA. Substance misuse
Coexisting conditions
How you take your insulin.
Infections
People who give themselves shots of
Pneumonia
insulin are more likely to get DKA than
people who use an insulin pump. Urinary tract infection
However, if you use an insulin pump Sepsis
and it gets clogged or stops working, Certain medications, especially
second-generation drugs for psychosis
Using expired insulin.
Renal impairment
Being sick or stressed.
Poor fluid intake
Infections.
Not following a diabetes treatment plan
Trauma to your body.
Heart attacks, strokes, and blood clots.
Pancreatitis (inflammation in your
pancreas).
Pregnancy.
Alcohol, drugs, and certain medicines.
 Endocrine

DKA Vs HHNS

Symptom chart HHNS AND DKA

Symptoms HHNS DKA

High blood
sugar levels X X

Extreme thirst X X

Frequent urination X X

Confusion X X

Nausea/vomiting X X

High ketone levels X

in urine
Fruity-smelling
X
breath

Rapid breathing X

Fast heart rate X

Fatigue X

Slurred speech X

One-sided Weakness X
 Endocrine

DKA Vs HHNS

Symptoms Symptoms

ABRUPT onset Symptoms of HHNS can include:

Diabetic ketoacidosis symptoms often come GRADUAL onset

on quickly, sometimes within 24 hours: Very high blood ThirsPolyuria
Being very thirsty sugar levels Slurred speech,
Urinating often Dry mouth Weakness
Dry membranes Fast heart rate. Fever
BG 250-500+ Polydypsia Polyphagia
Feeling a need to throw up and throwing up Frequent urina- Malaise
Having stomach pain tion
General weak-
Kussmaul respirations Nausea, vomiting. ness
Being weak or tired (attempt to blow off CO2) Stomachache Tachypnea
Being short of breath Confusion, Tachycardia
Having fruity-scented breath
Ketones in urine NO ketones
Metabolic acidosis (<7.35) NO fruity breath
Being confused NO kussmaul resp
More-certain signs of diabetic ketoacidosis — NO acidosis
which can show up in home blood and urine
test kits Include:
NO abdominal pain
High blood sugar level
High ketone levels in urine
 Endocrine

DKA Vs HHNS

Risk Factors Risk Factors

DKA Risk Factors Poorly managed diabetes.

Anyone who has diabetes can get diabetic Being 65 or older.
ketoacidosis. These risk factors include:
Having other health issues.
Type of diabetes. Infection.
People with type 1 diabetes are more likely Illness.
to get DKA, and it’s often more serious
Heart condition.
than it is in people with type 2 diabetes.
Age. Older adults are more likely to get
complications from diabetes, including
DKA.
Access to insulin. take smaller doses than
Complications
they need, or go without because insulin
costs too much. Shock.
Missing meals. Not eating regularly can Blood clot formation.
cause your body to start making too Brain swelling (cerebral edema)
many ketones.
Increased blood acid level (lactic acidosis)
Family history of diabetes or
Coma
autoimmune diseases.
Seizures,
Death.

Complications

DKA complications are possible if you don’t

have emergency treatments such as
electrolyte replacement and insulin. They
include:
Low blood sugar or hypoglycemia
Low potassium or hypokalemia
Brain swelling (cerebral edema) if your
blood sugar levels are adjusted too quickly
Loss of consciousness
Death
Swelling in the brain, also known as
cerebral edema.
 Endocrine

DKA Vs HHNS

Prevention Prevention
There are many ways to prevent diabetic
ketoacidosis Taking prescribed medications regularly
and consistently
Manage your diabetes..
Eating a balanced diet
Monitor your blood sugar level.
Checking blood sugar levels regularly
Adjust your insulin dosage as needed.
Staying hydrated
Check your ketone level.
Wearing a medical alert bracelet for
Be prepared to act quickly. diabetes sharing warning signs with
co-workers, friends, family, and neighbors
so they can help you if you are unaware of
the warning signs
Diagnosis Seeing your doctor regularly for checkups.

A physical exam and blood tests can help

diagnose diabetic ketoacidosis.
Blood tests Diagnosis
Blood tests used in the diagnosis of
diabetic ketoacidosis will measure: Healthcare provider will perform a physical
Blood sugar level. If there isn't enough exam and ask about your symptoms.
insulin in the body to allow sugar to enter They’ll order blood tests, such as a
cells, the blood sugar level will rise. comprehensive metabolic panel.
Ketone level. When the body breaks down To check your blood sugar level and other
fat and protein for energy, acids known as measurements of your health.
ketones enter the bloodstream. Treatment begins with intensive monitoring
Blood acidity. A too-high blood ketone of the patient and laboratory values,
level will cause the blood to become especially glucose, sodium, and potassium
acidic. This can change how organs levels.
throughout the body work. A blood sugar level over 600 mg/dL (33
Other tests mmol/L) with low ketone levels points to a
diagnosis of HHS.
Blood electrolyte tests
Urinalysis
Chest X-ray
 Endocrine

DKA Vs HHNS

Treatment Treatment

A medical professional can typically treat

Hydration first (normal saline)
HHNS using four steps:
Fluids
Giving you fluids through an IV
Fluids replace those lost through too
helping you manage your electrolytes
much urinating.
Giving you insulin through an IV
They also thin out the blood sugar.
10 to 15 units of regular human insulin
Fluids can be given by mouth or
should be injected as a bolus,
through a vein.
Hourly blood glucose checks
Lower sugar slowly
Diagnosing and managing the causes, and
Gradually transition to SQ
determining if there is a coexisting
When given through a vein, they're condition.
called IV fluids.
Monitor hydration status
Electrolyte replacement.
Electrolytes are minerals in the blood,
such as sodium, potassium and chlo- changes in body weight.
ride, that carry an electric charge. Urine osmolality.
Hourly blood glucose checks Strict I&O.
specific gravity.
Insulin therapy.
Skin turgor.
Insulin reverses diabetic ketoacidosis. Blood pressure.
In addition to fluids and electrolytes, Urine conductivity colour.
insulin is given, usually through a vein.
A return to regular insulin therapy may
be possible when the blood sugar level
falls to about 200 mg/dL (11.1 m mol/L)
and the blood is no longer acidic.
Monitor EKG rhythm& labs

Records the electrical activity of heart,

including the rate and rhythm.
Potassium
ABG (pH)
Ketones
Anion gap
 Endocrine

Hypoparathyroidism Vs Hyperparathyroidism

Parathyroid Gland
The parathyroid is comprised of 4 small
glands embedded in the posterior aspect
of the thyroid gland.
Its main function is the production and
Thyroid
secretion of parathyroid hormone (PTH),
Polypeptide hormone responsible for
maintaining serum calcium homeostasis.

Parathyroid hormone function:

Bones: Parathyroid hormone stimulates the release of small amounts of calcium from
your bones into your bloodstream.
Kidneys: Parathyroid hormone enables the production of active vitamin D (calcitriol) in
your kidneys.

PTH also signals your kidneys to retain calcium in your body rather than
flushing it out through your urine.
Small intestine: Parathyroid hormone signals your small intestine to absorb more
calcium from the food you eat.

Low concetration of calcium in blood

Release of parathyroid hormone

Efflux of Decreased loss Enhanced absorpation

calcium bone calcium in urine of calcium
from intestine

Increased concetration of calcium in blood

 Endocrine

Hypoparathyroidism Vs Hyperparathyroidism

Hypoparathyroidism Hyperparathyroidism
Vs
Hypoparathyroidism is a rare, treatable
Hyperparathyroidism is when your
condition that happens when you have
parathyroid glands create high amounts of
low levels of parathyroid hormone in
parathyroid hormone in the bloodstream.
your blood.
Which causes you to have high levels of
Which causes you to have low levels of
calcium (hypocalcemia) and low levels of
calcium (hypocalcemia) and high levels
phosphorous in your blood.
of phosphorous in your blood.
Hypoparathyroidism is usually a chronic
(lifelong) condition, but it can be
temporary. 1

Types of hyperparathyroidism

Primary hyperparathyroidism.
In primary hyperparathyroidism, a growth or
enlargement of one or more parathyroid
glands causes them to make too much PTH.

Secondary hyperparathyroidism.
If you have a condition that causes high
phosphate levels, low vitamin D levels or
low calcium levels, your parathyroid
glands will make more PTH to try to
increase your calcium levels and lower
your phosphate levels
It’s most common in people with
chronic kidney disease (CKD).

Tertiary hyperparathyroidism.
Tertiary Hyperparathyroidism happens if
you have long-lasting secondary
hyperparathyroidism that doesn’t respond
to treatment.
 Endocrine

Hypoparathyroidism Vs Hyperparathyroidism

Causes Causes
Autoimmune attack on the parathyroid
Primary
glands (common)
Adenoma. Adenomas noncancerous
Very low magnesium level in the blood
(benign) growths are the most common
(reversible)
cause of primary hyperparathyroidism.
Radioactive iodine treatment for
Hyperplasia. Hyperplasia is an enlarge-
hyperthyroidism (very rare)
ment of your parathyroid glands.
Neck surgery.
Cancer. Parathyroid carcinomas.
Hereditary hypoparathyroidism.
Low levels of magnesium in the blood. Secondary
Hypomagnesimia ( occurs when a drug or Kidney disease
a disease condition alters magnesium
Severe calcium deficiency.
homeostasis.)
Low vitamin D levels — from lack of sun or
Radiation exposure.(may cause skin and
malnutrition
blood damage, cataract, infertility, birth
defects and cancer.)
Extensive cancer radiation treatment of
the face or neck.
Symptoms
Joint or bone pain.
Muscle weakness.
Symptoms
Kidney stones
Carpopedal spasm Cataracts Tiredness (fatigue).
Numbness/tingling Calcium deposits Depression.
sensation in some tissues Trouble concentrating.
(+) Chvostek’s sign Decreased Loss of appetite.
(+) Trousseau sign consciousness Shortened QT interval
Dyspnea/wheezing Pain in the face, Frequent urination (kidneys working
(due to legs, and feet harder)
bronchoconstriction) Painful Nausea and vomiting.
Tingling lips, menstruation
Confusion or forgetfulness.
Muscle cramps Seizures
Increased thirst and frequent need to pee.
(most common) Teeth that do not
Constipation.
Muscle spasms grow in on time, or
called tetany at all
Abdominal pain Weakened tooth
enamel (in
Abnormal heart
children)
rhythm
 Endocrine

Hypoparathyroidism Vs Hyperparathyroidism

Risk Factors Risk Factors

Factors that can increase the risk of develop- Abnormal heart rhythms (heart
ing hypoparathyroidism include: arrhythmias) and fainting, even heart
Recent neck surgery, particularly if the failure.
thyroid was involved Calcium or vitamin D deficiencies. The
A family history of hypoparathyroidism foods you eat or certain medications can
cause ongoing low calcium or vitamin D
Having certain autoimmune or endocrine
levels.
conditions, such as Addison's disease
Kidney disease or damage.
Sex assigned at birth.

Complications

Cramp like spasms of the hands and

Complications
fingers that can be prolonged and
painful. Kidney stones from a buildup of calcium in
Muscle pain and twitches your kidneys.
Tingling or burning sensations, or a pins Osteoporosis from a loss of calcium in your
and needles feeling, in the lips, tongue, bones.
fingers and toes. Skin sores and infections .
Seizures. Neonatal hypoparathyroidism
Problems with kidney function, such as Cardiovascular disease
kidney stones and kidney failure. Kidney stones.
Abnormal heart rhythms (heart Heart attack, high blood pressure or stroke
arrhythmias) and fainting, even heart
Loss of kidney function after kidney
failure.
transplant.
 Endocrine

Hypoparathyroidism Vs Hyperparathyroidism

Diagnosis Diagnosis
Discuss medical history and physical exam, diagnose and monitor
and may suggest blood and urine tests. hyperparathyroidism include:
Blood tests Blood tests.
These blood test results might suggest 24-hour urine test. For this test, you
hypoparathyroidism: collect your pee for 24 hours and then
A low blood-calcium level bring it to a lab for testing. Your
A low parathyroid hormone level provider will give you instructions on
how to complete a 24-hour urine test.
A high blood-phosphorus level
Parathyroid scan.
A blood-magnesium level may also be
done. Ultrasounds or other imaging of your
kidneys or parathyroid glands.
A low blood-magnesium level may
cause a low blood-calcium level. Bone density scans.

Urine test
Parathyroid hormone acts on the kidneys to
prevent too much calcium from being
wasted in the urine. Treatment
Other tests
Other blood tests or a test to check heart Primary
rhythm (electrocardiogram, ECG). Remove only those glands that are enlarged
or have a tumor.
Secondary
Bisphosphonates. prevent calcium loss
Treatment from bones and improve bone.
Calcimimetics. Calcimimetics act like
Oral calcium. Oral calcium supplements calcium in your tissues and tell your
as tablets, chews or liquid can increase parathyroid glands to produce less PTH.
calcium levels in your blood. Diuretics (high excretion of calcium)
Vitamin D supplements Avoiding certain medications. Some
Magnesium level is low need to take a medications, like thiazide diuretics and
magnesium supplement. lithium, can increase your calcium levels.
Thiazide diuretics. Dietary changes. Your provider might
Parathyroid hormone replacement. recommend getting a certain amount of
Diet calcium or vitamin D through supplements
or the foods you eat.
Rich in calcium. This includes dairy products,
green leafy vegetables, broccoli and foods
with added calcium.
Low in phosphorus. This means avoiding Intravenous infusion
carbonated soft drinks, which contain Monitor levels of calcium and phosphorus.
phosphorus in the form of phosphoric acid.
 Endocrine

Hypoparathyroidism Vs Hyperparathyroidism

Nursing interventions Nursing interventions

Administer calcium and vitamin D Calcium Level Monitoring: Regularly

supplements check serum calcium levels.
Cardiac monitoring may be ordered to Bone Health Assessment: Monitor for
watch the rhythm of the heart signs of bone demineralization or
fractures.
Monitor VS, airway & EKG
Renal Function Assessment: Evaluate for
Anti-epileptic medications may be
kidney stone symptoms and monitor
ordered to prevent or stop seizures.
renal function tests.
Periodic monitoring of Neurological Status
1. Calcium, IV fluids for hydration ( risk kidney
2. Phosphorus, stones)
3. Renal function, Diet calcium phosphorous
4. Urine calcium excretion. Fall precautions
Seizure precautions

Keep moving. Physical activity can go

a long way toward fall prevention. ...
Wear sensible shoes.
Keep the bed Use a seizure alert
away from monitor while Remove home hazards. .
nightstands, sleeping. Light up your living space.
furniture, walls. Padded side rails. Use assistive devices.
Side lying & Keep electronic
head elevated devices away from
the bed.
 Endocrine

Hypothyroidism Vs Hyperthyroidism

Thyroid gland

Thyroid gland is situated at the front of

the throat, below the larynx (Adam's
apple),
Comprises two lobes that lie on either
Thyroid side of the windpipe.
Cartilage
Thyroid Harmons
Thyroid
Gland
1. thyroxine or tetraiodothyronine (T4)
2. triiodothyronine (T3).
Trachea

Sternum Clavicle

Thyroid functions

growth and energy energy levels,

expenditure internal
regulation of temperature,
weight, skin, hair, nail growth,
metabolism
Iodine, as a trace element, is a
necessary and limiting substrate for
thyroid gland hormone synthesis.

Hypothyroidism
Hyperthyroidism
LOW hyposecretion of thyroid hormones
LOW hyposecretion of thyroid hormones
Thyroid doesn’t create and release enough
thyroid hormone into your bloodstream. Hyperthyroidism happens when the
thyroid gland makes too much thyroid
This makes your metabolism slow down. hormone.
Also called underactive thyroid, This condition also is called overactive
hypothyroidism can make you feel tired, thyroid. Hyperthyroidism speeds up the
gain weight body's metabolism.
unable to tolerate cold temperatures. T3 T4 TSH
When your thyroid levels are extremely low, The hypothalamus
this is called myxedema Hypothalamus and the pituitary in
Pituitary the brain control the
Gland
normal secretion of
T3 T4 TSH
thyroid hormones,
whic in turn control
Thyroid metabolism
Glands

Healthy Thyroid Hypothyroidism

 Endocrine

Hypothyroidism Vs Hyperthyroidism

Causes Causes

Autoimmune disease. E.g Hashimoto's Graves disease

disease. Inflammation (thyroiditis) of the thyroid due
Thyroid surgery. to viral infections)
Radiation therapy. Taking too much thyroid hormone
Thyroiditis. Thyroiditis happens when (common)
the thyroid gland becomes inflamed. Noncancerous growths of the thyroid gland
Medicine. A number of medicines may or pituitary gland (rare)
lead to hypothyroidism Some tumors of the testes or ovaries (rare)
Problems present at birth. Getting medical imaging tests with contrast
Pituitary disorder. dye that has iodine

Pregnancy. . Excess thyroid replacement (Levothyroxine)

Not enough iodine. Toxic nodule goiter (nodules on thyroid

stimulate T3/T4)
Eating too much of foods that contain iodine

Symptoms
Everything is low & slow Symptoms
Hypothyroidism symptoms may include:
Everything is high, big & hot
Tiredness. slow
Anxiety Nail changes
Thinning hair. menstruation
Difficulty (thickness or flaking)
(irregular/
Slowed heart rate, missing periods) concentrating Nervousness
also called Fatigue Pounding or racing
bradycardia. slow skin moisture
(dry skin Frequent bowel heart beat
Depression. movements (palpitations)
Weight gain.
Memory Goiter (visibly Restlessness
problems. Puffy face.
enlarged thyroid Sleep problems
slow LOC Hoarse voice. gland) or thyroid big bulging eyes
(forgetfulness) Coarse hair and nodules (exophthalmos)
slow GI motility skin. Hair loss Protruding eyes
(constipation) Muscle weakness. Hand tremor (exophthalmos)
slow metabolism Muscle aches, Heat intolerance Skin blushing or
(weight gain) tenderness and Increased appetite flushing
More sensitivity to stiffness. Skin rash on the shins
Increased sweating
cold. Menstrual cycles Irregular menstrual Weakness of the hips
Constipation. that are heavier periods in women and shoulders
than usual or High blood pressure
Dry skin. irregular.
 Endocrine

Hypothyroidism Vs Hyperthyroidism

Myxedema coma Thyroid storm

severe hypothyroidism leading to Thyroid storm is a rare and

decreased mental status, hypothermia, life-threatening condition that happens
symptoms related to slowing of when your thyroid suddenly produces
function in multiple organs. and releases large amounts of thyroid
hormone.
Severe deficiency of thyroid hormones High It's usually caused by a sudden event or
risk after thyroidectomy or abrupt stop of illness such as surgery or an infection.
levothyroxine

Large amount of thyroid

Symptoms of myxedema coma. medical emergency hormones release at once
High risk after thyroidectomy
Decreased breathing (respiratory
depression)
lower than normal blood sodium levels. symptoms CAUSES
hypothermia (low body temperature) High fever ( Trauma.
temperature between
Infection.
confusion or mental slowness. 104 degrees to 106
degrees ) Acute illnesses such
shock. as diabetic
Having a rapid heart
ketoacidosis (DKA),
low blood oxygen levels. rate (tachycardia)
heart failure and a
Bradypnea (low RR)) medical emergency Feeling agitated,
drug reaction.
irritable and/or
High blood carbon dioxide levels. anxious. A sudden large
amount of iodine in
coma. Can lead to Delirium.
your body, such as
respiratory failure
Congestive heart from an iodinated
failure. contrast agent that’s
Loss of consciousness. used for certain
imaging procedures.
Cause, including Giving birth.
priority maintain
airway: Stroke.
Autoimmune disease, intubation
set-up at
Iodine deficiency,
bedside Treatment
congenital abnormalities,
or medications like lithium Iodine solution to stop your thyroid from
and amiodarone, releasing thyroid hormone.
Beta-blockers to manage your symptoms.
Treated in an intensive care unit (ICU) Bile acid sequestrants to prevent your gut
with continuous cardiac monitoring from reabsorbing thyroid hormone.
Acetaminophen and cooling blankets to
lower your temperature.
Corticosteroids (block T3/T4)
 Endocrine

Hypothyroidism Vs Hyperthyroidism

Risk Factors Risk Factors

Although anyone can develop Risk factors for hyperthyroidism include:

hypothyroidism, you're at an increased A family history of thyroid disease,
risk if you: particularly Graves' disease.
Are a woman. chronic illnesses,
Have a family history of thyroid disease. anemia and primary adrenal
Have an autoimmune disease, such as insufficiency.
type 1 diabetes or celiac disease. A recent pregnancy, which raises the
Have received treatment for risk of developing thyroiditis.
hyperthyroidism.
Received radiation to your neck or upper
chest. Complications
Have had thyroid surgery.
Heart problems such as fast heart rate,
abnormal heart rhythm, and heart failure

Complications Osteoporosis
Eye disease (double vision, ulcers of the
Goiter. Hypothyroidism may cause the cornea, vision loss)
thyroid gland to become larger. Scarring of the neck
Heart problems.. Hoarseness due to nerve damage to the
Peripheral neuropathy voice box
Infertility. Low levels of thyroid hormone Low calcium level due to damage to the
can interfere with ovulation parathyroid glands (located near the
thyroid gland)
Birth defects.
Hypothyroidism
Myxedema coma. This rare,
life-threatening condition can happen
when hypothyroidism goes without
treatment for a long time. Treatment

Antithyroid drugs methimazole

(Tapazole)
propylthiouracil (PTU):
Radioactive iodine:
Surgery:
Methimazole & PTU (Propylthiouracil):
Block synthesis of T3 & T4
Thyroidectomy: will require lifelong
levothyroxine
Beta blockers: These drugs block the
action of thyroid hormones on the body.
 Endocrine

Hypothyroidism Vs Hyperthyroidism

Treatment Nursing interventions

Treated by taking daily hormone Monitor vital signs, especially heart
replacement tablets called levothyroxine. rate and blood pressure (both
increase in hyperthyroidism)
Taken orally,
Ask if the patient has chest pain (Due
this medication increases the amount of
to increased heart work)
thyroid hormone your body produces
Listen to the heart for murmurs.
best taken on an empty stomach at the
same time every day. Obtain ECG (atrial arrhythmias may
occur in hyperthyroidism)
Ideally, you take the hormone in the
morning, and then wait 30 to 60 minutes Teach the patient to relax.
before you eat or take other medicine.
If you take the medicine at bedtime, wait
to take it until at least four hours after
your last meal or snack

Nursing interventions

Promote rest. Provide foods

Protect against high in fiber.
coldness. Manage
Avoid external respiratory
heat exposure. symptoms.
Mind the Pulmonary
temperature. exercises.
Increase fluid Orient to present
intake. surroundings

Nursing Assessment

Assessment of the patient with

hypothyroidism should include:
Assessment of the thyroid from an
anterior or posterior position.
Auscultation of the lobes of the thyroid
gland using the diaphragm of the
stethoscope if there are abnormalities
palpated.
Assess thyroid gland for firmness
(Hashimoto’s) or tenderness (thyroiditis).
 Endocrine

Diabetes Insipidus Vs SIADH

Posterior
Adrenal gland
Antidiuretic hormone (ADH) Pituitary

Human vasopressin, also called antidiuretic

hormone, arginine vasopressin or argipressin,
secreted into the blood by the pituitary ADH Aldosterone
gland. (Vasopressin)
Kidney
An increase in osmolality of the blood is a
trigger prompting the hypothalamus to
release ADH, Diuresis
which signals cells in the kidney tubules to
reabsorb more water by inserting aquaporin,
Preventing additional fluid loss in the urine.

Antidiuretic hormone function

Stored in pituitary gland & released in
Regulates fluid balance & blood pressure by response to low fluid volume
Antidiuretic hormone (ADH) helps regulate It is then released by the pituitary
the amount of water in your body. gland at the base of the brain.
Nonapeptide synthesized in the
hypothalamus.
Hormone that helps blood vessels
constrict and helps

Syndrome of inappropriate
Diabetes Insipidus
vs antidiuretic hormone
Hyposecretion of antidiuretic hormone losing water hypersecretion of thyroid hormones retaining water

the fluids in the body to become out of is a condition in which your body makes too
balance. That prompts the body to make much antidiuretic hormone (ADH).
large amounts of urine. ADH, also known as vasopressin,
It also causes a feeling of being very thirsty ADH plays a role in the following processes:
even after having something to drink.
The balance of water and salt (sodium) in
also is called arginine vasopressin your blood.
deficiency and arginine vasopressin
resistance. Blood pressure regulation.
Kidney functioning
 Endocrine

Diabetes Insipidus Vs SIADH

Types of Diabetes Insipidus

1. Central diabetes insipidus. Damage to 2. Nephrogenic diabetes insipidus. when

hypothalamus or pituitary gland affects your kidneys don’t respond to vasopressin
how body makes or puts out vasopressin. and take too much fluid from your
This damage can result from: bloodstream. :
A blocked urinary tract
Thyroid gland is situated at the front Chronic kidney disease
of the throat, below the larynx High levels of calcium in your blood
(Adam's apple),
Low levels of potassium in your blood
Comprises two lobes that lie on
either side of the windpipe. 3. Gestational diabetes insipidus. This is very
rare. You get this type only during pregnancy

Causes Causes
Certain medications, such as lithium and Certain cancers.
tetracycline. Central nervous system (CNS) issues.
Hypokalemia Certain medications.
Hypercalcemia Surgery under general anesthesia:
A blocked urinary tract. Lung disease.
Brain trauma/ surgery Hormone deficiency: Both hypopituitarism
Inflammation (granulomas) . and hypothyroidism may lead to SIADH.
Tumors that affect your hypothalamus or
pituitary gland.
Autoimmune reaction that causes your
immune system to damage.
 Endocrine

Diabetes Insipidus Vs SIADH

Symptoms Symptoms
Severe thirst Muscle cramps or weakness.
Peeing more than 3 liters a day. Nausea and vomiting.
Getting up to go a lot at night Headache.
Peeing during sleep (bed-wetting) Problems with balance, which may
Low urine specific gravity (<1.005) result in falls.
High serum sodium (145+) Mental changes, such as confusion,
memory problems and/or strange
Pale, colorless urine
behavior.
Low measured concentration of urine
High urine specific gravity (>1.030)
Preference for cold drinks
Low urine output
Dehydration.
Low blood osmolality
Weakness
Low serum sodium (<135)
Low urine specific gravity (<1.005)
Seizures or coma
Muscle pains
Confusion & irritability
Crankiness
Hypertension
With dehydration,
you might notice:
Extreme thirst:
Fatigue
Feeling sluggish

a little bit of salt a lot of salt

Soaked
Inside
Sodium
Osmolality

Dilute Concertrated
 Endocrine

Diabetes Insipidus Vs SIADH

Risk Factors Risk Factors

Anyone can get diabetes insipidus. But those Central nervous system disturbances
at higher risk include people who: Heart failure
Have a family history of the disorder. Hypothalamus
Take certain medicines, such as diuretics, Malignancies: Small cell lung cancer (SCLC)
that could lead to kidney problems.
Have high levels of calcium or low levels of
potassium in their blood.
Have had a serious head injury or brain
surgery. Complications

Headaches Respiratory failure

Memory problems Seizures
Depression Hallucinations
Complications
Tremors Coma
Dehydration Muscle cramps Death
Dry mouth.
Thirst.
Extreme tiredness.
DizzinessLightheadedness.
Fainting.
Nausea.

Electrolyte imbalance
Weakness
Nausea.
Vomiting.
Loss of appetite.
Confusion.
 Endocrine

Diabetes Insipidus Vs SIADH

Diagnosis Diagnosis

Tests used to diagnose diabetes Comprehensive metabolic panel (CMP).

insipidus include: Osmolality blood test.
Water deprivation test. Urine osmolality test.
Urine test. Urine sodium and potassium test.
MRIBlood tests. Serum K+, bicarbonate, chloride
Fluid deprivation test Fasting lipid profile
Short-form fluid deprivation test. Liver function tests
Formal fluid deprivation test.
Magnetic resonance imaging (MRI).
Genetic testing.
Treatment

Restrict fluid intake as first-line treatment.

Treatment Vasopressin antagonists (block
vasopressin)
Central diabetes insipidus. Second-line treatments include increasing
solute intake with 0.25–0.50 g/kg per day of
When treatment is needed beyond
urea or a combination of low-dose loop
that, a manufactured hormone called
diuretics and oral sodium chloride.
desmopressin (DDAVP, Nocdurna) is
used. Nephrogenic diabetes insipidus. Carbamazepine,
Treatment with hydrochlorothiazide Oxcarbazepine,
(Microzide) may ease your symptoms. Chlorpropamide,
Although hydrochlorothiazide is a Cyclophosphamide,
diuretic a type of medicine that causes Selective serotonin reuptake inhibitors
the body to make more (SSRI).
Hypotonic IV fluids.
Gestational diabetes insipidus.
Treatment for gestational diabetes
insipidus involves taking the
manufactured hormone desmopressin.
 Endocri ne

Diabetes Insipidus Vs SIADH

Nursing interventions Nursing interventions

Monitor intake and output. Interventions:
Monitor for increased thirst (polydipsia). Restrict free water.
Weigh daily. Administer diuretics as prescribed.
Monitor urine specific gravity. Monitor daily weights.
Monitor serum and urine osmolality. Consider vasopressin V2-receptor
Monitor urine and serum sodium levels. antagonists.
Monitor serum potassium. Educate the patient about the therapeutic
regimen and the association between
Monitor for signs of hypovolemic shock
SIADH and cardiac disease.
(e.g., tachycardia, tachypnea, hypotension)
Fluid restriction (monitor for fluid overload)
Safety precautions (frequent bathroom
trips= risk of falls) Neuro checks
Seizure precautions

Keep the bed away from nightstands,

furniture, walls.
Nursing Assessment Side lying & head elevated
Use a seizure alert monitor while sleeping.
Polyuria of 4 to 24 L per day
Padded side rails.
Polydipsia
Keep electronic devices away from the
Dehydration bed.
Decreased skin turgor, dry mucous
membranes
Inability to concentrate urine
A low urinary specific gravity: 1.006 or less Nursing interventions
Fatigue
Assess the patient’s ability to learn.
Muscle pain and weakness
Assess the patient’s learning needs.
Headache
Assess and monitor the presence or
degree of signs and symptoms such as:
Exertional dyspnea
Orthopnea
Activity intolerance
Paroxysmal nocturnal dyspnea
Nocturnal cough
Distended abdomen
 Endocrine

Pheochromocytoma

What is it?

Pheochromocytoma is a type of Types of Pheochromocytoma

neuroendocrine tumor that grows from
cells called chromaffin cells. (cells which Localized pheochromocytoma: The tumor
secrete epinephrine & norepinephrine) is in one or both adrenal glands only.
These cells produce hormones needed Regional pheochromocytoma: The cancer
for the body and are found in the adrenal has spread to lymph nodes or other tissues
glands. near your adrenal glands.
The adrenal glands are small organs Metastatic pheochromocytoma: The
located in the upper region of the cancer has spread to other parts of your
abdomen on top of the kidneys body, like your liver, lungs, bone or distant
lymph nodes.
Recurrent pheochromocytoma: The
cancer has recurred (come back) after it
has been treated.
Both substances e catecholamines that
stimulate the sympathetic nervous system
Play an important role in the body's fight or Pheochromocytoma
flight response, (Adrenal Medulla Tumor)
Their release into the bloodstream causes
increases in blood pressure, heart rate,
and blood sugar levels.

Or
 Endocrine

Pheochromocytoma

Risk Factors Symptoms

Cause is unknown High blood pressure.
Genetic defects & family history Increased appetite
Headache.
Heavy sweating.
Causes Rapid heartbeat.
Facial flushing
Multiple endocrine neoplasia 2 syndrome, Nervous shaking.
types A and B (MEN2A and MEN2B). Skin that turns a lighter color, also called
Von Hippel-Lindau (VHL) disease. pallor.
Neurofibromatosis type 1 (NF1). Shortness of breath.
Hereditary paraganglioma syndrome. Panic attack-type symptoms, which can
Carney- Stratakis dyad [paraganglioma include sudden intense fear.
and gastrointestinal stromal tumor (GIST)]. Anxiety or a sense of doom.
Carney triad (paraganglioma, GIST and Vision problems.
pulmonary chondroma). High blood sugar
High anxiety
Constipation.
Weight loss.
Complications
Heart disease. Kidney failure.
Stroke. Vision loss.
 Endocrine

Pheochromocytoma

Treatment Diagnostic
The best treatment option is surgery, Lab tests
Bilateral Adrenalectomy 24-hour urine test.
If both adrenal glands are removed, the Treatment options for
patient must take steroid hormones pheochromocytoma include:
(typically hydrocortisone and
Blood test.
fludrocortisone) twice daily.
Imaging tests.
Antihypertensive(diuretics, β-blockers,
calcium channel blockers, and CT scan.
renin-angiotensin system inhibitors) MRI.
M- iodobenzylguanidine (MIBG)
imaging.
Treatment options for
pheochromocytoma include: Positron emission tomography (PET),
a scan that also can detect radioactive
Surgery. compounds taken up by a tumor.
Radiation therapy. Genetic testing.
Chemotherapy. Clonodine suppression test.
Ablation therapy.
Embolization therapy. Metanephrine & vanillylmandelic acid
Targeted therapy.

During the test, patients remained supine

and blood pressure and heart rate were
monitored every 30 min
Take blood sample for epinephrine &
norepinephrine
Administer clonodine
Reassess levels of epinephrine &
norepinephrine

No change in levels
indicates pheochromocytoma
 Endocrine

Hypertensive Crisis

Hypertensive Crisis

A hypertensive crisis is a sudden, severe

Symptoms
increase in blood pressure.
Symptoms of a hypertensive crisis
The blood pressure reading is 180/120
may include:
millimeters of mercury (mm Hg) or greater.
A hypertensive crisis is a medical Anxiety Not responding to
emergency. Blurred vision stimulation
(unresponsiveness)
It can lead to a heart attack, stroke or other Chest pain
life-threatening health problems. Seizures
Confusion
Too much epinephrine or norepinephrine in Severe headache
Nausea and
the body can lead to signs and symptoms vomiting Shortness of breath
such as anxiety, high Blood pressure, heart
palpitations, rapid heartbeat,

Can lead to stroke, MI, or renal failure Treatment

if not treated promptly!
Hydralazine,
Hypertensive crises are grouped into two Labetalol
categories. Nicardipine
Urgent hypertensive crisis. Blood pressure is Decrease environmental stimuli
180/120 mm Hg or greater. There are no Angiotensin-converting enzyme inhibitors,
signs of organ damage.
Angiotensin receptor blockers,
Emergency hypertensive crisis. Blood
Direct renin inhibitors,
pressure is 180/120 mm Hg or greater. There
is life-threatening damage to the body's Sodium nitroprusside are contraindicated
organs. in treating these patients.

Causes Diagnosis
An eye examination
Having overweight
An echocardiogram of the heart
Eating an unhealthful diet that is high in salt
CT or MRI scan of the brain
Not getting very much physical activity
A chest X-ray of the heart and lungs
Smoking.
CT or MRI scan of the brain
Having a history of cardiovascular disease.
An ultrasound of the heart, kidneys, or both
Having an underlying health condition, such
as diabetes or kidney disease Blood tests
Urine tests
 Endocrine

Hypertensive Crisis

Nursing Interventions

Auscultate the patient's blood pressure to determine any orthostatic changes.

Monitor for hypertensive crisis: >180 systolic or >120 diastolic
Monitor VS & EKG
Monitor blood glucose level.
Provide Calm and engaging environments offer predictability, stability and positivity for
patients
High calorie diet (high metabolism)
Inspect the patient's urine for hematuria, which is associated with pheochromocytoma of the
urinary bladder.

Avoid triggers Avoid triggers

Emotional stress Aged cheeses

Patients with a history of seizures or Fermented or cured meats
epilepsy should avoid MAOIs; Fermented soy products
These medications can increase the Chocolate
occurrence of seizures
Sauerkraut
Surgery or injury
Some fruits and veggies
Stimulants (caffeine, smoking)
Overripe bananas
Tyramine rich foods
Avocados
HEMATOLOGY
 Hematology

Hematology Overview

WHAT IS IT....? COMPONENTS OF BLOOD Functions of each component

Plasma contains
Hematology is the branch of medicine that Plasma Carries water, minerals, enzymes,
• 91% water
deals with the study of blood, its functions, PLASMA • 7% protein hormones, nutrients and proteins
composition, blood-forming organs and 55% • 2% other solutes WBC WBCs are part of the immune
blood diseases.
system, defend body against
The average human adult has nearly 5 liters WBC & Platelets infections
of circulating blood. 1% RBCs are being Platelets Platelets are involve in blood clotting
Women tend to have a lower blood volume
constantly replaced
than men. RBC as they only have RBC Responsible for carrying oxygen to
A woman's blood volume increases by 45% 120 days lifespan. tissues and organs and remove CO2
roughly 50% during pregnancy.

Erythrocytes or RBCs Facts about RBCs

Normal range = 5 million/cc of blood RBCs carry oxygen to body tissues &
remove CO2.
Their red color is due to a protein called
Type Function Normal range hemoglobin.
1 liter of blood can carry 3 ml of oxygen
Male: 4.7-6.1 /uL
Erythrocyte count Amount of total RBCs in blood without Hb.
Female: 4.2-5.4 /uL
Anemia is the lack of RBCs or hemoglobin
in the blood.
Male: 39-54 g/ dL
HEMATOCRIT %age of RBCs in the blood Due to low oxygen at high altitude, more
Female: 36-48 g/ dL RBCs are created.

A protein in blood that Male: 13-18 g/d L A red blood cell can make a complete circuit
HEMOGLOBIN
carry oxygen and remove CO2 Female: 12-16 g/dL of your body in 20 seconds.

PLATELETS
Type of coadulation Tests
Smallest blood cells Colorless, round/oval, flattened disc shaped structures
When to use?

How fast blood can clot Prothrombin Time (PT)

Pt Normal Range: 10-13 seconds Evaulates ability to clot
(Prothrombin Time) Is used to measure the
effectiveness of heparin On Heparin: 1.5-2 x normal value International Normalized Ratio
(INR) Ensure that results from a
PT test are the same from one
lab to another
APTT How fast blood can clot Normal Range: 30-40 seconds Partial Thromboplastion Time
(Activated Partial Is used to measure the (PTT) Determines if blood-
Thromboplastin Time) effectiveness of heparin On Heparin: 47-70 seconds thinning therapy is effective

Measured from PT to check

INR how fast blood can clot Normal Range: <1 Why is My D-Dimer
(Activated Partial Level High?
Thromboplastin Time) is used to quantify the On Heparin: 2-3
efficiency of Coumadin You’re ove 60 years old
You recently had surgery
These are fragments of protein due You have sever liver disease
to blood clot dissolution in the blood
D-DIMER <0.5 mcg/ mL You have sickle cell disease
This test is commonly used to
confirm clotting diseases
 Hematology

Hematology Overview

• Total WBCs in blood = 4,500-11,000/uL • Largest of the blood cells • In case of INFLAMMATION
WHITE BLOOD CELLS
• Life span: from a few days to yearsr • Part of IMMUNE SYSTEM /INFECTION increase in numbe

Type Function Normal range

EOSINOPHILS • Inhibit chemical mediators released in allergy (histamine etc.)

• Fights parasites and inflammation
1-5 %

BASOPHILS • Controls allergic & swollen reactions

• Release enzymes to improve blood flow and prevent blood clots. 0.1- 2%

• First responders of body to infections

NEUTROPHILS • Lifespan < a day, so, bone marrow constantly makes new ones 40-70%

• Smallest WBCs
LYMPHOCYTES 20-40%
• Responsive against viruses and can identify antigen

• Largest blood cells of WBCs

MONOCYTES • Engulf invaders and abolish them 4-13%
 Hematology

Types of Anemia

Anemia Iron Deficiency Anemia Aplastic Anemia

WHAT IS IT? IRON DEFIICIENCY is the most common WHAT IS IT?

Anemia is a condition characterized nutrient deficiency in the world. Rare but serious condition
by a decrease in the number of red
blood cells or a deficiency in the WHAT IS IT? OCCURS DUE TO PROBLEMS WITH BONE
amount of hemoglobin in the blood. Most common type of anemia. MARROW.

Body doesn't possess sufficient iron It can mild to severe.

to produce sufficient Hb Bone marrow fails to produce enough
Normal HGB Male: 13-18 g/dL blood cells causing low blood count.
Iron needs are higher in teen ages.
values in blood Female: 12-16 g/dL
Frequent donation of blood can be
a reason of Iron Deficiency Anemia. Causes

Most common blood disorder. Autoimmune disorders affecting

Causes
It can be short or long term condition. BONE MARROW
Low DIETARY INTAKE of iron Exposure to certain toxins or
Based on ground reasons, anemia
iron absorption due to medications (sulfonamides,
can be classified in a number of ways.
GIT disorders Low Vit C level anticonvulsants)
Various types of anemia share similar Revelation to radioactivity
Surgery Medication
symptoms but have different causes Infections such as hepatitis
as well as differentreatments and Chronic blood loss (bleeding) due to Genetic factors
severity levels. Heavy menstruation
Stomach & instestial ulcers
GIT Bleeding Distinguishing symptoms
Symptoms
Iron requirement (pregnancy) Recurrent infections and weakened
Fatigue Palpitation Recent major surgery
IMMUNE SYSTEM
Weakness Cold hands Petechiae Petechiae:tiny red blood spots
Pale skin & feet Distinguishing symptoms Bruising & SKIN RASH
Shortness of Headache Bleeding gums & uncontrolled
Smooth and glossy tongue
breath Tachycardia bleeding from minor cuts
PICA (cravings for non-food items
Dizziness Brittle nails such as clay, brick, ice etc.)
Diagnosis
Causative factors Diagnosis
CBC to detct pancytopenia
HB Iron Hematocrit ANC <500
Iron deficiency Dietary Platelet <20,000)
Vitamin factors
Treatment hemoglobin hematocrit
deficiency Medications Bone marrow biopsy (high fat
Chronic and Vitamin C to iron captivation content, low stem cells existence)
diseases treatments Iron supplements (can cause)
Hereditary Pregnancy Food containing rich iron levels
disorders Endocrine (dry fruit, egg yolk, leafy vegetables,
Bone Marrow Biopsy
disorders meat etc.)
Hemorrhage Cortical Bone Marrow
Blood transfusion in severe defficinecy
Bone marrow Certain Spongy Bone Pelvis
disorders infections Daily requirement of iron
5-10% of the dietary iron is absorbed
1 molecule of hemoglobin=33% iron Treatment
Types of anemia 1ml blood loss=0.5mg iron loss
Blood transfusions
Dietary sources of iron
Immunosuppressive agents including
Iron deficiency anemia cyclosporine.
Vitamin deficiency Adult male 0.5 Constipation Medications to stimulate blood cell
megaloblastic anemia to 1 mg Diarrhea production (Epoetin injection).
Menstruating Indigestion Corticosteroids (methylprednisolone)
Aplastic anemia
demale 1-2 Stomache cramps In some cases, bone marrow
Hemolytic anemia & mg/day Nausea transplantation (HLA matched
Sickle cell anemia Pregnancy Black tarry stools sibling)
3-5 mg/day (could be a sign of
Infant 60 kg an upper GI ulcer)
Children 25kg
 Hematology

Types of Anemia

Megaloblastic Anemia Hemolytic anemia

WHAT IS IT? WHAT IS IT?

This occurs due to PREMATURE DESTRUCTION OF RED BLOOD
Vitamin B12 or FOLIC ACID (B9) deficiency anemia
CELLS (hemolysis) either within the bloodstream or in the
RBCs are large in size, abnormal and not fully matured spleen or liver in comparison to their RATE OF PRODUCTION

Causes Causes

intake WHAT IS IT?

absorption due to GI disorder This occurs due to PREMATURE DESTRUCTION OF RED BLOOD
utilization CELLS (hemolysis) either within the bloodstream or in the
Autoimmune diseases spleen or liver in comparison to their RATE OF PRODUCTION
(The body fails to generate intrinsic factor in the stomach,
necessary for B12 absorption)
Distinguishing symptoms
MEGALOBLASTIC ANAEMIA
Vitamin B12 Deficiency Folate Deficiency
Fatigue Dark, blood color
Malabsorption (e.g. Poor dietary intake (e.g. Pale skin urine (due to
pernicious anemia,IBD) elderly, alcoholics) SOB hemolysis)
Poor dietary intake Increased deamnd (e.g. Splenomegaly or Jaundice
(rare) haemolysis, pregnancy) enlarged liver Fever & chills

Surgical (e.g. post Malabsorption

gastrectomy) Anti-folate drugs
Diagnosis Coomb's Test

Direct antiglobulin test (DAT)

Distinguishing symptoms Positive

IgG + C3 in warm- antibody- mediated AIHA
Fatigue Fast heartbeat C3 in cold-antibody- mediated AIHA
Shortness of breath Body aches & pain Haptoglobin Decreased
Abnormal paleness Difficulty breathing Indirect bilirubin Increased
Tender tongue GI upset Lactate dehydrogenase Increased
Numbness Taste & smell Reticulocyte count Increased
Muscle weakness alterations Urine hemosiderin Present
Weight loss Beefy red tongue
Swollen tongue Confusion

Diagnosis
Treatment
Folic acid Immunosuppressive
vitamins (vit B9 or B12) Blood hemoglobin &
Blood transfusion agents
work Positive antibody test hematocrit
Chemotherapy Splenectomy
Corticosteroids: Prednisone in Immunoglobulin
combination with Rituximab
Treatment Plasmapheresis
Bone marrow transplant
Replacement of deficient vitamins.
Supplementation orally, sublingually or via injections
In severe cases, not given orally due to absence or low
levels of intrinsic factor
Treatment of underlying cause and regular monitoring
Vitamin rich food (fruit, meat, poultary, dry fruit, eggs,
fish, beans etc.)
 Hematology

Sickle Cell Anemia

WHAT IS IT?
Hemoglobin S
It is a genetic disorder characterized by
abnormal hemoglobin known as HbS change into a "SICKLE" It leads to blood stasis and
hemoglobin S (HbS) SHAPE, that block blood CLUMPING OF RED BLOOD
vessels. CELLS
HbS causes red blood cells to It cause poor circulation,
become RIGID & THEY DIE decreased blood supply,
CAUSES FASTER than normal RBC's can severe pain, and tissue death
be produced. INEFFECTIVE TISSUE
Inheritance of mutated Hb gene. HbS containing RBCs are vaso-
Most common in some ethnic groups e.g PERFUSION
occlusive in nature.
African americans.

A person can suffer from sickle cell

disease only when both genes inherited Triggers of crisis Normal RBC
from both parents were defected
Trauma
Mental stress
Inheritance of just one gene does not cause
symptoms and the person is said to be a Certain infection
"carrier" of the disease Hard exercise
Surgery
Dehydration
Symptoms Extreme temperatures
Pain Crises due to sticking cells
Anemia symptoms Fatigue, shortness of Sickle RBC
breath, pallor, tachycardia)
Jaundice & gall stones (sickel cell clog
vessels in liver). Types Of Sickle Cell Crisis/complications
Dactylitis includes swelling of hands & feet
(sickel cell blocking vessels).
Delayed Growth Frequent Infections ( sickel
Vaso-occlusive Aplastic anemia
cell clog vessels in spleen).
Strok RBCs can clump and stick RBC's are not produced
Organ Damage together enough because bone marrow
Priapism Interrupt blood flow (painful) can't keep up
Leg Ulcers Lead to strokes Lead to severe hypoxia
Acute Chest Syndrome including cough and AKI
leg ulcers
hypoxia

Hyperhemolytic Sequestration
Destruction of RBC's at Spleen becomes
rapid rate congested with RBC
It causes excess bilirubin Unable to perform
in blood normally
Lead to Gall stones and lead to various types
jaundice of infections
In severe cases cause
organ failure
 Hematology

Sickle Cell Anemia

Diagnosis
A thorough medical history and
physical examination through signs
&
symptoms.
Complete blood count
Peripheral Blood Smear
Hemoglobin Electrophoresis
Genetic Testing

TREATMENT Preventive measures or education

There is no definitive remedy, only Maintain oxygen levels Quit smoking
symptomatic management: Minimize exposure to triggers Follow a nutritious diet
Pain relief using analgesics and opioids Maintain proper hydration Avoid stress
Administration of Hydroxyurea Practice thorough hand Avoid non-pressurized
Blood transfusions hygiene flights
Ensuring adequate hydration Receive vaccinations Avoid too much sun
Steer clear of extreme exposure
Antibiotics for addressing infection
climates and high altitudes Limit contact with
Vaccination to preempt potential
Manage stress effectively pathogens
triggers for infections
Refrain from intense exercise Ensure sufficient sleep
Bone Marrow Transplantation (HLA
and strenuous activities and rest
matching sibling)
 Hematology

DIC

(Disseminated Intravascular Coagulation)

Clotting Factors
WHAT IS IT? are proteins in blood
Serious coagulation disorder
Characterized by widespread activation of Thrombin: Fibriogen:
the clotting cascade throughout the body Aids in clot formation Protein synthesized in the liver
This cascade overstimulate the proteins by initiating the that undergoes conversion
transformation of into fibrin during the process
controlling coagulation (clotting)
fibrinogen into fibrin of blood clot formation
Leads to the formation of blood clots
(thrombosis) in small blood vessels

Fibrin: In DIC, thrombin is

Final product of the irrepressibly converting
fibrinogen to fibrin for clotting
CAUSES clotting cascade,
forming a dense mesh
Not a disease triggered by underlying around the platelet plug
conditions or events that provokes
uncontrolled reactions of
This leads to abnormal
CLOTTING CASCADE
Abnormal clotting and clotting by depletion of
Progression of complications abnormal bleeding clotting factors and platelets,
allergic reaction occur same time in this leading to bleeding
Major surgery
Sepsis Organ transpplant
Blood transfusion rejection
reaction Toxin exposure
Trauma Liver disease SYMPTOMS
Cancer Snake bites Due to bleeding
Obstetric
Bleeding from multiple Purpura ( large bruise
sites, such as mucous like spots >4mm)
membranes, IV sites, or Ecchymosis (bruising)
surgical wounds Organ dysfunction or
Petechiae (small red or failure
HEMOSTASIS PROCESS purple spots on the skin Bloody stool
Initial injury <3mm) Hypotension
Due to clotting
Local platelets activaion,
vasoconstriction, vasoconstriction, Low platelet count
platelet adhesion to stop bleeding DVT DIAGNOSTICS
Stroke
Labs
Clot formation through the Mayocardial
Infraction INR or PT prolongation
Coagulation Cascade
Peripheral Platelet
cyanosis fibrinogen
Fibrinolisis to break down the aPTT (prolonged clotting time)
clot once the injury has healed D-dimer (indicates clot present)

Coagulation/clotting cascade
 Hematology

DIC

Both Occuring At The Same Time

Abnormal Clotting
In DIC, thrombin is uncontrollably
converting fibrinogen to fibrin
Abnormal causing clotting
& Bleeding

Abnormal clotting leads to increased

consumption of clotting factors and
platelets, leading to bleeding

TREATMENT NURSING INTERVENTIONS

Intravenous fluids: Increase blood volume Oxygen administration when required
Blood transfusions
Bleeding precautions including
Platelets to reduce bleeding
Fresh frozen plasma to enhance clotting
Bleeding precautions
Cryoprecipitate to augment fibrinogen levels
Minimize unnecessary needle punctures
Heparin infusion: Decrease clotting Use electric razors exclusively
Vasopressors: Be mindful of the risk of falls
Vasoconstrictors to sustain blood pressure

Bleeding manifestations
Monitor Blood in the urine
Vital signs & EKG Complete blood Bloody secretions
Fluid balance monitoring copunt, electrolytes IV site bleeding
( output may be sign & clotting factors Bruising/ ecchymosis
of shock) Signs of bleeding
 Hematology

Deep Vein Thrombosis (DVT)

1 PATHO
Endothelial damage:
WHAT IS IT? Root cause (from Virchow’s Triad)
Deep vein thrombosis (DVT) is a medical condition
that occurs when a blood clot forms in a deep vein.
It is a type of venous thromboembolism.
These clots usually develop in the LOWER LEG, THIGH, Hypercoagulability:
OR PELVIS, but they can also occur in the ARM. 2 Platelets accumulate at the cusps of the vein's valve
These clots can cause PAIN, SWELLING, AND Clotting factors generate fibrin,
POTENTIALLY LIFE-THREATENING COMPLICATIONS if
they dislodge and travel to the LUNGS, causing a Leading to the aggregation of white blood cells
pulmonary embolism (WBCs), red blood cells (RBCs), and platelets within the
vein,

Resulting in the formation of a clot that progressively

enlarges
High risk areas
In calves In thighs 3 Stasis:
Peroneal vein Popliteal vein A clot might detach and transform into a
Posterior tibial vein Superficial femoral vein pulmonary embolism (PE).

DVT in the lower limbs poses an increased risk

of detachment and subsequent development
into a pulmonary embolism (PE)
CAUSES: VIRCHOW'S TRIAD

Hypercoagulability
TREATMENT
Increased propensity for clot formation:
Deep vein trhombosis treatment includes:
Infection Heparin-induced
Anticoagulants
Sepsis thrombocytopenia
Thrombolytics
Dehydration Oral contraceptives Xa inhibitors
Compression stockings
The surgical and minimally Anticoagulants: Prevent
Venous Stasis invasive procedures for the growth of clo
Blood pooling or stagnation: DVT are as follows: but do not dissolve clot.
Endocascular procedures Common examples are:
Immobilization Atrial fibrillation
Stenting HEPARIN: Fast-acting,
Recent surgical Left ventricular failure Vena cava filter replacement Monitor APTT.
procedure WARFARIN: Takes time
to show effect (min. 5
Thrombolytic: Dissolve clot days), Monitor INR
but do not prevent clot
Vessel Damage formation or its growth.
Damage to blood vessel walls Example is:
IVC filter is inserted in IVC
Central lines & Intravenous drug tPA (Alteplase), Closely to clasp the clots and
IV lines administration monitor for bleeding preclude the traveling to
Venipuncture Trauma/ injury manifestations heart & lungs
 Hematology

Deep Vein Thrombosis (DVT)

NURSING INTERVENTIONS SYMPTOMS INVESTIGATION

Bed rest Watch for PE Swelling of the leg or calf Ultrasound
Neurovascular indicators such as: Pain that may worsen when normal < 0.5
assessments Sudden shortness standing or walking
of breath Warmth and redness of the leg D-dimer (need USG
Raise affected limb
Elevated heart rate for authentication)
Observe leg size and breathing Positive Homan's Sign
changes (pain upon dorsiflexing foot) Not definitive test
Oxygen deficiency
Low grade fever

Prevention Active DVT precautions

Compression stockings
Avoid using sequential compression devices (SCDs)
Sequential Compression Device (SCD)
Avoid rubbing or massaging the area as it may
Early ambulation dislodge the clot
Range of motion exercises for unaffected limbs
 Hematology

Hemophilia

NORMAL CLOTTİNG
WHAT IS IT?
Hemophilia is a genetic disorder characterized by
the deficiency or absence of certain blood clotting
proteins, known as clotting factors.

Clotting Cascade
Clotting proteins/factors Normal Bleeding
Activates To Form Plug
Blood Vessel Occurs
Factor VIII (Hemophilia A) from F8 gene mutation And Stop Bleeding
Factor IX (Hemophilia B) from F9 gene mutation
Factor XI (Hemophilia C) from F11 gene mutation

These clotting factors disturbs the intrinsic pathway

There is an instrinsic, extrinsic & shared pathway
that triggers specific factors within the coagulation
cascade Normal Bleeding Clotting Cascade Is
In HEMOPHILIA, certain factors found in the intrinsic Blood Vessel Occurs Interrupted And Blood
pathway are lacked. Unable To Form Clot
It leads to disruption in clotting cascade and The most common types of hemophilia are
Prolongs bleeding times hemophilia A and hemophilia B

Clotting proteins/factors SYMPTOMS

Inherited Excessive bleeding Bleeding following dental
procedures
Hemophilia A and B are inherited in a Blood in urine (hematuria)
Prolonged bleeding from
X-linked recessive pattern primarily impacting Profuse menstrual bleeding
wounds
MALES, while FEMALES TYPICALLY CARRY THE GENE Extensive or deep bruises
Joint pain and limited range
Hemophilia C is inherited in an autosomal Epistaxis (nosebleeds) of motion due to bleeding
recessive manner, affecting both males and within the joint space
females
It can also be acquired through spontaneous
genetic mutations
Complications include intracranial hemorrhage
Nosebleeds Coughing or vomiting Bleeding within the skull can elevate intracranial pressure,
Bleeding gums blood necessitating urgent medical attention. Symptoms may
Blood in stool or urine encompass:
Swollen and
stiff joints Heavy menstrual Headache Shift in level of consciousness
Bruises bleeding Alterations in vision Bleeding within joints
Impaired speech
 Hematology

Hemophilia

NURSING INTERVENTIONS TREATMENT

Replacement therapy:
Bleeding management protocols Substituting deficient clotting factors
Regular vital signs and laboratory assessments
Prophylactic treatment:
(including coagulation studies and complete blood count)
Routine infusions of clotting factors
Observation for skin discoloration indicative of bruising
Pain assessment and management Blood transfusions:
Restoring blood volume in cases of
Monitoring urine and stool for signs of bleeding severe bleeding
Desmopressin (DDAVP) therapy:
Stimulating clotting factor
Bleeding precautions production (applicable for mild hemophilia)
Minimize unnecessary blood sampling or finger pricks Antifibrinolytics:
Opt for electric razors and gentle toothbrushes Enhancing clot formation by delaying
Be cautious of falls and promote the use of assistive device fibrinolysis
Genetic intervention

Education of patients DIAGNOSTICS

Platelet count Assessment of clotting
Steer clear of high-impact sports or activities factor function via
Prothrombin time
Provide children with soft, non-sharp toys chromogenic assays
Elevated activated
Utilize helmets and protective padding during physical pursuits partial thromboplastin Genetic analysis may
time (aPTT) be conducted to detect
Engage in routine range of motion exercises to preserve mobility
specific gene mutatio
 Hematology

Thrombocytopenia

Normal platelet count 150,000 - 450,000

WHAT IS IT?
Condition that causes increased risk of bleeding
characterized by a low platelet count in the blood

Artery Red Blood Cells Platelets

Platelets formation Bone marrow

Storage Spleen (>50%) Thrombocytopenia < 140,000

Normal range in body 150,000-450,000 / UL

Functions Involve in clot formation to stop bleeding

CAUSES
DIAGNOSTICS
Impaired production Increased platelet destruction Complete blood count with platelets
of platelets Immune mechanism (ITP) Liver function test
Nutritional deficiency Microangiopathy Bone marrow
Coagulation studies
Aplastic anemia Consumptive biopsy/aspiration:
coagulopathy (DIC) peripheral blood smear
Cytotoxic chemotherapy may show abnormal
Heparin Induce Abdominal ultrasound
Cytokine stroms platelet formation or
Alcohol consumption thrombocytopenia Bone marrow aspiration
aplastic anemia
HIV test
( RBC production)
Impaired distribution of platelets Hepatitis C tests
Hyper-splenism
Massive transfusion
Liver damage due to high alcohol consumption

SYMPTOMS
Bruising
TREATMENT
Prolonged bleeding from wounds
Treatment depends on the underlying Immune
cause and severity of the condition Thrombocytopenic Visible red or purple dots
Platelet infusion Purpura
Spontaneous nosebleeds
Discontinuation of Glucocorticoids:
Increase platelet Bleeding gums, often during dental work
antithrombotic medications
generation Blood in urine stools
Bone marrow transplantation
Intravenous Unusually heavy menstrual flow
Splenectomy (if other therapies immunoglobulin:
prove ineffective) Slows down platelet Feeling tired or fatigue
breakdown
 Hematology

Thrombocytopenia

Immune Thrombocytopenic Purpura NURSING INTERVENTIONS

Type of thrombocytopenia because body develops Vital signs and laboratory tracking
antibodies that attack own platelets and show Skin surveillance for bruising
positive platelet antibodies
Evaluation of urine and stool for signs of bleeding
Risk Factors Implementation of measures to prevent bleeding
Prevalent in females
Occurrence in children post-viral illness
Autoimmune disorders (like rheumatoid arthritis, lupus)
EDUCATION
Viral infections (such as hepatitis)
Refrain from high-impact activities
Medications (antiviral drugs, antibiotics
Use a soft toothbrush
Do not floss if gums bleed
Avoid Aspirin or NSAIDs
Bleeding precautions
Minimize unnecessary needle punctures Avoid alcohol

Use electric razors exclusively Increase consumption of leafy greens for Vitamin K

Reduce fall hazards and promote assistive device use Abstain from forceful nose blowing

Opt for smaller needles when feasible Blow nose gently with soft tissue

Avoid rectal temperature measurements Shave with electric razor

Limit frequent blood pressure assessments if feasible Restrict alcohol intake

Avoid straining during bowel movements
Abstain from tampon use and monitor menstrual flow
IMMUNE
 Immune

Immune System

What is the immune system?

Immunity is The The various organs,
Your immune system is a large network of organs, immune system’s tissues and cells of
white blood cells, proteins and chemicals. way of protecting your immune system
These parts all work together to protect you from the body against an are distributed
germs and other invaders. infectious disease throughout your
body. They all work
Your immune system also helps your body heal together to help keep
from infections and injuries. you healthy.
Adenoids

Function Mucosa

Your immune system works hard to keep you

healthy. It does this by: Thymus
Keeping invaders (like germs) out of your body. Tonsils
Destroying invaders. Spleen
Limiting how much harm the invaders can do if
they’re inside your body.
Healing damage to your body.
Adapting to new challenges and threats. Lymph Nodes
Invaders your immune system protects you
against include: Bone
Marrow
Bacteria. Parasites.
Viruses. Cancer cells.
Fungi that can
cause infections. Skin

White Blood Cells

 Immune

Immune System

Working
Infected Cell
When your immune system is working properly, it:
Tells the difference between cells that are yours T Cell
and those that don’t belong in your body.
Activates and mobilizes to kill germs that may
harm you.
Macrophage Antigen-MHC
Ends an attack once the threat is gone. complex
Learns about germs after you’ve had contact with T-Cell
them and develops antibodies against them.
Sends out antibodies to destroy germs that try to Receptor
enter your body in the future. Cytokines
But things don’t always go this smoothly. Sometimes,
your immune system doesn’t work properly.
Example, it may be too weak to fight off invaders,
or it may launch too strong of a response.
Cell Dead Infected Cell Mitosis

Weak immune system Overactive Immune System

Many different conditions can At the other end of the spectrum, your immune system
weaken your immune system and may react too strongly to invaders (real or perceived).
make you more susceptible to It may mount an attack when there’s no invader.
infection.
Or it may keep attacking after getting rid of an invader.
Conditions at birth are less common
than those that develop later in life, An overactive immune system can lead to problems like
like Type 2 diabetes and cancer. autoimmune diseases or allergic reactions.
 Immune

Parts of Immune System

Many parts of your body, including immune system organs and cells, work together to keep you healthy. The
main components of your immune system are:

Thymus
Interlobular
The primary function of the thymus gland is to train special Septum
white blood cells called T-lymphocytes or T-cells.
Medulla
White blood cells (lymphocytes) travel from your bone
marrow to your thymus.
The lymphocytes mature and become specialized T-cells in
your thymus. Thymic
After the T-cells have matured, they enter your Corpsucle
bloodstream. They travel to your lymph nodes (groups of Capsule
cells) and other organs in your lymphatic system, where
they help your immune system fight disease and infection.
Your thymus gland is also part of your endocrine system. Cortex
Your endocrine system makes and releases hormones that Lymph Duct Artery
control the functions of your body. Vein

Thymus Gland

Thymus produces and releases several hormones including

Thymopoietin: fuels the production of T-cells and tells the pituitary gland to release hormones.
Thymosin and thymulin: help make specialized types of T-cells.
Thymic humoral factor: keeps your immune system working properly.

Spleen

The spleen is a lymphatic organ that plays a fundamental Lymphatic System

role in protecting the body from invading pathogens.
Spleen
Being an organ that is interposed in the blood stream,
It also stands as the body’s largest blood filter that
furthermore brings contribution to detecting senescent,
mechanically damaged and aberrant cells.
The spleen is part of your lymphatic system (which is
part of your immune system).
The spleen stores and filters blood and makes white
blood cells that protect you from infection.
Many diseases and conditions can affect how the Splenic Vein
spleen works
Splenic Artery
 Immune

Parts of Immune System

Lymphatic Vessels Tonsils

A thin tube that carries lymph (lymphatic fluid) and white Artery
blood cells through the lymphatic system. Thymus
Vein
Also called lymphatic vessel.
Lymph Node
Function of Lymph vessels:
Lymph Vessel
There are three primary functions of the lymphatic system:
First is the maintenance of fluid balance, Spleen
Second is the facilitation of the absorption of dietary fats
from the gastrointestinal tract to the bloodstream for
metabolism or storage,
Third is the enhancement and facilitation of the immune system

Appendix
Appendicitis
The appendix has been found to play a role in mammalian Inflamed Appendix
mucosal immune function.
It is believed to be involved in extrathymically derived
T-lymphocytes and B-lymphocyte-mediated immune
responses.
The appendix has been shown to function as a lymphoid Large Intestine
organ, Small Intestine
Assisting with the maturation of B lymphocytes (one variety of Rectum
white blood cell) and in the production of the class of
antibodies known as immunoglobulin A (IgA) antibodies
It is also said to produce early defences that help prevent
serious infections in humans.
Contains lymphoid cells that help prevent infection.

Lymph Nodes Lymphatic

Channels Capsule
A small bean-shaped structure that is part of the body’s immune
system.
Function:
Lymph nodes filter substances that travel through the lymphatic
fluid, and they contain lymphocytes (white blood cells)
That help the body fight infection and disease.
They clear out damaged cells and cancer cells.
Cortex
Lymph nodes also store lymphocytes and other immune system
cells that attack and destroy harmful substances like bacteria. Medulla
Blood Vessels
 Immune

Parts of Immune System

Yellow Blood
Bone Marrow Marrow Vessels Red Marrow

Bone marrow is the soft, spongy tissue

That is in the medullary cavities (centers)
of bones.
Healthy bone marrow is an essential part
of the body, as it contains stem cells that
produce blood cells
Cells that make up the immune System
Articular Compac
Cartilage Bone

Function
Bone marrow has been long thought to be a hematopoietic organ.
It is well known that B cells are produced and matured in the bone marrow.
Antigen-specific antibody producing, long-term lived plasma cells are largely found in the bone marrow.
Bone marrow contributes to humoral immune responses
Healthy bone marrow releases blood cells into the bloodstream when they are mature and when required.
Without bone marrow, our bodies could not produce the white cells we need to fight infection, the red blood

Tonsils
Tonsils
Tonsils are two round, fleshy masses in the back
Palatine of your throat (pharynx).
Tonsil
Part of your immune system, your tonsils are like
lymph nodes.
They help filter out germs that enter through your
nose or mouth to protect the rest of your body
from infection
Tonsils are part of the body’s immune system.
Because of their location at the throat and
palate, they can stop germs entering the body
through the mouth or the nose.
The tonsils also contain a lot of white blood cells,
which are responsible for killing germs.
 Immune

AntIgen Vs AntIbody

Antigen Antibody

An antigen is any substance that prompts your body to Antibodies are Y-shaped proteins
trigger an immune response against it. that the body produces when it
Antigens include allergens, bacteria and viruses. detects antigens.

Antigens are molecules capable of stimulating an Antibodies are produced by immune

immune response. cells called B cells

Each antigen has distinct surface features, or epitopes, Each antibody contains a paratope
resulting in specific responses. that recognizes a specific epitope on
an antigen, acting like a lock and key
Molecule type binding mechanism.
Usually proteins, may also be polysaccharides, This binding helps to eliminate
lipids or nucleic acids antigens from the body, either by
direct neutralization or by ‘tagging’
Origin
for other arms of the immune system.
Within the body or externally
Specific Binding site Molecule type
Epitome Always Protein
Origin
Within the body
Types of antigens Specific binding site
Paratome
Exogenous antigens
Exogenous antigens come from foreign substances that
can enter your body through your nose, your mouth or
cuts in your skin. Types of antigens
Endogenous antigens
IgG, powerful ability to bind to
Endogenous antigens exist on cells inside your body. bacteria and toxins,
IgM, IgM is constructed of five units of
basic Y-shaped structures and is
Role of antigens and antibodies in vaccinations: mainly distributed to the blood.
IgA, While in blood, IgA is mainly
Vaccines contain antigens that stimulate the B present as monomers
lymphocytes of the immune system to respond by IgD, IgD is present on the surface of B
producing plasma cells cells and it is reported to play a role in
Which secrete disease-specific antibodies (Primary the induction of antibody production
response). IgE , It is believed that IgE was
Some of the B cells become memory B cells, which will originally related to immunity
recognize future exposure to the disease. reactions to parasites. By binding to
mast cells,
This results in faster and more intense production of
antibodies, which effectively work to eliminate the disease
by binding to the antigens (Secondary response).
 Immune

Types of Leukocytes

Leukocytes(WBC)

A type of blood cell that is made in the bone marrow

Found in the blood and lymph tissue.
Leukocytes are part of the body’s immune system.
They help the body fight infection and other diseases.
White blood cells account for only about 1% of blood, but their impact is big.
White blood cells are also called at leukocytes.
They protect you against illness and disease.
Think of white blood cells as your immunity cells
They are always at war.
They flow through your bloodstream to fight viruses, bacteria, and other foreign invaders that threaten
your health.
When your body is in distress and a particular area is under attack,
white blood cells rush in to help destroy the harmful substance and prevent illness.
White blood cells are made in the bone marrow.
They are stored in your blood and lymph tissues.
Because some white blood cells called neutrophils have a short life less than a day, your bone marrow is
always making them.

Blood Stem Cell

Myeloid Stem Cell Lymphoid Stem Cell

Myeloblast

Basohil

Eosinophil Lymphoblast
Red Blood Cells

Platelets Neutrophil B Lymphocyte T Lymphocyte Natural Killer Cell

White Blood Cells

 Immune

Types of Leukocytes

Neutrophils Causes of High and low level of Neutrophils

Type of white blood cell that There are many reasons why a person may have higher or
help heal damaged tissues lower levels of neutrophils in their blood.
and resolve infections.
Neutrophil levels can rise or
fall in response to infections, High levels
injuries, drug treatments, Having an abnormally high level of neutrophils in
certain genetic conditions, the blood is called neutrophilic leukocytosis, also
and stress. known as neutrophilia.
Rises in neutrophil levels usually occur naturally due
Function of Neutrophils to infections or injuries.
Neutrophils are the most Causes
common type of white blood
cell in the body, which makes Some Medications, Such As Corticosteroids,
them a first line of defense to Beta-2-agonists, And Epinephrine
heal injuries and fight Some Cancers
infections. Physical or Emotional Stress
The amount of neutrophils in Surgery or Accidents
the blood typically increases if
a person is sick or injured to Smoking Tobacco
help their body heal. Pregnancy
Neutrophil levels may
decrease if a person has a
long-term infection, cancer, an
autoimmune condition, or is Low levels
taking certain medications. An abnormally low level of neutrophils in the blood is
called neutropenia.
Drop in neutrophil blood levels typically,
When the body uses immune cells faster than it
produces them or the bone marrow is not
Neutrophill producing them correctly.
An enlarged spleen may also cause a decrease in
neutrophil levels. This is because the spleen traps
and destroys neutrophils and other blood cells.

Causes
Severe or chronic bacterial infections
Allergic disorders
Certain drug treatments
Autoimmune
 Immune

Types of Leukocytes

Basophils
Basophils
Cryptoplasm
Two-lobed
Type of white blood cell that works closely with your immune Nucleus
system to defend your body from allergens, pathogens and
parasites.
Basophils release enzymes to improve blood flow and prevent
blood clots

Function of Neutrophils Granules

Allergens.
Bacterial, fungal and viral infections (pathogens).
Basophil
Blood clotting.
Parasites. Locations
Basophil cells are unique in that they don’t recognize pathogens
they’ve already been exposed to. Basophils form in the soft
Instead, they attack any organism they see that is unfamiliar to tissue of your bones
your body. Basophils destroy foreign organisms by surrounding (bone marrow).
and ingesting them (phagocytosis). After the cells mature,
They travel through your
bloodstream and
migrate to damaged
tissues to help heal the
Enzymes do basophils release
area after an injury

During allergic reactions, basophils release two enzymes:

Leukotrienes (allergy response) ,Cytokines (immune regulator
histamine and heparin.

Histamine (heparin and chondroitin)

Enlarges your blood vessels to improve blood flow and heal the
affected area.
Histamine opens pathways for other cells in your immune
system to quickly target and respond to the allergen.

Heparin
Is an enzyme that prevents blood from clotting too quickly.
The granules of basophils hold both histamine and heparin.
When a foreign organism enters your body, your basophils
activate and release these enzymes to assist your immune
system’s response to destroy the organism.
 Immune

Types of Leukocytes

Eosinophils

Eosinophils are a type of white blood cell (leukocytes).

There are three types of white blood cells, all with various functions to help your immune system,
Including granulocytes, lymphocytes and monocytes.

Function of Neutrophils
When an unfamiliar organism or particle enters your body, your white blood cells divide into special
troops to locate and destroy the invader before it causes harm to other cells.

Cells divide into special troops to locate and destroy the invader before it causes harm to other cells.
Each type of white blood cell undergoes specialized training before leaving your bone marrow and traveling to
your tissues where they watch for invaders to enter your body so they can destroy them.
Eosinophil cells contain small sand-like granules that release a toxic protein to destroy and consume
invading organisms. Eosinophils help your body defend itself from:
Infections by parasites (strongyloidiasis, pinworms).
Organisms that grow on other cells (intracellular bacteria).
Exposure to allergens (immediate hypersensitivity reactions)

Locations
Cryptoplasm Lipid Bodies Blood.
Bone marrow.
Sombrero
Vesicles Fat (adipose tissue
Primary
Granule
Nucleus
Is Bi-lov
Mitochondria

Goldgi Apparatus
 Immune

Types of Leukocytes

Lymphocytes White Blood Cell Golgia Apparatus

Nucleus Ribosomes
Lymphocytes are a type of white blood cell.
Mitchondria
They play an important role in your immune
system,
Helps your body fight disease and infection.
Immune system is made up of an intricate
web of immune cells, lymph nodes, lymph
tissue and lymphatic organs.
Lymphocytes are a type of immune cell.

Types of lymphocyte.
T lymphocytes (T cells): T cells control your
body’s immune system response and
directly attack and kill infected cells and
tumor cells.
How do T cells and B cells work?
B lymphocytes (B cells): B cells make
antibodies. Antibodies are proteins that target
T cells and B cells work together. They each
viruses, bacteria and other foreign invaders.
have different roles in your immune system.
Functions Cytotoxic (killer) T cells: Cytotoxic T cells attach
to antigens on infected or abnormal cells.
Lymphocytes help your body’s immune
system fight cancer and foreign viruses and Then, they kill the infected cells by making holes
bacteria (antigens). in their cell membranes and inserting enzymes
into the cells.
Lymphocytes help your immune system
remember every antigen it comes in Helper T cells: Helper T cells help your other
contact with. immune cells.

After an encounter, some lymphocytes turn Some helper T cells help B cells make
into memory cells. antibodies against foreign invaders.

When memory cells run into an antigen Others help activate cytotoxic T cells.
again, they recognize it and quickly respond. Regulatory (suppressor) T cells: Regulatory T
This is why you don’t get infections like cells make substances that help end your
measles or chickenpox more than once. It’s immune system’s response to an attack.
also the reason getting vaccinated can Sometimes, they prevent harmful responses
prevent certain diseases. from occurring
 Immune

Types of Leukocytes

Monocytes

Monocytes are a type of white blood cell (leukocytes) that

reside in your blood and tissues to find and destroy germs
(viruses, bacteria, fungi and protozoa) and eliminate
infected cells.
Monocytes call on other white blood cells to help treat
injury and prevent infection

Function of Neutrophils
Monocytes are cell’s firefighters.
Their lifecycle begins in the bone marrow (soft tissue
inside of your bones) where they grow and train to
protect your body.
Once they mature, they enter your bloodstream and
tissues to defend your body against foreign invaders, like
germs.
Germs are similar to fires when they enter your body.
Once germs are inside your tissues, monocytes hear an Locations
alarm, calling them into action to fight the fire.
Monocytes form in the soft tissue of
These cellular firefighters differentiate into two types of cells:
your bones (bone marrow).
Dendritic cells: Ask other cells in your immune system for
After the cells mature, they travel to
backup to fight germs
your tissues where they defend
your body from infection alongside
Mature other cells in your immune system.
Dendritic Cells
Immature Think dendrite
Dendritic Cells like in neuro
(communicate
to other cells)
Maturation
Pathogens
Cyrolumed

Macrophages: Defend your body from germs on the

front lines.

Phage means eat

 Immune

Normal Ranges

Type of WBC Normal percentage of overall WBC count

Neutrophil 55–70%

Lymphocyte 20–40%

Eosinophil 1–4%

Monocyte 2–8%

Basophil 0.5–1%

A High or Low WBC Count

WBC range per µL of blood

Low white blood cell count under 4000 per µL of blood

High white blood cell count over 11,000 per µL of blood

Age range WBC range per µL of blood

Adults assigned male at birth 5,000 to 10,000

Adults assigned female at birth 4,500 to 11,000

Children 5,000 to 10,000

 Immune

Cancer Overview

Normal Cells Cancer Cells

What is it?
Cancer refers to any one of a large number of diseases
characterized by the development of abnormal cells that
divide uncontrollably and have the ability to infiltrate and
destroy normal body tissue.

Cancer often has the ability to spread throughout your body.

Invasion of cells into other tissues cause

affected areas to not function properly

Tumor Difference between a tumor and a cyst

A tumor is a mass or group

A tumor is a solid mass A cyst is a small sac that may
of abnormal cells that form
of tissue. It may or may contain fluid, air or solid material. The
in the body. If you have a
not be cancerous. majority of cysts are not cancerous.
tumor,
It isn’t necessarily cancer.
Many tumors are benign
(not cancerous).
Tumors can form
throughout the body.
They can affect bone, skin,
tissues, glands and organs.
Neoplasm is another word
for tumor.

Types of Tumors

Benign Tumor Maligant Tumor

Tumor Tumor
Cells Cells

Normal Normal
Cells Cells
 Immune

Cancer Overview
Types of tumors

Malignant(Cancerous) tumors Benign (Noncancerous) tumor

Malignant or cancerous tumors can spread into Benign tumors are not cancerous and are
nearby tissue, glands and other parts of the rarely life-threatening.
body. The new tumors are metastases (mets). They’re localized, which means they don’t
Cancerous tumors can come back after typically affect nearby tissue or spread to
treatment (cancer recurrence). other parts of the body.
These tumors can be life-threatening. Many noncancerous tumors don’t need
treatment. But some noncancerous tumors
Types of cancerous tumors include: press on other body parts and do need
Bone tumors (osteosarcoma and chordomas). medical care.

Brain tumors such as glioblastoma and Types of benign tumors

astrocytoma.
Benign bone tumors (osteomas).
Malignant soft tissue tumors and sarcomas.
Brain tumors such as meningiomas and
Organ tumors such as lung cancer and schwannomas.
pancreatic cancer.
Gland tumors such as pituitary adenomas.
Ovarian germ cell tumors.
Lymphatic tumors such as angiomas.
Skin tumors (such as squamous cell carcinoma).

Precancerous Causes of Tumor

These noncancerous tumors can become cancerous if Body is constantly making new
not treated cells to replace old or damaged
ones that die off.
Types of precancerous tumors:
Sometimes, the cells don’t die off
Actinic keratosis, a skin condition. as expected.
Cervical dysplasia. Or, new cells grow and multiply
Colon polyps. faster than they should. The cells
start to pile up, forming a tumor.
Ductal carcinoma in situ, a type of breast tumor.

Risk Factors for Tumors

Non- Modifiable Modifiable

Gene mutations (changes), such as mutated Smoking, including exposure to secondhand
BRCA (breast cancer) genes. smoke.
Inherited conditions, such as Lynch syndrome Exposure to toxins like benzene or asbestos.
and neurofibromatosis (NFS). Previous radiation exposure.
Family history of certain types of cancer like Viruses like HPV.
breast cancer or prostate cancer.
Having obesity
Older Age
 Immune

Cancer Overview

Mutation inactivates
tumor suppresor
Carcinogenesis gene

Carcinogenesis is the uncontrolled replication of

tissue cells with a monoclonal character, implying Cell Proliferate Cancer
origin from a single cell mutation.

The carcinogenic process involves the alterations

of four broad categories of cancer genes, namely
the activation of oncogenes, inactivation of tumor Common Carcinogens
suppressors, evasion of apoptosis genes, and
defective DNA repair genes Beverages containing alcohol.
Causes Tobacco products, including smokeless
tobacco
Carcinogenesis may occur naturally in the
environment (such as ultraviolet rays in sunlight and Ultraviolet rays from the sun or from
certain viruses) or may be generated by humans radiation therapy may cause skin cancer
Such as automobile exhaust fumes and Radon.
cigarette smoke Asbestos
Most carcinogens work by interacting with a cell’s Formaldehyde.
DNA to produce mutations. Processed meat.

Stages of Carcinogenesis

Stage 1 | Initiation Stage Carcinogenic

Initiator
The first stage of carcinogenesis, initiation, results
from an irreversible genetic alteration, Unrepaired
DNA Damage
Most likely one or more simple mutations,
transitions, and/or small deletions in DNA.

Tumor
Stage 2 | Promotion Promotor

The reversible stage of promotion does not involve Clonal Expansion

changes in the structure of DNA
rather in the expression of the genome mediated Acquired
through promoter-receptor interactions. Mutation

Stage 3 | Progression
Benign Tumor
The final irreversible stage of progression is Formation
characterized by karyotypes instability and
malignant growth.
Critical molecular targets during the stages of
carcinogenesis include proto-oncogenes, cellular
oncogenes, and tumor suppressor genes, alterations Maligant Tumor
in both alleles of the latter being found only in the Formation
stage of progression
 Immune

Cancer Overview

TNM Staging System

The TNM system is the most widely used cancer staging system.
Most hospitals and medical centers use the TNM system as their main method for cancer reporting.
Examples of cancers with different staging systems include brain and spinal cord tumors and blood
cancers.

Tumor
Local
The T refers to the size and extent of the main tumor. Tissues
The main tumor is usually called the primary tumor.
Size & extent into other tissues
When your cancer is described by the TNM system,
there will be numbers
for example, T1N0MX or T3N1M0

0 1 2 3
TX Primary tumor cannot be evaluated Organ
T0 No evidence as primary tumor
Tis Carcinoma in situ (early cancer that has not
spread to neighboring tissue) Tis further divided to
provide more detail, such as T3a and T3b. The higher the number after the T, the
larger the tumor or the more it has grown
T1–T4 Size and/or extent of the primary tumor into nearby tissues.

Nodes Metastasized

The N refers to the number of nearby lymph The M refers to whether the cancer has
nodes that have cancer metastasized. This means that the cancer has
NX Regional lymph nodes cannot be evaluated spread from the primary tumor to other parts
of the body
N0 No regional lymph node involvement (no
cancer found in the lymph nodes) M0 No distant metastasis (cancer has not
spread to other parts of the body)
N1-N3 Involvement of regional lymph nodes
(number and/or extent of spread) M1 Distant metastasis (cancer has spread to
distant parts of the body)
Applies to Primary tumor only
The higher the number after the N, the more lymph MX: Metastasis cannot be measured.
nodes that contain cancer.

Distant Lung
Nodes
Bone ?
Local
Nodes Liver

0 1 2 0 1 2
 Immune

Cancer Overview

TNM classification

Stage 0 - Indicates carcinoma in situ. Tis, N0, M0.

Stage I - Localized cancer. T1-T2, N0, M0.
Stage II - Locally advanced cancer, early stages. T2-T4, N0,
Stage III - Locally advanced cancer, late stages. T1-T4, N1-N3, M0.
Stage IV - Metastatic cancer. T1-T4, N1-N3, M1.
Recurrent. Recurrent cancer has come back (recurred) after it has been treated. It may come back in the
same area or in a different part of the body.

Tumor Grading What is it

Grade X. Grade isn’t The grade of a cancer describes what the cancer cells look like
known using a microscope.
Grade 1. Well Most cancers are graded by how they compare with normal cells.
differentiated, low grade Low grade or grade I tumors are well-differentiated.
Grade 2. Moderately This means that the tumor cells are organized and look more like
differentiated, normal tissue.
intermediate grade
High grade or grade III tumor cells are poorly differentiated.
Grade 3. Poorly
differentiated, high This means that the tumor cells don’t look like normal cells.
grade They’re disorganized under the microscope and tend to grow and
Grade 4. spread faster than grade I tumors.
Undifferentiated, high Cancer cells that don’t look well-differentiated or poorly
grade differentiated are called moderately differentiated, or grade II.

Tumor Grade

Grade 1 Grade 2 Grade 3 Grade 4

Well Differentiated Moderately Differentiated Poorly Differentiated Undifferentiated

 Immune

Cancer Overview

Value Grade X Grade 0 Grade 1 Grade 2 Grade 3 Grade 4

T Main tumor Main tumor

Refers to the size/extent of main tumor. Higher
cannot be cannot be found
(Tumor) the number, greater the size and spread.
measured

Cancer in
N There is no cancer Refers to the number and location of lymph
nearby lymph
in nearby lymph nodes containing cancer. Higher the number,
(Node) nodes cannot
nodes the more lymph nodes that contain cancer
be measured

M Metastasis Cancer has not

cannot be spread to other Cancer has spread to other parts of the body
(Metastasis) measured parts of the body

General Symptoms of Cancer: Diagnostics

Remember CAUTION Tumor Marker Tests

These tests look for tumor markers, which are
sometimes called cancer markers.
Changes in bowel or bladder habits
Tumor markers are substances that are often
A sore that doesn’t heal
made by cancer cells or by normal cells in
Unusual discharge or bleeding response to cancer.
Thickening/ lump/ mass or tumor
Gold Standard for all cancer types
Indigestion or difficulty swallowing
Obvious changes in moles or warts Laboratory tests
Nagging cough or persistent hoarseness Laboratory tests, such as urine and blood tests

Other symptoms Imaging tests

Injury, benign tumors,
Computerized Tomography (CT) Scan, Bone Scan,
Bladder changes.
Magnetic Resonance Imaging (MRI),
Bleeding or bruising, for no known reason.
Positron Emission Tomography (Pet Scan)
Bowel changes.
Ultrasound And X-ray,
Cough or hoarseness that does not go away.
Eating problems. Biopsy
Fatigue that is severe and lasts. During a biopsy, your doctor collects a sample of
cells for testing in the laboratory.
Which biopsy procedure is right for you depends
on your type of cancer and its location.
In most situations, a biopsy is the only way to
definitively diagnose cancer.
 Immune

Types of Cancer

Lung Cancer

Lung cancer is a disease caused by Trachea

Tumor
uncontrolled cell division in your lungs.
Cells divide and make more copies of
themselves as a part of their normal function.
But sometimes, they get changes
(mutations) that cause them to keep making
more of themselves when they shouldn’t.
Damaged cells dividing uncontrollably create
masses, or tumors, of tissue that eventually
keep your organs from working properly.

Sign And Symptoms Diagnostics Cause of

Lung Cancer
Chest pain Blood tests
Shortness of breath Blood tests can’t diagnose cancer on Not sure what
Coughing up blood their own, but can help your provider causes these
(haemoptysis) check how your organs and other parts changes that lead
of your body are working. to cancer in some
Fatigue
Imaging people and not
Weight loss with no known others, but certain
cause Chest X-rays and CT scans give your
provider images that can show factors, including
Lung infections that keep changes in your lungs. smoking tobacco
coming back. products, can put
PET/CT scans are usually done to you at higher risk
Cough that doesn’t go away
evaluate a concerning finding on a for damage to
Losing weight without trying CT scan your cells that can
Bone pain Biopsy cause lung cancer
Headache Samples can also be tested for genetic
changes (mutations) that might affect
your treatment.

Types of Lung Cancer

Non-small cell lung cancer (NSCLC) Small cell lung cancer (SCLC)
Non-small cell lung cancer (NSCLC) is the most Small cell lung cancer (SCLC) grows more
common type of lung cancer. It accounts for over quickly and is harder to treat than NSCLC.
80% of lung cancer cases. It’s often found as a relatively small lung tumor
Common types include adenocarcinoma and that’s already spread to other parts of your body.
squamous cell carcinoma. Specific types of SCLC include small cell
Adenosquamous carcinoma and sarcomatoid carcinoma (also called oat cell carcinoma) and
carcinoma are two less common types of NSCLC. combined small cell carcinoma.
 Immune

Types of Cancer

TREATMENT FOR LUNG CANCER

Surgery Chemotherapy Immunotherapy

NSCLC that hasn’t spread and SCLC Chemotherapy is often Our bodies usually
that’s limited to a single tumor can be a combination of recognize cells that are
eligible for surgery. multiple medications damaged or harmful
designed to stop cancer and destroy them.
cells from growing. Cancer has ways to
It can be given before hide from the immune
Radiofrequency Ablation
or after surgery or in system to keep from
combination with other being destroyed.
NSCLC tumors near the outer edges of types of medication Immunotherapy
your lungs are sometimes treated with
Like immunotherapy. reveals cancer cells to
radiofrequency ablation (RFA).
Chemotherapy for lung your immune system
RFA uses high-energy radio waves to cancer is usually given so your own body can
heat and destroy cancer cells. through an IV. fight cancer.

Radiation Therapy
A lobectomy is a
Radiation uses high energy beams surgical procedure
to kill cancer cells. where an entire lobe of
To shrink tumors and relieve pain. your lung is removed
for a variety of reasons.
It’s used in both NSCLC and SCLC.
 Immune

Types of Cancer

Colorectal Cancer
Transverse Colon
Colon cancer is a growth of cells that begins in a
part of the large intestine called the colon.
The colon is the first and longest part of the
large intestine.
The large intestine is the last part of the
digestive system.
Ascending Colon
The digestive system breaks down food for the
body to us Descending Colon
Rectum

Diagnostics Tests Sigmoid Colon

A colonoscopy is an examination of the inside of your

large intestine (colon).
Complete blood count (CBC). Symptoms
Comprehensive metabolic panel (CMP). Blood on or in your stool (poop)
Carcinoembryonic antigen (CEA) assay: Cancer Persistent changes in your bowel habits
cells and normal cells release CEA into your
bloodstream. High CEA levels may be a sign of Abdominal (belly) pain
colon cancer. Unexplained weight loss
X-rays. Fatigue and feeling short of breath
Computed tomography (CT) scan. Anemia may be a sign of colon cancer
Magnetic resonance imaging (MRI) scan. Vomiting
Positron emission tomography (PET) scan. Weakness or tiredness.
Ultrasound. Losing weight without trying

Risk Factors Prevention

Factors that may increase the risk of colon cancer include: Lifestyle changes to reduce the risk
of colon cancer
Older age
A personal history of colorectal cancer or polyps Eat a variety of fruits, vegetables
Inflammatory bowel diseases. Inherited syndromes that and whole grains.
increase colon cancer risk Drink alcohol in moderation, if at
Family history of colon cancer all. If you choose to drink alcohol,
limit the amount you drink to no
Low-fiber, high-fat diet
more than one drink a day for
Not exercising regularly women and two for men.
Diabetes Stop smoking.
Obesity Exercise most days of the week.
Smoking
Maintain a healthy weight.
Drinking alcohol
Radiation therapy for cancer
 Immune

Types of Cancer

Treatment of Colorectal Cancer

Lymph Node Removal

Polypectomy
It is an operation usually performed as part of the
This surgery removes cancerous polyps. surgical management of malignant tumors.
Surgical Resection With Colostomy
Like a colectomy, surgeons the section of
your colon that contains a tumor. Endoscopic Mucosal Resection (EMR)
Radiofrequency Ablation is a minimally invasive procedure for removing
This procedure uses heat to destroy gastrointestinal (GI) cancer and precancerous lesions
cancer cells. using an endoscope — a flexible, tube-like tool.

Laparoscopic Surgery Chemotherapy

is a surgical technique in which short, narrow Chemotherapy is usually given intravenously

tubes (trochars) are inserted into the (through a vein). It’s an effective treatment but can
abdomen through small (less than one cause side effects.
centimeter) incisions.

Targeted Therapy

This treatment targets the genes, proteins and tissues

that help colon cancer cells grow and multiply.
 Immune

Types of Cancer

Prostate Cancer Symptoms

Prostate cancer develops in the prostate, Trouble urinating.

Small walnut-shaped gland located below the Decreased force in the stream of urine.
bladder and in front of the rectum Blood in the urine.
This tiny gland secretes fluid that mixes with semen, Blood in the semen.
keeping sperm healthy for conception and pregnancy.
Bone pain.
Losing weight without trying.
Erectile dysfunction
Dull pain in the lower pelvic area
Bladder Frequent urinating
Trouble urinating, pain, burning, or weak
urine flow
Tumor
Blood in the urine (Hematuria)
Painful ejaculation
Pain in the lower back, hips or upper
Rectum thighs

Urethra Prostate Loss of appetite

Bone pain

Early-stage Prostate Cancer Types of Prostate Cancers

Early-stage | Stages I & II Common types of prostate

cancers include:
The tumor has not spread beyond the prostate. This is
often called “early-stage” or “localized” prostate cancer. Small cell carcinomas.
Transitional cell carcinomas.
Locally Advanced | Stage III
Cancer has spread outside the prostate, but only to Neuroendocrine tumors.
nearby tissues. This is often called “locally advanced Sarcomas.
prostate cancer.”
Advanced | Stage IV
Cancer has spread outside the prostate to other parts
such as the lymph nodes, bones, liver or lungs.
 Immune

Types of Cancer

Gold Standard

Risk Factors Diagnosis of Prostate cancer:

The most common risk factors include: Prostate-specific antigen (PSA) test
is a blood test that measures the
Age. Your risk increases as you get older. You’re more
level of PSA in a sample of your
likely to get diagnosed if you’re over 50.
blood.
Race and ethnicity. You’re at greater risk if you’re Black
or of African ancestry. Screening tests for prostate cancer.
Family history of prostate cancer.
Digital rectal exam
Genetics.
Prostate-specific antigen (PSA)
Smoking. blood test
Prostatitis.
Biopsy Using Transrectal US and MRI
Having a BMI > 30 (having obesity).
Sexually transmitted infections (STIs). The fusion biopsy technology
combines your MRI images with the
ultrasound image in real time.
Imaging
Treatment For Prostate Cancer An MRI or a transrectal ultrasound
can show images of your prostate
gland.
Radial Prostatectomy

Open radical prostatectomy

Gold Standard
Robotic radical prostatectomy
Systemic Therapies

Chemotherapy Hormone therapy

The hormone testosterone boosts
The most common chemotherapy drug for prostate cancer cell growth.
cancer is docetaxel (Taxotere), which is usually given Hormone therapy uses
with prednisone, a steroid medicine. medications to combat
testosterone’s role in fueling
cancer cell growth.

Radiation Therapy Chemotherapy uses medicines to

destroy cancer cells.
Brachytherapy: A form of internal radiation therapy, Immunotherapy strengthens your
brachytherapy involves placing radioactive seeds inside immune system so it’s better able
your prostate. to identify and fight cancer cells.
External beam radiation therapy Targeted therapy
 Immune

Types of Cancer

Skin Cancer Symptoms

Skin cancer is a disease that Remember ABCDE

involves the growth of abnormal
cells in your skin tissues
Asymmetry
Melanoma is often asymmetrical, which means
the shape isn’t uniform. Non-cancerous moles
are typically uniform and symmetrical in shape.
Types
Border
Three main types of
Melanoma often has borders that aren’t well
skin cancer
defined or are irregular in shape, whereas
Basal cell carcinoma, non-cancerous moles usually have smooth,
which forms in your basal well-defined borders.
cells in the lower part of
your epidermis (the Color
outside layer of your skin). Melanoma lesions are often more than one
color or shade. Moles that are benign are
Squamous cell
typically one color.
carcinoma, which forms in
your squamous cells in the
outside layer of your skin.
Diameter
Melanoma growths are normally larger than
Melanoma, which forms in 6mm in diameter, which is about the
cells called melanocytes. diameter of a standard pencil. 6 mm
Melanocytes produce
melanin, a brown pigment Evolution
that gives your skin its Melanoma will often change characteristics,
color and protects against such as size, shape or color. Unlike most
some of the sun’s benign moles, melanoma tends to change
damaging UV rays. over time.

Risk factors Diagnosis

Fair skin. Skin Biopsy:

A history of sunburns. During a skin biopsy, dermatologist
Excessive sun exposure. removes a small amount of skin, which
Sunny or high-altitude climates. will be looked at under a microscope.
Moles. People who have many moles or abnormal Imaging Test
moles called dysplastic nevi are at increased risk
of skin cancer. Emerging optical imaging modalities such
as reflectance confocal microscopy (RCM),
Precancerous skin lesions
Optical coherence tomography (OCT),
A family history of skin cancer
Magnetic resonance imaging (MRI),
A personal history of skin cancer. If you developed
skin cancer once, you're at risk of developing it again. Near-infrared (NIR) bioimaging,
A weakened immune system. Exposure to radiation. Positron emission tomography (PET)
Exposure to certain substances. Exposure to certain And their combinations provide
substances, such as arsenic, may increase your non-invasive imaging data that may
risk of skin cancer. help in the early detection of skin Cancer
 Immune

Types of Cancer

Treatment for Skin Cancer

Cryotherapy, or cryosurgery (freezing), is a Immunotherapy

procedure that uses extreme cold (liquid nitrogen)
Enhances your immune system’s ability to
to remove sunspots,
destroy melanoma cells

Curettage and electrodessication

Radiation therapy may be used to treat aggressive Your dermatologist uses an instrument with a
forms of skin cancer. sharp, looped edge to remove cancer cells as
it scrapes across the tumor.

Photodynamic therapy
Chemotherapy Your dermatologist coats your skin with
medication, which they activate with a blue
Topical chemotherapy — Topical chemotherapy or red fluorescent light
medications, such as 5-flurouracil (5-FU) in cream
form, can be applied directly to the skin’s surface to
address precancerous skin
Side Effects of The Treatment

Bleeding.
Mohs Micrographic Surgery
Pain and swelling.

Procedure used to treat certain types of skin Scars.

cancer, Nerve damage that results in loss of feeling.
Penile cancer, Skin infection.
Mouth cancer (especially cancer of the lip), and Regrowth of the tumor after it’s been
Soft tissue sarcoma of the skin removed.

During Mohs micrographic surgery, the

visible tumor and a thin layer of tissue
around it is removed.
Mohs Surgery

Lesion on Skin

Epidermis

Dermis

Removed
 Immune

Types of Cancer

Testicular Cancer Symptoms

Testicular cancer forms when malignant A painless lump or swelling on either testicle.
(cancer) cells develop in the tissues of one Pain, discomfort, or numbness in a testicle or
or (less commonly) both testicles. the scrotum, with or without swelling.
Lump or swelling in testicles
Feeling of heaviness in the scrotum
Types of Testicular Cancer Change in the way a testicle feels or a feeling
of heaviness in the scrotum.
Seminoma: Slow-growing cancer that Dull ache in the lower abdomen or groin.
primarily affects people in their 40s or 50s.
Tenderness or changes in the male breast tissue
Non-seminoma: Cancer that grows more
rapidly than seminomas. It mainly affects
people in their late teens, 20s and early 30s.
Vas Deferens

Epididymis
Risk Factors
Tumor
For testicular cancer include:
Age: Testicular Undescended testicles Testis
cancer most Race and ethnicity
commonly affects Personal or family history
people between ages Infertility Treatment for Testicular Cancer
15 and 35.
Chemotherapy
Diagnosis
BEP (or PEB): bleomycin, etoposide,
A physical exam and history: Your provider will ask Cisplatin.
about your symptoms and examine you closely to
check for signs of testicular cancer EP: etoposide and cisplatin. VIP: VP-16
(etoposide) or vinblastine plus
Ultrasound
ifosfamide and cisplatin.
Inguinal orchiectomy and biopsy
A serum tumor marker test
CT scans, X-rays and MRIs Radiation Therapy

Imaging Tests Surgery

Testicular ultrasound is the mainstay of treatment for

testicular cancer.
Blood tests: Doctors use blood tests to detect
testicular cancer tumor markers Radical inguinal orchiectomy
Retroperitoneal lymph node dissection
(RPLND)
Tumor Marker Tests

Alpha-fetoprotein (AFP)
Cancer antigen 125 (CA125)
Immunotherapy
Cancer antigen 15-3 (CA15-3)
In this treatment, monoclonal antibody
Carbohydrate antigen 19-9 (CA19-9)
proteins are used to attack the cancer cells.
Carcinoembryonic antigen (CEA)
Human chorionic gonadotropin (hCG or beta- hCG )
Prostate-specific antigen (PSA)
 Immune

Types of Cancer

Breast Cancer Symptoms

When breast cells mutate and become A change in the size, shape or contour of your breast.
cancerous cells that multiply and form tumors A mass or lump, which may feel as small as a pea.
Breast cancer is one of the most common A lump or thickening in or near your breast or in your
cancers that affects women and people underarm that persists through your menstrual
assigned female at birth (AFAB). cycle.
A change in the look or feel of your skin on your
breast or nipple.
Your skin may look dimpled, puckered, scaly or
Breast Cancer Types
inflamed.

Invasive (infiltrating) ductal carcinoma It may look red, purple or darker than other parts of
(IDC); This cancer starts in your milk ducts your breast.
and spreads to nearby breast tissue. A marble-like hardened area under your skin.
Lobular breast cancer: This breast cancer A blood-stained or clear fluid discharge from your
starts in the milk-producing glands (lobules) nipple.
in your breast and often spreads to nearby
breast tissue.
Ductal carcinoma in situ (DCIS): Like IDC, this
breast cancer starts in your milk ducts..
Triple-negative breast cancer (TNBC) This
invasive cancer is aggressive and spreads
more quickly than other breast cancers. Chest Muscles
Inflammatory breast cancer (IBC): This rare,
fast-growing cancer looks like a rash on your Rib
breast. IBC is rare in the United States.
Paget’s disease of the breast: This rare cancer Tumor
affects the skin of your nipple and may look
like a rash Milk Duct

Subtypes include

ER-positive (ER+) breast cancers have

estrogen receptors.
PR-positive (PR+) breast cancers have
progesterone receptors. Fat
HR-positive (HR+) breast cancers have
estrogen and progesterone receptors. Lobules
HR-negative (HR-) breast cancers don’t have
estrogen or progesterone receptors.
HER2-positive (HER2+) breast cancers, which
have higher than normal levels of the HER2
protein.
 Immune

Types of Cancer

Stages of Breast Cancer

Stage 0: The disease is noninvasive, meaning it hasn’t spread from your breast ducts to other parts of
your breast.
Stage I: There are cancerous cells in nearby breast tissue.
Stage II: The cancerous cells have formed a tumor or tumors. The tumor is either smaller than 2
centimeters across and has spread to underarm lymph nodes or larger than 5 centimeters across but
hasn’t spread to underarm lymph nodes.
Stage III: There’s breast cancer in nearby tissue and lymph nodes. Stage III is usually referred to as locally
advanced breast cancer.
Stage IV: Cancer has spread from your breast to areas like your bones, liver, lungs or brain.

Causes Treatment

Age: Being 55 or older. Breast cancer surgeries include:

Sex Mastectomy.
Family history Lumpectomy.
Breast reconstruction
Genetics
Smoking Providers may combine surgery with one or
more of the following treatments:
Tobacco
Drinking beverages containing alcohol Chemotherapy.
Radiation therapy, including intraoperative
Having obesity
radiation therapy (IORT).
Radiation exposure: Hormone replacement Immunotherapy
therapy
Hormone therapy, including selective estrogen
receptor modulator (SERM) therapy.
Targeted therapy.
Diagnosed

Breast ultrasound
Breast magnetic resonance imaging (MRI) scan
Breast biopsy
Immunohistochemistry test to check for
hormone receptors.
Mammogram
Genetic tests to identify mutations that cause
breast cancer.
 Immune

Cancer Treatment and Complications

What is Chemotherapy? Types

Chemotherapy is a type of cancer treatment. Chemotherapy can treat a wide range of

Also called “chemo,” it’s one of several cancer cancers, including:
treatments that use drugs against various types Primary cancer: Cancer that hasn’t spread to
of cancer. other areas of your body.
Metastatic cancer: Cancer that’s spread to
other areas of your body.

The type of chemotherapy you receive

How Does Chemotherapy Work? depends on several factors:

Cancer cells grow and divide uncontrollably. Location of the cancer.

Chemotherapy destroys the cancer cells and Stage of the cancer, or how advanced it is.
prevents them from multiplying. Your overall health.
Oncologist may use chemotherapy in different ways

Adjuvant therapy: Chemotherapy destroys

cancer cells after surgery or radiation therapy.
Curative therapy: Chemotherapy (which may
also include radiation and/or surgery)
eliminates the cancer, and it doesn’t return.
Neoadjuvant therapy: Chemotherapy shrinks a
tumor before surgery or radiation therapy.
Palliative therapy: Chemotherapy shrinks Cancer Cells Death of
tumors and lessens Cancer Cells

Routes for Chemotherapy Side Effects of Chemotherapy

Intravenously (IV), or through a vein as an Chemotherapy drugs target all

“infusion.” Most people receive chemo through an IV. fast-growing cells, including cancer cells.
As an injection, or a shot. Anemia.
Intramuscular Bleeding.
Orally, as a pill or liquid that you swallow. Constipation.
Topically, as a cream that you rub into your skin. Diarrhea.
Intra-arterial chemotherapy: Goes into a single Fatigue.
artery that supplies blood to a tumor.
Hair loss.
Intracavitary chemotherapy: Goes directly into a
Infection.
body cavity, such as your bladder or belly.
Loss of appetite.
One form is hyperthermia intraperitoneal
chemotherapy (HIPEC). It puts heated Nausea and vomiting.
chemotherapy in your abdomen after surgery.
Intrathecal chemotherapy: Goes into the area
between your brain and spinal cord.
 Immune

Cancer Treatment and Complications

Radiation Therapy Why is Radiation Therapy Used?

Radiation therapy — or radiotherapy Radiation therapy kills cancer cells, shrinks tumors and
relieves cancer symptoms. It may be your only treatment,
Is a common cancer treatment
or it may be used to:
that uses radiation (usually
high-powered X-rays) to kill Shrink tumors before other cancer treatments, like
cancer cells. surgery (neo-adjuvant therapy).
Radiation therapy may be used Destroy any remaining cancer cells after surgery
independently or alongside other (adjuvant therapy).
treatments, like surgery or Kill cancer cells that return after previous treatment.
chemotherapy.
Radiation therapy can also destroy benign
(noncancerous) tumors causing symptoms.

Types of Radiation Therapy

External beam radiation therapy (EBRT)

With EBRT, a machine directs beams of high-energy radiation toward the tumor. The energy may be
X-rays (most common), electrons or protons.
Treatment plan to target the tumor with radiation while avoiding your healthy tissue.
Internal Radiation Therapy
Internal radiation therapy places radiation inside of your body, close to cancer cells. It treats smaller
tumors in your head, neck, breast, cervix, uterus or prostate.
Patient can receive internal radiation through a solid source or in liquid form

External Beam Radiation Therapy (EBRT) Internal Radiation Therapy

Radiation Machine Radioactive IV

Catheter Radioactive
Source

High Energy Tumor

Radiation

Tumor
Location

Brachytherapy Systemic Therapy

 Immune

Cancer Treatment and Complications

Routes for Radıatıon Therapy Side Effects

Brachytherapy Side Effects Of Radiation Therapy:

implants a solid radioactive source, or “seed,” Fatigue
inside or beside a tumor. Nausea.
The source releases radiation to a small area to Vomiting.
kill cancer cells.
Diarrhea.
Some implants release low doses for longer
periods (weeks). Others may release high doses Headaches.
for shorter periods (minutes). Skin irritation.

Systemic Therapy Dry, itchy scalp.

Hair loss
Sends liquid radioactive material through your
blood to find and destroy cancer cells. Some Mouth sores
forms are swallowed. Pain when you swallow.
For others, you’ll receive an injection through a Reduced appetite.
vein (IV). Treatments include radionuclide
A burning feeling in your throat or chest.
therapy (radioimmunotherapy).
Pain or a burning sensation when you pee.
With radioimmunotherapy, a radioactive protein
recognizes specific cancer cells, attaches to
them and then releases radiation to kill them.

External Beam Radiation

a machine directs beams of high-energy
radiation toward the tumor. The energy may be
X-rays (most common), electrons or protons. .
 Immune

Other Therapies

Immunotherapy Types

Immunotherapy is a cancer Immunotherapy types include:

treatment that uses your
Checkpoint inhibitors.
body’s immune system to find
and destroy cancer cells. Adoptive cell therapy (T-cell transfer therapy).
Your immune system identifies Monoclonal antibodies.
and destroys intruders, Cancer vaccines.
Including cancerous cells. Immune system modulators
Immunotherapy boosts your
immune system
It can do more to find and kill
cancer cells. How Does Immunotherapy Work?

Your immune system’s everyday job is to protect your body

from intruders, from allergens and viruses to damaged cells
Side Effects that could become cancerous.
When they find a damaged or cancerous cell, they destroy it.
Fatigue.
That keeps cancerous tumors from growing and spreading.
Itchy rash.
Cancerous cells constantly look for ways to dodge immune
Diarrhea.
system defenses.
Nausea and vomiting.
Immunotherapy works by Training your immune system so it
Decreased thyroid hormone levels can do more to find and kill cancer cells.
Helping your body produce cancer-fighting immune cells.

Traditional Cancer Therapies Cancer Immunotherapies

Radiation or Drugs Immunotherapies Unleashes
The Patient’s Own Immune System

Kills
Kills

Healthy Cells Cancerous Cells Selectively Cancerous Cells

 Immune

Other Therapies

Harmone Therapy

Treatment that adds, blocks, or removes

hormones. For certain conditions (such as
diabetes or menopause)
Hormones are given to adjust low hormone
levels.
Hormones can also cause certain cancers
(such as prostate and breast cancer) to grow.

Types

Types of Hormone Therapy:

1. Estrogen Therapy:
Estrogen is taken alone. .
Estrogen may also be prescribed as a cream,
vaginal ring, gel or spray.
You should take the lowest dose of estrogen
Side Effects
needed to relieve menopause symptoms
and/or to prevent osteoporosis. Short and Long-Term Side Effects of Hormone
Therapy
2. Estrogen Progesterone/Progestin Hormone Breast tenderness or pain.
Therapy (EPT):
Decreased sex drive.
Also called combination therapy, this form of
Nausea or vomiting.
HT combines doses of estrogen and
progesterone (or progestin, a synthetic form Erectile dysfunction.
of progesterone). Fatigue.
 Immune

Other Therapies

Cryoablation Why is Cryotherapy Used?

Cryoablation is a procedure that uses Cryoablation may be used to treat several

extremely cold gas to freeze and destroy conditions:
abnormal cells or diseased tissue. Abnormalities on the skin, such as atypical
It’s sometimes called cryotherapy or cryosurgery. moles, warts, skin tags or actinic keratosis
(precancerous skin growths).
Arrhythmia (abnormal heart rate and
rhythm).
Types
Cancer tumors (such as skin, liver, kidney,
bone, lung, prostate and breast).
Topically, on the surface of the skin.
Precancerous cells in the cervix.
Percutaneouslyinside your body through a
small puncture (hole).
Surgically, inside the body through a larger,
open incision (cut).

Side Effects

Bleeding.
Complications from anesthesia, such as
trouble waking up or nausea.
Damage to surrounding structures.
Fluid collection in surrounding areas (for
example, the lungs).
Infection from any opening in the skin.
Nerve damage
 Immune

Other Therapies

Targeted Therapy How Does Targeted Therapy Work?

Targeted therapy is a kind of cancer Once healthcare providers understand the

treatment that’s focused on genetic changes genetic mutation changing a healthy cell into
or mutations that turn healthy cells into a cancer cell
cancer cells. They identify specific cancer cell parts to
To use targeted therapy, healthcare providers target for treatment. Sometimes,
test for the genetic changes responsible for These are targets on cancer cells surfaces.
helping cancer cells grow and survive. Other times, the targets are substances inside
Then, they identify specific treatments to kill cancer cells.
those cells or keep them from growing.
Monoclonal antibodies
Monoclonal antibodies are lab-made versions
of your antibodies. Your antibodies are part of
Ligand-targeted Theraphy your immune system.
They’re proteins that scour your body for signs
Tumor Grwoth Factor of intruder proteins (antigens) that can come
Antigens Receptors from things like infections or cancer cells.
Therapeutic
Metalloproteinase Antibodies Antibodies target these antigens to get rid of
Inhibitors ±Toxins the intruders.
Monoclonal antibodies have several ways of
attacking cancer cells.
Immunotherapy
Small-molecule drugs
Cancer Tyrosine These drugs bind or attach to specific targets
Cell Kinase on cancer cells
Inhibitors
(Glivec, Gefitinib) Preventing cancer cell growth or killing the
m-RNA cancer cells.
Intracellular
Antisense Signaling Apoptosis
Molecules Agonists
Side Effects
Anglogenesis, Inhibitors
(Angiostatin, Endostatin & Avastin) Diarrhea
Elevated liver enzymes; damaging your liver.
Cardiotoxicity; This is damage to your heart
muscle.
Dry skin.
Extreme sensitivity to ultraviolet (UV) light
(photosensitivity).
High blood pressure (hypertension)
Loss of hair color.
Nail changes.
Problems with wound healing and blood clotting.
 Immune

Complications

Neutropenia Neutrophil
Red Blood Cells
Neutropenia refers to lower-than-normal levels
of neutrophils in your blood.
A neutrophil is a type of white blood cell that
your bone marrow primarily makes.
White blood cells in general, and neutrophils
in particular, fight infections in your body.
Neutrophils destroy germs that cause
infections, like viruses and bacteria.

Normal Blood Cells Neutropenia

The range of neutrophil numbers is:
Mild neutropenia: 1,000 – 1,500.
Causes
Moderate neutropenia: 500 – 1,000
Severe neutropenia: Less than 500. Genetic conditions
Infections
Cancer:
Symptoms Medications: Cancer treatments such as
chemotherapy and radiation therapy can
Fever (febrile neutropenia). harm or destroy neutrophils and/or the bone
Fatigue. marrow that makes WBC.

Sore throat (pharyngitis). Nutritional deficiencies: Not having enough

vitamins or minerals such as vitamin B12,
Swollen lymph nodes. folate or copper in your diet can cause
Ulcers in your mouth or around your anus. neutropenia.
Pain, swelling and rash at an infection site. Autoimmune deficiencies
Diarrhea.
Burning with urination or other urinary
symptoms (urgency, frequency). Nursing Interventions

Assess vital signs and any signs of infection.

Conduct a physical assessment.
Assess and monitor complete blood count.
Implement neutropenic precautions.
Limit visitors.
Hand hygiene
Teach the patient proper hand washing
techniques.
Administer medications as ordered.
Maintain aseptic technique.
 Immune

Complications

Alopecia Cause

Hair loss (alopecia) can affect just your scalp Chemotherapy. That's because chemo
or your entire body, and it can be temporary targets rapidly growing cells, which damages
or permanent. hair follicles and makes the hair fall out.
It can be the result of heredity, hormonal Radiation therapy
changes, medical conditions or a normal part
of aging.
More common in men.
Treatment

There is no cure for alopecia areata only

treatment.
However, if treatment is necessary, steroid
injections and topical medications may be
recommended.

Patchy Alopecia Diffuse Alopecia Patchy Alopecia

Symptoms

Losing hair in an unusual pattern.

Pain or itching with the hair loss.
The skin on your scalp under the involved
area is red, scaly, or otherwise abnormal.

Perievoid AA AA Ophiasis AA Sisaipho

Nursing Interventions

Giving the needed information and teaching self-care strategies to minimize alopecia,
Educate the patient and their caregivers about alopecia, including the causes, different types, and
available treatment options.
Provide information on self-care measures for scalp and hair health, such as gentle hair care practices
and the use of hypoallergenic products
Cope with alopecia, and protect the skin and eyes following alopecia.
Cooling cap
Use of wig, scarf, hat
Diet rich in protein & iron
Patient education, identification of available resources, and
supportive listening are therapeutic interventions.
 Immune

Complications

Lymphedema

Lymphedema is a long-term (chronic)

condition that causes swelling in the body's Examples of Lymphedema
tissues. in the Leg and Arm
It can affect any part of the body, but usually
develops in the arms or legs.
It develops when the lymphatic system does
not work properly. Tissue Cells

Causes

By cancer or by cancer treatment. Lymph

Cancerous tumor can get big enough to Node
block the lymph system.
Surgery to remove cancer may also remove
lymph nodes or some of the vessels that carry
the lymph fluid. This can cause the fluid to
build up in surrounding tissues.
Radiation treatment can damage the lymph Distrubed
vessels Flow

Symptoms Nursing Interventions

An aching, heavy feeling. Exercise. Exercise helps to restore flexibility

Difficulty with movement. and strength, and it improves drainage.

Repeated skin infections. Limb elevation

The skin becoming hard and tight. Bandage. Wearing a customized compression
sleeve or elastic bandage may help to
Folds developing in the skin. prevent an accumulation of fluid
Wart-like growths developing on the skin. Arm pump
A leakage of fluid through the skin. Diet
Keep the arm raised
Infection Prevention

The oncology nurse plays a major role in

the prevention, detection, and
management of lymphedema.
 Immune

Complications

Mucositis Causes

Mucositis is a painful inflammation of the Mucositis is one of the most common adverse
mucosa reactions encountered in radiation therapy
for head and neck cancers, as well as in
The protective mucous membrane that lines chemotherapy,
your entire gastrointestinal (GI) tract, from
your mouth through your intestines. In particular with drugs affecting DNA
synthesis (S-phase-specific agents such as
fluorouracil, methotrexate, and cytarabine).

Symptoms
Nursing Interventions
Diarrhea (frequent, watery poos)
ulcers around your rectum or anus. Consistent recommended intervention in
Bleeding from your gut, which you may notice mucositis research is the use of a
as blood in your poo. standardized oral care protocol.
Trouble swallowing because it hurts. Good oral hygiene
Feeling sick. Ice chips & lip moisturizer
Constipation (difficulty pooing) Brushing with soft toothbrush
Stomach cramps. Salt and soda rinses
 Immune

Complications

Malnutrition
The Prevalance of Malnutrition
Malnutrition refers to deficiencies or excesses Varies in Certain Cancer Types
in nutrient intake, imbalance of essential
nutrients or impaired nutrient utilization.
Malnutrition in cancer means deficiency in diet . Pancreas 66.7%

Esophagus and/
60.2%
Causes or Stomach

Cancer and cancer treatments may cause

Head and
malnutrition. 48.9%
Neck
Cancer and cancer treatments may affect
taste, smell, appetite, and the ability to eat
enough food or absorb the nutrients from Lung 45.3%
food or decrease appetite from nausea.

Ovaries/Uterus 44.8%
Nursing Interventions

Treat the underlying cause Colon/Rectum 39.3%

Provide the recommended caloric intake
Increase protein in the diet
Leukemia/
Increase calories 34.0%
Lymphoma
Correct the deficiencie
Refeed the patient
Breast 20.5%
Instruct on weight loss
Calorie dense foods (nut butters & dried fruits)
Encourage patient adherence
Prostate 13.9%
 Immune

Complications

Thrombocytopenia Causes

Thrombocytopenia is a condition that occurs Thrombocytopenia may develop if the bone

when the platelet count in your blood is too low. marrow isn’t working normally and doesn’t
make enough platelets. Some cancers, such
as leukemia, can cause thrombocytopenia.
The following cancer treatments can also
affect the bone marrow and lead to a low
platelet count:
Normal Platelet Count 150.000 - 450.000
Chemotherapy drugs,
Biological therapies or other drugs.
Radiation Therapy

Nursing Interventions
Artery Red Blood Cells Platelets
Continuously monitor coagulation values
Provide antidotes as necessary
Thrombocytopenia < 140.000
Review and identify medications that can
increase the risk of bleeding
Provide medications as ordered
Bleeding precautions
Avoid NSAID's & Aspirin
Prepare and assist in platelet transfusion
Use care with invasive procedures
 Immune

Leukemia

Leukemia Disease Progression

Leukemia is a cancer of the blood, characterized Acute Leukemia

by the rapid growth of abnormal blood cells. The leukemia cells divide rapidly and the
This uncontrolled growth takes place in your disease progresses quickly.
bone marrow, where most of your body’s blood Acute leukemia is life-threatening and
is made. requires immediate initiation of therapy.
Leukemia cells are usually immature (still Acute leukemia is the most common cancer in
developing) white blood cells. children.
The term leukemia comes from the Greek words
for “white” (leukos) and “blood” (haima). Chronic Leukemia
Often, these leukemia cells behave as both
immature and mature blood cells.
Some cells develop to the point where they
Grouped by disease progression & type of wbc involved function as the cells they were meant to become
But not to the extent their normal
counterparts do.

Neutrophil Red Blood Cells Type of WBC involved

Myelogenous
Monocytes Myeloid leukemia develops from myeloid cells.
Normal myeloid cells develop into red blood
cells, white blood cells and platelets.
Platelets Eosinophils, basophils & neutrophils

Lymphocytic Leukemia

Normal Blood Develops from lymphoid cells.

Normal lymphoid cells develop into white
blood cells
That are an important part of your body’s
immune system.
Leukimia B-cells & T-cells
Cells

Leukemia
 Immune

Leukemia

Diagnostics of Leukemia

Complete blood Count (CBC) Lumbar puncture (spinal tap)

Leukemia is most often diagnosed through a Your healthcare provider may test a sample
diagnostic test called a complete blood count of spinal fluid to see if leukemia has spread to
(CBC). the spinal fluid surrounding your brain and
If a patient’s CBC shows abnormal levels of spinal cord.
white blood cells or abnormally low red blood
cells or platelets, he or she has leukemia
High WBC (can be >30,000)
Lumbar Puncture
Low HGB low HCT
Low PLT

Bone Marrow Biopsy

In a biopsy, suspected cancer cells are

retrieved by the care team and studied under
a microscope.
Spinal Cord
For leukemia, patients undergo a bone
marrow biopsy. This requires taking a sample
of bone marrow from the hip with a needle to
determine if cancerous cells are present.
Cerebrospinal Fluid

Spinal Needle
Blood Smear

For the peripheral blood smear, a sample of

blood is looked at under the microscope.
Changes in the numbers and the appearance
of different types of blood cells often help
diagnose leukemia.
Most patients with AML have too many
immature white cells in their blood, and not
enough red blood cells or platelets.

Myeloblasts= AML Lymphoblasts= ALL

 Immune

Types of Leukemia

There are Four Main Types of Leukemia

Acute Lymphocytic leukemia (ALL)

is the most common type of leukemia in children, teens and young adults up to age 39. ALL can affect
adults of any age.

Acute myelogenous leukemia (AML)

is the most common type of acute leukemia in adults. It’s more common in older adults (those over 65).
AML also occurs in children.

Chronic lymphocytic leukemia (CLL)

is the most common chronic leukemia in adults (most common in people over 65). Symptoms may not
appear for several years with CLL.

Chronic myelogenous leukemia (CML)

is more common in older adults (most common in people over 65) but can affect adults of any age
 Immune

Types of Leukemia

Acute Lymphoid Risk Factors

Cancer of the blood and bone marrow Radiation exposure.

The spongy tissue inside bones where blood Certain chemical exposures.
cells are made.
Certain viral infections
The word “acute” in acute lymphocytic
Certain genetic syndromes.
leukemia comes from the fact that the disease
progresses rapidly and creates immature Age.
blood cells, rather than mature ones. Race/ethnicity.
Being male.
Most Common in Children
Genetics
Congenital disorders (Down's Syndrome)
Having an identical twin with ALL.
Symptoms
Bleeding.
Bruising.
Treatment
Pale skin.
Chemotherapy. Chemotherapy, which uses
Splenomegaly drugs to kill cancer cells, is typically used as
Swollen Glands an induction therapy for children and adults
with acute lymphocytic leukemia.
Rashes of tiny flat red spots (caused by bleeding)
Targeted therapy.
Fever with no clear cause.
Radiation therapy.
Feeling weak.
Bone marrow transplant.
Feeling tired (fatigue)
Engineering immune cells to fight leukemia.
Frequent infections or infections that don’t go away
Clinical trials.
May take several years for symptoms to appear
in chronic leukemias
 Immune

Types of Leukemia

Acute Myeloid Risk Factors

Acute myeloid leukemia (AML) starts in the Getting older. ( Peak at 60)
bone marrow (the soft inner part of certain
Smoking.
bones
Being exposed to certain chemicals. Like Benzene
Where new blood cells are made), but most
often it quickly moves into the blood, as well. Being treated with certain chemotherapy drugs.
It can sometimes spread to other parts of the Being exposed to radiation.
body including the lymph nodes, liver, spleen, Having certain blood disorders
central nervous system (brain and spinal
Having a genetic syndrome.
cord), and testicles.

Treatment
Symptoms
Combination chemotherapy that includes
Skin looking pale or “washed out” cytarabine.
Tiredness. Maintenance therapy with midostaurin, for
Breathlessness. people whose AML has a mutation in the
FLT3 gene.
Losing weight without trying.
Maintenance therapy with chemotherapy.
Frequent infections.
High-dose chemotherapy and stem cell
Having a high temperature, and feeling hot or transplant using the patient’s stem cells.
shivery (fever)
Immunotherapy
Night sweats.
Bone marrow transplant
Unusual and frequent bleeding, such as
bleeding gums or nosebleeds.
 Immune

Types of Leukemia

Chronic Lymphoid Risk Factors

Chronic lymphocytic leukemia (CLL) is a type Getting older. The risk of CLL goes up as you
of cancer of the blood and bone marrow get older
The spongy tissue inside bones where blood Having certain chemical exposures
cells are made.
Family history
The term “chronic” in chronic lymphocytic
Being male
leukemia comes from the fact that this
leukemia typically progresses more slowly than Race/ethnicity
other types of leukemia. Radon Exposure
The term “lymphocytic” in chronic
lymphocytic leukemia comes from the cells
affected by the disease
Prevention
Agroup of white blood cells called lymphocytes,
which help your body fight infection
Avoid using tobacco products
Tobacco has been tied to multiple cancers,
Most Common in Adults
and it is responsible for 90 percent of lung
cancer deaths
Stay physically active. Your physical activity is
related to risk for colon and breast cancer
Symptoms Limit alcohol consumption
Painless swelling of the lymph nodes in the
neck, underarm, stomach, or groin.
Weakness or feeling tired. Treatment
Pain or a feeling of fullness below the ribs.
Targeted therapy
Fever and infection.
Chemotherapy and rituximab.
Easy bruising or bleeding.
Immunotherapy (lenalidomide) with or
without rituximab.
A clinical trial of bone marrow or peripheral
blood stem cell transplantation.
 Immune

Types of Leukemia

Recurrent
Chronic Myeloid Infections
Blast Phase
Chronic myelogenous leukemia is a disease
Swollen Glands
in which the bone marrow makes too many
white blood cells.
Chronic Myelogenous leukemia (also called More Severe
CML or chronic granulocytic leukemia) is a Symptoms
slowly progressing blood and bone marrow Spontaneous
disease Infections
That usually occurs during or after middle
Lumps on
age, and rarely occurs in children.
The Skin

Symptoms Treatment
Feeling very tired. Targeted therapy with a tyrosine kinase
Weight loss for no known reason. inhibitor (imatinib mesylate, nilotinib,
Drenching night sweats. dasatinib, bosutinib).

Fever. High-dose chemotherapy with donor stem

cell transplant.
Pain or a feeling of fullness below the ribs on
the left side. Chemotherapy.
Splenectomy.
A clinical trial of lower-dose chemotherapy
with donor stem cell transplant.
Causes
CML is one of the few cancers known to be
caused by a single, specific genetic mutation.
More than 90% of cases result from a Risk Factors
cytogenetic aberration known as the
Philadelphia chromosome (see Radiation exposure: Being exposed to
Pathophysiology). high-dose radiation.
CML progresses through three phases: Age: The risk of getting CML goes up with age.
chronic, accelerated, and blast Smoking
 Immune

Types of Leukemia

Nursing Interventions

Infection Prevention

Hand washing
Using aseptic technique reduces the likelihood of transmitting pathogens
Limit visitors
Use protective isolation for patients who are at risk for infection
Good hand hygiene
Neutropenic precautions in hospital
Avoid crowded places

Diet Recommendation

Plant-based Proteins. Some of the best foods to eat during chemotherapy or other cancer treatments
are plant-based proteins.
Healthy Fats. Monounsaturated and polyunsaturated fats also have health benefits.
Healthy Carbs.
Vitamins and Minerals.
Avoid Raw foods(Rae meat &Raw vegetables)
High Calories food

Bleeding Precautions

Allow the patient to use normal saline nasal sprays and emollient lip balms.
For bleeding linked with excessive anticoagulant use, give appropriate antidotes as prescribed.
Educate the patient and family members about signs of bleeding that need to be reported to a health
care provider.
Administer blood products if indicated.
Use an electric razor for shaving (not razor blades).
Limit straining with bowel movements, forceful nose blowing, coughing, or sneezing.
Use a soft-bristled toothbrush and nonabrasive toothpaste.
 Immune

Lymphoma

Spleen Lymphatic Node

Lymphoma” is the general term for
cancer in your lymphatic system — the
network of tissues, vessels and organs
that help body fight infection.
It’s considered a blood cancer because
the condition starts in white blood cells
(lymphocytes) in your lymphatic system.

Lymphatic System Includes

Lymph nodes: help to filter substances in
lymphatic fluid Tumor
Lymphatic vessels: use to carry
lymphatic fluid & WBC's Blood Vessels
Spleen: filters and stores blood
Thymus: production & maturation of
T-cells
Bone marrow: production of blood cells Lymphocytes (white
(including WBC's) blood cells) that mutate
into cancer cells

Symptoms Complication Risk Factors

Unexplained fever. Superior Venna Cava syndrome: Exact Cause is Unknown
Swelling of one or more Refers to a medical emergency Age (>55 years old)
lymph glands such as in resulting from superior vena cava
the neck or armpits. More common in males
compression, which develops in
Swollen abdomen. 2%-4% of non-Hodgkin Impaired immune system

Abnormal sweating, lymphomas. Autoimmune disease

especially at night. Symptoms Immunosuppressant
Tiredness. Family history
Face/neck swelling,
Loss of appetite. Infections
Distended neck veins,
Bruising or bleeding easily. Epstein-Barr
Cough,
Weight loss. Herpes
Dyspnea
Cough Radiation exposure
Orthopnea
Shortness of breath Genetics
Upper extremity swelling,
Night sweats distended chest vein collaterals Smoking
Fatigue Conjunctival suffusion
Itching
Medical Emergency
 Immune

Types of Lymphoma

Hodgkin Lymphoma Non-Hodgkin Lymphoma

Once known as Hodgkin disease is a group of It is a group of blood cancers that develop in your
blood cancers that affects your lymphatic system. lymphatic system.
Reed-Sternberg lymphocyte is present Reed-Sternberg lymphocyte is absent
These blood cancers start in your People are living longer with these conditions
lymphocytes. thanks to new treatments, including targeted
Lymphocytes are white blood cells that are therapies.
part of your lymphatic system. Every year, In some cases, treatments eliminate
more people are living longer after treatment. non-Hodgkin lymphoma signs and
Many times, treatment eliminates all Hodgkin symptoms, putting the disease into remission
lymphoma signs and symptoms. for months or years.

Treatment Diagnostics Education

Common lymphoma Imaging tests Avoid exposure to pesticides.

treatments include: Computed tomography Have a healthy body weight.
Chemotherapy. (CT) scan to look for Follow occupational and
lymphoma signs such as safety guidelines.
Radiation therapy. enlarged lymph nodes,
Targeted therapy spleen or other organs. Find out if you’re at high risk
for NHL..
Immunotherapy. Positron emissions
tomography (PET) scans Good hand hygiene
CAR T-cell therapy.
to detect signs of cancer. Avoid large crowds
Stem cell (bone marrow)
Lymph node biopsy Cook food thoroughly
transplantation.
Bone marrow biopsy High protein calorie diet
Small, frequent meals
Avoid GI irritants (spicy food)
Nursing Interventions
Soft toothbrush
Monitor laboratory studies (ABGs, oximetry) Allow adequate rest
Administer antiemetic for nausea
Monitor I & O
Observe for neck vein distension, headache, dizziness,
periorbital and facial edema, dyspnea,
Encourage adequate fluid intake
Monitor CBC & electrolytes
Monitor infusion site for irritation
Prepare for emergency radiation therapy when indicated
Daily weights
Administer analgesics and tranquilizers as indicated.
Neutropenic precautions.
Private room
No flowers or fruits
Visitors & staff wear PPE (gown, gloves, mask)
 Immune

Multiple Myeloma

Risk Factors
Multiple myeloma, also known as myeloma, is
a type of bone marrow cancer. Agricultural and farm workers,
Bone marrow is the spongy tissue at the Cosmetologists,
center of some bones that produces the Petroleum workers
body’s blood cells.
Employees in the leather industries’
It’s called multiple myeloma as the cancer
often affects several areas of the body, such You're older than 65
as the spine, skull, pelvis and ribs. You're male
You're African American
You have a family member with it
Plasma cells develop from B-cells (type of You're overweight or obese
lymphocyte) and play a key role in immunity Radiation or chemical exposure
Benzene, environmental toxins
Viral infections
Cancer is within plasma cells (called myeloma HIV
cells) and causes excess production of abnormal
plasma cells causing pancytopenia & high risk Epstein-Barr
of infection

Red Marrow Normal Plasma Cells

Where Plasma
Cells are Made

Antibodies

Multiple Myeloma Cells (Abnormal Plasma Cells)

Bone
 Immune

Multiple Myeloma

Symptoms
Symptoms usually don’t Renal insufficiency
Remember CRAB show until reaches
advanced stages Renal insufficiency is poor function of the
kidneys that may be due to a reduction in
blood-flow to the kidneys

Symptoms
Hyper Calcemia Decreased urine output,
Symptoms associated with hypercalcemia may Fluid retention,
be subtle or dramatic, and can include: Causing swelling in your legs
Nausea and vomiting; Ankles or feet.
Confusion or depression; Shortness of breath
Myalgia's and arthralgias; Fatigue.
Dry mouth
Polydipsia
Anorexia
Constipation Bone Disease
Abdominal pain Myeloma bone disease (MBD) is a devastating
EKG changes complication of multiple myeloma (MM).

Muscle weakness More than 80% of MM patients suffer from

Fatigue Destructive bony lesions,
Leading to pain
Fractures
Mobility issues
Anemia Neurological deficits.
Anaemia is a condition in which the number of Lytic” lesions (area of bone damage)
red blood cells or the haemoglobin Osteoporosis
concentration within them is lower than normal.

Symptoms
Tiredness
Dizziness or feeling light-headed
Cold hands and feet
Headache
Shortness of breath, especially upon exertion
 Immune

Multiple Myeloma

Diagnostics Treatment

Blood Tests Chemotherapy

Blood tests also might find another protein myeloma Chemo drugs that can be used to treat
cells make, called beta-2-microglobulin. multiple myeloma include.

Low WBC Steroids

Low HGB low HCT They can also make chemotherapy and
Low PLT targeted therapies more effective.
GFR high
Monoclonal antibodies
Too much calcium in your blood (hypercalcemia)
There are three monoclonal antibody drugs
Too few red blood cells (anemia)
for multiple myeloma:
Kidney problems
Daratumumab (Darzalex):
High total protein levels in your blood
Attaches to the CD38 antigen on
High Creatinine
myeloma cells.
High BUN
Isatuximab (Sarclisa):
A complete blood count (CBC)
Attaches to the CD38 antigen on
Blood urea nitrogen (BUN) and creatinine myeloma cells.
Elotuzumab (Empliciti):
Attaches to the SLAM7 antigen on
myeloma cells
24 hours Urine test:
M proteins can show up in urine samples. In urine, the Radiation Therapy
proteins are called Bence Jones proteins. Radiotherapy aims to destroy myeloma cells
in the bone.

Bone Marrow Biopsy

increase monoclonal plasma cells. Symptomatic Treatment

Erythropoietin:
Bone Marrow Transplant Erythropoietin is a glycoprotein hormone,
stimulate bone marrow
It replaces the unhealthy blood-forming cells Bisphosphonates:
(stem cells) with healthy ones. Bisphosphonates are a class of drugs that
prevent the loss of bone density, prevent
bone loss
Blood transfusions:
For pancytopenia
 Immune

Multiple Myeloma

Complications Nursing Interventions

Multiple Myeloma Complications Management is multi-focused including

adequate hydration,
Blood tests also might find another protein myeloma
cells make, called beta-2-microglobulin. Anti-myeloma therapy,
Prompt management of hypercalcaemia,
Bone problems. Your bones can become
weaker, leading to fractures. Dose adjustment of bisphosphonate
therapy,
Blood problems.
Monitor CBC & electrolytes
Infections.
Avoidance of nephrotoxic drugs,
Kidney damage. Myeloma can clog your
kidneys so they don't filter the way they should. Monitor & manage pain
Monitor I & O
High risk ( bone fra8
Bleeding Precautions
Preventions
Fall risk (high risk fractures & bleeding)
Avoid public gyms and swimming pools
If you are at a higher risk of infection.
Minimize exercises which have an increased risk of
jarring or falling,
Especially if you have altered sensation or
numbness in your feet caused by peripheral
neuropathy.
Avoid lifting heavy weights.
Wear supportive well-fitting shoes.
 Immune

Polycythemia

Risk Factors
Polycythemia, refers to increased red blood cell
mass, noted on laboratory evaluation as Primary (Due to JAK 2 gene mutation)
increased hemoglobin and hematocrit levels.
Gender (most Common in males)
Too many red blood cells can make your blood Age above 50 years
thick and sluggish
Headaches
Increase risk of blood clots and complications
Dizziness
such as heart attack and stroke.
Fatigue
High blood pressure
Blurred or double vision.
High concentration of RBC causes blood to become
Radiation & Toxin Exposure
thick and increases risk of thrombosis.
Secondary(due to chronic hypoxemia)
A history of blood clots
In some cases, white blood cells and platelets will also Being over age 60.
be increased as well. high blood pressure.
Shortness of breath, especially when
lying down.
Itchy skin, especially after a warm bath
or shower.
Redness, heat, tingling or burning in your
hands and feet.
Excessive bleeding or bruising.
Nosebleeds and gum bleeding
Diabetes.
Smoking.
High cholesterol.
COPD
Hypertension

Normal Blood Anemia Polycythemia Complications

37%-47% Hematocrit Deoressed Elevated
42%-52% Hematocrit Hematocrit% Hematocrit% Blood clots
Enlarged spleen
Problems due to high levels of red blood cells
Other blood disorders
 Immune

Types of Polycythemia

Primary Polycythemia
Cause
The JAK2 mutation is an acquired, Caused by overproduction of red blood cells by the bone
somatic mutation present in the majority marrow due to mutation or biological factor in the body.
of patients with myeloproliferative cancer
Symptoms
Lack of energy (fatigue)
JAK 2 gene stimulates RBC production Weakness
Headaches
Dizziness
Causes elevated red blood cell
production along with secondary white Shortness of breath
blood cell and platelet production Visual disturbances

Life Expectancy
With treatment, many people with Polycythemia vera
(PV) will live at least 14 years after diagnosis.

Secondary Polycythemia Cause

which is caused by factors that reduce the amount of
Condition in which the body doesn't get
oxygen reaching the body's tissues, such as smoking,
oxygen due to a lack of healthy red blood
high altitude, or congenital heart disease.
cells cause hypoxia
Symptoms
Breathing difficulty.
Low amount of O2 stimulates kidneys
Chest and abdominal pain.
to produce erythropoietin
Fatigue.
Weakness and muscle pain.
Erythropoietin (EPO) is a glycoprotein Headache.
hormone, naturally produced by the Ringing in ears (tinnitus)
peritubular cells of the kidney, that Blurred vision.
stimulates red blood cell production.
Burning or “pins and needles” sensation in hands,
arms, legs, or feet.

Causes elevated red blood cell Life Expectancy

production along with secondary white Secondary polycythemia on its own does not affect your
blood cell and platelet production lifespan, as long as the underlying condition is treated.
 Immune

Types of Polycythemia

Symptoms
Headache. Myelodysplastic
Itchiness, especially after a warm bath. Syndromes are a group of cancers in which immature
blood cells in the bone marrow do not mature or
Red skin coloring, especially of the face.
become healthy blood cells. OR
Shortness of breath.
Group of disorders where RBC, PLT & WBC die too fast
Symptoms of blood clots in veins near
the skin surface (phlebitis) Anemia
Vision problems. Tiredness
Ringing in the ears (tinnitus) Dizziness or feeling light-headed
Joint pain. Cold hands and feet
Splenomegaly or hepatomegaly Headache
Finger clubbing Shortness of breath

Thrombocytopenia
Blood clots in arteries and veins, most often in the
Spongy Bone hands, feet, and brain.
(Contains Red Marrow)
Bruising easily.
Bleeding from the nose, gums, and GI
(gastrointestinal) tract.
Bloody stools.
Bleeding after injury or surgery.
Weakness.
Headache and dizziness.
Compact Bone Swollen lymph nodes.

Blood Stem Cells Leukocytosis

Shortness of breath
Anemia,
Pallor,
Unusual bleeding,
Petechiae,
Frequent infections,
Fatigue. May develop into
acute myeloid
Red Blood Celss White Blood Cells Plaletles
leukemia
 Immune

Types of Polycythemia

Diagnostics Nursing Interventions

Gene Testing IV fluids as order to low blood viscosity

Biopsy to check your JAK2 gene. Monitor VS & labs
Genetic tests done to confirm the diagnosis. Assess for signs of excess bleeding
VTE prophylaxis
Bone Marrow Biopsy
A bone marrow biopsy involves taking a sample of Early ambulation
solid bone marrow material. Avoid crossing legs
SCD’s if on bedrest
Labs
Frequent blood withdrawals
A bone marrow biopsy involves taking a sample of
solid bone marrow material. Using a needle in a vein (phlebotomy).
Altered gas exchange,
More red blood cells than normal and,
sometimes, an increase in platelets or white Altered tissue perfusion,
blood cells Nurses should stay at the patient's bedside
A greater percentage of red blood cells that and monitor vital signs
make up total blood volume (hematocrit
measurement)
Avoid
Elevated levels of the iron-rich protein in red
blood cells that carries oxygen (hemoglobin) Low oxygen environments
High WBC Extreme temperatures
High HGB high HCT Contact sports
High PLT Smoking
High erythropoietin (in secondary)

X-ray/US/CT scan Recommendation

Chest x-ray – to rule out lung disease; abdominal
ultrasound and/or CT scan – to rule out kidney Nutrient dense foods
disease and measure spleen/liver size. Adequate fluid intake
Lukewarm baths (not hot)
Balance rest with activity
Treatment
No cure Precautions
Goals of treatment include low count of RBC & high
risk of thrombosis. Exercise. Moderate exercise, such as
Phlebotomy. The most common treatment walking, can improve your blood flow
For PV is to have regular blood withdrawals. Avoid tobacco.
Treatments to reduce itching Avoid low-oxygen environments.
Drugs that reduce red blood cell count. Be good to your skin.
Clinical trials. Avoid extreme temperatures
Bone marrow transplant Watch for sores.
Hydroxyurea: Antineoplastic to RBC production
Aspirin: prevent thrombosis
 Immune

HIV/AIDS

Human immunodeficiency virus (HIV) is the virus that causes acquired immune deficiency syndrome (AIDS).

HIV(Human immunodeficiency Virus) targets

the body’s white blood cells, weakening the
immune system.
HIV is a retrovirus meaning it has RNA instead
of DNA as its genetic material
Uses an enzyme called reverse transcriptase
to become part of the host cell DNA

AIDS (acquired immunodeficiency syndrome)

A serious disease caused by a virus that destroys
the body’s natural protection from infection.
A retrovirus is a virus that works backward from
the way human cells do. Human cells have
instructions (DNA) that send a message (RNA) to
make building blocks for your body (proteins).
HIV is a retrovirus. All viruses invade your cells
and then use your cells “machinery” to make Uses an enzyme called reverse transcriptase to
more copies of themselves become part of the host cell DNA

Cells attacked by HIV: WBC with CD4 receptors

HIV attacks and destroys the CD4 cells (CD4 T
lymphocyte) of the immune system.
Helper” T cells.
Antigen
The T helper cells (Th cells), also known as CD4+
BCR
cells or CD4-positive cells,are a type of T cell
that play an important role in the adaptive
BCR immune system.
CD
40 B-cells make proteins called antibodies to fight
0L
CD4 pathogens.
TCR They aid the activity of other immune cells by
T Helper Cell MHC-II+ B Cell releasing cytokines.
Peptide

CD4
ILR
Other cells Affected
IL2/4/5
B-Cells Dendritic cells
Monocyte Macrophages
 Immune

HIV/AIDS

Risk Factors Diagnostics

Transmitted through The enzyme-linked immunosorbent assay (ELISA)

blood & bloody fluids It tests a patient’s blood sample for antibodies.
Use of alcohol or drugs before sex.
Oral fluid ELISA tests are considered as sensitive as a
Unprotected sexual activity
blood test.
Not using an HIV prevention
Not for definitive diagnosis
method during sex.
Sex with multiple partners. ...
Western Blot Test
Male–male sex.
The Western blot assay is a method in which individual
Sharing needles, syringes, or other proteins of an HIV-1 lysate are separated according to
drug injection equipment. size by polyacrylamide gel electrophoresis.
Maternal HIV(passed from + HIV
The viral proteins are then transferred onto nitrocellulose
mother to baby)
paper and reacted with the patient’s serum.
Medications
Hydralazine Nucleic Acid Test (NAT)
Isoniazid Assesses viral load (earliest detection)

CD4 count
CD4 count means that HIV has weakened your immune
system.
A CD4 count of 200 or fewer cells per cubic millimeter
means that you have AIDS.

Stage CD4 Cell Count (6year to % of CD4 Count

adult) [Cell/Micro Litre]

0 Negative HIV in 6 month

After HIV Infection

1 >500 >25

2 200-499 14-25

3 <200 <14
 Immune

HIV/AIDS

Before HIV Acute HIV Chronic HIV

Symptoms Infection Infection Infection AIDS
May not have symptoms for up to 10 years

Acute stage: Initial infection to 2 months

Infection
Acute HIV infection is the earliest stage of HIV
infection, and it generally develops within 2 to 4
weeks after infection with HIV.

Symptoms Weeks to Months Years

CD4 Cell HIV
Some people have flu-like symptoms,
Fever,
Headache,
AIDS | End stage
Rash.
Swollen lymph nodes CD4 count< 200 and oppurtunistic
Muscle aches diseases present
Symptoms
Chronic stage: can last up to 10 years Rapid weight loss.
HIV continues to multiply in the body but at very Recurring fever or profuse night sweats.
low levels. Extreme and unexplained tiredness.
People with chronic HIV infection may not have Prolonged swelling of the lymph glands in
any HIV-related symptoms the armpits, groin, or neck.
CD4 count between 200-500 & HIV continues to Diarrhea that lasts for more than a week.
replicate Sores of the mouth, anus, or genitals.
May be asymptomatic! Pneumonia.
But still able to transmit disease to others Herpes simplex virus
Kaposi’s Sarcoma (opportunistic cancer)
Wasting syndrome
 Immune

HIV/AIDS

Treatment Education

There is currently no cure for HIV, but there are Get tested for HIV
many treatment options that can slow the Choose less risky sexual behaviors.
progression of HIV significantly.
Use condoms every time you have sex.
The goal of ART is to reduce HIV in the blood
(viral load) to an amount that’s not Limit your number of sexual partners.
detectable by an HIV test and to slow HIV’s Get tested and treated for STDs
weakening of your immune system
Medication compliance
Earlier treatment= better outcomes.
Limit alcohol use
No smoking
Antiretroviral Therapy
Stress management
Nucleoside reverse transcriptase inhibitors
Keep up on vaccines
(NRTIs).
Good hand hygiene
Non-nucleoside reverse transcriptase
inhibitors (NNRTIs). Healthy diet
Protease inhibitors (Pis).
Fusion inhibitors.
Avoid
CCR5 antagonists.
Integrase strand transfer inhibitors (INSTIs). Raw eggs or foods that contain raw eggs,
Attachment inhibitors. Raw or undercooked poultry, meat, and
Post-attachment inhibitors. seafood.
Pharmacokinetic enhancers. Unpasteurized milk or dairy products and fruit
Combination of HIV medicines juices.

Medication compliance extremely important

or patient may develop resistance &
treatment won’t work.
 Immune

Lyme’s Disease

Lyme disease is caused by a bacteria,

Borrelia burgdorferi,
Which you can get if an infected deer tick
(also called black-legged tick) bites .

Risk Factors
Doing outside activities Red Rash
Gardening, (Bull’s Eye)
Hunting,
Hiking,
Living in grassy, bushy and wooded areas
Regions with widespread deer ticks

Symptoms
A reddish rash or skin lesion known as
erythema migraines (EM).
Fever.
Lyme Disease Bacteria
Headache.
Boreelia Burgdorferi
Stiff neck.
Body and joint aches.
Fatigue.
Swollen lymph nodes (swollen glands).
Areas of numbness or abnormal feelings
Multiple areas of rash.
Paralysis of facial muscles (Bell's palsy).
Heart block or an interruption of the electrical
system of the heart.
Areas of numbness or abnormal feelings
(neuropathy).
 Immune

Lyme’s Disease

Pathology
During transmission from the infected Bacteria Replicate, Bacteria Bacteria Replicate
tick, the bacteria undergo significant Alter Gene Inoculated and Spread in
changes in gene expression, Expression Into Skin Skin: Erythema
Disseminate in Tick Migrans Lesion

It is transmitted to humans through

Skin
the bite of infected blacklegged ticks.

Evasion of Innate Blood Vessel

Bacteria enters the bloodstream and adaptive Invasion
immunity,
peristent
Spreads through bloodstream & infecrtion of
attacks organs & tissues multiple tissues,
including joints, Blood Vessel
CNS, PNS, skin, Lumen
Tissue
inflammatory Invasion
any organ may be infected via the response;
bloodstream with one or another kind arthritis,
of virus. encephalopathy
, peripheral
neuropathy,
arcodermatitis
Causes body to have an
inflammatory response
Continued Replication, evasion of innate immunity, penetration
through vasculature, dissermination, entry into tissue matrix,
tissue colonization: non-specific illness, migratory arthralgias,
Symptoms include fever, headache, carditis, peripheral, neuropathy, facial palsy
fatigue, and a characteristic skin rash
called erythema migrans.
 Immune

Lyme’s Disease

Stages of Lyme’s Disease

Localized Disseminated Late Disseminated

Starts within 1 month Occurs weeks to months Occurs months to years after
of tick bite after initial infection initial infection

Symptoms Symptoms Symptoms

A reddish rash or skin Multiple areas of rash. Recurring episodes of
lesion known as erythema Paralysis of facial muscles swollen joints (arthritis).
migraines (EM). (Bell’s palsy). Chronic arthritis
Fever. Heart block or an Encephalopathy
Headache. interruption of the Fatigue
Stiff neck. electrical system of the
heart. Memory loss
Body and joint aches. Personality changes
Areas of numbness or
Fatigue. abnormal feelings Difficulty concentrating,
Swollen lymph nodes (neuropathy). known as “brain fog.”
(swollen glands). Transient migratory
Areas of numb arthritis (pain resolves in
one joint & moves to
Hallmark sign( occure
another)
within 3_ 30 days of bite)
Knees
Ankle
Wrists
Carditis

Lyme carditis occurs when

Lyme disease bacteria enter
the tissues of the heart.

Symptoms
Fever and chills.
General ill feeling.
Headache.
Joint pain.
Muscle pain.
Stiff neck.
Chest pain
Can lead to arrythmias
Syncope & heart block
 Immune

Lyme’s Disease

Diagnostics Nursing Interventions

ELISA Test Nurses should be aware of PTLDS.

Assess for antibodies against Monitor VS & EKG
Borrelia Burgdorferi bacteria Cool compress to painful and swollen joints
Generally considered the most reliable test Promote calm environment
currently available ROM exercises
Assess and monitor skin for rash
Wastern Bolt Test
Aware the patient to finish entire course of
Elisa test is confirmed by wastern Bolt test .It is
antibiotics
also an antibody test

Treatment Preventions for Lyme Disease

Antibiotics Wear light coloured, long-sleeved shirts and

pants to spot ticks easily.
Antibiotics are only effective way to
treat Lyme disease. Tuck your shirt into your pants, and your pants
into your socks.
Early Stage Wear closed-toe shoes.
Doxycycline Apply insect repellent containing DEET or
Amoxicillin, Icaridin to clothing and exposed skin (always
follow label directions).
Late Stage
Ceftriaxone
NSAIDS
Nonsteroidal anti-inflammatory drugs (NSAIDs).
Helpful for symptoms of arthritis that can occur
with late Lyme disease.
NSAIDs include aspirin and ibuprofen.
 Immune

Psoriasis VS Eczema

An immune response is a physiological reaction which occurs within an organism in the context of
inflammation for the purpose of defending against exogenous factors.
Two integumentary disorders due to immune system response

Psoriasis Eczema

Autoimmune Disorder Inflammatory Disorder

Psoriasis is a chronic (long-lasting) A group of conditions in which the skin
disease in which the immune system becomes inflamed, forms blisters, and
becomes overactive, causing skin cells to becomes crusty, thick, and scaly.
multiply too quickly.
Triggers
Triggers Environmental factors or allergens – house
Infections dust mites
Strep throat or skin infections. Animals
Weather especially cold, Pollen
Dry conditions. Food allergies –
Injury to the skin Such as allergies to cows’ milk, eggs,
Cut or scrape peanuts, soya or wheat.
A bug bite Certain materials worn next to the skin –
such as wool and synthetic fabrics.
Severe sunburn.

AKA atopic dermatitis

 Immune

Psoriasis vs Eczema

Psoriasis Types Eczema Types

Pustular psoriasis, which causes discolored,

scaly skin with tiny pustules on the palms of
the hands and soles of the feet.
Guttate psoriasis, which often starts in Atopic dermatitis
childhood or young adulthood, causes small
spots that are pink, red, brown, or purple in Contact dermatitis
color, mainly on the torso and limbs. Dyshidrotic eczema
Inverse psoriasis, which causes discolored, Neurodermatitis
shiny lesions that appear in skin folds, such as Nummular eczema
the armpits, groin, and under the breasts.
Seborrheic dermatitis
Erythrodermic psoriasis, which causes intense
discoloration of the skin and shedding of
scales in sheets.
Risk Factors Areas Affected
Smoking Usually in areas where
Risk Factors Areas Affected Genetics there is skin-to-skin
Usually on symmetrical Immune contact.
Genes dysfunction
sides of the body. Hands.
Alcohol Skin infections
Smoking Ears. Stress Neck
Eyelids. Age Elbows
Feet. Food allergies Ankles
Hands. Sleep loss Knees
Nails. Soaps and Feet
Scalp. cleansers Face, especially
cheeks
Elbows
Buttonks
Knees
Under arms
Lower back

Symptoms

Symptoms Red, weepy, crusty, itchy, flaky patches

Oval or circular-shaped areas on the skin
Mild-moderate itching Dry skin
Scaly patches on skin Itchy skin.
Patches of thick, Skin rash.
Red skin with silvery-white scales that itch or Bumps on your skin.
burn,
Thick, leathery patches of skin.
Dry, cracked skin that itches or bleeds.
Flaky, scaly or crusty skin.
Thick, ridged, pitted nails.
Swelling.
Poor sleep quality.
Severe itching
Silvery white, shiny scales
Redness & inflammation
Dry, cracked skin
Fluid filled bumps
Thick, ridged, pitted nails.
Crusty & oozing
 Immune

Psoriasis vs Eczema

Treatment Treatment

Steroid creams.(reduce inflammation) Oral medications like anti-inflammatory

Moisturizers for dry skin. medicines
Medication to slow skin cell production Topical steroids: reduces inflammation
(anthralin). Moisturizers (avoid dry skin) Apply moisturizer
Methotrexate: slow down immune response when your skin is damp after a bath or shower.
Tar: reduce growth of skin cells Antihistamines or corticosteroids: reduces
itching
UV light therapy: slow down growth of skin cells
Immunosuppressant drugs help regulate how
Medicated lotions or shampoos.
your immune system functions.
Vitamin D3 ointment.
Emollients: keep moisture in skin
Vitamin A or retinoid creams.
Light therapy to improve the appearance of
your skin and remove blemishes.

Education Education

Take daily baths. Avoid scratching the rash or skin.

Keep your skin moist. Relieve the itch by using a moisturizer or
Cover the affected areas overnight. topical steroids.
Expose your skin to small amounts of sunlight. Keep your fingernails cut short. .
Avoid scratching. Lubricate or moisturize the skin two to three
times a day using ointments such as
Avoid psoriasis triggers.
petroleum jelly.
Stay cool.
Take warm showers (not hot)
Strive to maintain a healthy lifestyle
Adequate fluid intake
Carefully treat strep infections
Avoid gluten & alcohol
 Immune

Systemic Lupus Erythematosus

Mouth and Skin

Systemic lupus erythematosus (SLE),
Nose Ulcers Butterfly Rash
is the most common type of lupus.
and Red Patches
SLE is an autoimmune disease in
which the immune system attacks its Heart
own tissues, causing widespread Endocarditis
inflammation and tissue damage in Lungs
Artherosclerosis
the affected organs. Pleuritis Inflammation of
Pneumonitis The Fibrous Sac
Pulmonary Emboli
Characterized by periods of Pulmonary
Hemorrhage Serve
exacerbations & remissions Abdominal pain

Kidney
Risk Factors
Blood in Blood
the Urine Anemia
Gender: Even though anyone can
High Blood
get lupus, it most often affects
Pressure
women
Age: Lupus can occur at any age,
Hair Loss Muscle and
but most are diagnosed in their 20s
High Fever Joints
and 30s
Abnormal Pain
Race: Lupus is two to three times
Headache Arthritisaches
more common in African-American
Swollen Joints
women , Italian and Asian women
Excessive Sun Exposure
Family history

Medications Types of Lupus

Hydralazine Cutaneous lupus erythematous: Lupus that only affects

your skin.
Isoniazid
Drug-induced lupus: Some medications trigger lupus
Analgesics.
symptoms as a side effect. It’s usually temporary and
Corticosteroids. might go away after you stop taking the medication that
Antimalarial Medications. caused it.
Immunosuppressive Medications Neonatal lupus: Babies are sometimes born with lupus
 Immune

Systemic Lupus Erythematosus

Phagocytosis
Receptors
Bacterium
Is the process by which a cell uses its plasma Phagosome
membrane to engulf a large particle
Phagocytosis, process by which certain living cells Phagocytosis
called phagocytes ingest or engulf other cells or
particles. Lysosome Phagolysosomes
Phagocytosis process doesn’t work properly,
causing apoptic cells (dead cells) to stay in body

Soruble
Debris
Apoptosis Exocytosis

Apoptosis is a form of programmed cell death

that occurs in multicellular organisms and in
some eukaryotic, single-celled microorganisms Chromatin
such as yeast. condensation
Cell
Helps in the elimination of cells that are not
required by the organism. Membrane
Blebbing

Nuclear
Collapse
Body thinks content in apoptic cells are antigens &
creates antigen-antibody complexes which get
lodged in connective tissue and cause inflammation Apopotic Body
Formation

Criteria for The Classification of SLE

Criteria Description

Malar rash Raised or flat erythema over the malar eminences sparing nasolabial folds urine.

Discoid rash Erythematosus raised patches with keratotic scale and follicular plugging with or without scarring.

Photosensitivity Rash from an unusual reaction to sunlight.

Oral ulcers Oral or nasopharyngeal ulcers or lesions.

Arthritis Nonerosive arthritis in two or more peripheral joints.

Serositis Pleuritis OR pericarditis.

Renal disorder Persistent proteinuria ≥0.5 g/day OR cellular casts and blood in the

Neurologic disorders Seizures OR psychosis in the absence of offending drug or metabolic imbalances.

Hematologic disorder Hemolytic anemia OR leukopenia, lymphopenia, and thrombocytopenia.

Immunologic disorder Abnormal levels of anti-ds DNA OR anti-Smith OR antiphospholipid antibodies: anticardiolipin
and lupus anticoagulant.

Positive ANA Abnormal levels of antinuclear antibody in the absence of drugs known to cause positivity.
 Immune

Systemic Lupus Erythematosus

Symptoms Causes
Anemia symptoms Genetic factors: Having certain genetic
Fatigue (feeling tired all the time). mutations may make you more likely to
have lupus.
Shortness of breath (dyspnea).
Hormones: Reactions to certain hormones
Pallor
in your body (especially estrogen) may
Fever make you more likely to develop lupus.
Hallmark Sign
Butterfly rash Environmental factors:
Joint pain, muscle pain or chest pain
Your health history: Smoking, your stress level
(especially when you’re taking a deep
and having certain other health conditions
breath)
Headaches
Rashes
Fever Complications
Hair loss Heart disease(Colitis)
Mouth sores
Photosensitivity (sensitivity to sunlight).
Fatigue
Lungs (Pleural Effusion)
Shortness of breath (dyspnea)
Depression (or other mental health conditions).
Swollen glands.
Heart (pericarditis)
Swelling in your arms, legs or on your face.
Seizures.
Confusion.
Blood clots Anemia.
Raynaud’s Phenomenon Raynaud’s syndrome.
Osteoporosis.
Fingers & toes become numb, pale Kidney(Lupus nepheritis)
& cold in response to low O2

Diagnosis
Lupus can cause damage to
anywhere in the body & cause Blood tests.
multiple complications, such as: Urinalysis
An antinuclear antibody (ANA)
Anti-smith antibody: antibody found in
nucleus specific to lupus
Anti- DSDNA antibody: antibody found
during active lupus disease
Biopsy
Labs: depending on where the antibodies
have targeted, may have:
Low WBC High GFR
Low HGB High Creatinine
Low HCT High BUN
Low PLT
 Immune

Systemic Lupus Erythematosus

Treatment Risk Factors

No known Cure People assigned female at birth (AFAB),
especially people AFAB between the ages of
Goal: prevent flare-ups and lessen 15 and 44.
their symptom severity Black people.
Hispanic people.
Hydroxychloroquine is a disease-modifying Asian people.
antirheumatic drug (DMARD) that can relieve Native Americans, Alaska Natives and First
lupus symptoms and slow down how they Nations people.
progress (change or get worse). Pacific Islanders.
Nonsteroidal anti-inflammatory drugs People with a biological parent who has lupus.
(NSAIDs): Over-the-counter (OTC) NSAIDs
relieve pain and reduce inflammation
Steroids(Corticosteroids) are prescription Education
medications that reduce inflammation. (not
for long term use) Educate the patient about the importance of
Immunosuppressants: Immunosuppressant's medication adherence,
are medications that hold back your immune regular follow-up visits,
system and stop it from being as active Self-monitoring for signs of disease
E.G Methotrexate exacerbation.
Avoid sun exposure
Always wear sunscreen
Get enough sleep
Nursing Interventions
Stress management Know the signs
Regular exercise for FLARE ups
Being aware of the vague nature of symptoms
Avoid sick people Fatigue
When symptoms continue to persist after
antibiotic treatment, nurses should be aware Low grade fever
of PTLDS. Achy joints
Fatigue Management Rash
Respiratory Support Edema of legs &
Anxiety Reduction hands
Coping Strategies:
Skin Care:
Nursing Assessment
Infection Prevention
Physical Mobility Support:
Health History
Monitor Symptom Assessment
VS & EKG Skin Examination
Swelling, Musculoskeletal Assessment
Pain, and limitation in range of motion. Cardiovascular Assessment
I&O Renal Assessment
CBC, LFT, BMP (can affect all organs!) Respiratory Assessmen
Skin & mucous membranes Neurological Assessment
Pain Psychosocial Assessment
Joints for redness, Medication Review
Patient Education
CRITICAL CARE
 Crıtıcal Care

BLS & ACLS Cheat Sheet

What is difference?

Basic Life Support BLS Advance Cardiac Life Support ACLS

Basic life support is a level of medical care which is used Advanced cardiac life support, advanced cardiovascular
for patients with life-threatening illnesses or injuries until life support refers to a set of clinical guidelines for the
they can be given full medical care by advanced life urgent and emergent treatment of life-threatening
support providers. cardiovascular conditions
It can be provided by trained medical personnel, that will cause or have caused cardiac arrest, using
such as emergency medical technicians, and by advanced medical procedures, medications, and
qualified bystanders. techniques.
Non invasive Invasive maneuvers
No medication administration Along with medication
Can be done by anyone trained Specialized medical person
No advance equipment Defibrillators , cardiac monitors used
Two person/Technician Sufficient Team of workers, doctor, nurses
No right to give basic treatment Basic treatment for cuts and injuries can be given

4 basic life support Drugs used during ACLS

Initial assessment, Adrenaline. Lidocaine.
Airway maintenance, Amiodarone. Atropine.
Expired air ventilation
(rescue breathing; mouth-to-mouth ventilation)
Chest compression.

Step by step BLS

1-Safety 4-Breathing & Pulse

Victim & rescuer should be in safe position No more than 10s assessment
no pulse + abnormal breathing

2-Check Response: Listen carefully for breathing sounds for at least 10

seconds (except for occasional gasping sounds).
Shake & shout
If you cannot hear breathing sounds, begin CPR.
Ask "Are you ok!”
Check the carotid pulse for a minimum of 5 seconds
Assess the situation but no more than 10 seconds to determine if there is a
Make sure the person is on a firm surface pulse present
Tap the person on the shoulder and confirm that they It's important to minimize delay in starting CPR, so take
need help. no more than 10 seconds to assess the patient.
Tilt head backward
3-Call for help: Chin up, check carotid pulse
Call 911 and get AED
Look for someone who can get an automated external 5-Start CPR
defibrillator (AED) if available at the nearest emergency If victim not breathing initiate
medical care center.
If there is no AED available, stay with the victim and Kneel next to the person's neck and shoulders.
call 911. Position both of your hands (lower palms) on top of
Call for Urgent Medical Emergency Assistance. each other in the middle of the person’s chest.
Activate emergency response system/shout for Compress (push straight down) the chest at least 2
nearby help inches (5 cm) but no more than 2.4 inches (6 cm).
Use your entire body weight (not just your arms) to
deliver pressure at a rate of at least 100 compressions
per minute.
Push hard and fast.
Allow a few seconds after each push so that the chest
springs back.
Chest compression 30 cycle
& 2 breaths
 Crıtıcal Care

BLS & ACLS Cheat Sheet

6_use AED as soon as it arrives

Tilt the person's head back, lift their chin, pinch their nose shut, and place your
mouth over their mouth to make a complete seal.
After mouth-to-mouth contact, blow to make the person’s chest rise.
If the chest rises, deliver a second breath.
Deliver at least two rescue breaths first, then continue compressions.
If a person is unresponsive, unconscious, and not
breathing normally, they need an AED.
Use the AED is soon as it arrives.
The quicker it is used, the higher the chances of survival.

7_resume CPR immediately

Continue with the chest compressions cycles and

breathing until:
The person exhibits signs of life, such as breathing or movement.
An AED becomes available.
Emergency medical services or a trained medical responder arrives
on the scene and takes over.
Chest compressions resume immediately after defibrillation attempts
and that rhythm and pulse checks be deferred until completion of 5
compression: ventilation cycles or minimally for 2min. Until help arrives
or patient is responsive

ACLS Cardiac Arrest algorithm

Shout for help/Activate emergency

Set of clinical guidelines grouped into different The cardiac arrest algorithm has two main branches.
algorithms based on the clinical situation that involves The left branch is used for the treatment of ventricular
CPR, medications, & medical proceed fibrillation and pulseless ventricular tachycardia.
The right branch is used for the treatment of asystole
and PEA.

1.start CPR 2.check the rhythm

CPR 30:2 until defibrillator attached Check for pulse and rhythm for no more than 10 seconds
Start CPR with hard and fast compressions, around 100 every 2 minutes.
to 120 per minute, No. If the patient shows signs of return of spontaneous
Allowing the chest to completely recoil. Give the patient circulation, or ROSC, administer post-cardiac care.
oxygen and attach a monitor or defibrillator. If a non shockable rhythm is present and there is no
pulse, continue with CPR and move to the algorithm for
Verify CPR: asystole or PEA.
Correct Reversible causes
Shockable
Check electrodes
Verify /attempt IV access Ventricular Fibrillation, or VFib.
Airway & oxygen Pulseless ventricular tachycardia, or V-tach.
Give uninterrupted compressions Non-Shockable
Give adrenaline every 3_5 minutes Asystole, seen as a flat line on an ECG monitor.
Consider amiodarone, atropine & magnesium Pulseless electrical activity, or PEA.
 Crıtıcal Care

BLS & ACLS Cheat Sheet

Shockable Rhythms Vs Non-Shockable Rhythms

The ECG will distinguish asystole from ventricular Rhythms that are not amenable to shock include
fibrillation, ventricular tachycardia and pulseless pulseless electrical activity (PEA) and asystole.
electrical activity. Give epinephrine ASAP & every 3-5 minutes Consider
good compressions and adequate ventilation are also intubation (capnography to confirm placement)
important. Antiarrhythmic Drugs use for Non-shockable
Clear & shock patient
NO electrical conduction!
Epinephrine increases the likelihood of successful
shock provides no benefit
defibrillation. (every 3-5 minutes)
Consider intubation (capnography to confirm
Remember your 5T’s & 5H’s
placement)
After 2 mines rhythm check & shock (if Shockable) Reversible causes
Give Amiodarone or Lidocaine 1.Tension pneumothorax 1.Hypoxia
Treat reversible causes 2.Toxins 2.Hypothermia
Treatment: 3.Thrombosis Culinary 3.Hypovolemia.
Multiple shocks may be needed, but good compressions 4.Thrombosis pulmonary 4.Hydrogen ion
and adequate ventilation are also important. 5.Tamponed 5.Hyper/ hypokalemia
Management of non-shockable rhythms;
life threatening shockable rhythms
On recognizing asystole, resume chest compressions
Ventricular Tachycardia, immediately and continue for two minutes.
Ventricular Fibrillation, On recognizing organized electrical activity, seek
Supraventricular Tachycardia evidence of ROSC and if absent (PEA), resume chest
compressions immediately and continue for two
minutes.
 Crıtıcal Care

BLS & ACLS Cheat Sheet

HIGH QUALITY CPR

5 Components of High Quality CPR
High-Quality CPR Depth: 2–2.4 inches (5–6 centimeters)
Minimize interruptions in chest compressions. Compression rate: 100–120/minute.
Provide compressions of adequate rate and depth. Recoil: Allow for full recoil after each compression.
Avoid leaning on the victim between compressions. Minimize pauses. ...
Ensure proper hand placement. Ventilation: 2 breaths after 30 compressions without an
Avoid excessive ventilation. advanced airway; 1 breath every 6 seconds with an
advanced airway.

Positioning Compression Breathing

Position for High Quality CPR Hand position: Two hands Give 2 gentle puffs or breaths of air
Heels of hands on top of centered on the chest. instead of a deep breath.
each other Body position: Shoulders Each puff should last 1 second.
Shoulders over hands directly over hands; elbows 2 breaths every 30 compressions
&elbow locked. Depth: At least 2 Head-tilt/ chin-lift to open airway
Victim should be on firm inches. Rate: 100 to 120 per Assess for chest rise with each breath
surface minute. Allow chest to AVOID excessive ventilation
return to normal position
after each compression.

Rescuer should do Rescuer should not do

Compression at rate 100_120/minutes Compression rate >100/min or <120/minutes

Compression depth 2 inches(5cm) Compression depth
Full recoil after compression <(5cm)2 inches or >2.4 inches(6cm)
Ventilate properly (2 breathes after 30 compressions, Lean on chest between compression
each breath over 1 second cause chest rise. Interrupt compression for more than 10s .
excessive ventilation

10 Steps to Administer CPR

1. Assess the Situation. 6. Begin Chest Compressions.

2. Check for Responsiveness. 7. Give Rescue Breaths.
3. Call for Help. 8. Continue Cycles of Compressions and Breaths.
4. Open the Airway. 9. Don’t Interrupt CPR Unless Necessary
5. Check for Breathing. 10. Reach Out To A Heart Specialist.
 Crıtıcal Care

Arterial Lines

What is it? Indications:

Thin, flexible tube (catheter)put in artery to check BP Ease of access
( also called art line) for hemodynamic monitoring. Continuous monitoring of arterial BP
routine procedure in diverse clinical settings, including Patient on inotropic drugs
the intensive care unit, emergency room, and Patient on Vasoactive drugs
operating room.

Arterial line used for Care For Arterial Line

It helps doctors and nurses check blood pressure and Check the site 6 –hourly to assess bleeding
take blood samples. Use minimal dressing material
It is used in operating rooms and intensive care units Assess for evidence of compromised Color, circulation
(ICUs). or motion
You may hear it called an "art-line" or "A-line." Lines should be removed, if there are sign of infection
This line is usually placed in the wrist or groin.

Complications
Sites Used
Temporary vascular occlusion thrombosis
Radial artery has low complications& Most common.
ischemia,hematoma formation,
Its Superficial artery for insertion Compressible for
Sepsis
homeostasis.
Bleeding
Alternatives: Pain
Ulnar, Swelling
Brachial Infection
Axillary , Air embolus
Dorsalis vascular occlusion,
Femoral arteries( can be used but have high risk of thrombosis,
infection) local and catheter-related infection and sepsis.

Transducer Nursing care

Arterial catheter tubing includes a section known as the Set-Up Hemodynamic Circuit.
transducer. The transducer converts the mechanical Maintain Accuracy.
pressure into an electrical waveform via a cable Monitor Blood Pressure.
connected to a monitor. Display Waveform.
Maintain Arterial Line Alarm.
Position:
Maintain Closed System.
Phlebostatic axis
Obtain Blood Cultures.
4th intercostal space, mid- axillary line
Change Dressings.
must be leveled properly for accurate reading
Monitor Arterial Site
Insertion techniques: Remove Arterial Line
1.Direct cannulation
2.Transducer.
Pressure bag
Connects catheter to monitor so measurement can occur
location: Aligned to height of right atrium
Phlebostatic axis;
located at the fourth intercostal space at the
Pressure transducer and
mid-anterior- posterior diameter of the chest wall. automatic flushing system
This is the location of the right atrium.
must be leveled properly for accurate reading
3.Guidewire (Salinger technique)

Arterial line
Saline-filled non-compressible tubing
 Crıtıcal Care

Arterial Lines

Waveform assessment for Arterial Line

Flow and pressure waveforms can be interpreted to confirm diagnosis and to optimize ventilator management.
Up and down movement of waveforms with BP shows accuracy of BP measurement

The arterial waveform is measured continuously in Inaccurate BP can lead to wrong treatment For right
many operating rooms and intensive care units, BP measurement Square wave test
Obtaining the arterial pressure waveform can be
accomplished by simple catheterization and even
noninvasively. Components of waveforms: 1
The benefit is the continuous measurement of arterial Peak systolic pressure
pressure with decreased risk to the patient. Dichotic Notch
Diastolic pressure
Anacrotic Notch
2
Square wave test
Activate snap or pull f tab on flush device. 4 3
Observe square wave generated on bedside monitor. Assess oscillations & wave
Count oscillations after square waves. to determine accuracy
Observe distance between the oscillations.

Normal Waveform: IF WAVE UNDERDAMPED OR

1_2 oscillations OVER DAMPED
Before return to baseline.
Over damped arterial waveforms will underestimate
Accurate BP
systolic blood pressure.
The arterial pulse is the result of a wave of vascular
And overestimate diastolic blood pressure.
distention, initiated by the impact of the stroke volume
Underdamping will have the opposite effect and
ejected into a closed system with every heartbeat.
overestimate systolic blood pressure and
The forward-propagating pressure wave has both a
underestimate diastolic blood pressure.
fast-moving (10m/sec) and slower (0,5m/sec)
In both cases, the mean arterial pressure (MAP) often
component.
remains the same.
oscillations Ensure there are no kinks in tubing.
duration
of flush Check pressure bag is inflated to 300 mmHg
Check for air bubbles or clots in tubing
Relevel and rezero transducer
Clinical Significance
Under Damped waveform: A key advantage of arterial lines is their ability to
>2 oscillations continuously monitor blood pressure and mean arterial
The under-damped trace will overestimate the systolic, pressure while facilitating regular blood gas sampling to
and there will be many post-flush oscillations assess arterial oxygenation, carbon dioxide levels, and
(false high BP) pH status.
Underdamping will have the opposite effect and
overestimate systolic blood pressure and underestimate The arterial waveform reflects the change in pressure
diastolic blood pressure. over time, or dP/ dt, and thus the slope of the upstroke
reflects this.
exaggerated
wave oscillations
steeper the slope, the quicker the rise, the greater the
duration
of flush
dP/ dt, and the stronger the contractile forces appear.

Over damped waveform

<1 oscillations
Overdamped arterial line waveform include
low infusion bag pressure,
loose connectors,
air bubbles in the tubing,
blood clot in the circuit, flattened oscillations
kinking of vascular catheter., wave absent

False Low BP duration

of flush
 Crıtıcal Care

Allen’s Test

Allen’s Test Reverse Allen's measures radial artery

What is it?
The Allen test is used to assess collateral blood flow to the hands, generally in preparation for a procedure
that has the potential to disrupt blood flow in either the radial or the ulnar artery.
These procedures include arterial puncture or cannulation and the harvest of the artery alone or as part of a forearm flap
Collateral blood flow to the hands, generally in preparation for a procedure that has the potential to disrupt blood flow in
either the radial or the ulnar artery
The Allen test is a first-line standard test used to assess the arterial blood supply of the hand.

Anatomical Basis of Allen’s test: Step 1

The hand is normally supplied by blood from both the Locate ulnar & Radial. Patient make
ulnar and radial arteries. tight fist for 30 sec. Have patient
The arteries join in the hand. clench hand & apply pressure to
Thus, if the blood supply from one of the arteries is cut radial & ulnar artery with thumbs
off, the other artery can supply adequate blood to the
hand. Step 2
A minority of people lack this dual blood supply.
Press down ulnar & Radial to stop
blood flow. Have patient unclench
hand while maintaining pressure
on both Keep hand elevated
How to Perform the Modified Allen Test
Explain the Procedure: Step 3
Always inform the patient about what you are going to Tell patient to unclench palm
do, so they are aware and can cooperate effectively. should blench Release pressure
Instruct the Patient to Make a Fist: from radial artery only & assess
Ask the patient to make a tight fist to temporarily restrict skin color in hand for perfusion
blood flow in the hand’s arteries. If they’re unable to do
so, gently help them close their fist. Step 4
Identify the Radial and Ulnar Arteries:
Position yourself facing the patient’s wrist. Detect the If no color appear don’t use
radial artery on the thumb side of the wrist and the ulnar radial artery, if appears proceed
artery towards the pinky side. It’s crucial to familiarize If hand flushes within 15 seconds
yourself with the pulse points of both these arteries. = positive result
Hold the Patient’s Hand:
Grasp the patient’s left hand with your right hand or vice Adequate blood flow for arterial
versa, based on comfort and accessibility for both you puncture
and the patient.
Position Your Fingers on the Pulses:
Place your index finger on the ulnar pulse and your
middle finger on the radial pulse.
Nursing interventions
Occlude Both Arteries:
Set-Up Hemodynamic Circuit.
Once you feel both pulses, apply firm pressure to
Maintain Accuracy.
simultaneously occlude the ulnar and radial arteries.
Neurovascular checks
Ensure the patient’s hand remains relaxed.
Monitor Blood Pressure.
Instruct the Patient to Open Their Hand:
Display Waveform. (zero Q4 or if inaccuracy is
Observe for blanching, signifying successful occlusion.
suspected)
The hand should exhibit a pallor or whitish hue.
Maintain Arterial Line Alarm.
Release Pressure on the Ulnar Artery:
Maintain Closed System.
Gently lift the finger from the ulnar artery while
Obtain Blood Cultures.
maintaining pressure on the radial artery. The hand
Change Dressings.
should redden or “flush” within 5 to 15 seconds, signifying
Monitor site for bleeding
that the ulnar artery is patent and circulation is intact.
Monitor site for:
Dislodgement
Hematoma Infection
 Crıtıcal Care

Mechanical Ventilation Basics

What is it?
Medical term for using a machine called a ventilator to fully or partially provide artificial ventilation.
Mechanical ventilation helps move air into and out of the lungs.
Uses positive pressure to push air into lungs Compared to normal breathing in which negative pressure is used to
inhale oxygen into lungs.

Indications:
Acute respiratory failure
Apnea/inability to breathe
Severe Hypoxia
Respiratory muscle fatigue
Cardiac Insufficiency
Neurological problem
Any thing that cause Impaired lung functioning

Mechanical ventilation USES

Mechanical ventilation is use of a machine to assist with
the work of breathing.
Mechanical ventilators are frequently used for
conditions that cause either low oxygen levels
(such as pneumonia) or high carbon dioxide levels
(such as chronic obstructive pulmonary disease).

VENTILATOR SETTINGS

A ventilator mode is a set of parameters that determines how a mechanical ventilator supports a patient’s breathing.
These parameters include the timing, volume, and pressure of breaths delivered to the patient, allowing for
customization based on the patient’s respiratory needs and condition.

Mode Ventilators setting Parameters

Respiratory rate (RR) Number of breaths delivered by Usually 4_20 breaths /min
the ventilator/min

Tidal volume (VT) Volume of gas delivered in each 5_15cc/kg

breath of ventilator

Fractional inspired oxygen FIO2 Amount of oxygen delivered 21%-100%: usually kept
by ventilator to patient. PaO2 >60mmHg/SaO2 >90%

Inspiratory: expiratory I: E Ratio Length of inspiration compared 1:2 or 1:1.5 unless inverse
with length of expiration ventilator ratio is required

Pressure Limit Maximum limit of pressure 5cmH2O below the preset upper
a ventilator can use to deliver oxygen. pressure alarm limit.

PEEP(positive end expiratory pressure) Pressure applied at the end of each 10-20 cm H2O above peak inspiratory
expiration Prevents alveolar collapse pressure maximum 35cm H2O
Prevents alveolar collapse
 Crıtıcal Care

Mechanical Ventilation Basics

MODES OF VENTILATION (Most common)

Assist Control ventilation mode (AC):

AC ventilation is a volume-cycled mode of ventilation. Pressure
It works by setting a fixed tidal volume (VT) that the
ventilator will deliver at set intervals of time or when
the patient initiates a breath. Flow
Delivers preset volume & number of mandatory breaths
Patient can trigger breaths
Indications: Volume
Myasthenia Gravis,
GBS,
post cardiac/respiratory arrest , edema
Advantages: (CMV)
Minimal work of breathing , patient can control RR Continuous mandatory ventilation (CMV)
which help normalize paCO2. Is a mode in which the ventilator takes full control of the
patient’s breathing by delivering a preset tidal volume
Can lead to respiratory alkalosis if patient is tachypnea at a specific, time-triggered frequency.
This mode is predominantly used for patients who are
fully sedated and have received neuromuscular
A/C mode provides full ventilator support, blocking agents.
making it a common choice during the initial phase of CMV is the total dependence of the patient on the
mechanical ventilation, ventilator, which necessitates careful
it significantly reduces the patient’s respiratory effort. monitoring to prevent accidental disconnection or
when the patient attempts to breathe, the machine machine failure.
actively supports the breath with positive pressure. (CMV)
Patient receive a preset TV at preset RR
(SIMV): Synchronized intermittent mandatory Patient can’t increase RR/breath spontaneously
ventilation (SIMV): Only use if patient is properly paralyzed
Complications: if disconnect can cause apnea/Hypoxia
The ventilator will deliver a mandatory (set) number of Indications: bucking during initial stages of Ventilation
breaths with a set volume while at the same time support fail.
allowing spontaneous breaths.
Provide assisted breaths to the patient or time
triggered breaths.
Patient can take spontaneous breathe in between Pressure
preset breaths.
Provide partial ventilator support
SIMV facilitates the patient’s contribution to their own Flow
minute ventilation, making it suitable for those requiring
partial respiratory support.
This mode is beneficial for preserving respiratory Volume
muscle strength and preventing muscular atrophy.
Additionally, SIMV promotes a more uniform distribution
of tidal volumes across the lung fields, minimizing V/Q
mismatch and effectively reducing the mean airway
pressure. Flow

Advantages:
Maintain respiratory muscle strength Pressure
Facilitate weaning
Reduce mean airway pressure

Volume
 Crıtıcal Care

Mechanical Ventilation Basics

(CPAP):
Continuous positive airway pressure (CPAP):
Constant level of pressure greater than atmospheric pressure is
continuously applied to the upper respiratory tract of a person When
require minima ventilator support. Commonly used to asses if patient
is ready to excubation. When medical therapy fails
Use in conjunction with bronchodilator, steroids, antibiotics to delay
intubation This mode requires the patient to breathe spontaneously,
as the ventilator does not deliver mandatory breaths.
CPAP is particularly useful for weaning patients off mechanical
ventilation, as it can help maintain airway pressure and improve
oxygenation without completely taking over the breathing process
Must be able to take own breath

(PSV)
Pressure support ventilation (PSV) supports the the patient initiates a breath, the ventilator assists by
patient’s spontaneous breaths by providing a preset adding positive pressure to ease the breathing effort.
level of pressure during the inspiratory phase.

Other Modes of Mechanical Ventilation

These modes offer a range of functionalities to cater to
the unique respiratory needs of patients.� Proportional Assist Ventilation (PAV)
This includes: Adaptive Support Ventilation (ASV)
Continuous Mandatory Ventilation (CMV) Adaptive Pressure Control (APC)
Airway Pressure Release Ventilation (APRV) Volume-Assured Pressure Support (VAPS)
Mandatory Minute Ventilation (MMV) Neutrally Adjusted Ventilatory Assist (NAVA)
Inverse Ratio Ventilation (IRV) Automatic Tube Compensation (ATC)
Pressure Regulated Volume Control (PRVC) High-Frequency Oscillatory Ventilation (HFOV)

PRESSURE ALARMS ON VENTILATOR

High airway pressure: Low airway pressure:

Ventilator will sound at high pressure Disconnect from ventilator
Kink in tubing Break in circuit
Excessive secretion Self intubation
, Decreased lung compliance Open valve in tubing
Causes Causes
for high pressure alarms are: for low pressure alarms:
Water in the ventilator circuit. The patient becomes disconnected
Increased or thicker mucus or from the ventilator circuit.
other secretions blocking Inadequate inflation of the tracheostomy
the airway (caused by not tube cuff.
enough humidity) Poorly fitting noninvasive masks or
Bronchospasm. Coughing, nasalpillows/prongs. Loose circuit and
gagging, or “fighting” the tubing connections.
ventilator breath.
Indicates that the pressure in the
Sound when the pressure in the ventilator circuit has dropped.
circuit has increased. Low pressure alarms are usually
It helps protect the lungs from caused by a leak or disconnect.
high pressures
delivered from the ventilator.
 Crıtıcal Care

Mechanical Ventilation Basics

Nursing interventions VAP Bundle

regular mechanical ventilator humidification (ventilator associated pneumonia)
equipment checks to ensure proper function;
The Ventilator Bundle contains components,
monitor and manage ventilator and alarm settings.
elevation of the head of the bed to 30-45 degrees, daily
Evaluate need for suctioning to minimize risk of airway
‘sedation vacation’
obstruction;
assessment of readiness to extubate,
regularly replace closed suction equipment.
peptic ulcer disease prophylaxis
Bowel regimen to prevent constipation
deep venous thrombosis prophylaxis,
100% Oxygen before and after suctioning
Oral care with chlorhexidine
Always suction out, not in
O2 turning
Suction only when needed to avoid lung injury
Significance of VAP:
The Ventilator Bundle is an effective method to reduce
VAP rates in ICUs.
The ventilator bundle should be modified and expanded
to include specific processes of care that have been
definitively demonstrated to be effective in VAP
reduction or a specific VAP bundle created to focus on
VAP prevention.
Aim of VAP Bundle:
Aimed to improve outcome in mechanically ventilated
patients, but not all are associated with VAP prevention.
Daily spontaneous awakening and breathing trials are
associated with early liberation from mechanical
ventilation and VAP reduction.
 Crıtıcal Care

CRRT
(Continuous Renal Replacement Therapy )

What is it?
Continuous renal replacement therapy, or CRRT, is a non-stop, 24-hour dialysis therapy. It is used to help patients with
acute kidney injury
Indicated for hemodynamically unstable patients who cannot tolerate
faster fluid & electrolyte shifts like in traditional dialysis

How CRRT Works Indications

It gently filters and cleans your blood Volume overload
by removing waste products and Metabolic acidosis
extra fluid. Electrolyte abnormalities
This keeps chemicals and electrolytes, Hyperkalemia
like potassium and phosphorus, in your Hyponatremia
blood balanced. A central venous Drug and toxin removal
catheter (CVC) is placed in one of your Hypophosphatemia
large veins. This is usually in the neck or Uremia
groin. The CVC is connected to a Encephalopathy
machine that circulates some of your Pericarditis
child’s blood in a loop outside the body. Persistent/progressive
After the blood has been filtered acute kidney injury
and cleaned, it is sent
back into the body

Contradictions
Advance directives indicating that the patient does not want dialysis Inability to establish vascular access
Lack of expertise or the right equipment
Irreversible liver failure when the patient is not a candidate for liver transplant

CRRT MODES

(CVVH) Ultrafitrate
Continuous vennovenous hemofiltration(CVVH) Blood Flow
Remove large volume fluid
No dialysate needed
Replacement fluid added
Effective for removal of large molecule
Uses ultrafiltration
convection to remove excess fluid & solutes
Small & large molecules are impacted
Indications: Uremia, severe acid base or electrolyte
imbalance Blood Flow
High rate of ultrafiltration across the semi-permeable
hemofilter membrane is created by a hydrostatic
gradient, and solute transport occurs by convection

Equipment:
Blood purification machine
Dialysate
Replacement fluid
Filter Dialysate
Anticoagulation method
Blood warmer
 Crıtıcal Care

CRRT
(Continuous Renal Replacement Therapy )

(SCUF) (CVVHDF)
Slow continuous ultrafiltration (SCUF) Continuous veno -venous hemodiafiltration (CVVHDF)
uses replacement fluid and dialysate.
combines the benefits of diffusion and convection for
solute removal
Diffusion, ultrafiltration & convection to remove waste,
solutes & fluid
Small , medium , large , molecules are impacted
Indication:
Fluid removal, acid base imbalance, fluid remova

Venous Access:
Correct venous access is important.

(CVVHD): Right IJ is recommended

(Due to proximity to right atrium)
Continuous veno - venous hemodialysis (CVVHD):
Formal= high risk of infection
removes fluid mainly by diffusion using dialysate.
Subclavian= high risk of stenosis
No replacement fluid is used
effective method for removal of small to medium sized stenosis which means narrowing, can cause pressure on
molecules your spinal cord or the nerves that go from your spinal
Uses Diffusion, ultrafiltration & convection to remove cord to your muscles.
waste, solutes & fluid
Indication:
uremia &severe acid base imbalance Principles of CRRT
Diffusion
is the movement of solutes through a semi-permeable
membrane from an area of higher concentration to an
area of lower concentration until equilibrium has been
achieve.
Solutes move from a higher concentration to a lower
concentration
In CRRT, diffusion occurs when blood flows on one side
of the membrane, and dialysate solution flows
counter-current on the other side
The dialysate does
not mix with the blood
Efficient for removing small
molecules but not large molecules
Molecular size and
membrane type can affect clearances
Diffusion occurs
during hemodylasis
 Crıtıcal Care

CRRT
(Continuous Renal Replacement Therapy )

Convection Ultrafiltration: Adsorption:

is the one-way movement of is the one-way movement of The rate of antibiotic elimination
solutes through a semi-permeable solutes through a semi-permeable during CRRT is influenced by the
membrane with a water flow. membrane with a water flow. intensity of the procedure
Sometimes it is referred to as Sometimes it is referred to as (dialysis dose) and by the
solvent drag solvent drag surface of the filter used .
This elimination occurs not only
Convection is movement of This is a process for removing through convection and
molecules through a excess fluid from the blood diffusion but also through
semipermeable membrane through the dialysis membrane adsorption on the filter
associated with the fluid being by means of pressure. membrane of the CRRT circuit
removed during ultrafiltration. In It is not a substitute for dialysis.
CRRT Solute molecule is swept In CRRT, Chemicals used:
through a membrane by a Ultrafiltration is utilized in cases Polymethyl methacrylate
moving stream of ultra filtrate. where excess fluid cannot be
Convective transport is removed easily during the Polyacrylonitrile (specifically
independent of solute regular course of hemodialysis. AN69™) are two major
concentration gradients across materials used in adsorption
Pressure gradient during CRRT.
the membrane.
can be created by:
Compared to diffusive transport,
convective transport permits the Positive pressure on blood side
removal of higher molecular (pushing blood through filter
weight solutes at a higher rate Negative pressure via effluent
pump (pulling blood

Heparin
Systemic Anticoagulation with Heparin. Unfractionated
or standard heparin (UFH) is the anticoagulant agent
most commonly used in CRRT to prolong the life of the
extracorporeal circuit.
Decided based on risk vs. benefit based on the clinical
status & risk factors of the patient
CRRT circuit clot prevention
Circuit preparation.
Good access.
Appropriate blood flow rate.
Appropriate membrane size and type.
Pre-dilution.
Post-dilution into the air-bubble trap.
Training and education of staff.
Anticoagulation.
 Crıtıcal Care

CRRT
(Continuous Renal Replacement Therapy )

TERMS

Dialysate: Replacement solution:

a fluid that carries toxins away from the filter, Fluid containing electrolytes & buffers
(given in CVVH or CVVHDF)
CRRT blood flow rates are typically 150 ml/min.
A dialysate flow rate of 1 L per hour, provides a dialysate a specialized, sterile fluid also used to flush toxins from
flow of 16 ml/min. Increasing the dialysate flow will have the body but also to replace electrolytes, other blood
a greater effect than any increase in blood flow rates elements and volume lost during the filtration process.
with CRRT.

Filter: Blood purification machine

Filter: Blood purification machine:
machine component that removes fluid and the machine pumps the blood, controls the rate of blood
uremic toxins flow and includes software to safely monitor therapy
delivery

Effluent transmembrane pressure (TMP):

Effluent volume significantly overestimates delivered Transmembrane pressure (TMP) indicates the
dose of small solutes in CRRT. permeability of the membrane and gradient pressure on
To assess adequacy of CRRT, solute clearance should both sides of the membrane (filter "clogging" high TMP)
be measured rather than estimated by the effluent and is calculated based on prefilter, effluent and return
volume (venous) pressures.

Effluent rate in dialysis? pressure drop

Typical dose of CRRT is 25-35 mL/kg/h pressure measurement in hollow fibers (clotting high PD).
(higher in some ICUs) The dose of CRRT can be thought Normal = 50-150 mmHg; maximum pressure tolerated is
of as the volume of blood “purified” per unit time around 300mmHg. > 300mmHg: "high return pressure"
alarm.

Anticoagulation method
Anticoagulation method:
a type of drug that helps the blood flow through the
system, lessening the likelihood that the blood will clot
in the filter
 Crıtıcal Care

Shock Overview

A critical condition brought on by the sudden drop in blood flow through the body.
Shock may result from trauma, heatstroke, blood loss or an allergic reaction.
It also may result from severe infection, poisoning, severe burns or other causes.

The term “shock” may refer to a psychologic or a physiologic type of shock.

signs and symptoms of shock?

Psychologic shock
Psychologic shock is caused by a traumatic event and is rapid, weak, or absent pulse
also known as acute stress disorder. This type of shock irregular heartbeat
causes a strong emotional response and may cause rapid, shallow breathing
physical responses as well. lightheadedness
cool, clammy skin
dilated pupils
Physiologic shock lackluster eyes
chest pain
Physiologic shock is when you don’t have enough blood nausea
to support your organs and tissues confusion
anxiety
decrease in urine
thirst and dry mouth
low blood sugar
causes shock to occur? loss of consciousness

severe allergic reaction

significant blood loss
heart failure
Comparasion of different types of shock
blood infections
dehydration Hypovolemic Hypotension, tachycardia, Decreased CO
poisoning Weak thready pulse Increased SVR
Burns Cool, pale, mosit skin,
Low blood volume. U/O decreased
Inadequate pumping action in your heart.
Excessive widening (dilation) of your blood vessels.
Cardiogenic Hypotension, tachycardia, Decreased CO
Weak thready pulse Increased SVR
Certain medications that reduce heart function.
Cool, pale, mosit skin,
Damage to your nervous system
U/O <30 ml/hr
Crackles, tachypnea
Neurogenic Hypotension, BRADYCARDIA Decreased CO
shock diagnosed WARM DRY SKIN Venous & arterial
vasodilation, loss
low blood pressure sympathetic tone
weak pulse
rapid heartbeat
Neurogenic Hypotension, tachycardia Decreased CO
coudh, dyspnea Decreased SVR
Imaging tests pruritus, urticaria
bone fractures Restlessness, decreased LOC
organ ruptures Septic Hypotension, tachycardia Decreased CO
muscle or tendon tears Full bounding pulse, Decreased SVR
abnormal growths tachypnea, Pink, warm,
Tests include: flushed skin,
Decreased U/O, fever
ultrasound CT scan
X-ray MRI scan

Blood tests
significant blood loss
infection in your blood
drug or medication overdose
 Crıtıcal Care

Shock Overview

Stages of shock

Initial stage: Compensated stage;

Hypoxia and anaerobic cell respiration leading to Characterized by compensatory mechanisms to counter
lactic acidosis. the decrease in tissue perfusion, including tachycardia,
peripheral vasoconstriction, and changes in systemic
blood pressure.
Signs and symptoms
fast pulse – as shock gets worse. Fast, shallow breathing. Signs and symptoms of
A weak pulse. Grey blue skin, especially inside the lips.
compensated shock
Managing shock Raise the patient’s legs above the
level of the heart, normal blood pressure;
Treat any wound or burn and immobilize fractures. tachycardia;
Loosen tight clothing around neck, chest and waist. tachypnea;
Maintain the patient’s body warmth peripheral vasoconstriction
such as cold and clammy skin, weak peripheral pulses,
Normal lactate <1Mmol delayed capillary refill, and decreased urinary output.)
Lactic acidosis >4MMOL
Perfusion to heart and rate:
High HR
High BP
Perfusion to GI skin and lungs
Progressive stage Gl skin
Low urine output
High RR
The point at which the compensatory mechanisms will
begin to fail
Symptoms and signs of shock may include:
Pale, cold, clammy skin. Refractory stage
Shallow, rapid breathing.
Difficulty breathing.
Anxiety. Persistent hypotension with end-organ dysfunction
Rapid heartbeat. despite fluid resuscitation, high-dose vasopressors,
Heartbeat irregularities or palpitations. oxygenation, and ventilation.
Thirst or a dry mouth. Known as irreversible or end-stage shock.
Low urine output or dark urine. Refractory shock is a potentially fatal manifestation of
Severely altered LOC cardiovascular failure with inadequate response to
vasopressors characterized by poor tissue perfusion,
Perfusion to all vital organs: hypotension.
RR O2 It can also be called
(will require intubation) “high vasopressor-dependent shock.”
BP, arrhythmias
temp Patients with refractory shock may have features of
risk of GI ulcers inadequate perfusion such as:
risk of bleeding hypotension (mean arterial blood pressure <65 mmHg),
tachycardia,
cold peripheries,
prolonged capillary refill time,
a tachypnea consequent to the hypoxia and acidosis
Death is inevitable in this case No CURE
 Crıtıcal Care

Types Of Shock

Cardiogenic Shock Hypovolemic shock

The heart is damaged and can’t pump blood adequately. There isn’t enough blood in your blood vessels to carry
It’s often the result of a heart attack. This can lead to oxygen to your organs. This can be caused inaccurate
organ failure. Cause by low Cardiac output circulating blood volume .

Causes of cardiogenic shock include: Causes:

Inflammation of the heart muscle (myocarditis) Major blood or fluid loss causes hypovolemic shock.
Infection of the heart valves (endocarditis) You may be bleeding a lot inside your body, where you
Weakened heart from any cause. can’t see it, or outside your body, where you can see an
Drug overdoses or poisoning with substances that can obvious injury
affect your heart’s pumping ability. You can also get hypovolemic shock from burns,
pancreatitis, or from too much sweating, throwing up
Symptoms or diarrhea
Rapid breathing.
Severe shortness of breath. Symptoms:
Sudden, rapid heartbeat (tachycardia) Anxiety or agitation.
Loss of consciousness. Cool, clammy skin.
Weak pulse. Confusion.
Low blood pressure (hypotension) Decreased or no urine output.
Sweating. Generalized weakness.
Pale skin. Pale skin color (pallor)
Rapid breathing.
Medication:
Sweating, moist skin.
Medications to treat cardiogenic shock are given to
increase your heart’s pumping ability and reduce the Treatment:
risk of blood clots.
Keep the person comfortable and warm
Vasopressors.
to avoid hypothermia).
These medications are used to treat low blood pressure.
Have the person lie flat with the feet lifted about
They include dopamine, epinephrine
12 inches (30 centimeters) to increase circulation. …
(Adrenaline, Auvi-Q), norepinephrine (Levophed) and
Do not give fluids by mouth.
others.
If person is having an allergic reaction, treat the allergic
reaction, if you know how.

Hypovolemic Shock

Healthy Hypovolemic

Blood flow

Hydrostatic pressure

Osmotic pressure

Capillary Venous end

 Crıtıcal Care

Types Of Shock

Obstructive shock
Obstructive shock Right Ventricle Dysfunction
occurs when blood can’t get where it needs to go. A
pulmonary embolism is one condition that may cause
an interruption to blood flow.
Causes of obstructive shock include:
Tension pneumothorax (collapsed lung).
Vena cava compression syndrome
(a large blood vessel that gets compressed).
Pulmonary (lung) compression syndrome.
High-PEEP (positive end-expiratory pressure) ventilation
(pressure in your airways after the ventilator exhales).
Tumors.
Obstructive shock symptoms include:

Unusually fast breathing.

Hypotension (low blood pressure).
Tachycardia (fast heart rate).
Altered consciousness.
Very little pee output.
Cool, clammy skin.
Subcutaneous emphysema
Chest or abdominal pain Pulmonary Hypertension
 Crıtıcal Care

Distributive Shock

Also known as vasodilator shock, is one of the four broad classifications of disorders that cause inadequate
tissue perfusion.
Systemic vasodilation leads to decreased blood flow to the brain, heart, and kidneys causing damage to vital organs.

Neurogenic shock Septic shock

an occur in the setting of trauma to the spinal cord or commonly caused by bacteria, although viruses, fungi,
the brain. The underlying mechanism is the disruption and parasites are also implicated. Gram-positive
of the autonomic pathway. bacteria are being isolated
Cause by CNS damage Cause by Infection
Treatment: Treatment:
Fluid resuscitation and vasopressor therapy are the oxygen therapy.
mainstay of initial management in patients with Fluids given directly through a vein (intravenously)
neurogenic shock. medication to increase your blood flow.
Blood pressure goals are different than those Antibiotics.
recommended for septic shock, although the Surgery (in some cases)
supporting data are not strong.
Guidelines recommend a target MAP of 85 to 90 mm Symptoms
Hg or greater. Change in mental status.
Fast, shallow breathing.
Medication: Sweating for no clear reason.
Phenylephrine Glycopyrrolate. Feeling lightheaded.
Norepinephrine. Isoproterenol. Shivering.
Epinephrine ). Theophylline . Symptoms specific to the type of infection, such as
Atropine Aminophylline painful urination from a urinary tract infection or
worsening cough from pneumonia.

Septic Shock
Spinal Bacteria White blood
cord damage cells
Cytokines

Normal vessel

Dilated vessels
Absence of sweating
Loss of body
temperature control Dilated vessel Leaky vessel

Blood
clots

Brain Lungs Heart Liver Kidneys

 Crıtıcal Care

Distributive Shock

Anaphylactic Shock

Anaphylactic shock results from a severe allergic reaction.

It causes blood pressure to drop and narrows your
airway, making breathing difficult. Without immediate
treatment, it is life threatening
Causes:
Food allergies like to
peanuts,
milk,
fish, and shellfish.
In adults, stings from insects, latex, and some
medications can cause anaphylaxis.
Medication allergy

Symptoms:
Skin reactions, including hives and itching and flushed Treatment
or pale skin. Give adrenaline injector (such as Epinephrine or Anapen
Low blood pressure (hypotension) use as first line drug )
Constriction of the airways and a swollen tongue or Causes Vasodilation and broncho constriction
throat, which can cause wheezing and trouble breathing. Cardiopulmonary resuscitation (CPR) if you stop
A weak and rapid pulse. breathing or your heart stops beating.
Nausea, vomiting or diarrhea. Medications
Dizziness or fainting
BP HR O2 Antihistamines: immune response
CO SVR Albuterol: open airways
Flushed or pale skin Corticosteroids: inflammation
IV fluids

Nurses interventions
Find & treat underlying cause
Ensure organs are getting adequate perfusion
Goal of treatment
Prevent further decompensation
Monitor vital signs.
Assess neurovitals.
Obtain cultures (blood, urine, sputum)
Administer antibiotics.
Lactic acid
Check labs for electrolytes, renal and liver function.
cardiac enzymes
Make sure organ and perfusion is accurate
CBC & coags
Find and treat underlying causes
BMP & LFT,
Safe administration of fluids.
Blood cultures
Monitor weight
ABG
Oxygen administration.
Ensure patient has DVT and pressure sore prophylaxis.
Preventing more decomposition
Continuous monitoring of VS & ECG Central line
Frequents labs Arterial line
Consult with dietitian regarding feeding. PAC
Assess oxygenation and ventilation. Foley Catheter
Strict I&O ETT
Anticipate placement of invasive lines/ devices NG or OG Tube
 Crıtıcal Care

Types Of Shock

Hypovolemic Vs Cardiogenic Vs Obstructive (In ALL 3 TYPES: CO bp 02 uo svr hr)

Hypovolemic CARDIOGENIC SHOCK

Causes There’s enough blood volume; the heart just isn’t

pumping it efficiently
Blood loss when a major blood vessel bursts or when
you’re seriously injured. Life-threatening condition in which your heart suddenly
This is called hemorrhagic shock. You can also get it can’t pump enough blood to meet your body’s need
from heavy bleeding related to pregnancy
Causes
Hemorrhagic Inflammation of the heart muscle (myocarditis)
Trauma Ectopic pregnancy Infection of the heart valves (endocarditis)
GI bleed An aneurysm that has burst. Weakened heart from any cause.
A traumatic injury. Gastrointestinal problems, such Cardiomyopathy
Surgery. as an ulcer. Dysrhythmias
Postpartum hemorrhage Drug overdoses or poisoning with substances that can
affect your heart’s pumping ability.
Non-hemorrhagic (fluid volume loss)
Trauma
Burns
Heart failure
Severe dehydration
Myocardial infarction
diabetes insipidus
Myocarditis
Severe vomiting/ diarrhe
Acidosis
GI bleed
Symptoms
Postpartum hemorrhage
Anxiety or agitation.
Cool, clammy skin. Symptoms
Confusion. Chest pain or pressure. ,Coma.
Decreased or no urine output. Decreased urination.
Weak, thread pulse Clammy skin and cold skin �Fast breathing.
Cold and clammy skin Fast pulse.�Heavy sweating,
Altered LOC Dyspnea
Generalized weakness. Crackles
Pale skin color (pallor)� tachypnea
Rapid breathing moist skin.
Lightheadedness.
Treatment Loss of alertness and ability to concentrate
An intravenous (IV) line will be put into the person’s arm
to allow blood, blood products, or fluids to be given. Treatment
Medicines such as epinephrine or norepinephrine may Clot-busting drugs,
be needed to increase blood pressure tissue plasminogen activator (tPA) .
Blood products (will need at least 2 good large bore iv’s) Anticlotting medicines –
Administer oxygen�Replace electrolytes aspirin
Replace volume! clopidogrel or heparin – to prevent new clots
Crystalloids (NS or LR) dobutamine,
dopamine
Mechanism of hypovolemic shock; norepinephrine.
Diuretics: fluid build-up
Hypovolemic shock results from depletion of
Intra-Aortic Balloon Pump:
intravascular volume, whether by extracellular fluid loss
cardiac output
or blood loss.
The pre-shock stage is characterized by compensatory
mechanisms with increased sympathetic tone resulting
in increased heart rate, increased cardiac contractility,
and peripheral vasoconstriction.

Nursing Interventions
Safe administration of blood. It is important to acquire
blood specimens quickly, to obtain baseline complete
blood count, and to type and cross match the blood in
anticipation of blood transfusions.
Safe administration of fluids. ...
Monitor weight. ...
Monitor vital signs. ...
Oxygen administration.
 Crıtıcal Care

Types Of Shock

Mechanism Mechanism:
The pathophysiology of cardiogenic shock involves a
downward spiral: Obstructive shock is one of the four types of shock,
Ischemia causes myocardial dysfunction, which, in turn, caused by a physical obstruction in the flow of blood.
worsens ischemia. Obstruction can occur at the level of the great vessels or
Areas of nonfunctional but viable (stunned or the heart itself.
hibernating) myocardium can also contribute to the
development of cardiogenic shock Examples of obstructive shock include acute pericardial
tamponade, tension pneumothorax, pulmonary or
For example, as blood pressure drops during cardiogenic systemic hypertension, and congenital or acquired
shock, the body tries to compensate by limiting blood outflow obstructions
flow to the hands and feet, causing them to cool down.
Treatment
As blood flow to the brain drops, the person may become
confused or lose consciousness. The kidneys may shut Removing an embolism with surgery or a catheter.
down, producing less urine. Replacing a severely narrowed aortic valve.
Reducing heart muscle wall thickness, either with
Nursing Interventions surgery or catheter-based alcohol ablation.
Assist with invasive monitoring, such as arterial lines, Dissolving a blood clot.
central venous lines, and pulmonary artery catheters, Draining or relieving a pericardial tamponade or
to continuously monitor hemodynamic status. tension pneumothorax.
Position the patient in a semi-Fowler's position to Treat the underlying cause!
reduce venous congestion and improve oxygenation. Tension pneumonic: needle
decompression & chest tube
Cardiac Tamponade:
pericardiocentesis
OBSTRUCTIVE SHOCK PE: heparin/ thrombolytics
volume resuscitation
Something is obstructing or getting in the way of blood (Colloids, crystalloids & blood products)
going into and out of your heart or great vessels Nursing Interventions
(major blood vessels connected to your heart
Initial treatment is the same for most types of shock,
Causes which involves giving a large amount of intravenous
Tension pneumothorax (collapsed lung). fluids very quickly and giving medications
Vena cava compression syndrome (a large blood that will increase the blood pressure to increase blood
vessel that gets compressed). flow to the rest of the body and organs.
Pulmonary (lung) compression syndrome.
Pericarditis
High-PEEP (positive end-expiratory pressure) ventilation
(pressure in your airways after the ventilator exhales).
Tumors.
Vena Cava Syndrome
Severe pulmonary hypertension
Restrictive cardiomyopathy
Heart failure
Myocardial infarction
Myocarditis
Cardiomyopathy
Tension Pneumothorax� Dysrhythmia

Symptoms
Unusually fast breathing.
Hypotension (low blood pressure).
Tachycardia (fast heart rate).
Altered consciousness.
Cool, clammy skin.
Subcutaneous emphysema (air under your skin).
Chest or abdominal pain.
 Crıtıcal Care

Types Of Shock

Distributive shock, also known as vasodilatory shock, is one of the four broad classifications of disorders that cause
inadequate tissue perfusion.
Systemic vasodilation leads to decreased blood flow to the brain, heart, and kidneys causing damage to vital organs
anaphylactic vs. Septic vs. neurogenic
All three are classification of distributive shock

Anaphylactic Shock
complications of anaphylactic shock
Causes vaso DILATION & broncho CONSTRICTION This can contribute to potential complications such as:
symptoms brain damage
skin reactions such as hives, flushed skin, or paleness kidney failure
suddenly feeling too warm cardiogenic shock, a condition that causes your heart to
feeling like you have a lump in your throat or difficulty not pump enough blood to your body
swallowing arrhythmias, a heartbeat that is either too fast or too
nausea, vomiting, or diarrhea slow
abdominal pain heart attacks
a weak and rapid pulse death
runny nose and sneezing
swollen tongue or lips Treatment:
wheezing or difficulty breathing
The first step for treating anaphylactic shock will likely be
a sense that something is wrong with your body
injecting epinephrine (adrenaline) immediately. This can
tingling hands, feet, mouth, or scalp
reduce the severity of the allergic reaction.
struggling to breathe
dizziness 1st line drug
confusion During an anaphylactic attack, you might receive
sudden feeling of weakness cardiopulmonary resuscitation (CPR) if you stop
loss of consciousness breathing or your heart stops beating.
Crystalloids (NS or LR)
causes and risk factors Colloids (Albumin)
medications such as penicillin Blood products will need at least 2
insect stings Oxygen, to help you breathe.
Foods such as: Replace electrolytes
tree nuts
shellfish
milk
eggs
agents used in immunotherapy
latex
In rare cases, exercise and aerobic activity such as
running can trigger anaphylaxis.
a previous anaphylactic reaction
allergies or asthma
a family history of anaphylaxis
Non-hemorrhagic (fluid volume loss)
Burns
Severe dehydration
Diabetes insipidus
Severe vomiting/ diarrhea
Hemorrhagic
Trauma
GI bleed
Postpartum hemorrhage
 Crıtıcal Care

Types Of Shock

Septic(Response to infection)
septic shock=end stage of sepsis Causes
3 main issues: Lungs, such as pneumonia.
Vasodilation causes pooling & low tissue perfusion Kidney, bladder and other parts of the urinary system.
Leaky blood vessels cause low blood volume Digestive system.
Clot formation blocks blood flow to tissues Bloodstream.
Catheter sites.
Septic shock is a life-threatening condition that happens Wounds or burns.
when blood pressure drops to a dangerously low level
after an infection. Infection
Symptoms Urinary tract infection
Wounds
Change in mental status.
Pneumonia
Fast, shallow breathing.
Invasive procedures
Sweating for no clear reason.
Immunocompromised
Feeling lightheaded.
Shivering.
Indwelling devices
Symptoms specific to the type of infection, such as
painful urination from a urinary tract infection or Central lines
worsening cough from pneumonia Foley catheter
Fast heart rate. ETT/ trach
Fever or hypothermia (low body temperature).
Shaking or chills
Warm, clammy or sweaty skin.
Confusion or disorientation.
Hyperventilation (rapid breathing).
Shortness of breath Septic Shock
Very low blood pressure.
Lightheadedness.
Little or no urine output. Bacteria White blood
Heart palpitations cells
Cytokines
Cool and pale limbs

Leaky vessel

Blood
clots

Brain Lungs Heart Liver Kidneys

 Crıtıcal Care

Types Of Shock

risk factors Neurogenic Shock

septic shock risk increases if have a weakened immune
system which increases your risk for sepsis. Remember
Sympathetic Nervous System= FIGHT or FLIGHT
Newborns.
Stimulation by the sympathetic system nerves results in
Those over age 65.
an increase of heart rate, as occurs during the
who are pregnant.
“fight-or-flight” response
who use recreational drugs.
with artificial joints or heart valves. LOSS of vasomotor tone= BP

Diagnosis and Tests Neurogenic shock is a life-threatening condition caused

blood tests to check for: by irregular blood circulation in the body.
Presence of bacteria and/or infection. Trauma or injury to the spine can cause this disruption.
Complete blood count. Loss of communication between sympathetic nervous
Blood chemistries, including lactate. system & blood vessels it controls
Blood oxygen levels.
Organ malfunction. Causes
Spinal cord injury (the most common cause).
imaging tests include: Autonomic nervous system toxins.
Chest X-ray. Guillain-Barre syndrome.
Computed tomography (CT) scan. Spinal anesthesia.
Magnetic resonance imaging (MRI) scan. car accidents that cause central nervous system
damage or spinal cord injury
complications of septic shock sport injuries causing trauma to the spine
Septic shock can lead to: gunshot wounds to the spine.
medications that affect the autonomic nervous system,
Brain damage. which regulates breathing and other automatic bodily
Lung failure. functions
Heart failure. improper administration of anesthesia to the
Kidney failure. spinal cord
Gangrene.
Death. Symptoms
Treatment Low blood pressure (hypotension).
Slow heart rhythm (bradyarrhythmia).
Oxygen therapy.
Flushed, warm skin that gets cold and clammy later.
breathing machine (ventilator)
Lips and fingernails that look blue.
Fluids given directly through a vein (intravenously)
Lack of full consciousness.
medication to increase your blood flow.
dizziness
Antibiotics.
nausea
Prevent stress ulcers (early nutrition, H2 blocks & PPI's)
vomiting
Monitor lactate levels
blank stares
Surgery (in some cases)
fainting
Medications such as vasopressin or norepinephrine
increased sweating
cause blood vessels to narrow and increase the blood
anxiety
flow to organs.
pale skin
If fluids and medication haven’t helped increase your
difficulty breathing
blood pressure, you may receive corticosteroids.
chest pain
weakness from irregular blood circulation
bradycardia, or a slower heart rhythm
faint pulse
Cyanosis. or discolored lips and fingers
Hypothermia, or decreased body temperature
 Crıtıcal Care

Types Of Shock

Diagnosing Treatment
Keep spine immobilized
CT scan
Fluid resuscitation and vasopressors remain the
A CT scan uses X-ray images to show pictures of the
mainstay of treatment.
body. If you have a spinal injury, CT scans can help to
Norepinephrine is started initially but in refractory cases
diagnose how severe the injury is.
epinephrine and vasopressin infusions may be required.
MRI scan Bradycardia usually responds to atropine and
An MRI scan is an imaging test used to show internal glycopyrrolate but in severe cases dopamine infusion
structures of your body, such as your spine. It can help is required.
to detect any irregularities with your spinal column
Fluid resuscitation and vasopressor
Urinary catheter Phenylephrine
Doctors will also use a urinary catheter to measure your Norepinephrine.
urine volume. With some spinal injuries, you may be Epinephrine
unable to urinate on your own or you may suffer from Atropine
incontinence
Dopamine
Maintain airway
DVT prophylaxis (blood is pooling)
SCD's
Anticoagulants
ROM exercises
 Crıtıcal Care

Sepsis

Sepsis is a serious condition that happens when the body’s immune system has an extreme response to an infection.
The body’s reaction causes damage to its own tissues and organs.

Symptoms Treatment

Chills. Antibiotics:
Confusion or delirium. You’ll receive antibiotics if you have a bacterial infection.
Fever or low body temperature (hypothermia) IV (intravenous) fluids:
Lightheadedness due to low blood pressure. You’ll need fluids to maintain blood flow to your organs
Rapid heartbeat. and prevent your blood pressure from dropping too low.
Skin rash or mottled skin. Vasopressor medications:
Warm skin Vasopressors tighten blood vessels. In some cases, you
may need them to reach an adequate blood pressure.
Appropriate supportive care:
Causes If organ failures occur, you’ll need other sepsis
treatments such as dialysis for kidney failure or
mechanical ventilation for respiratory failure.
Low energy/weakness.
Surgery:
Fast heart rate.
may need surgery to remove damaged tissue
Low blood pressure.
Fever or hypothermia (very low body temperature).
Shaking or chills.
Warm or clammy/sweaty skin.

Sepsis
Confusion or agitation.
Hyperventilation (rapid breathing) or shortness of breath.

Symptoms of sepsis include:

Diagnosis and Tests

may have sepsis if have confirmed or probable infection
and at least two of the following criteria:
Low blood pressure:
Systolic blood pressure (the top number) reading of less Fast heart rate Low blood pressure Fever or hyporthemia
than 100 mmHg (millimeters of mercury).
High respiratory rate:
Respiratory rate faster than 22 breaths per minute.
Glasgow coma scale:
A score of 15 or less on the Glasgow coma scale, which
determines your level of consciousness

Tests may include:

Blood tests: Shaking or chills Warm or clammy/ Confusion or
Complete blood count (CBC), blood cultures, tests to sweaty skin disorentation
check for abnormal liver and kidney function, clotting
problems and electrolyte abnormalities.
Blood oxygen level:
A test to evaluate the level of oxygen in your blood.
Urine tests:
Urinalysis and urine culture.
Imaging tests:
X-rays or CT scans.

Shorthess of Sepsis rash Extreme pain

breath or discomfort
 Crıtıcal Care

Sepsis

recognizing sepsis

A person with sepsis might have one or more of the following signs or symptoms: High heart rate or weak pulse. Fever,
shivering, or feeling very cold. Confusion or disorientation.

Remember TIME

Temperature Mental Decline

(Results are higher or lower than normal body temperature) (confusion & Unstable state of mind)

Infection Extremely
(symptom of infection/ attack of some infectious disease ill(pain/discomfort)
like bacteria )

Sepsis continuum
Stage 1(SIRS)
risk factors for SIRS
Systemic inflammatory Response Syndrome
Age: Infants and people over 65 are most at risk.
SIRS is an exaggerated defense response from your Weakened immune system: People with weakened
body to a harmful stressor. It causes severe immune systems, such as from cancer treatment, HIV or
inflammation throughout your body. an organ transplant, are at increased risk.
This can lead to reversible or irreversible organ failure Chronic conditions: Certain chronic conditions can put
and even death. you more at risk, like diabetes, cirrhosis and COPD.
Existing infection: Having a current infection like
symptoms of SIRS pneumonia, meningitis or cellulitis increases your risk
Redness and swelling (edema) in the affected parts of SIRS
of your body.
Intense pain. Diagnosis:
Loss of function of parts of your body. Physical exam including checking vital signs
Intense fatigue. symptoms.
Fast heart rate (tachycardia). medical history.
Abnormal breathing. Blood tests, like Blood oxygen level
Fever or hypothermia (low body temperature). Urinalysis
Shaking or chills. Bacteria culture test
Warm or clammy/sweaty skin. Imaging tests, such as X-rays or CT scans

causes SIRS SïRS Crïterïa: Any 2+ symptoms

The inflammation can damage organs and disrupt
Acute pancreatitis.
normal bodily functions,
An adverse reaction to a medication.
Bacterial infection. Temp >100.4 F or <96.8F
Blood cancers (hematologic malignancy), like leukemia, RR >20
lymphoma and multiple myeloma. HR >90
Burns. WBC >12,000 or <4,000
Erythema multiform. Body temperature over 100.4 degrees Fahrenheit
Lack of blood flow to your intestines and gastrointestinal (38 degrees Celsius) or under 96.8 degrees F
perforation. (36 degrees C).
Nonmedical substance use and overdose. Heart rate greater than 90 beats per minute.
Sudden worsening of vasculitis. Respiratory rate greater than 20 breaths per minute or
Toxic shock syndrome. partial pressure of CO2 less than 32 mmHg.
Trauma and surgery-related trauma. Leukocyte (white blood cell) count greater than 12,000.
Viral flu-like conditions.

Treatment
IV fluids to maintain blood flow to your organs and prevent your blood pressure from dropping too low.
Antibiotics (if you have a bacterial infection).
Vasopressor medications to reach healthy blood pressure.
Corticosteroids to prevent or reverse shock.
IV insulin to manage blood sugar levels (if necessary).
Surgery, such as for draining a wound infection, removing damaged tissue
or exploratory surgery.
 Crıtıcal Care

Sepsis

Stage 2 (sepsis) causes of MODS include:

Sepsis or septic shock. This may involve a serious
Characteristics of the second stage of sepsis is the onset bacterial or viral infection that leads to widespread
of organ dysfunction. inflammation.
Traumatic injury. This may include a motor vehicle
The inflammation can lead to decreased blood flow to crash, severe burns or a stabbing or gunshot wound.
vital organs,. symptoms such as shortness of breath, Pancreatitis inflammation of the pancreas. Causes may
decreased urine output, and confusion include gallstones, alcohol use disorder, certain
Confirmed or suspected infection medications and other factors.
Massive heart attack. Heart attacks occur as a result of
a blockage in a blood vessel that supplies blood to
your heart.
Stage 3:(Severe sepsis) (SIRS Liver failure may include hepatitis B, hepatitis C, fatty
liver disease, alcohol use disorder and cirrhosis.
Sepsis + organ dysfunction (1+ symptoms): Toxic injury and poisoning. Toxic injuries develop from
exposure to poisonous substances (toxins).
Fast heart rate.
Fever or hypothermia (low body temperature). Symptoms
Shaking or chills. Nausea and vomiting
Warm, clammy or sweaty skin. Loss of appetite
Confusion or disorientation. Feeling very weak or tired
Hyperventilation Fever
loss of consciousness. Chills
severe breathlessness. Confusion or difficulty concentrating.
a high temperature (fever) or low body temperature. Quick, shallow breathing
a change in mental state – like confusion or Fast or irregular heartbeat.
disorientation. Long-lasting chest pain and/or abdominal pain
slurred speech. Abdominal swelling
cold, clammy and pale or mottled skin. Swelling in your extremities (hands and feet).
a fast heartbeat. Yellow tint to your skin or eyes (jaundice)
fast breathing.
Extreme weakness Diagnosis and Tests
Dyspnea tests may include:
low platelets Blood tests
Arterial blood gas
Liver function tests
Kidney function tests
Stage 4 (multi organ dysfunction Blood and tissue cultures.
syndrome (MODS) Echocardiogram
Imaging tests, including an ultrasound or CT
(computed tomography) scan
(MODS) is an acute (develops rapidly) and
serious illness in which two or more organ Treatment
systems stop working. treatment may include:
Intravenous (IV) fluids to treat low blood flow.
The commonly affected organs include your: Vasopressor medications to increase blood flow
through your blood vessels and tissues (tissue perfusion).
Lungs. Kidneys. Antibiotics to treat infection and/or sepsis.
Heart. Liver. Blood transfusion to replace lost blood from an injury
or surgery.
Brain. Blood. Oxygen therapy to get your body more oxygen.
Mechanical ventilation to help you breathe if you can’t
The lung is the first organ to fail after injury breathe on your own.
(failure after 3.7 +/- 2.8 days). Kidneys, liver, Dialysis to help your body remove waste products and
lungs, heart, central nervous system, excess fluid from your blood.
hematologic system Extracorporeal membrane oxygenation (ECMO) to add
oxygen to your blood and remove CO2.
A molecular absorbent recirculating system (MARS) to
support the liver.
Surgery for patients with severe injuries.
 Crıtıcal Care

Sepsis

SEPSIS BUNDLE
Nursing interventions
Sepsis bundles represent key elements of care regarding Monitor vital signs.
the diagnosis and treatment of patients with septic shock Assess neuro vitals.
and allow ones to convert complex guidelines into Obtain cultures (blood, urine, sputum)
meaningful changes in behavior. Administer antibiotics.
Check labs for electrolytes, renal and liver function.
Sepsis Resuscitation Bundle is a combination of Ensure patient has DVT and pressure sore prophylaxis.
evidence-based objectives that must be completed Consult with dietitian regarding feeding.
within 6 h for patients presenting with severe sepsis, Assess oxygenation and ventilation.
septic shock, and/or lactate >4 mmol/L (36 mg/dL). Provide oxygen if saturations lower than 92%
Optimize fluid status
Measure serum lactate Measure Ins and outs
Obtain blood cultures prior to antibiotic administra- Weigh the patient
tion Broad-spectrum antibiotic within 3 h of ED Assess lung sounds for rales, crackles
admission and within 1 h of non-ED admission Encourage hand washing
(improved time to administration) Limit patient visitors
Educate the family about septic shock
Treat hypotension and/or elevated lactate with fluids
Prevent aspiration by elevating the head of the bed
Administer vasopressors for hypotension not
Check labs for culture results and antibiotic sensitivity
responding to initial fluid resuscitation to maintain
Check chest x-ray report for pneumonia or ARDs
mean arterial pressure (MAP) >65 mmHg. Normal
lactate 30mL/kg
The event of persistent hypertension despite fluid
resuscitation (septic shock) and/or lactate >4
mmol/L, maintain adequate central venous pressure
(CVP) and central venous oxygen saturation
norepinephrine is the 1st line press or for sepsis
administer vasopressors to keep map >65
Achieve a CVP of >8 mmHg
Achieve central venous oxygen saturation (ScvO2)
>70% or mixed venous oxygen saturation (SvO2) >65%.
 Crıtıcal Care

Burn Overview

A burn is an injury to the skin or other organic tissue primarily caused by heat or due to radiation, radioactivity,
electricity, friction or contact with chemicals.
Thermal burns occur when some or all the cells in the skin or other tissues are destroyed by hot liquids .

Types of burns Degree Classifications

classify the burn as:
Burn levels
Minor:
Burn degrees include:
First- and second-degree burns that cover less than 10%
First-degree burns, of the body are considered minor and rarely require
are mild (like most sunburns). The top layer of skin hospitalization.
(epidermis) turns red and is painful but doesn’t typically Moderate:
blister. Second-degree burns that cover about 10% of the body
Second-degree burns, are classified as moderate. Burns on the hands, feet,
affect skin’s top and lower layers (dermis). You may face or genitals can range from moderate to severe.
experience pain, redness, swelling and blistering. Severe:
Third-degree burns, Third-degree burns that cover more than 1% of the body
affect all three skin layers: epidermis, dermis and fat. are considered severe.
The burn also destroys hair follicles and sweat glands.

Causes
complications of burns
Chemicals, such as cement, acids or drain cleaners.
Radiation. Arrhythmia, or heart rhythm disturbances, caused by
Electricity. an electrical burn.
Sun (ultraviolet or UV light) Dehydration.
Disfiguring scars and contractures.
Edema (excess fluid and swelling in tissues).
Organ failure.
signs of burns Pneumonia.
Seriously low blood pressure (hypotension) that may
Burn symptoms include: lead to shock.
Blisters Severe infection that may lead to amputation or sepsis.
Pain.
Swelling.
White or charred (black) skin.
Peeling skin
 Crıtıcal Care

Burn Overview

Classifications of burn
Superficial burn Partial Thickness
(First-degree burns) Second-degree (partial thickness) burns
A partial thickness wound is confined to the skin layers;
It’s an injury that affects the first layer of your skin. damage does not penetrate below the dermis and
First-degree burns are one of the mildest forms of skin may be limited to the epidermal layers only.
injuries, and they usually don’t require medical treatment. Second-degree burns involve the epidermis and part
Causes of the lower layer of skin, the dermis.
Superficial burn
The burn site looks red, blistered, and may be swollen
Sunburns and painful.
Scalds
Electricity Epidermis
Causes
hot water or steam, Partial thickness second-degree burns are caused by
hot objects Dermis the following:
flames, Scald injuries.
Subcutaneous
chemicals, tissue
Flames.
Symptoms: Skin that briefly comes in contact with a hot object.
Sunburn.
involve only the top layer of skin.
Chemicals.
painful, dry, and red; and blanch when pressed .
Electricity.
Treatment: After Effects:
treat a first-degree, minor burn Shiny scars left behind
Cool the burn. Immediately immerse the burn in cool Affects epidermis & dermis
tap water or apply cold, wet compresses. Red, blistered & moist skin
Apply petroleum jelly two to three times daily. . Symptoms
Cover the burn with a nonstick, sterile bandage. ... Symptoms may include:
Consider taking over-the-counter pain medication.
Blisters.
Protect the area from the sun.
Deep redness.
Burned area may appear wet and shiny.
Skin that is painful to the touch.
Burn may be white or discolored in an irregular pattern.
Full thickness
Treatment
third degree Treatment of superficial partial-thickness burns
Burns destroy the epidermis and dermis. They may go generally consists of debridement,
into the innermost layer of skin, the subcutaneous tissue. topical antimicrobial applications, and dressing
The burn site may look white or blackened and charred. changes.
Little to no pain (nerve damage) Deeper burns (deep partial-thickness and deep burns)
Skin won't heal (will need skin grafting) generally require excision and skin grafting.
apply an antibiotic cream in order to help prevent
Eschar must be removed infection
Extend through and destroy all layers of the dermis
and often injure the underlying subcutaneous tissue.
Full-thicknes burn Second degree burn
Causes
Caused by the following:
A scalding liquid. Epidermis
Skin that comes in contact with a hot object for
an extended period of time. Dermis
Flames from a fire.
Subcutaneous
After Effects tissue

Skin won’t heal (will need skin grafting)

Charred, dry, leathery skin (eschar)
Treatments
Little to no pain (nerve damage)
surgical treatments, such as skin grafting.
symptoms
Extensive burns often require large amounts of
symptoms of a third-degree burn
intravenous fluid due to capillary fluid leakage and
Dry and leathery skin. tissue swelling.
Black, white, brown, or yellow skin.
Swelling.
Lack of pain because nerve endings have been
destroyed.
 Crıtıcal Care

Burn Overview

TYPES OF BURN

Thermal burn Electric burn

Electrical burn is a skin burn that happens when

Burns due to external heat sources which raise the electricity comes in contact with your body
temperature of the skin and tissues and cause tissue Burns from electrical current, either alternating current
cell death or charring. . (AC) or direct current (DC)
Examples:
Examples:
Hot metals, scalding liquids, steam, and flames,. Power light ,outlet , lightening
caused by: causes
heat Common causes include:
electricity exposed electrical wires
radiation water on electrical appliances
chemicals cutting through a live cable
friction old wiring
cold faulty appliances
Symptoms of burns include:
pain Diagnosing and treating electrical burn.
blisters Tests.
swelling EKG to check heart health.
red, white, or charred (blackened) skin Urinalysis and/or complete blood count to check for
peeling skin muscle enzymes.
Symptoms of airway burns are: X-ray to check for fracture or dislocation.
burns on your head, face, neck, eyebrows, or nose hairs CT scan to determine if head trauma occurred during
burned lips and mouth the electrical event.
coughing Treatment include:
shortness of breath or wheezing
Prescription pain medicine.
dark, black-stained mucus
Surgery to repair the burned area.
voice changes
Treatment for any internal trauma.

symptoms
The symptoms of an electric shock are:
difficulty breathing or no breathing at all
a weak, erratic pulse or no pulse at all
burns
loss of consciousness
cardiac arrest
Muscle contractions.
Numbness or tingling.
Problems with balance.
Red or red-black urine.
Seizures.
Shortness of breath.
Trouble staying awake.
 Crıtıcal Care

Burn Overview

TYPES OF BURN

Chemical burn
Chemical burns from ingestion (swallowing)
may cause:
Chemical burns are tissue damage caused by strong Chest pain.
acids, drain cleaners, paint thinner, gasoline and many Cough.
other substances Difficulty speaking (dysphonia).
Alkali burn Are harder to treat because they aren’t Drooling.
neutralized by the skin ike acid burns Hoarseness.
Low blood pressure (hypotension).
Examples: Nausea and vomiting, or vomiting blood.
Bleach ,gasses ,Drain cleaner Pain in your mouth or throat (especially when
swallowing).
Risk for chemical burns
Perforations (holes) in your stomach, esophagus
Anyone who works with chemicals is at risk for (the tube connecting your stomach and throat)
chemical burns, including: or cornea (the outermost lens of your eye).
Construction workers. Shortness of breath (dyspnea).
Factory workers. Upper airway swelling (edema).
Farmers.
Laboratory technicians. Diagnosis, Tests & Treatment
Mechanics.
Blood tests:
Military personnel.
Endoscopy:
Plumbers.
Eye exam:
cause Imaging:
Remove clothing:
Battery acid.
Remove the chemical:
Bleach.
Rinse with water: Drink water:
Detergents.
Evaluate the severity of your burn.
Drain cleaners.
Continue rinsing your burn.
Fertilizers.
Apply antibiotics to your skin to prevent infection. Or,
Hair relaxers.
they’ll give them to you through a vein in your arm.
Metal cleaners and rust removers.
Apply a dry dressing or bandage to mild or moderate
Paint removers.
burns
Pesticides.
Sanitizers and disinfectants.
Swimming pool chemicals.
Toilet bowl cleaners.
Wet cement.
symptoms of chemical burns?
Chemical burns on your skin may cause:
Blisters or scabs.
Cracked, dry skin.
Pain.
Peeling skin.
Redness.
Skin discoloration.
Swelling.
Chemical burns in your eyes may cause:
Blurry vision.
Eyelid swelling.
Pain.
Redness.
Stinging or burning.
Watery eyes.
Blindness (in severe cases
 Crıtıcal Care

Burn Overview

TYPES OF BURN

Radiation burn : Friction burn:

Burns due to prolonged exposure to ultraviolet rays A friction burn occurs when skin is scraped off by contact
of the sun, or to other sources of radiation such as x-ray with some hard object, such as the road, the floor, etc.
Radiation dermatitis or radiation burn is a side effect It is usually both an abrasion and heat burn.
of radiation therapy to treat cancer.
They are classified by degrees, based on how deep the
Examples: burn damages layers of your skin:
Sun ,Radiation Therapy, X-ray
First-degree friction burn:
symptoms are: This common type of friction burn affects the superficial
Reddening of white skin or darkening of skin that is layer of your skin, aka the epidermis.
black or brown. Second-degree friction burn:
Itchy skin. These burns affect your epidermis and dermis, the next
Dry and peeling skin. layer of skin.
Swelling. Third-degree friction burn:
Blistering. These severe burns damage or destroy your epidermis
Open sores and dermis and often leave scars.

Treated causes of friction burns include:

steroid cream to reduce your risk of developing Road rash:.
radiation dermatitis Sports:
Moving belts:
moisturizing cream,
Vacuum cleaners:
Cetaphil cream, .
treatment
treating minor friction burns with the following steps:
Cold burn Clean the wound
Apply cool compresses
Take over-the-counter (OTC) pain medication:
Also called “frostbite,” cold burns cause damage to your Acetaminophen or ibuprofen can help ease pain and
skin by freezing it. You can get frostbite by being outside inflammation.
in freezing temperatures. Keep the burn covered
Examples: Avoid further friction
Do not pop any blisters
Frostbite
symptoms include:
numbness
itchiness
tingly feeling
pain
blisters
unusually firm or waxy skin
Risk of cold burn
smoke
take medications that decrease blood flow to your skin,
like beta-blockers
have diabetes, peripheral vascular disease, or other
conditions that impair your circulation
have peripheral neuropathy or other conditions that
lower your ability to detect injuries

burns treated
To warm your skin:
Soak the affected area in warm water for 20 minutes.
The water should be around 104˚F (40˚C), and no more
than 108˚F (42.2˚C).
Repeat the soaking process if needed, taking 20-minute
breaks between each soak.
Apply warm compresses or blankets, in addition to the
warm-water treatments.
 Crıtıcal Care

Burn Overview

Burn Location Complications

Complications
Respiratory issue
Head ,Neck, Chest,Toumrs Bacterial infection, which may lead to a bloodstream
infection (sepsis)
Fluid loss, including low blood volume (hypovolemia)
Dangerously low body temperature (hypothermia)
Infection Breathing problems from the intake of hot air or smoke.
Scars or ridged areas caused by an overgrowth of scar
Bacterial infection,
tissue (keloids)
which may lead to a bloodstream infection
Open areas allow
bacteria to get in

Disability :
Hand, feat, joints, eyes

Impair healing :
Diabetes, CKD, malnourished

Compartment syndrome
Arms, legs
Eschar creates a tournaquet-like effect that cuts off
circulation
 Crıtıcal Care

Burn Care Phases

Emergent Phase Acute phase

aka resuscitative phase 48-72 hours after burn until wound closes
The emergent phase begins with the onset of burn injury The acute phase of burns is defined as a period
and lasts until the completion of fluid resuscitation or a extending from the onset of burns with shock to the time
period of about the first 24 hours & lasts 48 hour taken for wound epithelialization which normally takes
about 12 to 14 days, if management of burns is adequate
Symptoms:
Patho:
Emergent Phase (Resuscitative Phase)
HCT The pathophysiology of the burn wound is characterized
BUN/CR by an inflammatory reaction leading to rapid edema
Increase urine output formation, due to increased microvascular permeability,
high level of K+ vasodilation and increased extravascular osmotic
low level of Na activity.
Decrease WBC Capillary permeability is restored & causes diuresis
Lasts from onset to 5 or more days but usually lasts
primary focus:
24-48 hours.
Begins with fluid loss and edema formation and Nutrition
continues until fluid motorization and diuresis begins. Wound care Inflammation,
Greatest initial threat is hypovolemic shock to a major hyper metabolism,
burn patient. muscle wasting,
Infection prevention
Pathology: Pain management
Capillary permeability (leaky blood vessels) causes insulin resistance
edema & fluid volume deficit
Priorities
Extinguishing the burn source
Soaking the burn with cool water to relieve pain and to 1-Secure Airway:
limit local tissue edema 100% humidified oxygen is administered and the patient is
Removing jewelry and no adherent clothing encouraged to cough so that secretions can be removed
Covering the wound with a sterile (or at least clean) by coughing
dressing to minimize bacterial contamination 2-Infection prevention:
Brushing off chemical contaminants, removing Patients with burn injuries are at risk for infection due to
contaminated clothing, and flushing the water the loss of their skin barrier, which normally protects the
Patient is at high risk of hypovolemic shock body from
Assessment of the following needs to take 3_Managing Fluid Volume:
Airway Monitor vital signs, and central venous pressure (CVP).
Breathing Note capillary refill and strength of peripheral pulses.
Circulation 4_Minimizing Pain and give Comfort:
Assess reports of pain, noting location and character,
Periorities: and intensity (0–10 scale).
5_Maintaining Adequate Nutrition;
Maintaining an adequate airway and treating the client
The body requires more calories and nutrients to promote
for burn shock.
healing and repair damaged tissue, patients may
The eyes should be irrigated with water immediately if
experience decreased appetite, nausea, and difficulty
a chemical burn occurs.
swallowing, further complicating their nutritional status
Establish IV access (need at least 2 good IV's/ CVC)
Strict I & O (foley catheter)
Closely monitor VS, EKG & electrolytes
Fluid resuscitation (see parkland formula below)
 Crıtıcal Care

Burn Care Phases

Rehabilitative phase Fluid Resuscitation

can last weeks-years
From wound closure to optimal state of functioning In Emergent / Rescuiation phase Fluid replacement is
consider main periority and it’s need is calculated by
Rehabilitation from a burn injury is a lengthy process, using parkland formula and Rule of 9’s
which starts on day one and involves a continuum of
care through to scar maturation and beyond. Parkland formula calculation:
It involves a dedicated multidisciplinary team of Also known as Baxter formula, is a burn formula
professionals and the full participation of the patient. developed by Charles R. Baxter, used to estimate the
amount of replacement fluid required for the first
Burns Rehabilitation’ incorporates the physical,
24 hours in a burn patient so as to ensure the patient is
psychological and social aspects of care
hemodynamically stable.
Periorities of Burn Rehabilitative phase:
Calculation:
Psychosocial support
Total crystalloid fluid (i.e., a solution with small molecules
Improving function, that can move into cells) over the first 24 hours =
activities of daily living, 4 milliliters x % TBSA (total body surface area burned)
self-care, and mobility. x body weight (kg)
Prevent Scars and constructors
ROM Give first half in first 8 hours
PT / O T Give next half in next 16 hours
Medically In children, the formula is edited to 3 ml x % TBSA x
weight (kg).
Types
Rule of 9’s:
Estimation of body surface area burned is based on
Phase 1 –
assigning percentages to different body areas.
Control Pain and Swelling.
Phase 2 – The entire head is estimated as 9%
Improve Range of Motion and/or Flexibility. (4.5% for anterior and posterior).
Phase 3 – The entire trunk is estimated at 36% and can be further
Improve Strength & Begin Proprioception/Balance broken down into 18% for anterior components and 18%
Training. for the back.
Phase 4 –
Training & Sport-Specific Training.
Phase 5 –
Gradual Return to Full Activity.

Head and
neck 9%

Upper limbs
9% each

Trunk 36%

Genitalia 1%

Lower limbs
18% each
 Crıtıcal Care

Trauma & Emergency Care

Trauma care teams treat patients that have critical injuries threatening life or limbs.
These severely injured patients often require multi-disciplinary, comprehensive emergency medical services.

Primary Survey (ABCDE)

Airway: Breath:

Conscious and intentional breathing that releases

A life-threatening condition resulting from blunt and
trauma stored in the body.
penetrating injuries to the neck and chest, as well as from
Intentional trauma breath work helps with trauma
medical procedures that may injure the airway.
processing and healing by bypassing the conscious
Maxillofacial, mind, deactivating the sympathetic nervous system,
neck, and having a restorative effect on its practitioners.
laryngeal trauma.
Airway obstruction or obstruction by blood, Access for:
secretions, Inspection of the patient's breathing pattern,
tissue edema, skin color,
debris, respiratory status
vomitus. palpation to identify abnormalities
auscultation of lung sounds using a stethoscope.
Access for:
Chest rise
Position Secretions + bleeding Work for breathing
Potency Head, neck & spine Tracheal deviation
Need for protection Considering C spine
Obstruction/ foreign bodies Interventions:
Depends on cause:
Interventions:
Ventilate with bag-valve mask if RR
airway opening maneuvers
Chest tube if pneumonia
airways suction
Positive pressure ventilation if flail chest
insertion of an oropharyngeal
Monitoring O2 with pulse Ox
or nasopharyngeal airway
Chin lift / Jaw thrust
Chin-lift/ jaw-thrust
Administer oxygen Remove foreign bodies
Monitor O2 with pulse ox
Tracheal intubatio check breathing in trauma
To check if a person is still breathing:
look to see if their chest is rising and falling.
listen over their mouth and nose for breathing sounds.
Circulation: feel their breath against your cheek for 10 seconds.

Access for:
Cool skin .
High HR
Ensure adequate monitoring of saturations: Poor circulation can cause a number of symptoms,
cardiac monitor, including:
finger on femoral pulse for pulse check. Muscles that hurt or feel weak when you walk.
If the pulse is absent or less than 60 and there are no A “pins and needles” sensation on your skin.
other signs of life: Pale or blue skin color.
commence immediate chest compressions and full Cold fingers or toes.
cardiopulmonary resuscitation. Numbness.
Low cap refill Chest pain.
Find bleeding source Swelling.
Head/neck /chest /pelvic Veins that bulge.
Interventions:
Apply direct pressure on bleeding sites
Administer IV fluids & blood products
CPR if no pulse
 Crıtıcal Care

Trauma & Emergency Care

Disability
symptoms of trauma exposure?
These traumatic health events create long-term and
even life-long effects that leave people disabled or in Changes in physical and emotional reactions
debilitating chronic pain. Being easily startled or frightened.
Trauma may develop mental health disabilities such as Always being on guard for danger.
depression, Self-destructive behavior, such as drinking too much or
driving too fast.
anxiety disorders, Trouble sleeping.
post-traumatic stress disorder, Trouble concentrating.
disruptive behavior Irritability, angry outbursts or aggressive behavior.
disorders, Overwhelming guilt or shame.
obsessive compulsive disorders,
insomnia Access for:
Wounds
Access for: Injuries
Check neurological status Deformities
GCS Complete assessment of patient /prevent hypothermia
Blood glucose
Interventions
Intervention: Remove all clothing for full assessment
Frequently reassess neuro status for changes Cover with warm blankets to prevent hypothermia
Intubation if unconscious & unable to protect airway Maintain privacy throughout
CT scan to assess for head trauma/ injury

Exposure
The therapist and patient together identify a range of
possible stimuli and situations connected to the
traumatic fear, such as specific places or people.
They agree on which stimuli to confront as part of in
vivo exposure and devise a plan to do so between
sessions
 Crıtıcal Care

Trauma & Emergency Care

Secondary Survey(FGHI)
A rapid but thorough head-to-toe examination assessment to identify all potentially significant injuries

FULL SET OF VITALS: Pelvis

Inspect the pelvis for grazes over the iliac crest. Examine
Note any changes in: for bruising, deformity, pain or crepitus on movement.
Body Temperature, RR
Pulse Rate, PERRLA Limbs
Respiration Rate, Weight Inspect all the limbs and joints, palpate for bony and soft
Blood Pressure LOC tissue tenderness and check joint movements, stability
Heart rate O2 saturation and muscular power

Give Comfort: Back

A log roll should be performed either in the primary survey
Complete bed rest or in the secondary survey.
Mentally relax
Inspect the entire length of the back and buttocks.
Assure peaceful environment patient
Palpate, then percuss, the spine for tenderness,
History &head to toe assessment: Palpate the scapulae and sacroiliac joints for
tenderness
Conduct health history using SAMPLE & do head-to-toe
Use sample to collect complete history of patient Urinalysis
During this examination, any injuries detected should be Interpretation of the urine dipstick in blunt pediatric
accurately documented and any required treatment trauma suffers from high rates of false positive and false
should occur, such as covering wounds, managing negative results – formal microscopy is the better test
non-life-threatening bleeding and splinting of fractures. where renal injury is suspected

Signs :What make them trauma patient Inspect posterior surface:

Allergies: things allergic to patient
To check breakdown signs inspect
Medication: medicine they are using
Past health history : any serious past disease Back
Last meal: last time of any oral intake secrum
Event: Reason of this event pressure points
inspect the posterior surfaces for
wounds.
Performing the examination of Secondary Survey deformities,
discolorations
Head and face
Inspect the face and scalp. Look for:
Bleeding, lacerations, bruising,
depressions or irregularities in the skull,
Battles sign (bruising behind the ear indicative of a
base of skull fracture).
Neck
Inspect the neck - it is necessary to open the collar to do
this whilst maintaining manual in-line stabilization of the
neck. Examine the anterior neck
(as per the primary survey)
checking for:
tracheal deviation
wounds / bruising to the neck
subcutaneous emphysema
Chest
Inspect the chest, observe the chest movements.
Look in particular for:
bruising (from seat-belts)
asymmetric or paradoxical chest wall movement
Abdomen
Inspect the abdomen, the perineum and external genitalia.
Look in particular for:
seat-belt bruising / handle-bar injuries
distension
blood at the urinary meatus / introitus
 Crıtıcal Care

Trauma & Emergency Care

Emergency survey index

Level 1/Resuscitation: Level 3/Urgent

Immediate life saving interventions Life threatening but stable. Must be seen in 1 hour
Unstable__ Check immediately
Cases: fracture Abdomen pain vomiting
The following questions are used to determine whether
the patient requires an immediate lifesaving intervention:
Does this patient have a patent airway?
Is the patient breathing? Level 4/Stable(less urgent)
Does the patient have a pulse?
Cases: Can be Delayed
Unconsciousness. Prolonged Seizure. Stable with only one type of resource anticipated
Cardiac arrest. Shock. Can be Delayed
Cases: Back pain cystitis Rash

Level 2/Emergent ESI 2

Level 5/ Stable No Resources Required
High alert condition severe pain must be seen in 10 min

Cases: Stable with no resource anticipated except oral

Chest pain Stroke Strider
medication and prescription
Can be Delayed

Cases: Vaccination Sore throat

Needs promt, life-saving NO

High-risk clinical YES
interventions? symptoms?

NO
YES
YES
Altered Mental Status? Level 2
Level 1
NO
YES
Severe distress?

NO
YES
Number of resources
Level 5 needed:
YES
One Many

Level 4 Danger-zone
vitals?
HR >100
RR >20
SpO2 ≤92%

Level 3
 Crıtıcal Care

Disaster Triage For Trauma

The process of prioritizing casualties according to the level of care they require. It is the most important,
and psychologically most difficult, mission of disaster medical response

Goals of disaster Triage: triage rules

The objective of disaster triage is to do the greatest Using this algorithm,
good for the greatest number of patients triage status is intended to be calculated in less than
The determinants of triage in disasters are, however, 60 seconds.
based on three parameters: Various criteria are taken into consideration, including
the patient's pulse,
Severity of injury
respiratory rate,
Likelihood of survival
capillary refill time,
Available resources (logistics, personnel,
presence of bleeding
evacuation asset)
the patient's ability to follow commands.
Four principles of triage? the triage system has five levels:
Some of the main indicators of triage principles include Level 1 – Immediate: life threatening.
prioritizing the injured people, Level 2 – Emergency: could become life threatening.
the duration of triage, Level 3 – Urgent: not life threatening.
the accuracy of triage, Level 4 – Semi-urgent: not life threatening.
the factors causing injuries Level 5 – Non-urgent: needs treatment when time permits

START
Developed to allow first responders to triage multiple victims in 30 seconds or less, based on three primary observations:
Respiration, (check in this order Perfusion, Mental Status (RPM).

Immediate: Red Triage Tag Color Delayed: Yellow Triage Tag Color
SEEN 1ST SEEN 2ND
life threatening. Victim’s transport can be delayed Includes serious and
Victim can be helped by immediate intervention and potentially life-threatening injuries, but status not
transport expected to deteriorate significantly over several hours
Requires medical attention within minutes for survival Significant injuries but ABC’s are currently stable;
(up to 60 minutes) treatment can be delayed (1 hour) without significant
Includes compromise to patient’s airway, breathing, and risk of mortality
circulation (the ABC’s of initial resuscitation) Examples: Open wound, Fracture pain

Examples: Spinal cord injury , Major burns ,LOC ,Shock ,

Severe bleeding Respiratory Trauma Minor: Green Triage Tag Color
Compromise in ABC’s “WALKING WOUNDED"
Breathing
Victim with relatively minor injuries
Circulation
Status unlikely to deteriorate over days
Mental Status
May be able to assist in own care: also known as
Unconscious & unable to protect airway
“walking wounded”
RR >30
Minimal injuries that are not life-threatening;
No radial pulse
patient can get up and move
Examples: Open wound , Fracture, Pain
 Crıtıcal Care

Disaster Triage For Trauma

black:deceased
Clinical parameters used to evaluate patients include:
DEAD OR DYING
Ability to walk
Victim unlikely to survive given severity of injuries, level Presence or absence of spontaneous breathing
of available care, or both Respiratory rate greater or less than 30 per minute
Palliative care and pain relief should be provided Perfusion assessment using either the palpable radial
Injuries are severe to the point that patient will not pulse or visible capillary refill rate
survive Mental status as assessed by ability to obey commands.
Examples: open ABC, Deteriorate mental state

Assessment
Triage is the process of rapidly screening sick children soon after their arrival in hospital, in order to identify:
those with emergency signs, who require immediate emergency treatment

Is the patient walking?

Is the patient walking? What's their

1 Are they breathing? 2 Is there circulation? 3
Green tag mental status?
Yes
Radial pulse present Can obey commands
RR >30 Red tag Check mental status Yellow tag
If unable to walk RR <30 Check circulation
Radial pulse absent Cannot obey commands
No Red tag Red tag

Reposition airway
-RR Black tag

+RR Red tag

 Crıtıcal Care

Drug Overdose And Poisoning

What is it?
An overdose is when you take a toxic (poisonous) amount of a drug or medicine.
Symptoms of an overdose can occur rapidly, but sometimes people can experience a delay in symptoms.
Not all overdoses are fatal or life threatening, however medical advice should always be sought if overdose is suspected
or has occurred.

Opioid overdose Acetaminophen overdose

Their face is extremely pale and/or feels clammy to the A single acetaminophen overdose that causes serious
touch. Their body goes limp. toxicity is usually not accidental.
Their fingernails or lips have a purple or blue color. Toxicity also may develop if multiple smaller doses are
They start vomiting or making gurgling noises. taken over time. In toxic doses, acetaminophen can
damage the liver.

Signs of an overdose may include: Symptoms:

Small, constricted “pinpoint pupils” Continued nausea and vomiting.
Falling asleep or loss of consciousness. Pain in the right side of their abdomen under their ribs.
Slow, shallow breathing. Loss of appetite.
Choking or gurgling sounds. Tiredness (fatigue).
Limp body. Dark or bloody urine, or reduced amount or frequency
Pale, blue, or cold skin. of urine.
HR BP RR Confusion, sleepiness and loss of consciousness.
Pinpoint pupils First 24 hours: Nausea, vomiting, stomach pain, and loss
Snoring or gurgling sounds of appetite. Paleness. Tiredness. …
24 to 72 hours after the overdose: Pain in your upper
causes an opioid overdose? right side. Dark urine. …
An opioid overdose can happen for a variety of reasons, 72 to 96 hours after the overdose: Blood in your urine.
including if you: Fever, lightheadedness, or fainting
Take an opioid to get high.
Take an extra dose of a prescription opioid or take it too
Treatment:
often (either accidentally or on purpose). Oral acetylcysteine is given as a loading dose of 140 mg
Mix an opioid with other medicines, illegal drugs, or per kilogram of body weight, with maintenance doses of
alcohol. An overdose can be fatal when mixing an opioid 70 mg per kilogram that are repeated every 4 hours for a
and certain anxiety treatment medicines, such as Xanax total of 17 doses.
or Valium. Antidote: N-acetyl cysteine
Take an opioid medicine that was prescribed for Activated charcoal: to prevent from absorbing into
someone else. Children are especially at risk of an GI tract
accidental overdose if they take medicine not intended
for them.

Treatment:
Naloxone is a life-saving medication that can reverse an
overdose from opioids— including heroin, fentanyl, and
prescription opioid medications—when given in time.
Naloxone is easy to use and small to carry.
Antidote: Naloxone
 Crıtıcal Care

Drug Overdose And Poisoning

Alcohol overdose Benzodiazepines overdose

Symptoms: benzodiazepine overdose will include central nervous
mental confusion, system (CNS) depression with normal or near-normal
remaining conscious, vital signs
seizures, trouble breathing,
slow heart rate, serious risks of benzodiazepines
clammy skin,
dulled responses (such as no gag reflex, which prevents Benzodiazepines increase the risk of addiction,
choking), withdrawal, cognitive decline, motor vehicle crashes,
extremely low body temperature. and hip fracture.
Alcohol overdose can lead to permanent brain damage The risk of overdose is particularly great when combined
or death. with sedative drugs such as opioids or alcohol.
Mental confusion
, difficulty remaining conscious, vomiting, seizures, Symptoms
trouble breathing, Dizziness.
slow heart rate, clammy skin Confusion.
, dulled responses (such as no gag reflex) Drowsiness.
low body temperature Blurred vision.
Unresponsiveness.
stages of alcohol poisoning Temporary memory loss
Larger doses can cause coma or RR
Reduced Awareness, Information Processing, an Anxiety.
Visual Acuity. Agitation.
Stages of Intoxication. slurred speech, ataxia, and altered mental status.
Reduced Muscle Coordination (BAC = 0.09 to 0.25
percent)
Confusion (BAC = 0.18 to 0.30 percent) Treatment:
Stupor (BAC = 0.25 to 0.49 percent) Antidote:
Coma (BAC = 0.35 to 0.50 percent) Flumazenil is a selective competitive antagonist of the
Death (BAC = 0.50 + percent) gamma-aminobutyric acid (GABA) receptor and is the
only available specific antidote for benzodiazepine (BZD)
Treatment: toxicity
Ethanol or, preferably, fomepizole for alcohol
dehydrogenase (ADH) inhibition
Benzodiazepines for withdrawal
Protect airway (High risk for aspiration)
Overdose Prevention Tips& Educations
Be careful when using. …
Try not to mix drugs as this can increase the risk for
Stimulant Overdose overdose. …
Have a safety plan written down that you can refer to
Stimulant overdose is commonly characterized by before/during use. …
dangerous overheating, and often the individual Never Use Alone is a number that anyone can call when
experiencing the overdose remains conscious. they are about to use a substance

Symptoms:
Treatment:
Dilated pupils.
benzodiazepines administered by a health professional
Dizziness.
Antidote: Ammonium Chloride (for amphetamines)
Tremor.
Seizure precautions
Irritability.
Confusion.
Mood swings.
Nausea or vomiting.
Rapid breathing, fast heart rate or arrhythmia
Agitation and restlessness
Seizures
Respiratory distress
Profuse sweating
hallucinations
Stroke or heart attack
Coma
Dilated pupils
Hyper alertness & sweating.
 Crıtıcal Care

Drug Overdose And Poisoning

Management of poisoning:
Identify type & amount of History &
Assess ABC’s Antidote administration
substance ingested if possible assessment

patients are often clinically Toxicology test, any of a The practice of functionally may not only result in the
unstable when discovered, group of laboratory analyses removing an ingested toxin reduction of free or active
resuscitation with that are used to determine from the gastrointestinal (GI) toxin level, but also in the
establishment of the airway, the presence of poisons and tract in order to decrease its mitigation of end-organ
adequate support of other potentially toxic agents absorption or increase its effects of the toxin by
ventilation and perfusion, in blood, urine, or other bodily clearance mechanisms that include
and maintenance of all vital substances. competitive inhibition,
signs (including Do NOT induce vomiting with receptor blockade or direct
temperature) must be corrosive chemicals & antagonism of the toxin
accomplished first agents;

Must report case to local Poison Control Center

Accidental Overdose VS Intentional Overdose

An accidental overdose refers to an overdose that Intentional misuse leading to overdose can include using
happens unintentionally. A person may not realize that prescribed or non-prescribed drugs in excessive quantities
they are taking a harmful amount of a substance. in an attempt to produce euphoria.

Example: Usage of illicit drugs, in large quantities, or after a period of

a person ingests a substance like heroin or cocaine that is drug abstinence can also induce overdose.
laced with fentanyl, Example:
How can you prevent an accidental overdose? Taking too much of a drug to get high or for the purpose
of harming yourself.
Take all prescription medications as prescribed.
Avoid mixing alcohol, medications, or other substances.
Avoid using substances when no one else is around.
Must initiate suicide precautions
Use fentanyl test strips

Suicide precautions:
Keep all medications, both prescribed and non-prescribed (over the counter), in a locked box.
An adult should hand out and control all prescribed and over the counter medications to children and adolescents.
Keep track of all bottles of medication as well as the number of pills in each container, including those prescribed as over
the counter medications (such as pain relief, allergy pills, vitamins, and supplements, etc) for every person and any pets in
the home.
Dispose of all expired and no longer used prescribed

Nursing interventions:
Ensure safety and monitor for withdrawal symptoms.
Provide education on substance abuse and its effects.
Assist in developing coping skills and relapse prevention strategies.
Facilitate access to appropriate treatment programs and resources
Listen to patient and show empathy
Work with social worker & team to coordinate care to detox facility
Monitor VS & EKG for complications� Initiate suicide precautions if deemed intentional overdose
 Crıtıcal Care

Organ Donation

What is organ Donation? Purpose

When you decide to give an organ to save or transform People who are on an organ waiting list typically
the life of someone else. You can donate some organs have end-stage organ disease that significantly impacts
while you are alive, and this is called living organ their quality of life and may be near the end of their life
donation.

RN’s Role in Organ Donation

After identifying the potential donor, with clinical signs of brain death (irreversible coma,
unresponsive and unperceptive), the nurse initiates the technical procedures and protocols
that confirm the condition the individual as a potential donor
It is the nurse’s responsibility
to refer them to the organ procurement organization who determines if the patient is
a declared organ donor or not. If the patient is, the process of consultation begins

Organ procurement Organization: Referral Triggers:

The OPO’s role is to assess donor potential, Any patient in ICU that is on bipap or ECMO may also
collect and convey accurate clinical information, qualify for organ donation with these triggers.
follow national policies for offering organs. (It is the *A consult does NOT indicate a family conversation will
transplant hospital’s role to review organ offers and occur. The consult is only made for initial evaluation of
decide whether they are suitable for their patients.) the clinical status for eligibility.
Coordination of the evaluation and preparation of Report any patient immediately (within 1 hour) on a
patients for organ transplantation and long-term ventilator that meets any of the following clinical
management of patients after transplant. triggers:
Work directly with medical facilities & receive referral Any consideration of withdrawal of life sustaining
triggers for possible donors therapies, or deceleration of care (example: palliative
care consults.
DNR for purposes to not escalate care) OR
Brain death testing discussed, planned or initiated
Reason for Decline candidate by OPO Absence of 2 or more neuro reflexes
No cough
Donors may be declined if they have No gag
inadequate support for recovery, No corneal response
questionable donor-recipient relationship No pupillary response
or motivation for donation, No pain response
a history of poor coping or psychiatric illness GCS < 5, not due to sedation or paralytics
history of not taking good care of their health, or other Family initiates conversation about donation
similar concerns.
Infectious or communicable disease
Sepsis
Blood-borne pathogens (HIV or Hepatitis)
Advanced heart disease
 Crıtıcal Care

Organ Donation

Facts about organ donation: Donor Management:

Buying or selling organs is illegal. It is a federal felony to Aims:
give or receive money or any other tangible gift in to build strong, long-lasting relationships with donors,
exchange for a donated organ. increase retention rates, and ultimately, secure ongoing
financial support for an organization’s mission and
There is no standard age limit or cut off to receiving a program
transplant. Each transplant hospital has its own specific
criteria for accepting transplant candidate Periorities:
Hemodynamic Stability:
An open-casket funeral is possible for organ and tissue Monitoring of
donors. BP HR
MAP ECG
There is no cost to the donor’s family or estate for organ
and tissue donation.
Maintain lab parameters:
Information about an organ donor is only released to the All lab tests suggested by OPO
recipient if the family of the donor requests or agrees to it.
Family support:
Otherwise, a patient’s privacy is maintained for both Provide comfortable space for family to visit patient
donor families and recipients Emotional support to family

DECLARATION OF DEATH
The method of declaring death must fulfill the legal definition of death by an irreversible cessation of circulatory and
respiratory functions before the pronouncement of death.

Brain Death: Cardiac Death:

when a person on an artificial life support machine no A sudden cardiac arrest occurs when the heart stops
longer has any brain functions. This means they will not beating or is not beating sufficiently to maintain perfusion
regain consciousness or be able to breathe without and life.
support.
Criteria:
Three separate brain death criteria,
whole-brain, Absence of heartbeat and respiration and the loss of
higher-brain
brainstem brain function
formulations
electrocardiogram (ECG or EKG) will show a severe
The tests used to determine brain stem death are: ventricular arrhythmia or no heartbeat at all.
a torch is shone into both eyes to see if they react to the
light Asystole:
pressure is applied to the forehead and the nose is When your heart’s electrical system fails entirely, which
pinched to see if there’s any movement in response causes your heart to stop pumping. It is also known as
Apnea testing is an essential component . “flat-line” or “flat-lining”
The main objective of apnea testing is to prove the EKG
absence of respiratory control system reflexes in the Pulse check
brainstem when intense physiologic stimulation to Heart & lung auscultation
breathe takes place Patient must be pronounced officially by MD by
Steps to perform apnea test: auscultation of heart & lungs after asystol
Preoxygenate with 100% O2 for 10 minutes on ventilator
symptoms:
Disconnect ventilator & assess for spontaneous
respirations Chest pain or discomfort.
insertion of a catheter or cannula into the endotracheal Feeling of a pounding heartbeat.
tube, down to the level of the carina, through which Unexplained wheezing.
oxygen is delivered. Shortness of breath.
Access for respiratory effort for 10 minutes Rapid or irregular heartbeats.
if no respiratory effort in 10 minutes draw ABG Fainting or near fainting.
No respiratory effort + Lightheadedness or dizziness.
CO2 >60= positive result
Stages of brain death?
The three essential findings in brain death are
coma, absence of brainstem Patient must be pronounced officially by MD by
apnoea, auscultation of heart & lungs after asystole
TEMPLATES &
PLANNERS
 Disease Name

PATHO WHAT IS IT?

RISK FACTORS/ CAUSES

DIAGNOSTICS/ LABS SIGN & SYMPTOMS

TREATMENT

COMPLICATIONS

NURSING INTERVENTIONS PATIENT & FAMILY EDUCATION

Drug Class:

Suffix/ Prefix Generic Name(S) Trade Name(S)

Mechanism of Action Mechanism of Action

Mechanism of Action Mechanism of Action

Mechanism of Action Mechanism of Action

Notes
 drug class

Generic Name: Generic Name:

Trade Name: Suffix/ Prefix Trade Name: Suffix/ Prefix

Mechanism Of Action Mechanism Of Action

Side Effects Uses Side Effects Uses

Nursing Considerations Nursing Considerations

Generic Name: Generic Name:

Trade Name: Suffix/ Prefix Trade Name: Suffix/ Prefix

Mechanism Of Action Mechanism Of Action

Side Effects Uses Side Effects Uses

Nursing Considerations Nursing Considerations

 Date:
Nursing Care Plan Patient Room #:

Assessment
Objective Subjective

Diagnosis
Problem (S) Etiology (Aeb) Signs & Symptoms

remember to set Planning

SMART goals
S pecific Short Term Goals Long Term Goals
M easureable
A ttainable
R elevant
T imely

Implementation
Nursing Interventions

Evaluation
Outcome (S) As Evidenced By:
 Room/ Bed # Past Medical History Reason Patient Came In

Patient name:
Age:
Code status:
Admit date:
Living situation:
Isolation:
Allergies:

Neuro Vte
AAOx:

Cardiac Iv Sites/ Central Lines

Rhythm:
Tele:

Respiratory Drips/ Infusions

O2 requirements:
Lung sounds:Tele:

Gi Abnormal Labs/ Tests

Diet:
Blood sugar checks:
Last BM:

Gu Pending Tests & Consults

Foley:
Urine output:

Skin Notes
Wounds:
 NCLX
4 week study plan

Study Tips nclex exam date:

Plan a rest day each week! Rest is vital to retaining information
Prioritize your weak areas (think what subjects did you get the lowest grades)
Do practice questions EVERY DAY and read the rationales!
Keep track of practice q scores and review info on subjects that you missed

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS:

# of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's:

SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS:

# of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's:

SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS:

# of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's:

SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS:

# of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's:

 NCLX
5 week study plan

Study Tips nclex exam date:

Plan a rest day each week! Rest is vital to retaining information
Prioritize your weak areas (think what subjects did you get the lowest grades)
Do practice questions EVERY DAY and read the rationales!
Keep track of practice q scores and review info on subjects that you missed

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS:

# of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's:

SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS:

# of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's:

SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS:

# of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's:

SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS:

# of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's:

SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS:

# of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's:

 NCLX
6 week study plan

Study Tips nclex exam date:

Plan a rest day each week! Rest is vital to retaining information
Prioritize your weak areas (think what subjects did you get the lowest grades)
Do practice questions EVERY DAY and read the rationales!
Keep track of practice q scores and review info on subjects that you missed

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS:

# of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's:

SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS:

# of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's:

SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS:

# of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's:

SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS:

# of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's:

SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS:

# of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's:

SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS:

# of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's:

Monthly Month & Year :

Planner

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS:

# of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's:

SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS:

# of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's:

SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS:

# of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's:

SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS:

# of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's:

SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS:

# of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's:

SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS: SUBJECTS:

# of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's: # of Q's:

Top Priorities This Month notes

1
2
3
4
5
 Weekly Planner
SUNDAY Top Priorities This Month

1
2
3
MONDAY

To Do

TUESDAY

WEDNESDAY

THURSDYA Assignment/ Exam Dates

FRIDAY

notes

SATURDAY
 Daily Planner
Date:
12:00 AM Top Priorities This Month

01:00 AM 1
02:00 AM 2
03:00 AM 3

04:00 AM To Do
05:00 AM

06:00 AM

07:00 AM

08:00 AM

09:00 AM

10:00 AM

11:00 AM

12:00 PM

01:00 PM
Assignment/ Exam Dates
02:00 PM

03:00 PM

04:00 PM

05:00 PM

06:00 PM notes
07:00 PM

08:00 PM

09:00 PM

10:00 PM

11:00 PM