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Archive for the ‘Nursing Subject’ Category

1mg= 1000mcg

1g= 1000mg

1kg= 1000g

1kg= 2.2lbs

1oz= 30ml

1tbsp= 15 ml or 3 tspn

1tspn= 5ml

1cup= 8 oz or 240ml

1 lb= 16 oz

Farenheit to Celcius      (F-32)/ 1.8

Celcius to Farenheit      (1.8xC)+32

NPO  General Surgery 6-8 hours; Local Surgery  3 hours to avoid Aspiration

Drops/Min= Total Volume x Drop Factor / Time in Minutes

Infusion Time= Total Volume to Infuse / Ml/hr being infused

Number of ml/hr= Total Volume in ml / Number of hours

POSITIONING

1. Burn of the face and neck- elevate the head of the bed

2. Masectomy- Semi-fowlers then one hand up above the head

3. Hypophysectomy- Elevate the head of the bed

4. Thyroidectomy- Semi-fowlers

5. Hemorrhoidectomy- Side Lying

6. Gastroesophageal Reflux Disease- Reverse Trendelenburg

7. Liver Biopsy- During- Supine with Right side upper abdomen exposed, Right Arm raised

After- right side lying and out pillow below to avoid bleeding

8. NGT insertion: high fowlers, head tilted forward

9. Rectal Enema and Irrigation- left Sims position

10. COPD- sitting position; lean on table ( orthopnic position)

11. Laryngectomy- Semi-fowlers, fowlers

12. Bronchoscopy POST- semi-fowlers

13. Postural Drainage- different position

14. Thoracentesis- During- sitting, lean on the table or lying in bed on unaffected area with 45 degree elevation

After- any comfortable position

15. Abdominal Aneurysm Resection- Limit elevation of the head to 45 degrees

16. Amputation of lower Extremity- During 24hours- elevate foot of the bed then after 24 hours FLAT

17. Catheterization femoral- 3-4 hours bed rest, Extremity should be straight with sandbag

18. CHF and pulmonary edema- Upright

19. Cataract Surgery- Elevate head of the bed

20. Retinal Detachment- Bed rest, Bilateral eye patch

21. Autonomic Dysreflexia- Elevate head of the bed high fowlers

22. Cerebral Angiography- 12-14 hours bed rest; extremity straight

23. Stroke- hemorrhagic- elevate 30 degrees; ischemic- flat

24. Laminectomy- log roll the client

25. Increase Intracranial Pressure 30-45 degrees head of the bed, midline and in neutral position

26. Lumbar Puncture- during- side lying and fetal position

After- Supine Position 4-12 hours

27. Myelogram- oil- flat; water- elevated ; air- trendelenburg

PREGNANCY-INDUCED HYPERTENSION

-Pregnancy induced hypertension (PIH) is a high blood pressure disorder of pregnancy.

-is a condition in which vasospasm occurs during pregnancy.

Classification:

1. Gestational HPN

2. Mild Pre-eclampsia HPN

3. Severe Pre-eclampsia HPN

4. Eclampsia

Signs and Symptoms

• High blood pressure

• Fluid retention

• Edema

• Persistent headaches

• Blurred vision

• Abdominal pain

• Kidney problems

• Proteinuria

• Albuminurea

Diagnostic Test

• Urinalysis

• Blood pressure test

• Complete blood cell count

• Platelet count

Treatments

• anti-hypertensive medications

• Bed rest – in mild cases

• Hospitalization

• Intravenous saline

• Induced labor – once the condition is stable.

• Caesarian section – once the condition is stable.

Diagnostic Procedure

• A CT scan of the head, with or without contrast

• Magnetic resonance imaging

• Angiography

Mood disorder

• Is a condition whereby the prevailing emotional mood is distorted or inappropriate to the circumstances.

The two major types of mood disorders

• depression (or unipolar depression)

• Bipolar disorder.

Bipolar disorder

• Is a psychiatric condition defined by recurrent episodes of significant disturbance in mood.

• is also known as manic-depression or manic-depressive illness

• Often begins in adolescence or early adulthood and may persist throughout life. The causes of bipolar disorder are elusive, and there’s no cure.

• Can be managed with medications and other therapies.

Signs and symptoms

Bipolar disorder is characterized by an alternating pattern of emotional highs (mania) and lows (depression).

Manic phase

• Feelings of euphoria, extreme optimism and inflated self-esteem

• Rapid speech, racing thoughts, agitation and increased physical activity

• Poor judgment

• Recklessness or taking chances not normally taken

• Difficulty sleeping

• Tendency to be easily distracted

• Inability to concentrate

• Aggressive behavior

Depressive phase

• Persistent feelings of sadness, anxiety, guilt or hopelessness

• Disturbances in sleep and appetite

• Fatigue and loss of interest in daily activities

• Problems concentrating

• Irritability

• Chronic pain without a known cause

• Recurring thoughts of suicide

A. Definition

STROKE is also known as cerebrovascular accident (CVA) or “brain attack”, is a syndrome caused by a disruption in the flow of blood to part of the brain due to either occlusion of a blood vessel (ischemic stroke) or rupture of a blood vessel (hemorrhagic stroke). A stroke occurs when blood flow to the brain is damage resulting in abnormal function of brain. The interruption in blood flow deprives the brain of nutrients and oxygen, resulting in injury to cells in the affected vascular territory of the brain. Ischemic strokes are more common than hemorrhagic strokes.

B. Etiology

According to the nature of blockage or rupture, causes can be divided as 3 types.

• Thrombosis

A thrombus starts with damage to the endothelial lining of the vessel. Atherosclerosis causes fatty material to deposit and form plaques on the vessel walls. A blood clot or a piece of atherosclerotic plaque that breaks and travels into an artery of the brain thus blocking the flow of oxygen-rich blood. Usually, these clots stay attached to the inner lining of the organs but occasionally they can break off. This clot can then travel through the blood stream, to form an embolism in a brain artery to cause a stroke.

• Embolism

The occlusion of a cerebral artery by an embolus causes an embolic stroke. Typically, a clot that form in a blood vessel which is previously narrowed due to atherosclerosis. Other sources of emboli include tumor, fat, bacteria and air. Any cerebrovascular territory may be affected.

• Hemorrhage

Cerebral hemorrhage results from rupture of a cerebral vessel, which causing bleeding into the brain tissue. Cerebral hemorrhage is most often secondary to hypertension and is most common after age 50 years. These hemorrhages usually produce extensive residual functional loss and have the slowest recovery of all the types of stroke. The volume of hemorrhage is the single most important predictor of the clients’ outcome.

Risk Factors

Modifiable Risk Factors can be reduced or eliminated through lifestyle changes. Hypertension is the most important modifiable risk factors for both ischemic and hemorrhagic stroke. Adequate blood pressure control is associated with a 38% reduction in stroke incidence. Diabetes mellitus increases the risk of stroke and morbidity and mortality after stroke. The mechanism is related to macro vascular changes in people with DM. Prior stroke, carotid stenosis and a history of transient ischemic attacks are all considered modifiable risk factors for stroke.

Other modifiable risk factors for stroke include hyperlipidemia, cigarette smoking, heavy alcohol consumption, cocaine use and obesity.

Non-modifiable Risk Factors are advancing age is one of the most significant risk factors for stroke. The incidence of stroke in men is slightly higher than that in women. Family history of stroke increases one’s risk for stroke.

C. General Signs and Symptoms

Symptoms depend on the affected part.

1. Hemiparesis and Hemiplegia- complete hemiplegia involves half of the face and tongue as well as the arm and leg of the ipsilateral side of the body. Infarction in the right side of the brain causes left-sided hemiplegia and vise versa because nerve fibers cross over in the pyramidal tract as they pass from the brain to the spinal cord. Hemiparesis is a muscular weakness or partial paralysis restricted to one side of the body.

2. Aphasia- is a deficit in the ability to communicate. It involves any or all aspects of speaking, reading, writing, and understanding spoken language.

3. Dysarthria- is imperfect articulation that causes difficulty in speaking. The client understands language but has difficulty pronouncing words and may slur them. There is weakness or paralysis of the muscles of the lips, tongue and larynx.

4. Dysphagia- means difficulty in swallowing

5. Apraxia- is a condition that affects complex motor integration and therefore can result from a stroke in several areas in the brain.

6. Agnosia- inability to recognize familiar objects through the senses. This may result from an occlusion of the middle or posterior cerebral arteries supplying the temporal or occipital lobes.

THE NERVOUS SYSTEM

The nervous system integrates and monitors the countless actions occurring simultaneously throughout the entire human body. Therefore, every task, no matter how menial, accomplished by a person is a direct result of the components of the nervous system.

The nervous system consists of two parts

• The central nervous system (CNS) consists of the brain and spinal cord.

• The peripheral nervous system (PNS) consists of nerves outside the CNS.

The Brain

The brain is the most complex part of the nervous system. It is composed of more than 100 billion neurons and associated fibers. The brain tissues have a gelatin-like consistency. This semi-solid organ weighs about 1400 grams in the adult human.

Cerebrum – consists of two hemispheres that are completely separated by the great longitudinal fissure.

Four lobes

• Frontal lobe – largest lobe. Major functions are concentration, abstract thought, information, storage or memory, and motor function. It also contains Broca’s area, critical for motor control of speech.

• Parietal lobe – predominantly sensory lobe. Contains the sensory cortex, which analyzes sensory information to the thalamus and other cortical areas.

• Temporal lobe – contains the auditory receptive areas. Contains a vital area that provides integration of somatization, visual, and area of the cortex in cerebration.

• Occipital lobe – the posterior lobe of the cerebral hemisphere is responsible for visual interpretation.

Cerebellum – separated from the cerebral hemispheres by a fold of dura mater, the tetorium cerebelli.

Brain Stem – consists of the midbrain, pons, and medulla oblongata. It contains sensory and motor pathways and serves as the center for auditory and visual reflexes.

Arterial Blood Gas or ABG results are one topic that nurses or student nurses should know even the doctors because this test is very important. And this is also considered one of the hardest topics in school. And now I’m going to try my best to share my techniques to make this topic very interesting in an easy way. When I was still in college I’ll love analyzing ABG results even though my classmates hate it. I enjoyed it because I can answer it correctly.

ABG Results includes Blood PH, PaO2, PaCO2 and HCL

pH measures the Acidity or Alkalinity of the Blood

PaO2 measures the partial pressure of Oxygen

PaCO2 measures the Partial Pressure of Carbon Dioxide in the blood

HCL means Hydrochloric Acid concentration

Normal Values: This is very important. You have to memorize this by heart because from this you’ll be able to analyze the results

pH= 7.35-7.45

PaO2= 80-100

PaCO2= 35-45

HCL= 22-26

OK. So here’s the technique. If the pH is higher than 7.45 you call it ALKALINE. If it’s lower than 7.35 it’s ACIDIC. Then if the ph and the PaCO is not the same (high and low) you’re going to have a Respiratory Problem. But if the pH and the HCL is the same (high and high, low and low) you’ll have a Metabolic Problem. Let’s have an Example.

Ph=7.60     PaO2=88     PaCO2= 38  HCL= 21

ANALYSIS: pH is HIGH and PaCO2 is LOW. So they are not the same, we have a RESPIRATORY PROBLEM while HIGH pH means ALKALINE. Therefore, it’s RESPIRATORY ALKALOSIS.

Ph= 7.30   PaO2=95    PaCO2= 36   HCL=21

ANALYSIS: pH is LOW means ACID. Next PaCO2 is normal and the HCL is LOW. So the pH and HCL is same so it’s METABOLIC ACIDOSIS.

DID YOU GET IT? SEE HOW SIMPLE IT IS. THIS IS JUST THE GENERAL ANALYSIS…I’LL JUST GIVE YOU TIME TO MASTER THIS FOR MORE COMPLICATED ANALYSIS SOON…WATCH OUT..THANKS…JUST LEAVE A MESSAGE IF YOU HAVE QUESTIONS.

Critical Care Nurse: Day in The Life

Hi guys try to watch this video: