HERBAL MEDS

St. John's wort - antidepressant, photosensitive (C/Iin SULFA drugs)

Garlic - antihypertensive (avoid aspirin)

Ginseng - Anti stress (C/I in coumadin)

Green tea - antioxidant (check if risk forcalculi-oxalates)

Echinacea - immune stimulant (6-8 weeks only)(C/I inSANDIMMUNE-Immunosuppressant)

Licorice - cough and cold

Ginger root - antinausea (C/I in Coumadin)

Ginkgo - improves circulation (C/I in anticoagulant,headache side effect - check PT)

Ma huang - bronchodilator, stimulant (Ephedra)

Digitalis Toxicity includes.. N - nauseaA - anorexiaV - vomitingD - diarrheaA - abdominal pain

Drugs which can cause URINE DISCOLORATION Adriamycyn------ ReddishRifabutin--------- Red orangeRifampicin------- Red orangeBactrim---------- Red orangeRobaxin--------- Brown, Black or GreenishAzulfidine------ Orange yellowFlagyl------------ BrownishDilantin---------- Pink tingedAnti Psychotic-- Pinkish to Red brown Early signs of hypoxia: R-restlessnessA-anxietyT-Tachycardia Late signs of hypoxia: B-bradycardiaE-extreme restlessnessD-dyspnea In pedia- F-feeding difficultyI-inspiratory stridorN-nares flareE-expiratory gruntingS-sternal retractions Respiratory PatternsKussmaul- fruity acetone breath odorCheyne-stokes- near death breathing pattern

Seasonal Affective Disorder (SAD) may affect over 10 million Americans. The typical symptoms of SAD include depression, lack of energy, increased need for sleep, a craving for sweets and weight gain. Symptoms begin in the fall, peak in the winter and usually resolve in the spring. Some individuals experience great bursts of energy and creativity in the spring or early summer. Susceptible individuals who work in buildings without windows may experience SAD-type symptoms at any time of year. Some people with SAD have mild or occasionally severe periods of mania during the spring or summer. If the symptoms are mild, no treatment may be necessary. If they are problematic, then a mood stabilizer such as Lithium might be considered. There is a smaller group of individuals

who suffer from summer depression. SAD is recognized in the DSM-IV (The American Psychiatric Association's diagnostic manual) as a subtype of major depressive episode. Some individuals who work long hours inside office buildings with few windows may experience symptoms all year round. Some very sensitive individuals may note changes in mood during long stretches of cloudy weather.

A sign of improvement from dehydration would be a decreased urine specific gravity and a decreased/decreasing hematocrit. So the SG of 1.015 and a Hct of 46% would be the answer. It is the best answer of the two you had in you question. The normal urine SG is 1.003-1.035 (Usually between 1.010-1.025 with normal hydration and volume) (different texts give a slightly different range). SG 1.025-1.030+ (concentrated urine)SG 1.001-1.010 (dilute urine)SG 1.001-1.018 in infants under 2 years of age Specific gravity is a measurement of the kidney's ability to concentrate urine. The range of urine's SG depends on the state of hydration and varies with urine volume and the load of solids to be excreted under standardized conditions; when fluid intake is restricted or increased, SG measures the concentrating and diluting functions of the kidney. Loss of these functions is an indication of renal dysfunction. SG values usually vary inversely with amounts of urine excreated (decrease in urine volume = increase in specific gravity). However in some conditions this is not the case.

EYE ABBREVIATIONSOU- both eyesOR- right eyeOS- left eye

CUSHINGS (Hypersecretion of Adrenal Cortex Hormones)

C = Check VS, particularly BPU = Urinary output & weight monitoringS = Stress ManagementH = High CHON dietI = Infection precautionN = Na+ restrictionG = Glucose & Electrolytes MonitoringS = Spousal support

ADDISON'S (Hyposecretion of Adrenal Cortex Hormones)Always Remember the 6 A's of Addison's disease

1.) Avoid Stress2.) Avoid Strenuous3.) Avoid Individuals with Infection4.) Avoid OTC meds5.) A lifelong Glucocorticoids Therapy6.) Always wear medic alert bracelet

Hirschsprung’s diagnosed with rectal biopsy looking for absence of ganglionic cells. Cardinal sign in infants is failure to pass meconium, and later the classic ribbon-like and foul smelling stools.

Intussusception common in kids with CF. Obstruction may cause fecal emesis, currant jelly-like stools (blood and mucus). A barium enema may be used to hydrostatically reduce the telescoping. Resolution is obvious, with onset of bowel movements.

With omphalocele and gastroschisis (herniation of abdominal contents) dress with loose saline dressing covered with plastic wrap, and keep eye on temp. Kid can lose heat quickly.

After a hydrocele repair provide ice bags and scrotal support.

No phenylalanine with a kid positive for PKU (no meat, no dairy, no aspartame).

Second voided urine most accurate when testing for ketones and glucose.

Never give potassium if the patient is oliguric or anuric.

Nephrotic syndrome is characterized by massive proteinuria (looks dark and frothy) caused by glomerular damage. Corticosteroids are the mainstay. Generalized edema common.

A positive Western blot in a child <18 months (presence of HIV antibodies) indicates only that the mother is infected. Two or more positive p24 antigen tests will confirm HIV in kids <18 months. The p24 can be used at any age.

For HIV kids avoid OPV and Varicella vaccinations (live), but give Pneumococcal and influenza. MMR is avoided only if the kid is severely immunocompromised. Parents should wear gloves for care, not kiss kids on the mouth, and not share eating utensils.

Hypotension and vasoconstricting meds may alter the accuracy of o2 sats.

An antacid should be given to a mechanically ventilated patient w/ an ng tube if the ph of the aspirate is <5.0. Aspirate should be checked at least every 12 hrs.

Ambient air (room air) contains 21% oxygen.

The first sign of ARDS is increased respirations. Later comes dyspnea, retractions, air hunger, cyanosis.

Normal PCWP is 8-13. Readings of 18-20 are considered high.

First sign of PE (pulmonary embolism) is sudden chest pain, followed by dyspnea and tachypnea.

High potassium is expected with carbon dioxide narcosis (hydrogen floods the cell forcing potassium out). Carbon dioxide narcosis causes increased intracranial pressure.

Pulmonary sarcoidosis leads to right sided heart failure.

An NG tube can be irrigated with cola, and should be taught to family when a client is going home with an NG tube.

PRIORITY QUESTIONS (WHO TO SEE FIRST)Sample Test Item: 1. Which of the following clients should the nurse deal with FIRST?o 1 A client who needs his daily vitamino 2 A client who needs to be suctionedo 3 A client who needs diaper to be changedo 4 A client who is being prepared for dischargeCorrect Answer: 2. A client who needs to be suctionedPRIORITY (Use ABC)Obstruction in the airway – secretions Need to be suctioned2. Delegation, RN, LVN, UAP, CNAWhich of the following clients should the LPN be assigned to?o 1 A newly diagnosed patient with MYASTHENIC CRISISo 2 An immediate post-op client in PACUo 3 A client awaiting medication for vitaminso 4 A new admission for KIDNEY Transplant PatientCorrect Answer: 3-stable, A client awaiting medication for vitaminsMyasthenic Crisis – Unstable, Acute Respiratory FailureImmediate Post – op – Unstable, Risk for Complications, Kidney Transplant – Unstable, needs assessment for rejectionDELEGATION: Remember the 5R's, Right Task, Right Person, Right Circumstance, Right Communication & Right Feedback)RN Least stable, unstable, central catheters (hickman, broviac), admission, discharge, health teachings, patient for transfer, blood transfusion (2RNs)LPN Technical Doer, Stable, medications, wound dressingCNA Routine Care, Urine Dip Stix, Reporting to RN, Routine VSUAP turning q2H, conducting group activities, ambulationFor future USRNsThis is for you... from the purkinje fibers of my heart....Room Assignment(Who to Share Room with)Check:A ge

B eside the nurse's station? At the end of the hallway? Single Room/Private Room?C hain of infection/circumstanceD iagnosisE nviroment (dim light, darkened, red nightlapm)Sample Test Item:The best roommate for patient with LEUKEMIA isO 1 A 9-year-old with ruptured appendixO 2 A 12-year-old with chicken poxO 3 A 2-year-old with fever of unknown originO 4 A 5-year-old with nephrotic syndromeCorrect Answer: 4. A 5-year-old with nephrotic syndrome.1,2 & 3, manifest symptoms of infection. A client with leukemia is immunosuppressed and Patients with infection shouldn't be placed in this room. Since patient with nephrotic syndrome receives diuretics and steroids, this child will also need immunocompromised host precaution.

INFECTION CONTROL:Sample Test Item:3. Which of the following methods should the RN utilize in patient with SALMONELLA?O 1 Airborne PrecautionsO 2 Droplet PrecautionsO 3 Neutropenic PrecautionsO 4 Enteric PrecautionsThe correct answer: 4. Salmonella mode of transmission is fecal oral (enteric)HandwashingGloves must be used in handling bedpan and diapersGown - if soiling is likely to happen.Source of infection:Contaminated food and water.Remember - Transmission Based precautions:A irB orne, small particles are dispersed in the air like MTB, varicellaC ontact, drug-resistant microorganisms D roplet, large particles are dispersed into air, resp.infections except resp syncytialE nteric, fecal-oral like hepaA & salmonella

AGE APPROPRIATE GROWTH AND DEVELOPMENT(HOPPING WITH ONE LEG)Sample test Item:4. Which of the following is NOT a characteristic of a preschooler?O 1 predominantly "parallel play" periodO 2 balances on 1 foot with eyes closedO 3 skips on alternate feetO 4 jumps ropeThe correct answer is: 1. Parallel play is more common in TODDLERS.Preschooler (3-6 years)Gross motor developmentHOPS ON ONE (1) FOOT BY 4 YEARSSKIPS & HOPS ON ALTERNATE FEET BY 5 YEARSPLAY : ASSOCIATIVE, IMAGINATIVE, MAGICAL THINKING, SUPERHEROES (Remember the movie: Jingle All The way!)FEAR: Intrusive procedures, venipunctures, IM injections, body mutilation

Toxoplasmosis, where else you can contract this (thinking of cat litter but it aint there)Sample test Item:5. To which of the following pregnant clients will be risk for TOXOPLASMOSIS?Select all that apply:O 1 A pregnant client who eat raw meat.O 2 A pregnant client handling cat litter of infected cats.O 3 A pregnant client gardening and cultivating soil exposed to cat feces.O 4 A pregnant client with low rubella titerO 5 A pregnant client who have undergone external radiation.O 6 A pregnant client with draining, painful vesicles in the external genitalia.The correct answers: 1, 2 & 3.TOXOPLASMOSISHow do people get toxoplasmosis? A Toxoplasma infection occurs by:

Accidentally swallowing cat feces from a Toxoplasma-infected cat that is shedding the organism in its feces. This might happen if you were to accidentally touch your hands to your mouth after gardening, cleaning a cat's litter box, or touching anything that has come into contact with cat feces. Eating contaminated raw or partly cooked meat, especially pork, lamb, or venison; by touching your hands to your mouth after handling undercooked meat. Contaminating food with knives, utensils, cutting boards and other foods that have had contact with raw meat. Drinking water contaminated with Toxoplasma. Receiving an infected organ transplant or blood transfusion, though this is rare. (From the internet-Division of Parasitic Disease)Which of these statements by the nurse is incorrect if the nurse has the goal to reinforce information about cancers to a group of young adults?1. “You can reduce your risk of this serious type of stomach cancer by eating lots of fruits and vegetables, limiting all meat, and avoiding nitrate-containing foods.” 2. “Prostate cancer is the most common cancer in American men with results to threaten sexuality and life.” 3. “Colorectal cancer is the second-leading cause of cancer-related deaths in the United States.” 4. “Lung cancer is the leading cause of cancer deaths in the United States. Yet it's the most preventable of all cancers.

Need to memorize for Nclex

Tonometry: normal (10-21 mm Hg)

PR Interval: normal (0.12-0.20 seconds)

Serum Amylase: normal (25-151 units/dL)

Serum Ammonia: normal (35 to 65 mcg/dL)

Calcium: adult (8.6-10 mg/dL) child (8 to 10.5 mg/dL) term<1week (7 to 12 mg/dL)

Partial Thromboplastin Time (aPTT): normal (20-36 seconds) therapeutic 1.5-2.5

Prothrombin Time: normal (Male: 9.6-11.8 seconds) and (Female: 9.5-11.3 seconds)

Platelet Count: normal (150,000-400,000 cells/uL)

Albumin level: normal (3.4 to 5 g/dL)

Serum Osmolality: normal (285 to 295 mOsm/kg)high value indicates dehydrationSafe Suction Range: normal [Infant] 50-95 mm Hg [Child] 95-115 mm Hg [Adult]100-120 mm Hg)Serum Lithium: normal (1 to 1.5 mEq/L) acute mania (0.6 to 1.4 mEq/L) maintenance treatmentPhenytoin (Dilantin): normal serum (10 to 20 mcg/mL)Digoxin: therapeutic blood level (0.8 to 2.0 ng/ml)

Magnesium Sulfate: Therapeutic Range (4 to 8 mg/dl)

Pregnancy Temperature: normal (36.2-37.6 celcius or 98-99.6 Farenheit)

WBC’s In Pregnancy: normal (11,000 to 15,000 cells/mm3, up to 18,000 cells/mm3). Immediate postpartum period, (maybe as high as 25,000 to 30,000 cells/mm3)

Stomach Capacity: Newborn infant (10 to 20 mL) 1-week-old (30 to 60 mL) 2-3-week-old infant (75 to 100 mL) 1-month-old infant (90 to 150 mL)Left Atrial Pressure: normal (1 to 10 mm Hg)Fibrinogen Levels: normal (male: 180 to 340 mg/dL) and

(female: 190 to 420 mg/dL)

Insulin (Regular, Humulin R)Type: Fast actingOnset: ½ -1 hrPeak: 2-4 hrDuration: 6-8 hr Insulin(NPH, Humulin N)Type: Intermediate actingOnset: 2hrPeak: 6-12hrDuration 18-26hr Insulin(Ultralente, Humulin U)Type: Slow actingOnset: 4hrPeak: 8-20hrDuration: 24-36hr Insulin(Humulin 70/30)Type: CombinationOnset: ½ hrPeak: 2-12hrDuration: 24hr

Central Venous Pressure: < 3 mm Hg = inadequate fluid and >11 mm Hg = too much fluid

Potassium: 3.5-5.0 mEq/LSodium: 135-145 mEq/LCalcium: 4.5-5.2 mEq/L or 8.6-10 mg/dLMagnesium: 1.5-2.5 mEq/LChloride: 96-107 mEq/LPhosphorus: 2.7 to 4.5 mg/dL

PR measurements: normal (0.12 to 0.20 second)

QRS measurements: normal (0.04 to 0.10 second)

Ammonia: 35 to 65 ug/dLAmylase:25 to 151 IV/L

Lipase: 10 to 140 U/L

Cholesterol: 140 to 199 mg/dLLDL: <130 mg/dLHDL: 30 to 70 mg/dLTriglycerides: <200 mg/dL

Bilriubin• Direct: 0 to 0.3 mg/dL• Indirect: 0.1 to 1.0 mg/dL• Total: <1.5 mg/dL

Protein: 6.0 to 8.0 g/dL

Uric acid: Male 4.5 to 8 mg/dLFemale 2.5 to 6.3 mg/dL

Glycosylated Hemoglobin HbA1c: good control 7.5% or less

Serum creatinine: 0.6 to 1.3 mg/dL

BUN: 9-25 mg/dL

Normal CK is 26-174 U/L

Troponin I value: normal (<0.6 ng/mL)Troponin T >0.1 to 0.2 ng/mL = MI

Erythrocyte studies: 0-30 mm/hour

Serum iron: Male 65-175 ug/dLFemale 50-170 ug/dL

RBC: Male 4.5 to 6.2 M/uL

Female 4.0 to 5.5 M/uL

Theophylline levels normal (10 to 20 mcg/dl)

MOTOR DEVELOPMENT

Chin up 1 month

Chest up 2 month

Knee push and “swim” 6 month

Sits alone/stands with help 7 month

Crawls on stomach 8 month

Stands holding on furniture 10 month

Walks when led 11 month

Stands alone 14 month

Walks alone 15 month

AT THE PLAY GROUND

* Stranger anxiety: 0 -1 year* Separation anxiety: 1 - 3 years * Solitary play: 0 – 1 year* Parallel play: 2 – 3 years* Group play: 3 – 4 years

PSYCHOLOGICAL DEVELOPMENT

AGE ERIKSON FREUD PIAGETInfant0 – 1.5 Trust vs. mistrust Oral (trust & dependence sensorimotorToddler1.5 -3 Autonomy vs. shame Anal (holding vs. letting out) preoperationalPre-school 3 - 6 Initiative vs. guilt Phallic (Oedipus complex) preoperationalSchool age6 - 11 Industry vs. inferiority latency Concrete operational

11 - 20 Identity vs. role confusion genital Formal operational

20 – 25

Intimacy vs. isolation

25 – 50 Generativity vs. stagnation

50 - ? Integrity vs.despair

LABORATORY VALUES

ELECTROLYTES

Sodium (Na+): 135 – 145 meq/L (increase-dehydration; decrease overhydration)Potassium (K+): 3.5 - 5.0 meq/LMagnesium (Mg++): 1.5 – 2.5 meq/LCalcium (Ca++): 4.5 – 5.8 meq/LNeonate : 7.0 to 12 mg/dLChild: 8.0 to 10.5 mg/dLPhosphorus (PO4): 1.7 – 2.6 meq/LChloride (Cl-): 96 – 106 meq/L

COAGULATION STUDIES

Activated partial thromboplastin time(APTT): 20 – 36 seconds depending on the type of activator usedProthrombin time(PT): male: 9.6 – 11.8 secondsFemale: 9.5 – 11.3 secondsInternational Normalized Ratio(INR): 2.0 - 3.0 for standard Coumadin therapy3.0 – 4.5 for high-dose Coumadin therapyClotting time: 8 – 15 minutesPlatelet count: 150,000 to 400,000 cells/UlBleeding time: 2.5 to 8 minutes

SERUM GASTROINTESTINAL STUDIES

Albumin: 3.4 to 5 g/dLAlkaline phosphatase: 4.5 to 13 King-Armstrong units/dLAmmonia: 15 to 45 ug/dLAmylase: 50 – 180 Somogyi U/dL in adult20 – 160 Somogyi U/dL in the older adultBilirubin: direct: 0 - 0.3 mg/dLIndirect: 0.1 – 1.0 mg/dLTotal: less than 1.5 mg/dLCholesterol: 120 – 200mg/dLLipase: 31 -186 U/LLipids: 400 – 800 mg/dLTriclycerides: Normal range: 10 – 190 mg/dLBorderline high: 200 – 400 mg/dLHigh: 400 – 1000mg/dLVery high: greater than 1000mg.dLProtien: 6.0 – 8.0 g/LUric acid: male: 4.5 – 8 ng/dLFemale: 2.5 – 6.2 ng/dL

GLUCOSE STUDIES

Fasting blood sugar: 70 – 105 mg/dLGlucose monitoring (capillary Blood): 60 – 110 mg/dL

RENAL FUNCTION TEST

Creatinine: 0.6 – 1.3 mg/dLBlood urea nitrogen (BUN): 5 – 20 mg/dL

ERYTROCYTES STUDIES

Erytrocyte sedimentation rate(ESR): 0 – 30 mm/hr depending on ageHemoglobin: male: 14 – 16.5 g/dLFemale: 12 – 15 g/dLHematocrit: male: 42% - 52% (increased in hemoconcentration, fluid

loss and dehydration)Female: 35% - 47% ( decreased in fluid retention)Red blood cell (RBC): male: 4.5 to 6.2 million/uLFemale: 4 to 5.5 million/uL

White blood cell (WBC): 4500 to 11,000/uLErytrocyte Protoporthyrin (EP) : <9ug/dLPhenylalanine Level: <2 mg/dLPKU: >25 mg/dL

CRANIAL NERVES

MAJOR FUNCTIONS

I. Olfactory (S) smell

II. Optic (S) vision

III. Oculomotor (M)IV. Trochlear (M) Eye movement

V. Trigeminal (S-M) Facial sensationJaw movement

VI. Abducent (M) Eye movement

VII. Facial (S-M) TasteFacial expression

VIII. Acoustic (S) Hearing and balance

IX. Glossopharyngeal (S-M) TasteThroat sensationGag and swallow

X. Vagus (S-M) Gag and swallowParasympathetic activity

XI. Spinal Accessory (M) Neck and back muscles

XII. Hypoglossal (M) Tongue movement

On Old Olympus’ Towering Tops, A Finn And German Viewed Some HopsSome Says Marry Money, But My Brother Says Bad Business Marry Money

ARTERIAL BLOOD GAS (ABG)

pH: 7.35 – 7.45PCO2: 35 - 45 mmHgPO2: 80 - 100 mmHgHCO3: 22 - 27 mEq/LO2 saturation: 96% - 100%Acid-base “RAMS”(Respiratory Alternate, Metabolic Same)

GLASGOW COMA SCALE

Eye opening responseMotor responseVerbal response

AUTONOMIC NERVOUS SYSTEM

SYMPATHETIC/ADRENERGIC PARASYMPATHETIC/CHOLINERGIC

Heart Increased heart rateIncreased conductionIncreased force

Decreased heart rate

Bronchi dilation constriction

GI tract Reduced motility Increased motility

Rectum Allows filling Empties rectumRelaxes internal sphincter

Bladder Allows filling Empties bladderRelaxes internal sphincter

Erection Maintains erection

Ejaculation Triggers ejaculation

Pupils of eye Big (mydriasis) Small (miosis)

Salivary glands Secretion

Blood vessels Depends on receptors-a contrict-b dilates

FLOW OF BLOOD THROUGH THE HEART

Inferior vena cava and superior vena cava – right atrium – tricuspid valve – right ventricle – pulmonic valve – pulmonary artery – lungs – pulmonary veins – left atrium – bicuspid valve (mitral) – left ventricle – aortic valve aorta – systemic circulation

CARDIAC IMPULSES

Sinoatrial (SA) node – right and left atria (atria contract) – atrioventricular (AV) node – bundle his – bundle brabches – purjinje’s fibers – ventricles contract.

Blood volume: 5000mLCentral venous pressure: 4 to 10 cmH2O (increased in cardiac overload; decreased in dehydration)Pressure within the right atrium: 2 to 7 mmHgCapillary refill time: <3 secondsNormal sweat chloride: <40 mEq/LNormal pupil diameter: 3 to 5mmNormal ocular pressure: 10 to 21 mmHgNormal Pulmonary capillary wedge pressure (PCWP): 8 to 13 mmhgNormal cardiac output : 4 to 8 L/min.

THERAPEUTIC SERUM MEDICATION LEVELS

Acetaminopen (Tylenol) 10 – 20 ug/mLAmikacin (Amikin) 25 – 30 ug/mLAmitryptyline (Elavil) 120 -150 ng/mLCarbamazepine (Tegretol) 5 -12 ug/mLChloramphenicol (Chloromycetin) 10 – 20 ug/mLDesipramine (Norpramin) 150 -300 ng/mLDigotoxin ( Crystodigin) 15- 25 ng/mLDigoxin ( Lanoxin) 0.5 – 2.0 ng/mLDisopyramide (Norpase) 2 -5 ug/mLEthosuximide ( Zarontin) 40 – 100 ug/mLGentamycin (Garamycin) 5 – 10 ug/mL

Imipramide (Tofranil) 150 – 300 ug/mLLidocaine (Xylocaine) 1.5 – 5.0 ug/mLLithium (Lithobid) 0.5 -1.5 ug/mLMagnesium sulphate 4 -7 mg/dLNortriptyline (Aventyl) 50 – 150 ng/mLPhenobarbital (Luminal) 10 – 30 ug/mLPhenytoin (Dilantin) 10 -20 ug/mLPrimidone (Myoline) 5 – 20 ug/mL Procainamide (Pronestryl) 4 – 10 ug/mLPropranolol (Inderal) 50 – 100 ng/mLQuinidine (Quinalaglute, Cardioquin) 2 – 5ug/mLSalisylate 100 -250 ug/mLTheophylline (Aminiphylline, Theo-Dur) 10 -20 ug/mLTobramycin (Nebcin ) 5 -10 ug/mLValproic acid (depakene) 50 -100 ug/mL

Pulmonary capillary wedge pressure: 5 to 13 mmHgPulmonary artery pressure: systolic: 16 to 30 mmHgDiastolic: 0 to 7 mmHgSpinal pressure: 70 to 200mmH2OMorphine sulphate pediatric dose: 0.1mg/kg every 3 – 4 hour

SULFONYLUREASFor treatment of NIDDM Sulfonylureas should not be given to patients with liver or kidney failure. Accummulation of drug will increase risk of hypoglycaemia.

DURATION

tolbutamide 8 h

Glycburide, glipizide 20 h, most potent

chlorpropamide 48 h

Apothecary and Household System

Grain –gr 1 gr = 60 mgDram – dr 5 gr = 300 mgOunce –oz 15 gr = 1000mg or 1gMinim – min, M, m 1/150 gr =0.4 mgQuart – qt 1 oz = 30 mLPint – pt 1 dr = 4 mLDrop – gtt 1 T = 15 mL or 3 tspTablespoon – T or tbs 1 min = 1 gttTeaspoon – t or tsp 15 min = 1mLPound – lb 60 min = 1 dr8 dr = 1 oz1 qt = 1000mL or 1L1 qt = 2 pt or 32 oz1 pt = 16 oz16 oz = 1 lb2.2lb = 1 kg

Fahrenheit to Celcius (F – 32) divide 1.8 = C

Celcius to Fahrenheit 1.8 C + 32 = F

Formula for Calculating a Medication Dosage

D (desired ) = the dosage that the physician orderedA (available) =the dosage strength as stated on the medication labelQ (quantity ) = the volume that the dosage strength is available in, such as tablet, capsules, or mL

D X Q = X

A

Formulas for Intravenous Calculations

Flow Rates:Total volume x gtt factor = gtt per minTime in minutes

Infusion Time:Total volume to infuse = Infusion timemL per hour being infused

IMMUNIZATION

Birth Hepatitis B1 months Hepatitis B2 months OPV, DPT, HIB4 months DPT, HIB, OPV6 months DPT, HIB, hepatitis B12 months HIB, OPV15 months MMR18 months DPT12 – 18 months Varicella vaccine4 -6 years DPT, OPV, MMR11 – 12 years MMR ( if not administered at 4 -6 years)11 – 16 TD booster

SPINAL CORD INJURYCervical Injury: C2 to C3 injury usually fatal C4 is the major innervation to the diaphragm by th phrenic nerve Involvement above th C4 causes respiratory difficulty and paralysis of all the four extremities C5 or below client may have movement in the shoulder

Thoracic Level Injury: loss of movement of the chest, trunk, bowel, bladder, and legs, depending on the level of injury Leg paralysis (paraplegia) Autonomic dysreflexia with lesions above T6 and in cervical lesions Visceral distention from a distended bladder or impacted rectum may cause reactions such as sweating, bradycardia, hypertension, nasal stuffiness, and gooseflesh

Lumbar and Sacral Level Injuries: loss of movement and sensation of the lower extremities. S2 and S3 center on micturation; therefore below this level, the bladder will contract but not empty (neurogenic bladder) Injury above S2 in males allows them to have an erection, but they are unable to ejaculate because of sympathetic nerve damage. Injury between S2 and S4 damages the sympathetic and parasympathetic response, preventing erection and ejaculation.

RULE OF NINE

Head and neck 9%Anterior trunk 18%Posterior trunk 18%Arms (9%) 18%Legs (18%) 36%Perineum 1%

NORMAL ADULT WHITE BLOOD CELL DIFFERENTIAL

Neutrophils 56% or 18000 – 7800/uLBands 3% or 0 – 700/uL

Eosinophils 2.7% or 0 – 450/uLBasophils 0.3% or 0 – 200/uLLymphocytes 34% or 1000 – 4800/uLMonocytes 4% or 0 – 800/uL

THYROID STUDIESThyroid –stimulating hormone (thyrotropin; THS): 0.2 to 5.4 ug/dLThyroxine (T4): 5.0 to 12.0 ug/dLThyroxine free (FT3) : 0.8 to 2.4 ng/dLTriiodothyronine (T3): 80 to 230 ng/dL

Normal Fribrinogen level: for men: 180 to 340mg/dLWomen: 190 to 420mg/dLFribrinogen is used up in the clotting process.

Erythrocyte Protoporhyrin (EP): < 9ug/dLPhenylalanine level: < 2mg/dLPKU: >25 mg/dLUrine specific gravity: 1.016 - 1.022 increase in SIADH; decrease in diabetes insipidus Normal CSF protein: 15 – 45 mg/dL increase in Guillain-Barre syndromeNormal CSF pressure: 5 – 15 mmHgNormal serum osmolality: 285 – 295 mOsmlkgH2O increase in dehydration;Decrease in over hydrationNormal scalp pH: 7.26 and aboveBorderline acidosis: 7.20 to 7.25Acidosis: < 7.15

HERBAL MEDICINE

Aloe vera Gel – abrasionsand dermatologic conditionsAmerican Ginseng (Panax quinquefolius) – boost energy, relieve stress, improve concentration and enhance physical or cognitive performance.Ashwagandha (Withania somnifera) – stress arthritisAsian gingseng (Panax ginseng) – enhance health and combat stress and diseaseBilberry (Vaccinium myrtillus) – vision and peripheral vascular disorders and as antioxidantBlack Cohosh (Cimicifuga racemosa) – menopausalBlack Currant and Borage oil (Ribes nigrum and Borago offinalis) – anti-inflammatory, rheumatoid arthritisCapsicum Peppers (Capsicum spp.) – arthritis, neuralgia and other painful treatmentChamomile (Matricaria recutita) “manzanilla”- skin inflammation, colic, or dyspepsia and anxietyChaste tree (Vitex agnus-castus) – menstrual related disorders, PMS, cyclical mastalgiaChodroitin – osteoarthritisCoenzyme Q10 – antioxidantColtsfoot ( Tussilago farfara ) – cough and other respiratory disodersCranberry (Vaccinium macrocarpon) – UTIDevil’s Claw ( Harpagophytum procumbers) – anti inflammatory and analgesicEchinacea (Echinacea spp.) – acute viral URI symptomsEderberry (Sanbacus nigra) – respiratory tract infectionEphedra or Ma Huang (Ephedra sinica) Source of ephedrine and pseudoephedrineEvening Primrose Oil (Oenothera biennis) – eczema, breast pain associated with PMS and inflammatory conditionFenugreek (Trigonella foenum-graecum) – lowering blood glucoseFeverfew ( Tanacetum parthenium) – migraine headache prophylaxisGarlic (Allium sativaum)- help prevent cardiovascular disease and cancerGinger (Zingiber officinale) –nausea and motion sickness, anti-inflammatoryGinkgo (Ginkgo biloba) – dementia and intermittent claudication, memory enhancement and treatment of vertigo nad tinnitusGlucosamine – osteoarthritisGoldenseal ( Hydrastis Canadensis) – tonic and antibioticGotu Kola (Centella asiatica) – mental support, wound healing and

venous disordersHawtorn ( Crategus species) – CHF and related cardiovascular conditionsHorebound (Marribium vulgare) – primary cough suppression and expectorationHorse Chestnut Seed (Aesculus hippocastanum) chronic venous insufficiencyIvy (Hedera helix) – coughs, rheumatic disordes and skin diseaseKava ( piper methysticum) – mild psychoactive and antianxiety propertyLemon Balm (Melissa officinalis) – sedative and for dyspepsiaLicorice (Glycyrrhiza glabra) – respiratory disorders, hepatitis, inflammatory diseases, and infectionsMelatonin – insomia, jet lagMilk Thistle – hepatitis, liver deseaseMints (Mentha species) – minor calcium channel antagonists, used for upper respiratory problems, irritable bowel syndrome, dyspepsia, and colonic spasm and as a topical counterirritantNettle (Urtica dioica) – arthritis pains, allergies, BPH, or as diureticPapaya (Carica papaya) – digestive aid, dyspepsia, and for inflammatory, topically applied to woundsPassion flower (Passiflora incarnata)- sedative-hypnotic or anxiolytic herbPokeroot (Phytolacca Americana) – inflammatory conditions also as an emetic/catharticPygeum (Pygeum africanum) – mild symptoms of BPHRed Clover (Trifolium pratense) – used as a natural estrogen substitute for women’s healthSt. John’s Wort (Hypericum perforatum) – antidepressant effectTea Tree Oil (Melaleuca alternifolia) – antifungal and antibacterialTurmeric (Curuma longa ) – anti-inflammatory, anti-arthritis, anti cancer, and antioxidantUva Ursi (Arctostaphylos uva ursi) – urinary antiseptic and diureticYohimbe – erectile dysfunction

FOUR STRATEGIES:1. If the question asks what you should do in the situation. Use the nursing process to determine which step in the nursing process would be next?2. If the question asks what the client needs. Use maslow’s hierarchy to determine which need to address.3. If the question indicates that the client doesn’t have urgent physiologic need, focus on the patient safety.4. If the question involves communicating with a patient. Use principles of therapeutic communication.

REMEMBER:AIRWAY, BREATHING,CIRCULATION AND SAFETY (ABCS)

The nurse in primary care clinic is caring for a 50-year-old woman. History reveals that she had experienced on and off chest pain. After series of cardiac tests (EKG & Blood Chem), the doctor orders for THALLIUM STRESS TEST. Which of the following medications should the RN prepare if the patient needs an alternative exercise in thallium test? 1.Nitroglycerin2.Morphine3.Aminophylline4.Persantin The correct answer is #4. Persantin (dipyridamole)Persantin is use as an alternative to exercise in thallium myocardial perfusion imaging for the evaluation of CAD in those who cannot exercise adequately. Purpose: to determine myocardial wall viabilityOther names:1. Cardiac pooling2. MUGA-multigated radionuclide angiographic scanning3. nurclear scan4. sestamibi test5. thallium scan6. dipyridamole or persantin stress test7. In short, heart scan :) Loving NCLEX-RNURC 09178364589

Posted by Anaski from IP 203.131.183.186 on August 23, 2005 at 21:44:00: For Future USRN's:Cervical CancerEtiology:* Early age of sexual intercourse* Multiple sexual partners* Sexually Transmitted Disease (Venereal Wart)* Virus - HPV Cancer Carcinoma in SITU - only in epithelial liningsSitu sounds like Ziru - Stage 0 Tumor marker - CEASigns and Symptoms (3 P's)POST COITAL BLEEDING

PAINFUL INTERCOURSEPROFUSE (PERIOD IRREGULARITIEs - menorrhagia and metrorrhagia)

Management:

U - pera (Surgery HYSTERECTOMY)R - radiation (intracavitary cessium - remember STD - shielding, timing and distance))C - chemotherapy to destroy the DNA,RNA & CHON synthesis.

Psychiatric Drugs

ANTI PARKINSON'S

C- cogentinA- artaneP- parlodelA- akinetonB- benadrylL- larodopaE- EldeprylS- symmetril

Increase protein and give B6AkathisiaDystoniaTardive DysinesiaNeuroleptic Malignant Syndrome

ANTI-ANXIETY

V-valiumL-libriumA-ativanS-seraxT-tranxene

M-miltownE- equanilV-vistarilA-taxeneI-InderalB-buspar

Tolerance develop until seven days

A- void abrupt discontinuation after prolonged useN- Not give if BP is up, hepatic/renal dysfunction or history of drug abuseX-xanax, ativan, serax is also an anti-anxiety medsI-increase in 3D's- drowsiness, dizziness, decreased BPEnhances action of GABAT-teach client to rise slowly from supine positionY-es alcohol should also be avoided.

MAOI Drugs

M-marplanN-nardilP-parnate

Hypertensive crisis within several hours of ingestion of tyramine containing foodsTyramine foods:aged cheese, beer, ale, red wine, pickled foods, smoked or pickled fish, beef or chopped liver, avocado of figs.

ANTI-DEPRSSION

A- asendinN-norpraminT- tofranil

S-sinequanA-anafranil- aventylV-vivactilE-ElavilP-paxilZ-zoloft

D-riving is contraindicatedE-ffect has a delayed onset of 7-21 daysP-regnancy consult with your physicianR-elieves symptoms but never cureE- valuate vital signS-toppind drug abruptly is Out!S-afety measuresI-nstruct to report undesirable side effectO-bserve for suicidal tendenciesN-o alcohol or CNS depressants

ANTI-MANIC DRUGS

Lithium- Eskalith

Increase risk of toxicity when given with: thiazide diuretics, methyldopa, and NSAIDsDecrease lithium levels with excess sodium and antacids.Increase CNS toxicity with Haloperidol

0.6-1.2 -meq/l Therapeutic Effect> 1.5 meq/l Toxic2.0 meq/l lethal

L- evel - therapeutic 0.6-1.2 meq/lI-ncreased UrinationT-hirst IncreasedH-eadaches and TremorsI-ncreased fluidsU-nsteadyM-orton's Salt -adequate intake

Hepatotoxic Drugs ( liver)

* ACE inhibitors* acetaminophen* alcohol* iron overdose* erythromycins* estrogens* fluconazole (Difulcan)* isoanazid (INH)* itraconazole (Sporanox)* phenothiazines* phenytoin (Dilantin)* rifampin (Rifadin)* sulfonamids

Drugs That Can Cause Nephrotoxicity

acetaminophen (high doses, acute)

* acyclovir; parenteral (zovirax)* aminoglycocides* amphotericin B* ciprofloxacin* cisplatin (platinol)* methotrexate (high doses)* nonsteriodal anti-inflamatory drugs (NSAIDS)* rifampicin* sulfonamides* tetracyclines ( exceptions are doxycycline and minocycline)* vancomycin

Basic Nursing Abbreviations

A /G = albumin/globulin ratio ABG = arterial blood gases AC = before eatingACE = angiotensin converting enzymeACL = anterior cruciate ligamentACLS = advanced cardiac life support ACTH = adrenocorticotropic hormone ad lib = as much as needed ADH = anti-diuretic hormone ADL = activities of daily living AFB = acid-fast bacilli AFP = alpha-fetoproteinAGA = appropriate for gestational ageAI = aortic insufficiencyAIDS = acquired immune deficiency syndrome AKA = above knee amputationALD = alcoholic liver diseaseALL = acute lymphocytic leukemia ALP = alkaline phosphatase ALT = alanine transaminase, alanine aminotransferaseATN = acute tubular necrosisAU = both earsAV = atrioventricular B.S. = Bachelor of Science B/K = below kneeBM = bowel movement or breast milkBX = biopsy c = withC/O = complaining of CA = calcium, cancer, carcinomaCAA = crystalline amino acidsCABG = coronary artery bypass graftCAD = coronary artery diseaseCAPD = continuous ambulatory peritoneal dialysisCAT = computerized axial tomography CBC = complete blood count CBD = common bile ductCBG = capillary blood gas CBI = continuous bladder irrigationCBS = capillary blood sugar CC = chief complaint CCK = cholecystokininCCPD = continuous cyclic peritoneal dialysis CCU = clean catch urine or cardiac care unit CCV = critical closing volume CF = cystic fibrosisCHF = congestive heart failure CHO = carbohydrateCI = cardiac indexCLT = Clinical Laboratory Technician CML = chronic myelogenous leukemiaCN = cranial nerves CNS = central nervous system CO = cardiac output COPD = chronic obstructive pulmonary diseaseCP = chest pain, cleft palateCPD = cephalo-pelvic disproportionCPK = creatinine phosphokinaseCPP = cerebral perfusion pressureCPR = cardiopulmonary resuscitationCRCL = creatinine clearance CRF = chronic renal failure

CRT = capillary refill time CSF = cerebrospinal fluid CT = computerized tomography CVA = cerebral vascular accident, costovertebral angle CVP = central venous pressureD5W = 5% dextrose in water DAT = diet as tolerated DC = (dc) discontinueDIC = disseminated intravascular coagulopathy DKA = diabetic ketoacidosis DM = diabetes mellitus DNA = deoxyribonucleic acid DNR = do not resuscitateDOA = dead on arrival DOE = dyspnea on exertion DPT = diphtheria, pertussis, tetanus DTR = deep tendon reflexes DVT = deep venous thrombosis DX = diagnosis EAA = essential amino acids EBL = estimated blood lossEBV = Epstein-Barr Virus ECF = extracellular fluid, extended care facility ECG = electrocardiogramECT = electroconvulsive therapy EENT = eye, ear, nose and throatEFAD = essential fatty acid deficiencyEMG = electromyogramEMV = eyes, motor, verbal response (Glasgow coma scale)ENT = ears, nose, and throatEOM = extraocular muscles ESR = erythrocyte sedimentation rateESRD = end stage renal disease ET = endotracheal tubeETT = endotracheal tubeEUA = examination under anesthesia FBS = fasting blood sugar FDA = Food & Drug AdministrationFEV = forced expiratory volumeFFP = fresh frozen plasma FNP = Family Nurse PractitionerGB = gallbladder GC = gonorrheaGERD = gastroesophageal reflux disease GFR = glomerular filtration rate GI = gastrointestinalGSW = gun shot wound GTT = glucose tolerance testGU = genitourinaryHB = hemoglobinHBP = high blood pressure HCG = human chorionic gonadotropin HCO3 = bicarbonate HCT = hematocritHD = hemodialysisHDL = high density lipoprotein HEENT = head, eyes, ears, nose, throat

Caring for the Patient on a Ventilator

The nurse must be able to do the following:

1. Identify the indications for mechanical ventilation.2. List the steps in preparing a patient for intubation.3. Determine the FIO2, tidal volume, rate and mode of ventilation on a givenventilator.4. Describe the various modes of ventilation and their implications.5. Describe at least two complications associated with patient’s response to mechanical ventilation and their signs and symptoms.6. Describe the causes and nursing measures taken when trouble-shooting ventilator alarms.7. Describe preventative measures aimed at preventing selected other complications related to endotracheal intubation.8. Give rationale for selected nursing interventions in the plan of care for the ventilated patient.

9. Complete the care of the ventilated patient checklist.10. Complete the suctioning checklist.

1. To review indications for and basic modes of mechanical ventilation, possible complications that can occur, and nursing observations and procedures to detect and/or prevent such complications.2. To provide a systematic nursing assessment procedure to ensure early detection of complications associated with mechanical ventilation.

Indication for Intubation1. Acute respiratory failure evidenced by the lungs inability to maintain arterial oxygenation or eliminate carbon dioxide leading to tissue hypoxia in spite of low-flow or high-flow oxygen delivery devices. (Impaired gas exchange, airway obstruction or ventilation-perfusion abnormalities).2. In a patient with previously normal ABGs, the ABG results will be as follows:PaO2 > 50 mm Hg with pH < 7.25PaO2 < 50 mm Hg on 60% FIO2 : restlessness, dyspnea, confusion, anxiety, tachypnea, tachycardia, and diaphoresisPaCO2 > 50 mm Hg : hypertension, irritability, somnolence (late), cyanosis (late), and LOC (late)3. Neuromuscular or neurogenic loss of respiratory regulation. (Impaired ventilation)4. Usual reasons for intubation: Airway maintenance, Secretion control, Oxygenation and Ventilation.

Types of intubation: Orotracheal, Nasotracheal, TracheostomyPreparing for Intubation1. Recognize the need for intubation.2. Notify physician and respiratory therapist. Ensure consent obtained if not emergency.3. Gather all necessary equipment:a. Suction canister with regulator and connecting tubingb. Sterile 14 Fr. suction catheter or closed in-line suction catheterc. Sterile glovesd. Normal salinee. Yankuer suction-tip catheter and nasogastric tubef. Intubation equipment: Manual resuscitator bag (MRB), Laryngoscope and blade, Wire guide, Water soluble lubricant, Cetacaine sprayg. Endotracheal attachment device (E-tad) or tapeh. Get order for initial ventilator settingsi. Sedation prnj. Soft wrist restraints prnk. Call for chest x-ray to confirm position of endotracheal tubel. Provide emotional support as needed/ ensure family notified of change in condition.

Intubation

Types of VentilatorsVentilator SettingsModes of Mechanical VentilationComplications of Mechanical Ventilation1. Associated with patient’s response to mechanical ventilation:

A. Decreased Cardiac Output1. Cause - venous return to the right atrium impeded by the dramatically increased intrathoracic pressures during inspiration from positive pressure ventilation. Also reduced sympatho-adrenal stimulation leading to a decrease in peripheral vascular resistance and reduced blood pressure.2. Symptoms – increased heart rate, decreased blood pressure and perfusion to vital organs, decreased CVP, and cool clammy skin.3. Treatment – aimed at increasing preload (e.g. fluid administration) and decreasing the airway pressures exerted during mechanical ventilation by decreasing inspiratory flow rates and TV, or using other methods to decrease airway pressures (e.g. different modes of ventilation).

B. Barotrauma1. Cause – damage to pulmonary system due to alveolar rupture from excessive airway pressures and/or overdistention of alveoli.2. Symptoms – may result in pneumothorax, pneumomediastinum, pneumoperitoneum, or subcutaneous emphysema.

3. Treatment - aimed at reducing TV, cautious use of PEEP, and avoidance of high airway pressures resulting in development of auto-PEEP in high risk patients (patients with obstructive lung diseases (asthma, bronchospasm), unevenly distributed lung diseases (lobar pneumonia), or hyperinflated lungs (emphysema).

C. Nosocomial Pneumonia1. Cause – invasive device in critically ill patients becomes colonized with pathological bacteria within 24 hours in almost all patients. 20-60% of these, develop nosocomial pneumonia.2. Treatment – aimed at prevention by the following:Avoid cross-contamination by frequent handwashingDecrease risk of aspiration (cuff occlusion of trachea, positioning, use of small-bore NG tubes)Suction only when clinically indicated, using sterile techniqueMaintain closed system setup on ventilator circuitry and avoid pooling of condensation in the tubingEnsure adequate nutritionAvoid neutralization of gastric contents with antacids and H2 blockers

D. Positive Water Balance1. Syndrome of Inappropriate Antidiuretic Hormone (SIADH) – due to vagal stretch receptors in right atrium sensing a decrease in venous return and see it as hypovolemia, leading to a release of ADH from the posterior pituitary gland and retention of sodium and water. Treatment is aimed at decreasing fluid intake.2. Decrease of normal insensible water loss due to closed ventilator circuit preventing water loss from lungs. This fluid overload evidenced by decreased urine specific gravity, dilutional hyponatremia, increased heart rate and BP.

E. Decreased Renal Perfusion – can be treated with low dose dopamine therapy.

F. Increased Intracranial Pressure (ICP) – reduce PEEP

G. Hepatic congestion – reduce PEEP

H. Worsening of intracardiac shunts –reduce PEEP

2. Associated with ventilator malfunction:A. Alarms turned off or nonfunctional – may lead to apnea and respiratory arrestTroubleshooting Ventilator AlarmsLow exhaled volume: Cuff leak, Tubing disconnect, Patient disconnectedEvaluate cuff; reinflate prn; if ruptured, tube will need to be replaced. Evaluate connections; tighten or replace as needed; check ETT placement, Reconnect to ventilatorHigh pressure: Secretions in airway, Patient biting tubing, Tube kinked, Cuff herniation, Increased airway resistance/decreased lung compliance (caused by bronchospasm, right mainstem bronchus intubation, pneumothorax, pneumonia), Patient coughing and/or fighting the ventilator; anxiety; fear; pain.Suction patient, Insert bite block, Reposition patient’s head/neck; check all tubing lengths, Deflate and reinflate cuff, Auscultate breath sounds, Evaluate compliance and tube position; stabilize tube, Explain all procedures to patient in calm, reassuring manner, Sedate/medicate as necessarLow oxygen pressure: Oxygen malfunctionDisconnect patient from ventilator; manually bag with ambu; call R.T

3. Other complications related to endotracheal intubation.A. Sinusitis and nasal injury – obstruction of paranasal sinus drainage; pressure necrosis of nares1. Prevention: avoid nasal intubations; cushion nares from tube and tape/ties.2. Treatment: remove all tubes from nasal passages; administer antibiotics.B. Tracheoesophageal fistula – pressure necrosis of posterior tracheal wall resulting from overinflated cuff and rigid nasogastric tube1. Prevention: inflate cuff with minimal amount of air necessary; monitor cuff pressures q. 8 h.2. Treatment: position cuff of tube distal to fistula; place gastrostomy tube for enteral feedings; place esophageal tube for secretion clearance proximal to fistula.C. Mucosal lesions – pressure at tube and mucosal interface

1. Prevention: Inflate cuff with minimal amount of air necessary; monitor cuff pressure q. 8 h.; use appropriate size tube.2. Treatment: may resolve spontaneously; perform surgical interventions.D. Laryngeal or tracheal stenosis – injury to area from end of tube or cuff, resulting in scar tissue formation and narrowing of airway1. Prevention: inflate cuff with minimal amount of air necessary; monitor cuff pressure q. 8.h.; suction area above cuff frequently.2. Treatment: perform tracheostomy; place laryngeal stint; perform surgical repair.E. Cricoid abcess – mucosal injury with bacterial invasion1. Prevention: inflate cuff with minimal amount of air necessary; monitor cuff pressure q. 8 h.; suction area above cuff frequently.2. Treatment: perform incision and drainage of area; administer antibiotics.4. Other common potential problems related to mechanical ventilation:Aspiration, GI bleeding, Inappropriate ventilation (respiratory acidosis or alkalosis, Thick secretions, Patient discomfort due to pulling or jarring of ETT or tracheostomy, High PaO2, Low PaO2, Anxiety and fear, Dysrhythmias or vagal reactions during or after suctioning, Incorrect PEEP setting, Inability to tolerate ventilator mode.

PLAN OF CARE FOR THE VENTILATED PATIENTPatient Goals:Patient will have effective breathing pattern.Patient will have adequate gas exchange.Patient’s nutritional status will be maintained to meet body needs.Patient will not develop a pulmonary infection.Patient will not develop problems related to immobility.Patient and/or family will indicate understanding of the purpose for mechanical ventilation.

Nursing DiagnosisNursing InterventionsRationaleIneffective breathing pattern r/t ____________________________.Observe changes in respiratory rate and depth; observe for SOB and use of accessory muscles.An increase in the work of breathing will add to fatigue; may indicate patient fighting ventilator..Observe for tube misplacement- note and post cm. Marking at lip/teeth/nares after x-ray confirmation and q. 2 h.Indicates correct position to provide adequate ventilation..Prevent accidental extubation by taping tube securely, checking q.2h.; restraining/sedating as needed.Avoid trauma from accidental extubation, prevent inadequate ventilation and potential respiratory arrest..Inspect thorax for symmetry of movement.Determines adequacy of breathing pattern; asymmetry may indicate hemothorax or pneumothorax..Measure tidal volume and vital capacity.Indicates volume of air moving in and out of lungs..Asses for painPain may prevent patient from coughing and deep breathing..Monitor chest x-raysShows extent and location of fluid or infiltrates in lungs..Maintain ventilator settings as ordered.Ventilator provides adequate ventilator pattern for the patient..Elevate head of bed 60-90 degrees.This position moves the abdominal contents away from the diaphragm, which facilitates its contraction.

Impaired gas exchange r/t alveolar-capillary membrane changesMonitor ABG’s.Determines acid-base balance and need for oxygen..Assess LOC, listlessness, and irritability.These signs may indicate hypoxia..

Observe skin color and capillary refill.Determine adequacy of blood flow needed to carry oxygen to tissues..Monitor CBC.Indicates the oxygen carrying capacity available..Administer oxygen as ordered.Decreases work of breathing and supplies supplemental oxygen..Observe for tube obstruction; suction prn; ensure adequate humidification.May result in inadequate ventilation or mucous plug..Reposition patient q. 1-2 h.Repositioning helps all lobes of the lung to be adequately perfused and ventilated.Potential altered nutritional status: less than body requirements r/t NPO statusMonitor lymphocytes and albumin.Indicates adequate visceral protein..Provide nutrition as ordered, e.g. TPN, lipids or enteral feedings.Calories, minerals, vitamins, and protein are needed for energy and tissue repair..Obtain nutrition consult.Provides guidance and continued surveillance.Potential for pulmonary infection r/t compromised tissue integrity.Secure airway and support ventialtor tubing.Prevent mucosal damage..Provide good oral care q. 4 h.; suction when need indicated using sterile technique; handwashing with antimicrobial for 30 seconds before and after patient contact; do not empty condensation in tubing back into cascade.Measures aimed at prevention of nosocomial infections..Use disposable saline irrigation units to rinse in-line suction; ensure ventilator tubing changed q. 7 days, in-line suction changed q. 24 h.; ambu bags changes between patients and whenever become soiled.IAW Infection Control Policy and Respiratory Therapy Standards of Care for CCNS.Potential for complications r/t immobility.Assess for psychosocial alterations.Dependency on ventilator with increased anxiety when weaning; decreased ability to communicate; social isolation/alteration in family dynamics..Assess for GI problems. Preventative measures include relieving anxiety, antacids or H2 receptor antagonist therapy, adequate sleep cycles, adequate communication system.Most serious is stress ulcer. May develop constipation..Observe skin integrity for pressure ulcers; preventative measures include turning patient at least q. 2 h.; keep HOB < 30 degrees with a 30 degree side-lying position; use pressure relief mattress or turning bed if indicated; follow prevention of pressure ulcers plan of care; maintain nutritional needs.Patient is at high risk for developing pressure ulcers due to immobility and decreased tissue perfusion..Maintain muscle strength with active/active-assistive/passive ROM and prevent contractures with use of span-aids or splints.Patient is at risk for developing contractures due to immobility, use of paralytics and ventilator related deficiencies.Knowledge deficit r/t intubation and mechanical ventilationExplain purpose/mode/and all treatments; encourage patient to relax and breath with the ventilator; explain alarms; teach importance of deep breathing; provide alternate method of communication; keep call bell within reach; keep informed of results of studies/progress; demonstrate confidence.Reduce anxiety, gain cooperation and participation in plan of care.

Common Syndromes

DOWN SYNDROME:

Trisomy 21. Mental retardation, characteristic facial features, Simeon crease in hand.

MARFAN SYNDROME: Connective Tissue disorder * Arachnodactyly: Abnormally long digits and extremities * Subluxation of lens * Dissecting aortic aneurism

SUDDEN INFANT DEATH SYNDROME: Unexplained death in sleeping infants.

TURNER'S SYNDROME: XO monosomy. * Dwarfism * Webbed neck * Valgus of elbow. * Amenorrhea

WILSON SYNDROME: Congenital defect in Ceruloplasmin, leading to buildup of copper mental retardation, cirrhosis, hepatolenticular degeneration.

AMENNORRHEA-GALACTORRHEA SYNDROME: Non-physiologic lactation, resulting from endocrinologic causes or from a pituitary disorder.

CUSHING'S SYNDROME: Hypersecretion of cortisol secondary symptoms and characteristics: * Fatness of face and trunk with wasting of extremities * Buffalo hump * Bone decalacification * Corticoid diabetes * Hypertension

PREMENSTRUAL SYNDROME: Abnormal sensation in breasts, abdominal pain, thirst, headache, pelvic congestion, nervous irritability.

Ocassionally nausea and vomiting.

GUILLAN-BARRE SYNDROME: Infectious Polyneuritis of unknown cause.

REYE'S SYNDROME: Loss of consciousness and seizures in kids, after a viral infection treated by aspirin.

REITER'S SYNDROME: Symptom cluster. Etiology is thought to be Chlamydial or post-chlamydial. Urethritis Iridocyclitis (Conjunctivitis) Arthritis Skin lesions like karatoderma blenorrhagicum Also can see fatty liver or liver necrosis.

STEVENS-JOHNSON SYNDROME: Erythema Multiforme complication. Large areas of skin slough, including mouth and anogenital membranes. Mucous membranes: stomatitis, urethritis, conjunctivitis. Headache, fever, malaise.

TOXIC SHOCK SYNDROME: Caused by superabsorbent tampons. Infection with Staph Aureus and subsequent toxicity of exotoxin TSST systemic anaphylaxis. * Fever, vomiting, diarrhea * Red rash followed by desquamation

CARPAL-TUNNEL SYNDROME: Compression of Median Nerve through the Carpal Tunnel - pain and parasthesia over distribution of Median N.

HORNER'S SYNDROME: Loss or lesion of cervical sympathetic ganglion -* Ptosis, miosis, anhydrosis * Enophthalmos (caved in eyes)

KORSAKOFF SYNDROME: Loss of short-term memory in chronic alcoholism, caused by degeneration of mamillary bodies.

MALABSORPTION SYNDROME: Impaired absorption of dietary substance - diarrhea, weakness, weight loss, or symptoms from specific deficiencies.

RESTLESS LEGS SYNDROME: Need to stretch legs at night before going to sleep; twitch in legs causing insomnia.

Herbal Plants

1) ALOE VERA Aloe vera syn. A. barbadensis (Liliaceae)The clear gel found inside the plant's leaf contains aloin, are both used for medicinal and cosmetic purposes. It is a effective healer of wounds and burns, speeding up the rate of healing and reducing the risk of infection. The brownish part containing aloin is a strong laxative, useful for short-term constipation. Aloe is present in many cosmetic's formulae because its emollient and scar preventing properties.

MAIN PROPERTIES: Heals wounds, emollient, laxative.

2) ANGELICA Angelica arcangelica (Umbelliferae)Angelica has been used to reduce muscular spasms in asthma and bronchitis. It has also been shown to ease rheumatic inflammation, to regulate menstrual flow and as an appetite stimulant. The stems are candied for culinary use.

MAIN PROPERTIES: Antispasmodic, promotes menstrual flow.

3) ANISEPimpinella anisum (Umbelliferae)It has been used as a flavoring spice in recipes and as a diuretic, to treat digestive problems and to relieve toothache. Anise seeds are known for their ability to reduce flatulence and colic, to settle the digestion, to relieve colic, and to ease nausea and indigestion. It also has an expectorant and antispasmodics action that is helpful in countering period pain, asthma, whooping cough and bronchitis. The mild hormonal action of anise seeds may explain its ability to increase breast-milk production and its reputation for easing childbirth and treating impotence and frigidity. Anise essential oil is used externally to treat lice and scabies.

MAIN PROPERTIES: Reduces colic and flatulence, promotes digestion, antispasmodic

4) ARNICAArnica montana (Compositae)Arnica improves the local blood supply and accelerates healing. It is anti-inflammatory and increases the rate of re-absorption of internal bleeding. The internal use of arnica is restricted to homeopathic dosages as it is potentially toxic.

MAIN PROPERTIES: Anti-inflammatory, germicide, muscular soreness, pain reliever.

5) ARROWROOTMaranta arundinacea (Marantaceae)Its root is used as a poultice for smallpox sores, and as an infusion for urinary infections. It helps to relieve acidity, indigestion and colic, and

is mildly laxative. It may be applied as an ointment or poultice mixed with some other antiseptic herbs such as comfrey.

MAIN PROPERTIES: Anti-inflammatory, digestive, antiseptic.

6) ARTEMISIA, WORMWOODArtemisia absinthium (Compositae)Wormwood has a marked tonic effect on the stomach, the gallbladder and in adjusting weak digestive problems. It is used to expel roundworms and threadworms. By improving the functions of the digestive system it helps in many conditions, including anaemia. It is also a muscle relaxant occasionally used to treat rheumatism. The leaves of wormwood have antiseptic properties which may derive from the azulenes that the plant contains.

MAIN PROPERTIES: Bitter, carminative, muscle relaxant, antiseptic.

7) BASIL, HOLY BASIL Ocimum sanctum (Labiatae)The herb has very important medicinal properties - notably its ability to reduce blood sugar levels. It also prevents peptic ulcers and other stress related conditions like hypertension, colitis and asthma. Basil is also used to treat cold and reduce fever, congestion and joint pain. Due to its anti-bacterial and fungicide action, basil leaves are used on itching skin, insect biting and skin affections.

MAIN PROPERTIES: Lowers blood sugar levels, antispasmodic, analgesic, lowers blood pressure, reduces fever, fungicidal, anti-inflammatory.

8) BELLADONA, DEADLY NITIGHTSHADE Atropa belladonna (Solanaceae)Herba bella dona, or "herb of the beautiful lady" is known for its poisonous effects (belladonna increases heartbeat and can lead to death), like many other plants it is an important and beneficial remedy when used correctly. Belladonna contains atropine used in conventional medicine to dilate the pupils for eye examinations and as an anesthetic. In herbal medicine, deadly nightshade is mainly prescribed to relieve intestinal colic, to treat peptic ulcers and to relax distended organs, especially the stomach and intestine. Deadly nightshade is also used as an anaesthetic in conventional medicine.

MAIN PROPERTIES: Smooth muscle, antispasmodic, narcotic, reduces sweating, sedative.

9) BENZOIN GUM Styrax benzoin (Styraceae)Its trunk exudes a gum well known for its strong astringent and antiseptic action. For this reason it is used externally to fight tissue inflammation and disinfection of wounds. When taken internally, benzoin gum acts to settle griping pain, to stimulate coughing, and to disinfect the urinary tract. Benzoin gum is widely used in cosmetics as an antioxidant in oils, as a fixative in perfumes and as an additive to soaps. When steam inhaled, it helps healing sore throats, head and chest colds, asthma and bronchitis.

MAIN PROPERTIES: Antiseptic, astringent, anti-inflammatory.

10) BERGAMOT Citrus bergamia syn. C. aurantium var. bergamia (Rutaceae)Bergamot oil, expressed from the peel, assists in avoiding infectious diseases. In cosmetics it is used in preventing oily skin, acne, psoriasis and acne. The oil (or constituents of it) is sometimes added to sun-tanning oils. Bergamot oil is also used to relieve tension, relax muscle spasms and improve digestion.

MAIN PROPERTIES: Disinfectant, muscle relaxant.

11) BITTER ORANGE Citrus aurantium (Rutaceae)Its oil contains flavonoids which are anti-inflammatory, antibacterial and antifungal. Bitter orange juice is rich in vitamin C which helps the immune system. As an infusion, it helps to relieve fever, soothe headaches and lower fever. It yields neroli oil from its flowers, and the oil known as petitgrain from its leaves and young shoots. Both distillates are used extensively in perfumery. Orange flower water is a by-product of distillation and is used in perfumery and to flavor sweets

and biscuits, as well as being used medicinally to reduce heart rate and palpitations, to encourage sleep and calm the digestive tract.

MAIN PROPERTIES: Anti-inflammatory, antifungal, antibacterial, digestive.

12) BOLDOPeumus boldus (Umbelliferae)It activates the secretion of saliva and gastric juices. Boldine, one of its constituents, induces the flow of bile as well as the total amount of solids that it excretes. Its protective action over the hepatic cells has been demonstrated "in vitro" and "in vivo". Boldo stimulates liver activity and bile flow and is chiefly valued as a remedy for gallstones and liver or gallbladder pain. It is normally taken for a few weeks at a time, either as a tincture or infusion. Boldo also has antiseptic properties which help in combating cystitis.

MAIN PROPERTIES: Bile and liver activity stimulant, digestive.

13) CALENDULA, MARIGOLD Calendula officinallis (Compositae)Marigold is one of the best herbs for treating local skin problems. Infusions or decoctions of Calendula petals decrease the inflammation of sprains, stings, varicose veins and other swellings and also soothes burns, sunburns, rashes and skin irritations. These remedies are excellent for inflamed and bruised skin, their antiseptic and healing properties helping to prevent the spread of infection and accelerate the healing. Marigold is also a cleansing and detoxifying herb, and the infusion and tincture are used to treat chronic infections. Taken internally, it has been used traditionally to promote the draining of swollen lymph glands such as tonsillitis.

MAIN PROPERTIES: Anti-inflammatory, astringent, heals wounds, antiseptic, detoxifying.

14) CAMPHOR Cinnamomum camphora syn. Laurus camphora (Lauraceae)Camphor crystals have strong antiseptic, stimulant and antispasmodic properties and are applied externally as unguents or balms as a counter-irritant and analgesic liniment to relieve arthritic and rheumatic pains, neuralgia and back pain. It may also be applied to skin problems, such as cold sores and chilblains, and used as a chest rub for bronchitis and other chest infections.

MAIN PROPERTIES: Antiseptic, antispasmodic, analgesic, expectorant.

15) CARDAMOM Elettaria cardamomum (Zingiberaceae)Cardamom is an excellent remedy for many digestive problems, helping to soothe indigestion, dyspepsia, gastralgia, colon spasms and flatulence. It has an aromatic and pungent taste and combines well with other herbs and helps to disguise the less pleasant taste of other herbs.

MAIN PROPERTIES: Eases stomach pain, carminative, aromatic, antispasmodic.

16) CARDUS, MILK THISTLE, MARY THISTLECarduus marianus syn. Silybum marianum (Compositae)Milk thistle has been in use as a remedy for liver problems for hundreds, if not thousands, of years. It is used in a whole range of liver and bladder conditions including hepatitis and cirrhosis. Recent research has confirmed that the herb has a remarkable ability to protect the liver from damage resulting from alcoholic and other types of poisoning. Today, milk thistle is widely used in the West for the treatment of a range of liver conditions.MAIN PROPERTIES: Digestive, liver tonic, stimulates secretion of bile, increases breast-milk production, antidepressant.

17) CELERY, SMALLAGE Apium graveolens (Umbelliferae)More familiar as a vegetable than as a medicine, celery find its main use in the treatment of rheumatism, arthritis and gout. Containing apiol, the seeds are also used as a urinary antiseptic. Celery is a good cleansing, diuretic herb, and the seeds are used specifically for arthritic complaints where there is an accumulation of waste products. The seeds also have a reputation as a carminative with a mild tranquilizing

effect. The stems are less significant medicinally.

MAIN PROPERTIES: Anti-rheumatic, antispasmodic, diuretic, urinary antiseptic.

18) CHAMOMILE, GERMAN CHAMOMILE Chamomilla recutita syn. Matricaria recutita (Compositae)Its flowers help to ease indigestion, nervousness, depressions and headaches, being ideal for emotion related problems such as peptic ulcers, colitis, spastic colon and nervous indigestion. Chamomile's essential oil have anti-inflammatory, anti-spasmodic and anti-microbial activity. It is an excellent herb for many digestive disorders and for nervous tension and irritability. Externally, it is used for sore skin and eczema. Roman chamomile (Chamaemelum nobile) is a close relation, used in a similar way.

MAIN PROPERTIES: Anti-inflammatory, antispasmodic, relaxant, carminative, bitter, nervine.

19) CHICORY Cicorium intybus (Compositae)As a tea or extract, chicory root is a bitter digestive tonic that also increases bile flow and decrease inflammation. Its roasted root is commonly used as a coffee substitute. Chicory is an excellent mild bitter tonic for the liver and digestive tract. The root is therapeutically similar to dandelion root supporting the action of the stomach and liver and cleansing the urinary tract. Chicory is also taken for rheumatic conditions and gout, and as a mild laxative, one particularly appropriate for children. An infusion of the leaves and flowers also aids the digestion.

MAIN PROPERTIES: Digestive, liver tonic, anti-rheumatic, mild laxative.

20) CINNAMON Cinnamomum verum syn. C. zeylanicum (Lauraceae)The infusion or powder is used for stomach pains and cramps. Traditionally, the herb was taken for colds, flu and digestive problems.

MAIN PROPERTIES: Warming stimulant, carminative, antispasmodic, antiseptic, anti-viral.

21) CLOVEEugenia caryophyllata syn. Syzgium aromaticum (Myrtaceae)The dried flower buds, clove, are extensively used as spice. The buds, leaves and stems are used for the extractions of clove's oil. The oil contains eugenol, a strong anesthetic and antiseptic substance. Cloves are also well known for their antispasmodic and stimulant properties.

MAIN PROPERTIES: Antiseptic, mind and body stimulant, analgesic, antibacterial, carminative.

22) COMFREY, KNITBONE Symphytum officinale (Boraginaceae)Comfrey leaves and roots contain allantoin, a cell multiplication agent that increases the healing of wounds. Today, it is still highly regarded for its healing properties. Externally it is used for rashes, wounds, inflammations and skin problems. Internally, comfrey has action over the digestive tract helping to cure ulcers and colitis. It is also used for a variety of respiratory problems.

MAIN PROPERTIES: Digestive problems, anti-inflammatory, wound healing, astringent.

23) CORIANDER Coriandrum sativum (Umbelliferae)It aids digestion, reduce flatulence and improves appetite. It helps relieving spasms within the gut and counters the effects of nervous tension. Coriander is also chewed to sweeten the breath, especially after consumption of garlic (Allium sativum). It is applied externally as a lotion for rheumatic pain. Coriander essential oil is used in the manufacture of perfumes, cosmetics and dentifrices.

MAIN PROPERTIES: Digestive, antispasmodic, anti-rheumatic.

24) CYMBOPOGON, LEMON GRASS Cymbopogon citratus (Gramineae)

Its oil is used as a culinary flavoring, a scent and medicine. Lemon grass is principally taken as a tea to remedy digestive problems diarrhea and stomach ache. It relaxes the muscles of the stomach and gut, relieves cramping pains and flatulence and is particularly suitable for children. In the Caribbean, lemon grass is primarily regarded as a fever-reducing herb. It is applied externally as a poultice or as diluted essential oil to ease pain and arthritis.

MAIN PROPERTIES: Digestive, antispasmodic, analgesic.

25) DAMIANA Turnera diffusa syn. T. diffusa var. aphrodisiaca (Turneraceae)It has an ancient reputation as an aphrodisiac and is an excellent remedy for the nervous system acting as a stimulant and tonic in cases of mild depression. Damiana has a strongly aromatic, slightly bitter taste. The leaves are used to flavor liqueurs and are taken in Mexico as a substitute for tea.

MAIN PROPERTIES: Nerve tonic, antidepressant, urinary antiseptic.

26) DANDELION Taraxacum officinale (Compositae)Known principally as a weed, dandelion has an astonishing range of health benefits. The leaves, which can be eaten in salads, are a powerful diuretic. The roots act as a "blood purifier" that helps both kidneys and the liver to remove impurities from the blood. This effect seems to be due to its potassium content. It also acts like a mild laxative and improves appetite and digestion.

MAIN PROPERTIES: Diuretic, digestive, antibiotic, bitter.

27) DILLAnethum graveolens syn. Peucedanum graveolens (Umbelliferae)Dill has always been considered a remedy for the stomach, relieving wind and calming the digestion. Dill's essential oil relieves intestinal spasms and griping and helps to settle colic, hence it is often used in gripe water mixtures. Chewing the seeds improves bad breath. Dill makes a useful addition to cough, cold and flu remedies, and is a mild diuretic. Dill increases milk production, and when taken regularly by nursing mothers, helps to prevent colic in their babies.

MAIN PROPERTIES: Digestive, antibacterial, antispasmodic, diuretic.

28) EUCALYPTUS, BLUE GUM Eucalyptus globulus (Myrtaceae)Eucalyptus is a powerful antiseptic used all over the world for relieving coughs and colds, sore throats and other infections. The leaves cool the body and relive fever. Inhaling the vapors of the essential oils heated in water, clears sinus and bronchial congestions. Eucaliptol, one of the substances found in the essential oil, is one of the main constituents of the many existing commercial formulas of chest rubs for colds. The essential oil has also strong anti-biotic, anti-viral and anti-fungal action. Eucalyptus is a common ingredient in many over-the-counter cold remedies.

MAIN PROPERTIES: Antiseptic, expectorant, stimulates local blood flow, anti-fungal.

29) FENNEL Foeniculum vulgare (Umbelliferae)The primary use of fennel seeds is to relieve flatulence, but they also settle colic, stimulate the appetite and digestion. Fennel is also diuretic and anti-inflammatory. Like anise (Pimpinella anisum) and caraway (Carum carvi), it has a calming effect on bronchitis and coughs. An infusion of the seeds may be taken as a gargle for sore throats and as a mild expectorant. Fennel increases breast-milk production and the herb is still used as an eye wash for sore eyes and conjunctivitis. Essential oil from the sweet variety is used for its digestive and relaxing properties.

MAIN PROPERTIES: Digestive, antispasmodic, anti-inflammatory.

30) GARLIC Allium sativum (Liliaceae)Recognized for its pungent odor and taste, garlic is a powerful home medicine for the treatment for a host of health problems. It is one of the most effective anti-biotic plants available, acting on bacteria, viruses

and alimentary parasites. It counters many infections, including those of the nose, throat and chest. Garlic is also known to reduce cholesterol, helps circulatory disorders, such as high blood pressure, and lower blood sugar levels, making it useful in cases of late-onset diabetes.

MAIN PROPERTIES: Antibiotic, expectorant, diaphoretic, hypotensive, antispasmodic, expels worms.

31) GENTIAN Gentiana lutea (Gentianaceae)Gentian is a powerful bitter that stimulates appetite and promotes digestion through the increased production of saliva, gastric juices and bile. It also decreases gastric inflammation and kill worms. Gentian is also used to treat liver and spleen problems and to promote menstruation. Medicinally, gentian strengthens a weak or under-active digestive system.

MAIN PROPERTIES: Bitter, digestive stimulant, eases stomach pain.

32) GINGER Zingiber officinali (Zingiberaceae)The Chinese consider ginger as an important drug to treat cold and encourage sweating. Ginger brings relief to digestion, stimulates circulation, reduce headaches and kill intestinal parasites.

MAIN PROPERTIES: Diaphoretic, carminative, circulatory stimulant, inhibits coughing, anti-inflammatory, antiseptic.

33) GINKGO Ginkgo biloba (Ginkgoaceae)Traditionally known as an anti-microbial and anti-tubercular action, it has now been shown that ginkgo as a profound activity on brain function and cerebral circulation. This action is useful to prevent dizziness, tinnitus, short-term memory loss, depression and other symptoms related to poor brain circulation. Its effect on poor circulation also used to treat other related disorders like diabetes, hemorrhoids and varicose veins. Ginkgo is also valuable for asthma.

MAIN PROPERTIES: Circulatory stimulant and tonic, anti-asthmatic, antispasmodic, anti-allergenic, anti-inflammatory.

34) GINSENGPanax ginseng (Araliaceae)Ginseng increases mental and physical efficiency and resistance to stress and disease. It often shows a dual response like sedating or stimulating the central nervous system according to the condition it is being taken to treat. In the West, ginseng is regarded as a life-enhancing tonic.

MAIN PROPERTIES: Tonic, stimulant, physical and mental enhancement.

35) GUMPLANT Grindelia camporum syn. G. robusta var. rigida (Compositae)Its anti-spasmodic, expectorant and hypotensive actions find applications in treating heart conditions, asthmatic and bronchial conditions. It has been employed in the treatment of wooping cough, hay fever and cystitis. Externally in relieves and heals skin irritations and burns.MAIN PROPERTIES: Anti-spasmodic, expectorant, hypotensive.

36) HAMAMELIS, WITCH HAZEL Hamamamelis virginiana (Hamamelidaceae)Witch hazel acts mostly on the veins and circulation. For this reason it has been used to decrease the inflammation and pain of bruises, sore muscles, bleeding, hemorrhoids, varicose veins, phlebitis, and insect bites. American indians used poultices soaked in a decoction of bark to treat tumors and inflammations, especially of the eye, and took the herb internally for hemorrhaging and heavy menstrual bleeding.

MAIN PROPERTIES: Astringent, anti-inflammatory, stops external and internal bleeding.

37) HAWTHORN Crataegus oxyacantha & C. monogyna (Rosaceae)It has been shown that its effects are only present when a whole plant preparation is used. Its applications are: the loss of cardiac function,

feelings of congestions and oppression in the hearth region. Western herbalists consider it literally to be a "food for the heart", increasing blood flow to the heart muscles and restoring normal heart beat. Recent research has confirmed the validity of these uses.

MAIN PROPERTIES: Cardiotonic, diuretic, astringent, dilates blood vessels, relaxant, antioxidant.

38) HYSSOP Hyssopus officinalis (Labiatae)Currently an undervalued medicinal herb, hyssop is potentially useful as it is both calming and tonic. It has a large spectrum of uses which are due to its anti-spasmodic action. It is used in coughs, bronchitis, tight-chestedness, respiratory catarrh, sore throat and common cold. As a sedative, hyssop is a useful remedy against asthma in both children and adults, especially where the condition is exacerbated by mucus congestion.

MAIN PROPERTIES: Anti-spasmodic, expectorant, diaphoretic, anti-inflammatory, hepatic.

39) JASMINE Jasminum grandiflorum (Oleaceae)Jasmine flowers make a calming and sedative infusion, taken to relieve tension. The oil is considered antidepressant and relaxing. It is used externally to soothe dry and sensitive skin.

MAIN PROPERTIES: Aromatic, anti-spasmodic, expectorant.

40) JUNIPER Juniperus communis (Cupressaceae)It is a valuable remedy for cystitis, and helps relieve fluid retention, but should be avoided in cases of kidney disease. In the digestive system, juniper is warming and settling, easing colic and supporting the function of the stomach. Taken internally or applied externally, juniper is helpful in the treatment of chronic arthritis, gout and rheumatic conditions. Applied externally as a diluted essential oil, it has a slightly warming effect on the skin and is thought to promote the removal of waste products from underlying tissues.

MAIN PROPERTIES: Diuretic, anti-microbial, carminative, anti-rheumatic.

57) RADISH Raphanus sativus (Cruciferae)Radish stimulates the appetite and the digestion. The juice of the black radish is drunk to counter gassy indigestion and constipation. Black radish juice has a tonic and laxative action on the intestines, and indirectly stimulates the flow of bile. Consuming radish generally results in improved digestion, but some people are sensitive to its acridity and strong action. In China, radish is eaten to relieve abdominal distention.

MAIN PROPERTIES: Digestive, mild laxative.

58) RAUVOLFIA, INDIAN SNAKEROOT Rauvolfia serpentina (Apocynaceae)Indian snakeroot contains reserpine, a substance now widely used to lower blood pressure and lessen some symptoms of mental illness. The root has a pronounced sedative and depressant effect on the sympathetic nervous system. By reducing the system's activity, the herb brings about the lowering of blood pressure. It may also be used to treat anxiety and insomnia, as well as more serious mental health problems such as psychosis.

MAIN PROPERTIES: Antidepressant, lowers blood pressure.

59) RHUBARB, CHINESE RHUBARB Rheum palmatum (Polysonaceae)Its main use is as a laxative safe even for young children due to its gentle action. It is also extremely effective in the treatment for many digestive problems. Paradoxically, it is a laxative when taken in large doses but has a constipating effect in small measures. The rhizome has an astringent, unpleasant taste.

MAIN PROPERTIES: Laxative, constipating, astringent, eases stomach pain, antibacterial.

60) ROSERosa gallica (Rosaceae)The essential oil, called "attar of rose", is used in aromatherapy as a mildly sedative, antidepressant and anti-inflammatory remedy. Rose petals and their preparations have a similar action. They also reduce high cholesterol levels. Rosewater is mildly astringent and makes a valuable lotion for inflamed and sore eyes.

MAIN PROPERTIES: Aromatic, antidepressant,, sedative, anti-inflammatory.

61) ROSEMARY Rosmarinus officinalis (Labiatae)Rosemary is a well-known and greatly valued herb that is native to southern Europe. It has been used since antiquity to improve and strengthen the memory. Rosemary leaves increase circulation, reduce headaches and have anti-bacterial and fungal properties. Rosemary improves food absorbtion by stimulating digestion, the liver, the intestinal tract, and the gallbladder. It also is used in antiseptic gargles for sore throats, gum problems and canker sores. Rosemary has a long-standing reputation as a tonic, invigorating herb, imparting a zest for life that is to some degree reflected in its distinctive aromatic taste.

MAIN PROPERTIES: Tonic, stimulant, astringent, nervine, anti-inflammatory, carminative.

62) RUERuta graveolens (Rutaceae)The rutin contained in the plant helps to strengthen fragile blood vessels and alleviates varicose veins. Rue is also used due to its antispasmodic properties, especially in the digestive system where it eases griping and bowel tension. The easing of spasms gives it a role in the stopping of spasmodic coughs. In European herbal medicine, rue has also been taken to treat conditions as varied as hysteria, epilepsy, vertigo, colic, intestinal worms, poisoning and eye problems. The latter use is well founded, as an infusion used as an eyewash brings quick relief to strained and tired eyes, and reputedly improves the eyesight.

MAIN PROPERTIES: Antispasmodic, increases peripheral blood circulation, relieves eye tension.

63) SAGE, CLARY CLARY SAGE Salvia sclarea (Labiatae)Clary sage has been perceived both as a weaker version of its close relative, sage (S. officinalis), and as a significant herb in its own right. Since the seeds were once commonly used to treat eye problems, it was also known as "clear eye". An antispasmodic and aromatic plant, clary sage is used today mainly to treat digestive problems such as wind and indigestion. It is also regarded as a tonic, calming herb that helps relieve period pain and premenstrual problems. Owing to its estrogen-stimulating action, it is most effective when levels of this hormone are low.

MAIN PROPERTIES: Astringent, antiseptic, aromatic, carminative, estrogenic, reduces sweating, tonic.

64) SAGESalvia officinalis (Labiatae)Its leaves are a well-known cold germ and flu fighter. It has been found to be very effective to reduce many physical emissions like sweating and is an excellent remedy for sore throats, poor digestion and irregular periods. It is also taken as a gently stimulating tonic. It has a slightly warm, noticeably bitter and astringent taste.

MAIN PROPERTIES: Astringent, antiseptic, aromatic, carminative, estrogenic, reduces sweating, tonic.

65) SANDALWOOD Santalum album (Santalaceae)The heartwood is most often used in perfumery, but it has also been taken as a remedy in China since around AD 500. Sandalwood and its essential oil are used for their antiseptic properties in treating genito-urinary conditions such as cystitis and gonorrhea. In India, a paste of the wood is used to soothe rashes and itchy skin. In China, sandalwood is held to be useful for chest and abdominal pain.

MAIN PROPERTIES: Antiseptic, aromatic.

66) SARSAPARILLA Smilax spp. (Liliaceae)Sarsaparilla is anti-inflammatory and cleansing, and can bring relief to skin problems such as eczema, psoriasis and general itchiness, and help treat rheumatism, rheumatoid, arthritis and gout. Sarsaparilla also has a progesterogenic action, making it beneficial in pre-menstrual problems, and menopausal conditions such as debility and depression.

MAIN PROPERTIES: Diuretic, anti-inflammatory, anti-rheumatic.

67) SCOTS PINE Pinus sylvestris (Pinaceae)Its oil, extracted from the leaves, is added to disinfectants and other preparations. Scots pine leaves, taken internally, have a mildly antiseptic effect within the chest, and may also be used for arthritic and rheumatic problems. Essential oil from the leaves may be taken for asthma, bronchitis and other respiratory infections, and for digestive disorders such as wind. Scots pine branches and stems yield a thick resin, which is also antiseptic within the respiratory tract. The seeds yield an essential oil with diuretic and respiratory-stimulant properties.

MAIN PROPERTIES: Antiseptic, diuretic and anti-rheumatic.

68) SESAME Sesamum indicum (Pedaliaceae)The seeds are prescribed for problems such as dizziness, tinnitus (ringing in the ears), and blurred vision. Owing to their lubricating effect within the digestive tract, the seeds are also considered a remedy for constipation. Sesame seed oil benefits the skin and is used as a base for cosmetics. A decoction of the root is used in various traditions to treat coughs and asthma.

MAIN PROPERTIES: Digestive, aromatic, antispasmodic.

69) ST JOHN'S WORTHypericum perforatum (Guttiferae)St. John's wort flowers at the time of the summer solstice, and in medieval Europe it was considered to have powerful magical properties that enabled it to repel evil. The most well-known action of St. John's wort is in repairing nerve damage and reducing pain and inflammation. It is taken to relieve the pain of menstrual cramps, sciatica and arthritis. The oil is applied to inflammations, sprains, bruises and varicose veins. St. John's wort is also used to treat circulation problems, bronchitis and gout.

MAIN PROPERTIES: Antidepressant, antispasmodic, astringent, sedative, relieves pain, anti-viral.

70) TARRAGON Artemisia dracunculus (Compositae)Tarragon is widely used as a herb in cooking. In French, it is sometimes known as herbe au dragon, because of its reputed ability to cure serpent bites. While tarragon stimulates the digestion, it is reputed to be a mild sedative and has been taken to aid sleep. With its mild menstruation-inducing properties, it is taken if periods are delayed. The root has traditionally been applied to aching teeth.

MAIN PROPERTIES: Anti-inflammatory, digestive.

71) TEA TREE Malaleuca alternifolia (Myrtaceae)Tea tree, and in particular its essential oil, is one of the most important natural antiseptics. Useful for stings, burns, wounds and skin infections of all kinds, the herb merits a place in every medicine chest. Its therapeutic properties were first researched during the 1920s and it is now widely used in Europe and the US, as well as in Australia.

MAIN PROPERTIES: Antiseptic, antibacterial, anti-fungal, anti-viral.

72) THYMEThymus vulgaris (Labiatae)Its main medicinal application is in treating coughs and clearing congestion. Many current formulas for mouth washes and vapor rubs contain thymol, one of the constituents found in thyme. It also improves digestion, destroys intestinal parasites and is an excellent

antiseptic and tonic.

MAIN PROPERTIES: Antiseptic, tonic, relieves muscle spasm, expectorant.

73) TURMERIC Curcuma longa syn. C. domestica (Zingiberaceae)Best known for its bright yellow color and spicy taste to lovers of Indian food, its medicinal value is not so well known. However, recent research has confirmed the effects traditionally associated in ancient practices in the treatment of digestive and liver problems. The herb has also been shown to inhibit blood-clotting, relieve inflammatory conditions and help lower cholesterol levels.

MAIN PROPERTIES: Stimulates secretion of bile, anti-inflammatory, eases stomach pain, antioxidant, antibacterial.

74) VALERIAN Valeriana officinalis (Valerianaceae)Valerian root is a general tranquilizer used for relieving nervous tension, insomnia and headaches. Valerian decreases muscular spasm, being useful in cases of nervous digestion, bowel syndrome, stomach and menstrual cramps. Valerian helps relieve stress and has become an increasingly popular remedy in recent decades. It is a safe, non-addictive relaxant that reduces nervous tension and anxiety and promotes restful sleep.

MAIN PROPERTIES: Sedative, relaxant, relieves muscle spasm, relieves anxiety, lowers blood pressure.

75) VERBENAVerbena officinalis (Verbenaceae)Verbena is used in mouth washes for infected gums and as a poultice for hemorrhoids. A tea has been used as a nerve tonic, to treat insomnia and to help digestion. It has tonic, restorative properties, and is used to relieve stress and anxiety, and to improve digestive function.

MAIN PROPERTIES: Nervine, tonic, mild sedative, stimulates bile secretion, mild bitter.

76) WHITE WILLOW Salix alba (Salicaceae)White willow is an excellent remedy for arthritic and rheumatic pain, affecting the joints like knees and hips.

MAIN PROPERTIES: Anti-inflammatory, analgesic, reduces fever, anti-rheumatic, astringent.

77) WORMWOOD Artemisia absinthium (Compositae)Wormwood leave's primary uses is to stimulate the gallbladder, help prevent and release stones, and to adjust digestive malfunctions. It also increases bile secretion and is useful in expelling intestinal worms. It is taken in small doses and sipped, the intensely bitter taste playing an important part in its therapeutic effect. In the past, wormwood was one of the main flavorings of vermouth (whose name derives from the German for wormwood).

MAIN PROPERTIES: Aromatic bitter, stimulates secretion of bile, anti-inflammatory, eliminates worms, eases stomach pains, mild antidepressant.

78) WILD THYME Thymus serpyllum (Labiatae)Like its close relative thyme (Thymus vulgaris), wild thyme is strongly antiseptic and anti-fungal. It may be taken as an infusion or syrup to treat flu and colds, sore throats, coughs, whooping cough, chest infections, and bronchitis. Wild thyme has anti-catarrhal properties and helps clear a stuffy nose, sinusitis, ear congestion and related complaints. It has been used to expel thread worms and roundworms in children, and is used to settle wind and colic. Wild thyme's antispasmodic action makes it useful and is used to settle wind and colic. Wild thyme is also used in herbal baths and pillows.

MAIN PROPERTIES: Antiseptic, anti-fungal, antispasmodic.

79) YARROW

Achillea millefolium (Compositae)It has long been taken as a strengthening bitter tonic and all kinds of bitter drinks have been made from it. Yarrow helps recovery from colds and flu and is beneficial for hay fever. It is also helpful for menstrual problems and circulatory disorders.

MAIN PROPERTIES: Antispasmodic, astringent, bitter tonic, increases sweating, lowers blood pressure, reduces fever, mild diuretic and urinary antiseptic.

80) YLANG -YLANGCanananga odorata syn. Canangium odoratum (Annonaceae)Their scent is thought to have aphrodisiac qualities. The flowers and essential oil are sedative and antiseptic. The oil has a soothing effect, and its main therapeutic uses are to slow an excessively fast heart rate and to lower blood pressure. With its reputation as an aphrodisiac, ylang-ylang may be helpful in treating impotence.

MAIN PROPERTIES: Antiseptic, aromatic, regulates blood pressure.

Preventing Clogged Feeding Tubes

Going with the flow. (preventing clogged feeding tubes)Author/s: Karen Brennan KruppIssue: April, 1998

Find out what problems to anticipate-- and how a few simple steps canhead them off.

A clogged enteral feeding tube that can't be cleared must be replacedan unwelcome prospect for you and your patient. At the very least,he'll miss getting some of the fluid and nutrition he needs. Atworst, if he's homebound or a nursing home resident, he'll need totravel to an appropriate facility for tube reinsertion and X-rayconfirmation of placement. The expression An ounce of prevention isworth a pound of cure could have been coined by a nurse managingfeeding tubes.

In this article, we'll describe two simple ways you can keep feedingtubes patent: pump-assisted infusion of enteral formulas and frequenttube flushing. But first, let's review factors that can increase therisk of a clogged feeding tube.

Problems in the pipeline

Feeding tubes can become clogged for one of these reasons:

* calorically dense formulas. When a dense formula is delivered in aslow, uneven infusion (as by gravity drip), formula coagulation andtube occlusion are more likely.

* small-bore feeding tubes. Small-bore tubes are more flexible andless irritating to patients and can be left in place longer thanlarger ones. But their smaller lumens make them more likely to clog.

* gravity drip. An imprecise roller clamp adjustment may increase ordecrease the amount of formula delivered by as much as 50%. Whenformula flows slowly, residue clings to the wall of the tube,creating a buildup that eventually clogs the tube.

A slow or stopped flow of formula also causes gastric pH to decreasebecause there's less nutritional liquid to dilute the stomach acid.This excess acid may then flow into the tube, causing the formula toclump.

* medications. Bulk-forming agents such as psyllium (Metamucil),antacids, and medications that haven't been properly crushed orreconstituted can also clog a tube. The combination of crushedmedications and a small-bore feeding tube is a common cause of slowedor blocked formula flow. Whenever possible, administer the liquidformulation of a medication rather than creating a mixture fromcrushed tablets.

* gastric residuals. When you check gastric residuals through afeeding tube, gastric acid mixes with the formula in the tube and

causes formula coagulation, which can lead to tube clogging. Thisproblem is more common when small-bore feeding tubes are used toaspirate gastric residuals.

An ounce of prevention

Now let's look at the two steps you can take to prevent feeding tubesfrom clogging.

A pump-assisted infusion is especially helpful for administering acalorically dense formula. The slight degree of pump-generatedpressure means the formula is delivered in a continuous, eveninfusion, avoiding the problems associated with an unevenadministration rate.

Regular tube flushing with water is, the simplest way to prevent tubeclogging--and the most often neglected. The most common practice isto instill 50 to 100 ml of water every 4 hours; before, after, andbetween multiple doses of medications; and when stopping and startinga feeding. If you flush the tube consistently, you can clear evenviscous enteral formulas from the tube lumen. Also flush before andafter you check gastric residuals.

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Cranberry juice, carbonated beverages, meat tenderizers, enzymaticsolutions ... over the years, nurses have tried all sorts of remediesfor clogged enteral tubes. But researchers who've studied variouspreventive irrigants have learned something surprising: Nothing beatsplain water. In fact, acidic colas and cranberry juice can actuallycause an obstruction by promoting formula coagulation.

The bottom line? Flushing the tube regularly with water remains themost effective and practical way to prevent enteral, feeding tubeclogs.

Making it automatic

A heavy nursing workload and lack of written policies and proceduresfor tube flushing can lead to inconsistency in tube flushing. So someenteral pumps also have an automatic flush feature, which delivers apreprogrammed amount of fluid, typically water, every hour. Thissimulates the flushing action of a syringe and helps minimize residuebuildup.

Automatic flushing doesn't just save nursing time--it's also moreeffective. Two studies found clogging in 75% of gastrostomy tubes inthe manually flushed group, compared with only 5% in theautomatically flushed group. The results were even more dramatic fornasogastric tubes: 91% in the manually flushed group clogged; noneclogged in the automatic flush group.

Smooth sailing

By knowing which, factors predispose an enteral tube to clogging andtaking a few preventive measures, you can keep your patientcomfortable- -and save yourself some time.

Psyche Nursing

For Withdrawn clients· Allow client to set pace· Encourage social activities or games

For Depressed client· Assess suicide potential· Let client talk about personal problems· Do not leave alone

For Suicidal clientsCrisis intervention to assess suicide protential.· Communicate intent “ are you tired of living?”· Previous attempts· Specific plan· Social support system· DO NOT make “ suicide contract”!

For Anxious clients· Convey interest and care· Don’t “force” client· Help client identify source of anxiety· Suggest relaxation techniques

For Violent clients· Remain calm and in control of the situation· Give client space, avoid sudden movements· Encourage verbal expression of anger· Restrain or seclude if necessary

For Compulsive clients· Allow client to engage in rituals (these are used to cover up anxiety)· Gradually limit length of time for rituals.

For Manipulative clients· Set clear limits· Hold client responsible for behavior

For Dependent clients· Don’t reward dependent behavior· Client should share responsibility for treatment

For Paranoid clients· Don’t argue with client (simply state that you don’t share his beliefs)· Be reliable and consistent

For Delusional clients· Stay with client· Don’t argue about the reality of delusions· Orient frequently to reality (place, situation)· Assess potential for self harm

For Somatization clients· Respect client and his problems (client is not faking)· Rule out physical basis for symptoms· Help client express anxiety

DEFENSE MECHANISMS:1. Conversion: A college student develops diarrhea on day of exam2. Regression: Returning to immature ways of dealing with stress: crying, tantrums…3. Repression: Blocking of unacceptable urges and feelings from awareness.4. Denial: Blocking of unacceptable information or perceptions from awarness.5. Dissociation of affect: A girl laughs when telling about her failed exam6. Rationalization: Substituting an acceptable motive for attitudes or behavior for an unacceptable motive7. Reaction formation: you want to “kick your bosses ass” but end up kissing it.8. Identification: A teenager dresses like Madonna and mimics her behavior.9. Projection: “ you are acting like a teenager, not I”10. Introjection: A boy yells at his dog like his father does him11. Displacement: Client is upset about disease and yells at nurse. Nurse gets upset and yells at nursing assistant12. Undoing: “ magic,”

SIGNS AND SYMPTOMS

AphasiaReceptive (Wernicke =difficulty to comprehend language) or expressive (Broca = difficulty to find “the right word” language disorder

ApraxiaFailure to do, despite intact motor function

AgnosiaFailure to recognize

Dementia

Gradual impairment of cognitive functions, memory· Alzheimer dementia: early memory loss· Multi infarct dementia: step like decline

DeliriumAcute, organic, short lastingClouded consciousnessConfusion, disorientation, anxietySometimes hallucinations

DelusionsPersistent false belief despite invalidating evidenceGrandeurParanoiaSomatic delusions

illusionsMisperception of external stimuli

HallucinationsPerception without external stimuli

TERMS:1. Neologisms: invents new words: Schizophrenia2. Echolalia: echoes words or sentences: Schizophrenia3. Word Salad: jumble of words without meaning: Schizophrenia4. Flight of ideas: rapid switching from topic to topic: Mania5. Confabulation: invents stories to fill memory gaps: Korsakoff encephalopathy.

DELIRIUMØ Acute onsetØ Fluctuating consciousnessØ DisorientationØ Optical hallucinations

DEMENTIAØ Gradual onsetØ No impairment of consciousnessØ Loss of intellectual functions: memory, orientation, language.

ALZHEIMER’S

ASSESSMENT:§ Progressive memory loss§ Declining mental, social, and self care abilities

ANALYSIS:§ Risk of injury due to cognitive deficits§ Family/caregiver burnout

IMPLEMENTATION:§ Support family caregivers§ Provide safe and familiar environment§ Support client’s attempts at independence§ Continually orient client to time, date and person§ Advance directive should be drafted as early as possible

GRIEF DEPRESSION

Initial: shock/ denial

Illusions/hallucinations may occur

Low risk of suicide

Feeling of hopelessness

Feeling of worthlessness

High risk of suicide

PERSONALITY DISORDERS:

Behavior is inflexible across a broad range of situations

Behavior is markedly deviant from cultural norms

Significant distress and impairment of functioning

DEPENDENT Afraid of being helpless

Need to be cared for

COMPULSIVE Fear of loss of control

Tries to control physician

PASSIVE-AGGRESSIVE Appears willing but is not compliant

HISTRIONIC Dramatic, emotional

May display inappropriate sexual behavior

NARCISSISTIC Feels better than others

Perfect self image is threatened by disease

PARANOID May blame nurse or others for disease

SCHIZOID Anxious, withdrawn

(doesn’t want close relationships)

BORDERLINE Severe disorder!

Intense unstable relationships

Paranoia and suicidal behavior

Features of psychoses

ANXIETY DISORDERS:

Clients are distressed and know that their symptoms are irrational.

PHOBIA Persistent excessive of specific objects or situations.

Patient knows that his fear is unrealistic

PANIC ATTACK Abrupt onset, peak within 10 min.

Palpitations, tachycardia

Sweating, trembling, shaking

Fear of dying

Derealization: feeling of unreality of the external world.

Depersonalization: feeling of being detached from oneself

AGORAPHOBIA Hx of panic attacks

Patient avoids places where panic attack might occur (especially public places)

OBSESSSIVE COMPULSIVE Obsessions: recurrent thoughts

Compulsions: repetitive behavior

POSTRAUMATIC STRESS DISORDER Traumatic event in client’s history

May occur any time after event

Persists for > 1 month

HYPOCHONDRIASIS & MALINGERING:

HYPOCHONDRIASIS Unrealistic interpretation of body signs

Client believes to have serious disease that is unrecognized by family and physicians

FACTITIOUS DISORDER Intentional feigning of symptoms

Motivation: to assume the sick role: external incentives such as economic gain or avoiding legal responsibilities are absent

MALINGERING Intentional feigning of symptoms

Motivation: economic gain

Avoiding leagal responsibilities

MAJOR DEPRESSION

ASSESSMENT:

Feeling of worthlessness Thoughts of death or suicide Lethargy Slow, muted speech Anorexia, weight loss Early morning awakening

ANALYSIS:

Risk of suicide

IMPLEMENTATION:

Assess suicidal risk ( ask client directly) Remove potentially harmful objects Encourage verbal expression of feelings Encourage participation in group activities

MEDICATIONS:

Antidepressants (require several weeks for full effect) Watch for anticholinergic side effects:

Blurred vision

Dry mouth

Constipation

Urinary retention

BIPOLAR DISORDER:Manic episodes alternate with episodes of major depression.Some clients have only manic episodes, no depressive episodes.

ASSESSMENT:

Euphoria Grandiose ideas Uninhibited sexuality Buying sprees Psychomotor agitation

IMPLEMENTATION:

Low stimulus environment Provide frequent small meals, snacks Encourage physical activity as a means to “act out”

MEDICATION:

Lithium Watch for signs of toxicity

Abdominal pain, nausea

Hand tremor

Ataxia, nystagmus

Slurred speech

Monitor serum levels closelyNot to exceed 1 mEq/L

SCHIZOPHRENIA:

ASSESSMENT:

Defect in reality testing Affect incongruent ( does not match thoughts) Thought form: tangential, circumstantial, loose associations

“POSITIVE SYMPTOMS”

Delusions

Hallucinations

“NEGATIVE SYMPTOMS”

Flat affect

Loss of interest

Ambivalence

Autism

CATATONIA:

Waxy rigidity of muscles

Client maintains bizarre positions

IMPLEMENTAION:

Establish trusting, honest relationship

Maintain calm, consistent manner

Don’t challenge client’s thought content

Decrease environmental stimuli

MEDICATION:

Neuroleptics: monitor for signs of tardive dyskinesiaChoreoathetosis

Lateral movements of jaw

Tongue protrusion

CLIENT EDUCATION:

Stress importance to comply with follow up visits

Encourage family support

DRUG ABUSE:

Abuse: recurrent use of drugs resulting in social failures at home, school or work, legal problems or hazardous situations.Dependence: Tolerance (needs larger doses to achieve effect). Withdrawal symptoms.

INTOXICAITON WITHDRAWAL

ALCOHOL Euphoria

Disorientaion

Nausea

Delusions, hallucinations

Unsteady gait Delirium

Tremor, seizures

BARBITURATES Sedation Delirium

Epilepsy

Coma, death

BENZODIAZEPINES Antianxiety

Sedation

Anxiety

Irritability

insomnia

AMPHETAMINES, COCAINE Arousal

Euphoria

Fatigue

Dysphoria

OPIOIDS Euphoria

Apathy

Nausea, vomiting

Sweating, fever

Muscle aches

LSD Hallucinations

Anxiety

Paranoid ideas

NONE