Nclex Handout

SUPPLEMENTAL NOTES ON NCLEX FOUNDATIONS DELEGATION / SCOPE OF DUTIES

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R.N. PLANNING AND HEALTH TEACHING  LICENSURE REQUIREMENTS  ASSESSMENT AND EVALUATION  NEED FOR KNOWLEDGE AND SKILL  LPN/LVN STABLE PATIENTS  STANDARD UNCHANGING PROCEDURES  SIMPLE MONITORING AND IMPLEMENTATION  SEQUENCED/PREDICTABLE OUTCOMES  STATE PRACTICE ACT INCLUSION

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UAP-DIRECT UAP-DIRECT PATIENT CARE ACTIVITY AND STANDARD OPERATING UNCHANGING PROCEDURES

TRIAGE-GREATEST TRIAGE-GREATEST GOOD FOR THE GREATEST NUMBER OF PEOPLE PRINCIPLES- ABCD , MASLOWS     

RED-UNSTABLE – IMMEDIATE CARE YELLOW- STABLE – CAN WAIT 30-60 MIN GREEN –STABLE- CAN WAIT LONGER BLACK- UNSTABLE – FATAL, LAST SEEN DOA – SUPPORTIVE COMFORT MEASURES

LIVING WILL – DECLARATION OF A COMPETENT INDIVIDUAL DNR – COMPETENT CLIENTS AND VALUES – PRIORITY ADVANCE DIRECTIVES- CLEARLY DOCUMENTED , RECEIVED AND UPDATED PROVIDE COMFORT MEASURES IF NURSE IS NOT COMFORTABLE – CONSULT NURSE MANAGER MEET STANDARDS OF CARE CRITERIA- TERMINAL/BRAIN DEATH – TO PREVENT SUFFERING RESTRAINTS-NOT RESTRAINTS-NOT INSTITUTED FOR THE PURPOSE OF CONVENIENCE AND AS A TREATMENT OF MEDICAL SYMPTOMS(FALSE IMPRISONMENT) BOTH PHYSICAL AND CHEMICAL INFORMED CONSENT-DURATION REQUIRED NOT PRN ALTERNATIVE MEASURES FIRST REMOVE Q2h for skin care and ROM DONE TO PREVENT HARM OR INJURY OR COMPLICATION IF PNT. DISORIENTED (SAFETY)

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LIABLE FOR FALSE IMPRISONMENT

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LAST RESORT INFORMED CONSENT(PROXY)

ALTERNATIVE MEASURES FIRST BENEFITS> RISKS LENGTH OF TIME AND CIRCUMSTANCES SPECIFIED ENSURE SAFETY – CIRCULATION CHECKS,SKIN CARE, ROM AND REMOVE Q2H INCIDENT REPORTS

INCIDENT REPORTS-STATEMENT OF FACTS AND PATIENT’S PHYSICAL RESPONSE FROM

UNEXPECTED OCCURRENCE THAT (COULD/) AFFECT THE CLIENT----SEQUENCE, W/IN 24 HOURS---RISK MANAGER—COMPR. SITUATIONS NO-REFERENCE , INAPPROPRIATE TERMS OR WORDS, JUDEGMENTAL STATEMENTS, -----MONITORING AND DOCUMENTATION A.M.A. NOT SYNONYMOUS WITH HAMA WHICH IS RELEASING THE HOSPITAL FROM ANY LIABILITY AFTER DEPARTURE( THE FORMER MEANS REFUSING A TREATMENT OR THERAPY) ASCERTAIN

NOTIFY 

Offer assistance

TELEPHONE ORDERSORDERS- REPEAT ORDER TO THE AP AND LET HIM SIGN WITHIN 24 HOURS

INFORMED CONSENT AGGREED UPON FACTS KNOWN TREATMENT EXPLANATION RISK UNDERSTOOD CONSENT CONSIDERATIONS OB , STD,REHAB ,BLOOD DON. ( MINOR CAN GIVE) ER, LIFE THREATENING(IMPLIED) MENTALLY ILL(INCAPABLE) MODELS FOR DELIVERY OF NURSING CASE METHOD-TOTAL CARE-CONSISTENCY FUNCTIONAL METHOD-TASK ORIENTED- CENTRALIZED DIRECTION AND CONTROL TEAM NURSING-TEAM COORDINATED CARE-INDIV. ROLES –EFFICIENCY PRIMARY NURSING-COMPREHENSIVE,INDVIDUALISTIC, CONSISTENT – TECHNICAL KNOWLEDGE

AND MNGT.SKILLS CASE MNGT. COMPREHENSIVE CONTINOUS CARE MANAGED CARE- COST CONTAINMENT DIFFERENTIATED-COMPETENCY-DELINEATION

IMMUNIZATIONS CONSIDERATIONS  CONTRAINDICATIONS:  SEVERE FEBRILE ILLNESS  LIVE VIRUSES C/I FOR IMMUNOCOMPROMISED  ALLERGIES  RECENTLY ACQUIRED PASSIVE IMMUNITY(BLOOD TRANSFUSION AND IMMUNOGLOBULINS)  if child –no evidence of immunization <7 y.o.  Give DPT,TOPV,TINE  4-6 WKS LATER MMR  1 MONTH AFTER DPT AND TOPV  REPEATED IN ANOTHER MONTH  AGAIN IN 10-16 MOS.  CAN GIVE DPT,MMR,TOPV, AND TINE SIMULTANEOUSLY       

TD- 2 DOSES 4-8 WKS APART;3RD DOSE 6-12 MOS;BOOSTER AT 10 YRS FO LIFE OPV/IPV – 2 DOSES AT 4-8 WKS APART ; 3RD DOSE 2 -12 MOS AFTER 2ND(OPV NOT USED IN US) MMR-ONE DOSE – 12 MOS VARICELLA – TWO DOSES 4-8 WEEKS APART STARTS AT 12 MOS. HEPA B – 3 DOSES;2ND 1-2 MOS AFTER;3RD 4-6 MS AFTER PPV- ONE DOSE ;IF 65 AND RECEIVED > 5YEARS – ADMINISTER INFLUENZA –ANNUALLY EACH FALL

Allergy Considerations:    

EGGS – INFLUENZA , MMR NEOMYCIN – VARICELLA,IPV,MMR YEAST – HEPA-B GELATIN – VARICELLA

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PREGNANCY C/I: MMR AND VARICELLA IMMUNOSUPPRESSED; VARICELLA

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WITH Ig or BT PREVIOUS 3-11 MOS – MMR AND VARICELLA

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DPT - IM – ANTERIOR OR LATERAL THIGH  FEVER AND SWELLING 24-48 H POTENTIAL  SERIOUS-CONVULSIONS,HYPERPYREXIA,LOC AND SCREAMING MMR – SC – ANTERIOR OR LATERAL THIGH  RASH, FEVER ARTHRITIS-10DAYS-2 WKS TRIVALENT OPV – PO

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PPD-ID- 4-6/11-16YRS.OLD IN HIGH PREVALENCE AREAS – EVALUATED 48-72 HOURS

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GLASGOW COMA SCALE=15 POINTS, 7 COMA  EYE OPENING  SPONTANEOUS=4  TO VERBAL COMMAND=3  TO PAIN=2  NO RESPONSE=1  MOTOR RESPONSE  TO VERBAL COMMAND=6  TO PAINFUL STIMULI/LOCALIZES PAIN=5  FLEXES AND WITHDRAWS=4  DECORTICATE=3  DECEREBRATE=2  NO RESPONSE=1  VERBAL RESPONSE  ORIENTED,CONVERSES=5  DISORIENTED,CONVERSES=4  USES INAPPROPRIATE WORDS=3  USES INCOMPREHENSIBLE SOUNDS=2  NO RESPONSE=1 PIAGET’S COGNITIVE THEORY 0-2 SENSORIMOTOR REFLEXES IMITATIVE REPETITIVE BEHAVIOR SENSE OF OBJECT PERMANENCE AND SELF SEPARATE FROM ENVT. TRIAL AND ERROR RESULTS IN PROBLEM SOLVING

2-7Y PRE-OPERATIONAL SELF-CENTERED,EGOCENTRIC CANNOT CONCEPTUALIZE OTHER’S VIEW ANIMISTIC THINKING IMAGINARY PLAYMATE – SYMBOLIC MENTAL REPRESENTATION – CREATIVITY 2-4 PRE-CONCEPTUAL (PRE-LOGICAL) 4-7 INTUITIVE (UNDERSTANDING OF ROLES)

7-12Y CONCRETE OPERATIONAL LOGICAL CONCRETE THOUGHT INDUCTIVE RESAONING (SPECIFIC TO GENERAL) CAN RELATE ,PROBLEM SOLVING ABILITY REASONING AND SELF-REGULATION

12-ABOVE FORMAL OPERATIONAL THOUGHT Abstract thinking Separation of fantasy and fact Reality oriented Deductive reasoning Apply scientific method

Kohlberg – MORAL DEVELOPMENT/ DEVELOPMENT/ THINKING/ JUDGEMENT PRE-CONVENTIONAL (0-6) PUNISHMENT AND OBEDIENCE OBEDIENCE TO RULES TO AVOID PUNISHMENT

CONVENTIONAL ( 6-12 ) MUTUAL INTERPERSONAL EXPECTATIONS,RELATIONSHIPS AND CONFORMITY

SOCIAL SYSTEM AND CONSCIENCE MAINTENANCE BEING GOOD IS IMPORTANT SELF RESPECT OR CONSCIENCE

POST –CONVENTIONAL (12 – 18 Y) PRIOR RIGHT OR SOCIAL CONTRACT UNIVERSAL ETHICAL PRINCIPLE ABIDE FOR COMMON GOOD RATIONAL PERSON-VALIDITY OF PRINCIPLES-AND BECOME COMMITTED TO THEM INNER CONTROL OF BEHAVIOR UNDERSTANDING THE EQUALITY OF HUMAN RIGHTS

AND DIGNITY OF HUMAN BEINGS AS INDIVIDUALS Universal Precautions Strict Isolation-highly Isolation-highly transmissible diseases by direct contact and airborne routes of transmission Private room,gowns, mask , gloves, handwashing,double bagged techniques for soiled articles Diptheria(pharyngeal),Herpes Zoster, Varicella , Pneumonia( S.Aureus , Strep,group A) Respiratory Isolation-droplet Isolation-droplet transmission(3 feet) Private rom,patient w/ same organism,mask,handwashing,labelled plastic bags for soiled articles H. influenza, measles, mumps, N. Meningitidis Tuberculosis/ AFB isolation-suspected isolation-suspected / active TB Private room with negative pressureventilation so that air room is vented outside, mask, handwashing, bronchoscopy and dental examination postponed until 2 weeks of antibiotic therapy Tuberculosis Contact Isolation – infectious disseases or multiple resistant microorganisms that are spread by direct contact or close contact Private room , mask gown , gloves diptheria( cutaneous), Herpes simplex, MRSA , Pediculosis , Scabies , Syphilis Enteric Precautions – infectious diseases transmitted through direct or indirect contact with infected feces. Handwashing , gloves , gowns worn only when handling contaminated objects with feces Aseptic meningitis, AGE , Hepa A , Typhoid fever, diarrhea (CDT ) Drainage / Secretions precautions – patients with wound drainage or infected wounds Gloves, gowns indicated if clothing is likely to be contaminated Burns Universal Blood and Body fluids precautions – blood borne , body fluids pathogens ( blood , semen , vaginal secretions , CSF , synovial fluid , pleural fluid , peritoneal fluid , pericardial fluid , amniotic fluid and tissues. Gloves , mask, protective eyegears, gown , contaminated needles not recapped and sharps in puncture resistant containers Aids , Hepatitis B and C , STD’s Reversed isolation Patient is protected from pathogens and nosocomial infections by instituting reversed transmission precautions Burns and open wounds, patients with artificial airway , immunocompromised patients – leukemia , AIDS , steroid therapy , radiation or cancer chemotherapy , medication effect of leukopenia or agranulocytosis ANXIETY – SLIGHT AROUSAL AND INCREASED PERCEPTION MODERATE-INC. TENSION AND SELECTIVE INATT. SEVERE – DEC. PERCEPTION AND FOCUSSED ENERGY PANIC – OVERPOWERING AND LOSS OF CONTROL MILD

POSITIONING FOR SPECIAL CONDITIONS ABDOMINAL ANEURYSM

SURGERY-FOWLERS

ASTHMA – ORTHOPNEIC POSITION AUTNOMIC DYSREFLEXIA-HIGH FOWLERS POST BRONCHOSCOPY-SEMI FOWLERS CARDIAC CATHETERIZATION-KEEP INSETION SITE EXTENDED FOR 4-6 HOURS TO PREVENT

ARTERIAL OCCLUSION CAST – ELEVATE EXTREMITY CATARACT – SEMI FOWLERS CEREBRAL ANEURYSM – SEMI - FOWLERS CLEFT LIP – SUPINE CLEFT PALATE – PRONE CHF – HIGH FOWLERS CRANIOTOMY – SUPRATENTORIAL – SEMI FOWLERS ;INFRATENTORIAL – FLAT ICP – LEVATE HEAD DUMPING SYNDROME – SUPINE AFTER MEALS EPISTAXIS – LEAN FORWARD

FLAIL CHEST

– AFFECTED SIDE GRAFT – AFFECTED EXTREMITY EXTENDED GLAUCOMA(POST OP) – AFFECTED SIDE HEMORROIDECTOMY – SIDE LYING HIATAL HERNIA- UPRIGHT HIP SURGERY – LEGS IN ABDUCTION LAMINECTOMY – BACK AS STRAIGHT AS POSSIBLE LIVER BIOPSY – RIGHT SIDE LYING LOBECTOMY – SEMI FOWLERS POST LP – FLAT MASTECTOMY – ELEVATE EXTREMITY ON PILLOW MYELOGRAM – WATER BASED DYE – ELEVATE THE HEAD --- OIL BASED DYE - FLAT POSTURAL DRAINAGE – LUNG SEGMENT – UPPERMOST POSITION PROLAPSED CORD – KNEE-CHEST PULMONARY EDEMA – FOWLERS PYLORIC STENOSIS – RIGHT SIDE LYING RADIUM IMPLANT – FLAT ON BED RETINAL DETACHMENT – AFFECTED SIDE TOWARDS THE BED SEIZURE – SIDE-LYING SHOCK – MODIFIED TRENDELENBURG SCI – IMMOBILIZE TONSILLECTOMY – SIDELYING / PRONE THYROIDECTOME – SEMI – FOWLERS THROMBOPHLEBITIS – ELEVATE LEG TPN – TRENDELENBURG – DURING INSERTION THORACENTESIS – FOWLER’S(DURING) AFTER – POSITION OF COMFORT FEMORO-POPLITEAL BYPASS

THERAPEUTIC DIET FOR SPECIFIC CONDITIONS – CLEAR LIQUID AGN – LOW NA , LOW CHON ADDISON’S – HIGH NA , LOW K ANEMIA , PERNICIOUS – HIGH CHON , VIT. B. ANEMIA SICKLE CELL – HIGH FLUID GOUT – PURINE RESTRICTED ADHD AND BIPOLAR – FINGER FOODS BURN – HIGH CAL. HIGH CHON CELIAC – GLUTEIN FREE CHOLECYSTITIS – HIGH CHON, HIGH CARB, LOW FAT CHF – LOW NA , LOW CHOL. CROHNS – HIGH CHON AND CHO, LOW FAT CYSTIC FIBROSIS – HIGH CAL., HIGH NA LITHIASIS----ACID ASH FOR ALK. STONES------ALK. ASH FOR ACID STONES DECUBITUS ULCERS – HIGH CHON , HIGH VIT C DIARRHEA – HIGH K AND NA DUMPING SYNDROME – HIGH FAT, HIGH CHON,DRY HEPATIC ENCEPHALOPATHY-LOW CHON HEPATITIS – HIGH CHON,HIGH CAL. HIRSPRUNGS – LOW RESIDUE, HIGH CHON AND CHO CIRRHOSIS – LOW CHON MENIERE’S LOW NA MI AND HPN – LOW CHOL.,FATS,NA HYPERTHYROIDISM- HIGH CAL. AND CHON HYPOTHYROIDISM – LOW CAL. , LOW CHOL, LOW SAT. FAT NEPHROTIC SYNDROME – LOW NA, HIGH CHON , HIGH CAL. HYPERPARATHYROIDISM – LOW CALCIUM HYPOPARATHYROIDISM – HIGH CA, LOW PHOSPHORUS OSTEOPOROSIS – HIGH CALCIUM AND HIGH VIT. D PANCREATITIS – LOW FAT PUD – HIGH FAT, HIGH CARB. LOW CHON PKU – LOW CHON / PHENYLALANINE PIH – HIGH CHON RENAL FAILURE (ACUTE) – LOW CHON,HIGH CARB LOW NA (OLIGURIC PHASE) HIGH CHON , HIGH CAL AND RESTRICTED FLUID (DIURETIC PHASE RENAL FAILURE (Chronic) – LOW CHON , LOW NA , LOW K AGE

PREVENTION AND EARLY DETECTION OF DISEASE

GROWTH AND DEVELOPMENT DEVELOPMENTAL TASKS---MILESTONES ----DELAYS(FIXATIONS/LAG) IQ = MA / CA X 100 JUDGEMENT , COMPREHENSION AND LISTENING DDST – BIRTH TO 6 YEARS PERSONAL SOCIAL, FINE , GROSS MOTOR AND LANGUAGE SKILL AREAS HEALTH SCREENING OB – GYNE / REPRODUCTIVE TESTS UTZ-5

WKS CONFIRM PREGNANCY AND AOG – 16 WKS-DETECT GENETIC DISORDERS – 30 WEEKS – L/S RATIO ( 2-4 WKS RESULT)(EMPTY Bladder) OCT – (28 WKS)FHR DECELERATIONS – IV OXYTOCIN 15-20 MIN----3 CONTRACTIONS OBTAINED WITHIN 10 MINUTES- REACTIVE NST – FHR ACCELERATIONS (32-34 WKS) – 2-MORE FHR ACCELERATION OF 15BPM/MORE LASTING 15 SECS -20 MINS. AND RETURN OF FHR TO NORMAL/BASELINE – REACTIVE DOPTONE- 12 WEEKS (18 – 20 WKS-AUSCULTATION) AFPT-FETAL SERUM CHON , -DETECT NEURAL TUBE DEFECTS – 16-18 WKS CHORIONIC VILLI SAMPLING –FETAL ABNORMALITIES- 10-12 WKS NEWBORN/INFANT HEALTH SCREENING PKU – GUTHRINE BLOOD TEST-EAT CHON FOR 2 DAYS MIN.(PHEONISTICS – DIAPER) SICKLE CELL DISEASE –ABNORMALLY SHAPED Hg , ELISA AND WESTERN BLOT CARRIER SCREENING FOR CYSTIC FIBROSIS AND SWEAT CHLORIDE TEST SCHOOL AGE HEARING AND VISION TESTS ALLEN PICTURE CARDS SNELLEN CHART-20/40 AT TODDLER AND 20/20 AT SCHOOL AGE WEBER’S-SENSORINEURAL AND CONDUCTIVE RINNE’S- CONDUCTIVE DENTAL EXAM – STARTS AT 2 YEARS ADOLESCENT PPD – INDURATION – 72 HOURS BSE – (18-20 YRS.) POST MENSTRATION/MONTHLY TSE – MONTHLY (18-20 YRS) PELVIC EXAM WITH PAP SMEAR – IF SEXUALLY ACTIVE OR 18 Y.O. ANNUALLY  ADULT/ELDERLY  HPN , DM, HEARING AND VISION  PROSTATE –ANNUALLY@40  Ca CHECK-UPS-Q3Y-20YO ; QY – 40 YO SIGMOIDOSCOPY- > 50 Y.O. =Q3-5 YRS FECAL OCCULT BLOOD TEST- > 50 = ANNUALLY DIGITAL RECTAL EXAM - > 40 Y.O. = YEARLY PELVIC EXAM – 18-40 Y.O. =PERFORMED Q 1 – 3 YEARS WITH PAP TEST MAMMOGRAM – 35-39 = BASELINE 40-49 = Q2Y 50 AND OLDER = QYEAR AMNIOCENTESIS

NORMAL VITAL SIGNS NEWBORN=

30 – 50 / MIN; 120 – 140 / MIN;

60/40 – 80/50 mmHg

1 – 4 YEARS= 20 – 40 / MIN;

80 – 140 /MIN;

90/60 – 99/65 mmHg

5 – 12 YEARS= 15 – 25 / MIN;

70 – 115 / MIN;

100/56 – 110/60 mmHg

ADULT=

12 – 20 / MIN; 60 – 100 / MIN ;

90 / 60 –140 / 90 mmHg

“ NOTHING Here on earth can harm you except yourself……..nothing here cannot be done unless you choose to give up……failure cannot overcome you unless you permit it………AIM HIGH AND HIT THE MARK” TRANSCULTURAL CONCEPTS HINDU – REINCARNATION , AUTOPSY , ORGAN DONATION, CREMATION ISLAM – NO TO ORGAN DONATION , CREMATION AND AUTOPSY …..CONFESS AND TURN

TO MECCA JUDAISM – WASHED NATIVE AMERICAN – NOT TO AUTOPSY BUDDIST – OK – EUTHANASIA AND WITH LAST RITES

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HINDU- all meats and animal shortening ISLAM- pork , alcohol and beverages(extracts of lemon and vanilla) , animal shortening and gelatin made of pork JUDAISM – pork , fowl , shellfish and scavenger fish( without scales or fins) , blood by ingestion(transfusion –o.k.), packed fods – kosher-properly presserved or fitting  KOSHER- no meat and milk altogether  Pareve – made without milk or meat items MORMON – alcohol, tobacco, beverages with caffeine stimulants 7TH DAY ADVENTIST – pork , certain seafoods including shelfish, fermented beverages , vegetables are encouraged YIN AND YANG – cold foods in hot illness , vice versa  Hot – rash , fever , sorethroat , surgery , ulcer , infection  Cold – Ca , HA , stomach cramps and colds BEDSIDE SAFETY/EMERGENCY MATERIALS / EQUIPMENTS

AMPUTATION – TOURNIQUET AUTONOMIS HYPERREFLEXIA – CATHETER CHEST TUBE DRAINAGE- EXTRA BOTTLE- FORCEPS – VASELINIZED GAUZE CHOLINERGIC AND MYASTHENIC CRISIS – ENDOTRACHEAL TUBE / TRACHEOSTOMY SET EPIGLOTITIS - ENDOTRACHEAL TUBE / TRACHEOSTOMY SET PIH – PADDED MOUTH GAG PARKINSONS – SUCTION APPARATUS

RADIUM IMPLANT – LEAD CONTAINER , FORCEPS SENGSTAKEN BLAKEMORE TUBE – SCISSORS SCI AND THYROIDECTOMY – TRACHEOSTOMY TONSILLECTOMY – FLASHLIGHT TRACHEOSTOMY TUBE – OBTURATOR , HEMOSTAT

PREVENTION OF FALLS L IGHTING L OWER BED POSITION L OCATE GRAB BARS AND CALL BELL S UFFICIENT ORIENTATION S IDERAILS S UPERVISE AND ORIENT

THERAPEUTIC EXERCISES PASSIVE ROM-RETENTION OF ROM AND MAINTENANCE OF CIRCULATION ASSISTIVE- INCREASES MOTION , MAINTAINS MUSCLE TONE ACTIVE – MAINTAINS MOBILITY OF THE JOINT AND MAINTAINS MUSCLE STRENGTH RESISTIVE – INCREASES MUSCLE POWER ISOMETRICS- MAINTENANCE OF STRENGTH AND PREVENTS MUSCULAR ATROPHY

ERGONOMICS-BODY POSITIONING AND MECHANICS PERSONAL CAPACITY 1ST USE PROTECTIVE DEVICES/ TRANSFER AIDS CHANGE POSITION SLOWLY-ORTHOSTATIC HYPOTENSION(DANGLE LEGS FIRST) PIVOT ON THE STRONGER SIDE,MOVE PNT TOWARDS STRONGER SIDE USE LARGER MUSCLES OF THE BODY AND FACE THE DIRECTION OF THE MOVEMENT PULL SHEETS ARE BETTER METHOD THAN SLIDING ALWAYS MOBILZE MAXIMUM MANPOWER/HAVE AN ASSISTANT STANDING BY. ROCK FROM FRONT TO BACK/VICE VERSA.WIDE BASE OF SUPPORT, WEIGHT NEAR MIDLINE OF THE BODY.USE APPROPRIATE TRANSFER AND AMBULATION AIDS. (TRAPEZE, HOYER LIFT, SLIDE BOARD, DRAW SHEET AND TRANSFER BELT PRIORITY-ASSESS

DANGERS OF IMMOBILITY ULCER-OSTEOMYELITIS OSTEOPOROSIS-PATHOLOGICAL FRACTURES AND RENAL CALCULI INCREASED CARDIAC WORKLOAD- TACHYCARDIA CONTRACTURES- DEFORMITIES THROMBUS FORMATION-PULMONARY EMBOLISM ORTHOSTATIC HYPOTENSION-WEAKNESS,FAINTNESS AND DIZZINESS RESPIRATORY STASIS – HYPOSTATIC PNEUMONIA CONSTIPATION – FECAL IMPACTION URINARY STASIS-URINARY RETENTION NEGATIVE NITROGEN BALANCE-WEIGHT LOSS/DEBILITATION DECUBITUS