Nursing Board Exam Test Drill 1

HERBAL MEDS St. John's wort - antidepressant, photosensitive (C/I in SULFA drugs) Garlic - antihypertensive (avoid aspirin) Ginseng - Anti stress (C/I in coumadin) Green tea - antioxidant (check if risk for calculi-oxalates) Echinacea - immune stimulant (6-8 weeks only)(C/I in SANDIMMUNE-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 - nausea A - anorexia V - vomiting D - diarrhea A - abdominal pain Drugs which can cause URINE DISCOLORATION Adriamycyn------ Reddish Rifabutin--------- Red orange Rifampicin------- Red orange Bactrim---------- Red orange Robaxin--------- Brown, Black or Greenish Azulfidine------ Orange yellow Flagyl------------ Brownish Dilantin---------- Pink tinged Anti Psychotic-- Pinkish to Red brown Early signs of hypoxia: R-restlessness A-anxiety T-Tachycardia Late signs of hypoxia: B-bradycardia E-extreme restlessness D-dyspnea In pediaF-feeding difficulty I-inspiratory stridor N-nares flare E-expiratory grunting S-sternal retractions Respiratory Patterns Kussmaul- fruity acetone breath odor Cheyne-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 ABBREVIATIONS OU- both eyes OR- right eye OS- left eye CUSHINGS (Hypersecretion of Adrenal Cortex Hormones) C = Check VS, particularly BP U = Urinary output & weight monitoring S = Stress Management H = High CHON diet I = Infection precaution N = Na+ restriction G = Glucose & Electrolytes Monitoring S = Spousal support ADDISON'S (Hyposecretion of Adrenal Cortex Hormones) Always Remember the 6 A's of Addison's disease 1.) Avoid Stress 2.) Avoid Strenuous 3.) Avoid Individuals with Infection 4.) Avoid OTC meds 5.) A lifelong Glucocorticoids Therapy 6.) 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.

B eside the nurse's station? At the end of the hallway? Single Room/Private Room? C hain of infection/circumstance Nephrotic syndrome is characterized by massive proteinuria (looks D iagnosis dark and frothy) caused by glomerular damage. Corticosteroids are the E nviroment (dim light, darkened, red nightlapm) mainstay. Generalized edema common. Sample Test Item: The best roommate for patient with LEUKEMIA is A positive Western blot in a child <18 months (presence of HIV O 1 A 9-year-old with ruptured appendix antibodies) indicates only that the mother is infected. Two or more O 2 A 12-year-old with chicken pox positive p24 antigen tests will confirm HIV in kids <18 months. The O 3 A 2-year-old with fever of unknown origin p24 can be used at any age. O 4 A 5-year-old with nephrotic syndrome Correct Answer: 4. A 5-year-old with nephrotic syndrome. For HIV kids avoid OPV and Varicella vaccinations (live), but give 1,2 & 3, manifest symptoms of infection. A client with leukemia is Pneumococcal and influenza. MMR is avoided only if the kid is immunosuppressed and Patients with infection shouldn't be placed in severely immunocompromised. Parents should wear gloves for care, this room. Since patient with nephrotic syndrome receives diuretics and not kiss kids on the mouth, and not share eating utensils. steroids, this child will also need immunocompromised host precaution. Never give potassium if the patient is oliguric or anuric.

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.

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

An NG tube can be irrigated with cola, and should be taught to family AGE APPROPRIATE GROWTH AND DEVELOPMENT when a client is going home with an NG tube. (HOPPING WITH ONE LEG) Sample test Item: PRIORITY QUESTIONS (WHO TO SEE FIRST) 4. Which of the following is NOT a characteristic of a preschooler? Sample Test Item: O 1 predominantly "parallel play" period 1. Which of the following clients should the nurse deal with FIRST? O 2 balances on 1 foot with eyes closed o 1 A client who needs his daily vitamin O 3 skips on alternate feet o 2 A client who needs to be suctioned O 4 jumps rope o 3 A client who needs diaper to be changed The correct answer is: 1. Parallel play is more common in o 4 A client who is being prepared for discharge TODDLERS. Correct Answer: 2. A client who needs to be suctioned Preschooler (3-6 years) PRIORITY (Use ABC) Gross motor development Obstruction in the airway – secretions HOPS ON ONE (1) FOOT BY 4 YEARS Need to be suctioned SKIPS & HOPS ON ALTERNATE FEET BY 5 YEARS 2. Delegation, RN, LVN, UAP, CNA PLAY : ASSOCIATIVE, IMAGINATIVE, MAGICAL THINKING, Which of the following clients should the LPN be assigned to? SUPERHEROES (Remember the movie: Jingle All The way!) o 1 A newly diagnosed patient with MYASTHENIC CRISIS FEAR: Intrusive procedures, venipunctures, IM injections, body o 2 An immediate post-op client in PACU mutilation o 3 A client awaiting medication for vitamins o 4 A new admission for KIDNEY Transplant Patient Toxoplasmosis, where else you can contract this (thinking of cat litter Correct Answer: 3-stable, A client awaiting medication for vitamins but it aint there) Myasthenic Crisis – Unstable, Acute Respiratory Failure Sample test Item: Immediate Post – op – Unstable, Risk for Complications, 5. To which of the following pregnant clients will be risk for Kidney Transplant – Unstable, needs assessment for rejection TOXOPLASMOSIS? DELEGATION: Remember the 5R's, Right Task, Right Person, Right Select all that apply: Circumstance, Right Communication & Right Feedback) O 1 A pregnant client who eat raw meat. RN Least stable, unstable, central catheters (hickman, broviac), O 2 A pregnant client handling cat litter of infected cats. admission, discharge, health teachings, patient for transfer, blood O 3 A pregnant client gardening and cultivating soil exposed to cat transfusion (2RNs) feces. LPN Technical Doer, Stable, medications, wound dressing O 4 A pregnant client with low rubella titer CNA Routine Care, Urine Dip Stix, Reporting to RN, Routine VS O 5 A pregnant client who have undergone external radiation. UAP turning q2H, conducting group activities, ambulation O 6 A pregnant client with draining, painful vesicles in the external For future USRNs genitalia. This is for you... from the purkinje fibers of my heart.... The correct answers: 1, 2 & 3. Room Assignment(Who to Share Room with) TOXOPLASMOSIS Check: How do people get toxoplasmosis? A ge A Toxoplasma infection occurs by:

Accidentally swallowing cat feces from a Toxoplasma-infected cat that (female: 190 to 420 mg/dL) is shedding the organism in its feces. This might happen if you were to accidentally touch your hands to your Insulin mouth after gardening, (Regular, Humulin R) cleaning a cat's litter box, or Type: Fast acting touching anything that has come into contact with cat feces. Onset: ½ -1 hr Eating contaminated raw or partly cooked meat, especially pork, lamb, Peak: 2-4 hr or venison; Duration: 6-8 hr Insulin by touching your hands to your mouth after handling undercooked (NPH, Humulin N) meat. Type: Intermediate acting Contaminating food with knives, utensils, cutting boards and other Onset: 2hr foods that have had contact with raw meat. Peak: 6-12hr Drinking water contaminated with Toxoplasma. Duration 18-26hr Insulin Receiving an infected organ transplant or blood transfusion, though this (Ultralente, Humulin U) is rare. Type: Slow acting (From the internet-Division of Parasitic Disease) Onset: 4hr Which of these statements by the nurse is incorrect if the nurse has the Peak: 8-20hr goal to reinforce information about cancers to a group of young adults? Duration: 24-36hr Insulin 1. “You can reduce your risk of this serious type of stomach cancer by (Humulin 70/30) eating lots of fruits and vegetables, limiting all meat, and avoiding Type: Combination nitrate-containing foods.” Onset: ½ hr 2. “Prostate cancer is the most common cancer in American men with Peak: 2-12hr results to threaten sexuality and life.” Duration: 24hr 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 Central Venous Pressure: < 3 mm Hg = inadequate fluid and >11 mm States. Yet it's the most preventable of all cancers. Hg = too much fluid 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 dehydration Safe 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 treatment Phenytoin (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

Potassium: 3.5-5.0 mEq/L Sodium: 135-145 mEq/L Calcium: 4.5-5.2 mEq/L or 8.6-10 mg/dL Magnesium: 1.5-2.5 mEq/L Chloride: 96-107 mEq/L Phosphorus: 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/dL Amylase:25 to 151 IV/L Lipase: 10 to 140 U/L Cholesterol: 140 to 199 mg/dL LDL: <130 mg/dL HDL: 30 to 70 mg/dL Triglycerides: <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/dL Female 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/dL Female 50-170 ug/dL RBC: Male 4.5 to 6.2 M/uL

Female 4.0 to 5.5 M/uL

Intimacy vs. isolation 25 – 50 Generativity vs. stagnation

Theophylline levels normal (10 to 20 mcg/dl)

50 - ? Integrity vs.despair LABORATORY VALUES

MOTOR DEVELOPMENT ELECTROLYTES 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

Sodium (Na+): 135 – 145 meq/L (increase-dehydration; decrease overhydration) Potassium (K+): 3.5 - 5.0 meq/L Magnesium (Mg++): 1.5 – 2.5 meq/L Calcium (Ca++): 4.5 – 5.8 meq/L Neonate : 7.0 to 12 mg/dL Child: 8.0 to 10.5 mg/dL Phosphorus (PO4): 1.7 – 2.6 meq/L Chloride (Cl-): 96 – 106 meq/L COAGULATION STUDIES Activated partial thromboplastin time(APTT): 20 – 36 seconds depending on the type of activator used Prothrombin time(PT): male: 9.6 – 11.8 seconds Female: 9.5 – 11.3 seconds International Normalized Ratio(INR): 2.0 - 3.0 for standard Coumadin therapy 3.0 – 4.5 for high-dose Coumadin therapy Clotting time: 8 – 15 minutes Platelet count: 150,000 to 400,000 cells/Ul Bleeding time: 2.5 to 8 minutes SERUM GASTROINTESTINAL STUDIES

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 PIAGET Infant 0 – 1.5 Trust vs. mistrust Oral (trust & dependence sensorimotor Toddler 1.5 -3 Autonomy vs. shame Anal (holding vs. letting out) preoperational Pre-school 3-6 Initiative vs. guilt Phallic (Oedipus complex) preoperational School age 6 - 11 Industry vs. inferiority latency Concrete operational

Albumin: 3.4 to 5 g/dL Alkaline phosphatase: 4.5 to 13 King-Armstrong units/dL Ammonia: 15 to 45 ug/dL Amylase: 50 – 180 Somogyi U/dL in adult 20 – 160 Somogyi U/dL in the older adult Bilirubin: direct: 0 - 0.3 mg/dL Indirect: 0.1 – 1.0 mg/dL Total: less than 1.5 mg/dL Cholesterol: 120 – 200mg/dL Lipase: 31 -186 U/L Lipids: 400 – 800 mg/dL Triclycerides: Normal range: 10 – 190 mg/dL Borderline high: 200 – 400 mg/dL High: 400 – 1000mg/dL Very high: greater than 1000mg.dL Protien: 6.0 – 8.0 g/L Uric acid: male: 4.5 – 8 ng/dL Female: 2.5 – 6.2 ng/dL GLUCOSE STUDIES Fasting blood sugar: 70 – 105 mg/dL Glucose monitoring (capillary Blood): 60 – 110 mg/dL

RENAL FUNCTION TEST Creatinine: 0.6 – 1.3 mg/dL Blood urea nitrogen (BUN): 5 – 20 mg/dL ERYTROCYTES STUDIES

11 - 20 Identity vs. role confusion genital Formal operational 20 – 25

Erytrocyte sedimentation rate(ESR): 0 – 30 mm/hr depending on age Hemoglobin: male: 14 – 16.5 g/dL Female: 12 – 15 g/dL Hematocrit: 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/uL Female: 4 to 5.5 million/uL White blood cell (WBC): 4500 to 11,000/uL Erytrocyte Protoporthyrin (EP) : <9ug/dL Phenylalanine Level: <2 mg/dL PKU: >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 sensation Jaw movement VI. Abducent (M) Eye movement VII. Facial (S-M) Taste Facial expression VIII. Acoustic (S) Hearing and balance

Decreased heart rate Bronchi dilation constriction GI tract Reduced motility Increased motility Rectum Allows filling Empties rectum Relaxes internal sphincter Bladder Allows filling Empties bladder Relaxes 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

IX. Glossopharyngeal (S-M) Taste Throat sensation Gag and swallow X. Vagus (S-M) Gag and swallow Parasympathetic activity XI. Spinal Accessory (M) Neck and back muscles XII. Hypoglossal (M) Tongue movement

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

On Old Olympus’ Towering Tops, A Finn And German Viewed Some Hops Some Says Marry Money, But My Brother Says Bad Business Marry Money ARTERIAL BLOOD GAS (ABG) pH: 7.35 – 7.45 PCO2: 35 - 45 mmHg PO2: 80 - 100 mmHg HCO3: 22 - 27 mEq/L O2 saturation: 96% - 100% Acid-base “RAMS”(Respiratory Alternate, Metabolic Same) GLASGOW COMA SCALE Eye opening response Motor response Verbal response AUTONOMIC NERVOUS SYSTEM SYMPATHETIC/ ADRENERGIC PARASYMPATHETIC/ CHOLINERGIC Heart Increased heart rate Increased conduction Increased force

Sinoatrial (SA) node – right and left atria (atria contract) – atrioventricular (AV) node – bundle his – bundle brabches – purjinje’s fibers – ventricles contract. Blood volume: 5000mL Central venous pressure: 4 to 10 cmH2O (increased in cardiac overload; decreased in dehydration) Pressure within the right atrium: 2 to 7 mmHg Capillary refill time: <3 seconds Normal sweat chloride: <40 mEq/L Normal pupil diameter: 3 to 5mm Normal ocular pressure: 10 to 21 mmHg Normal Pulmonary capillary wedge pressure (PCWP): 8 to 13 mmhg Normal cardiac output : 4 to 8 L/min. THERAPEUTIC SERUM MEDICATION LEVELS Acetaminopen (Tylenol) 10 – 20 ug/mL Amikacin (Amikin) 25 – 30 ug/mL Amitryptyline (Elavil) 120 -150 ng/mL Carbamazepine (Tegretol) 5 -12 ug/mL Chloramphenicol (Chloromycetin) 10 – 20 ug/mL Desipramine (Norpramin) 150 -300 ng/mL Digotoxin ( Crystodigin) 15- 25 ng/mL Digoxin ( Lanoxin) 0.5 – 2.0 ng/mL Disopyramide (Norpase) 2 -5 ug/mL Ethosuximide ( Zarontin) 40 – 100 ug/mL Gentamycin (Garamycin) 5 – 10 ug/mL

Imipramide (Tofranil) 150 – 300 ug/mL Lidocaine (Xylocaine) 1.5 – 5.0 ug/mL Lithium (Lithobid) 0.5 -1.5 ug/mL Magnesium sulphate 4 -7 mg/dL Nortriptyline (Aventyl) 50 – 150 ng/mL Phenobarbital (Luminal) 10 – 30 ug/mL Phenytoin (Dilantin) 10 -20 ug/mL Primidone (Myoline) 5 – 20 ug/mL Procainamide (Pronestryl) 4 – 10 ug/mL Propranolol (Inderal) 50 – 100 ng/mL Quinidine (Quinalaglute, Cardioquin) 2 – 5ug/mL Salisylate 100 -250 ug/mL Theophylline (Aminiphylline, Theo-Dur) 10 -20 ug/mL Tobramycin (Nebcin ) 5 -10 ug/mL Valproic acid (depakene) 50 -100 ug/mL

Pulmonary capillary wedge pressure: 5 to 13 mmHg Pulmonary artery pressure: systolic: 16 to 30 mmHg Diastolic: 0 to 7 mmHg Spinal pressure: 70 to 200mmH2O Morphine sulphate pediatric dose: 0.1mg/kg every 3 – 4 hour SULFONYLUREAS For 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 8h Glycburide, glipizide 20 h, most potent chlorpropamide 48 h Apothecary and Household System Grain –gr 1 gr = 60 mg Dram – dr 5 gr = 300 mg Ounce –oz 15 gr = 1000mg or 1g Minim – min, M, m 1/150 gr =0.4 mg Quart – qt 1 oz = 30 mL Pint – pt 1 dr = 4 mL Drop – gtt 1 T = 15 mL or 3 tsp Tablespoon – T or tbs 1 min = 1 gtt Teaspoon – t or tsp 15 min = 1mL Pound – lb 60 min = 1 dr 8 dr = 1 oz 1 qt = 1000mL or 1L 1 qt = 2 pt or 32 oz 1 pt = 16 oz 16 oz = 1 lb 2.2lb = 1 kg

A Formulas for Intravenous Calculations Flow Rates: Total volume x gtt factor = gtt per min Time in minutes Infusion Time: Total volume to infuse = Infusion time mL per hour being infused IMMUNIZATION Birth Hepatitis B 1 months Hepatitis B 2 months OPV, DPT, HIB 4 months DPT, HIB, OPV 6 months DPT, HIB, hepatitis B 12 months HIB, OPV 15 months MMR 18 months DPT 12 – 18 months Varicella vaccine 4 -6 years DPT, OPV, MMR 11 – 12 years MMR ( if not administered at 4 -6 years) 11 – 16 TD booster SPINAL CORD INJURY Cervical 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%

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 ordered A (available) =the dosage strength as stated on the medication label Q (quantity ) = the volume that the dosage strength is available in, such as tablet, capsules, or mL NORMAL ADULT WHITE BLOOD CELL DIFFERENTIAL DXQ=X

Neutrophils 56% or 18000 – 7800/uL

Bands 3% or 0 – 700/uL Eosinophils 2.7% or 0 – 450/uL Basophils 0.3% or 0 – 200/uL Lymphocytes 34% or 1000 – 4800/uL Monocytes 4% or 0 – 800/uL THYROID STUDIES Thyroid –stimulating hormone (thyrotropin; THS): 0.2 to 5.4 ug/dL Thyroxine (T4): 5.0 to 12.0 ug/dL Thyroxine free (FT3) : 0.8 to 2.4 ng/dL Triiodothyronine (T3): 80 to 230 ng/dL

Normal Fribrinogen level: for men: 180 to 340mg/dL Women: 190 to 420mg/dL Fribrinogen is used up in the clotting process. Erythrocyte Protoporhyrin (EP): < 9ug/dL Phenylalanine level: < 2mg/dL PKU: >25 mg/dL Urine specific gravity: 1.016 - 1.022 increase in SIADH; decrease in diabetes insipidus Normal CSF protein: 15 – 45 mg/dL increase in Guillain-Barre syndrome Normal CSF pressure: 5 – 15 mmHg Normal serum osmolality: 285 – 295 mOsmlkgH2O increase in dehydration; Decrease in over hydration Normal scalp pH: 7.26 and above Borderline acidosis: 7.20 to 7.25 Acidosis: < 7.15

HERBAL MEDICINE

Gotu Kola (Centella asiatica) – mental support, wound healing and venous disorders Hawtorn ( Crategus species) – CHF and related cardiovascular conditions Horebound (Marribium vulgare) – primary cough suppression and expectoration Horse Chestnut Seed (Aesculus hippocastanum) chronic venous insufficiency Ivy (Hedera helix) – coughs, rheumatic disordes and skin disease Kava ( piper methysticum) – mild psychoactive and antianxiety property Lemon Balm (Melissa officinalis) – sedative and for dyspepsia Licorice (Glycyrrhiza glabra) – respiratory disorders, hepatitis, inflammatory diseases, and infections Melatonin – insomia, jet lag Milk Thistle – hepatitis, liver desease Mints (Mentha species) – minor calcium channel antagonists, used for upper respiratory problems, irritable bowel syndrome, dyspepsia, and colonic spasm and as a topical counterirritant Nettle (Urtica dioica) – arthritis pains, allergies, BPH, or as diuretic Papaya (Carica papaya) – digestive aid, dyspepsia, and for inflammatory, topically applied to wounds Passion flower (Passiflora incarnata)- sedative-hypnotic or anxiolytic herb Pokeroot (Phytolacca Americana) – inflammatory conditions also as an emetic/cathartic Pygeum (Pygeum africanum) – mild symptoms of BPH Red Clover (Trifolium pratense) – used as a natural estrogen substitute for women’s health St. John’s Wort (Hypericum perforatum) – antidepressant effect Tea Tree Oil (Melaleuca alternifolia) – antifungal and antibacterial Turmeric (Curuma longa ) – anti-inflammatory, anti-arthritis, anti cancer, and antioxidant Uva Ursi (Arctostaphylos uva ursi) – urinary antiseptic and diuretic Yohimbe – erectile dysfunction

FOUR STRATEGIES: 1. If the question asks what you should do in the situation. Use the Aloe vera Gel – abrasionsand dermatologic conditions nursing process to determine which step in the nursing process would American Ginseng (Panax quinquefolius) – boost energy, relieve stress, be next? improve concentration and enhance physical or cognitive performance. 2. If the question asks what the client needs. Use maslow’s hierarchy to Ashwagandha (Withania somnifera) – stress arthritis determine which need to address. Asian gingseng (Panax ginseng) – enhance health and combat stress 3. If the question indicates that the client doesn’t have urgent and disease physiologic need, focus on the patient safety. Bilberry (Vaccinium myrtillus) – vision and peripheral vascular 4. If the question involves communicating with a patient. Use disorders and as antioxidant principles of therapeutic communication. Black Cohosh (Cimicifuga racemosa) – menopausal Black Currant and Borage oil (Ribes nigrum and Borago offinalis) – REMEMBER: anti-inflammatory, rheumatoid arthritis AIRWAY, BREATHING,CIRCULATION AND SAFETY (ABCS) Capsicum Peppers (Capsicum spp.) – arthritis, neuralgia and other painful treatment Chamomile (Matricaria recutita) “manzanilla”- skin inflammation, The nurse in primary care clinic is caring for a 50-year-old woman. colic, or dyspepsia and anxiety History reveals that she had experienced on and off chest pain. After Chaste tree (Vitex agnus-castus) – menstrual related disorders, PMS, series of cardiac tests (EKG & Blood Chem), the doctor orders for cyclical mastalgia THALLIUM STRESS TEST. Which of the following medications Chodroitin – osteoarthritis should the RN prepare if the patient needs an alternative exercise in Coenzyme Q10 – antioxidant thallium test? Coltsfoot ( Tussilago farfara ) – cough and other respiratory disoders 1.Nitroglycerin Cranberry (Vaccinium macrocarpon) – UTI 2.Morphine Devil’s Claw ( Harpagophytum procumbers) – anti inflammatory and 3.Aminophylline analgesic 4.Persantin Echinacea (Echinacea spp.) – acute viral URI symptoms The correct answer is #4. Persantin (dipyridamole) Ederberry (Sanbacus nigra) – respiratory tract infection Persantin is use as an alternative to exercise in thallium myocardial Ephedra or Ma Huang (Ephedra sinica) Source of ephedrine and perfusion imaging for the evaluation of CAD in those who cannot pseudoephedrine exercise adequately. Evening Primrose Oil (Oenothera biennis) – eczema, breast pain Purpose: to determine myocardial wall viability associated with PMS and inflammatory condition Other names: Fenugreek (Trigonella foenum-graecum) – lowering blood glucose 1. Cardiac pooling Feverfew ( Tanacetum parthenium) – migraine headache prophylaxis 2. MUGA-multigated radionuclide angiographic scanning Garlic (Allium sativaum)- help prevent cardiovascular disease and 3. nurclear scan cancer 4. sestamibi test Ginger (Zingiber officinale) –nausea and motion sickness, anti5. thallium scan inflammatory 6. dipyridamole or persantin stress test Ginkgo (Ginkgo biloba) – dementia and intermittent claudication, 7. In short, heart scan :) memory enhancement and treatment of vertigo nad tinnitus Loving NCLEX-RN Glucosamine – osteoarthritis URC Goldenseal ( Hydrastis Canadensis) – tonic and antibiotic 09178364589

Posted by Anaski from IP 203.131.183.186 on August 23, 2005 at 21:44:00: For Future USRN's: Cervical Cancer Etiology: * Early age of sexual intercourse * Multiple sexual partners * Sexually Transmitted Disease (Venereal Wart) * Virus - HPV Cancer Carcinoma in SITU - only in epithelial linings Situ sounds like Ziru - Stage 0 Tumor marker - CEA Signs and Symptoms (3 P's) POST COITAL BLEEDING PAINFUL INTERCOURSE PROFUSE (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- cogentin A- artane P- parlodel A- akineton B- benadryl L- larodopa E- Eldepryl S- symmetril Increase protein and give B6 Akathisia Dystonia Tardive Dysinesia Neuroleptic Malignant Syndrome ANTI-ANXIETY

M-marplan N-nardil P-parnate Hypertensive crisis within several hours of ingestion of tyramine containing foods Tyramine foods: aged cheese, beer, ale, red wine, pickled foods, smoked or pickled fish, beef or chopped liver, avocado of figs. ANTI-DEPRSSION A- asendin N-norpramin T- tofranil S-sinequan A-anafranil - aventyl V-vivactil E-Elavil P-paxil Z-zoloft D-riving is contraindicated E-ffect has a delayed onset of 7-21 days P-regnancy consult with your physician R-elieves symptoms but never cure E- valuate vital sign S-toppind drug abruptly is Out! S-afety measures I-nstruct to report undesirable side effect O-bserve for suicidal tendencies N-o alcohol or CNS depressants ANTI-MANIC DRUGS Lithium- Eskalith Increase risk of toxicity when given with: thiazide diuretics, methyldopa, and NSAIDs Decrease lithium levels with excess sodium and antacids. Increase CNS toxicity with Haloperidol 0.6-1.2 -meq/l Therapeutic Effect > 1.5 meq/l Toxic 2.0 meq/l lethal

V-valium L-librium A-ativan S-serax T-tranxene

L- evel - therapeutic 0.6-1.2 meq/l I-ncreased Urination T-hirst Increased H-eadaches and Tremors I-ncreased fluids U-nsteady M-orton's Salt -adequate intake

M-miltown E- equanil V-vistaril A-taxene I-Inderal B-buspar

Hepatotoxic Drugs ( liver)

Tolerance develop until seven days A- void abrupt discontinuation after prolonged use N- Not give if BP is up, hepatic/renal dysfunction or history of drug abuse X-xanax, ativan, serax is also an anti-anxiety meds I-increase in 3D's- drowsiness, dizziness, decreased BP Enhances action of GABA T-teach client to rise slowly from supine position Y-es alcohol should also be avoided. MAOI Drugs

* 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 eating ACE = angiotensin converting enzyme ACL = anterior cruciate ligament ACLS = 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-fetoprotein AGA = appropriate for gestational age AI = aortic insufficiency AIDS = acquired immune deficiency syndrome AKA = above knee amputation ALD = alcoholic liver disease ALL = acute lymphocytic leukemia ALP = alkaline phosphatase ALT = alanine transaminase, alanine aminotransferase ATN = acute tubular necrosis AU = both ears AV = atrioventricular B.S. = Bachelor of Science B/K = below knee BM = bowel movement or breast milk BX = biopsy c = with C/O = complaining of CA = calcium, cancer, carcinoma CAA = crystalline amino acids CABG = coronary artery bypass graft CAD = coronary artery disease CAPD = continuous ambulatory peritoneal dialysis CAT = computerized axial tomography CBC = complete blood count CBD = common bile duct CBG = capillary blood gas CBI = continuous bladder irrigation CBS = capillary blood sugar CC = chief complaint CCK = cholecystokinin CCPD = continuous cyclic peritoneal dialysis CCU = clean catch urine or cardiac care unit CCV = critical closing volume CF = cystic fibrosis CHF = congestive heart failure CHO = carbohydrate CI = cardiac index CLT = Clinical Laboratory Technician CML = chronic myelogenous leukemia CN = cranial nerves CNS = central nervous system CO = cardiac output COPD = chronic obstructive pulmonary disease CP = chest pain, cleft palate CPD = cephalo-pelvic disproportion CPK = creatinine phosphokinase CPP = cerebral perfusion pressure CPR = cardiopulmonary resuscitation

CRCL = 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 pressure D5W = 5% dextrose in water DAT = diet as tolerated DC = (dc) discontinue DIC = disseminated intravascular coagulopathy DKA = diabetic ketoacidosis DM = diabetes mellitus DNA = deoxyribonucleic acid DNR = do not resuscitate DOA = 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 loss EBV = Epstein-Barr Virus ECF = extracellular fluid, extended care facility ECG = electrocardiogram ECT = electroconvulsive therapy EENT = eye, ear, nose and throat EFAD = essential fatty acid deficiency EMG = electromyogram EMV = eyes, motor, verbal response (Glasgow coma scale) ENT = ears, nose, and throat EOM = extraocular muscles ESR = erythrocyte sedimentation rate ESRD = end stage renal disease ET = endotracheal tube ETT = endotracheal tube EUA = examination under anesthesia FBS = fasting blood sugar FDA = Food & Drug Administration FEV = forced expiratory volume FFP = fresh frozen plasma FNP = Family Nurse Practitioner GB = gallbladder GC = gonorrhea GERD = gastroesophageal reflux disease GFR = glomerular filtration rate GI = gastrointestinal GSW = gun shot wound GTT = glucose tolerance test GU = genitourinary HB = hemoglobin HBP = high blood pressure HCG = human chorionic gonadotropin HCO3 = bicarbonate HCT = hematocrit HD = hemodialysis HDL = 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 given ventilator. 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 troubleshooting 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.

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 autoPEEP in high risk patients (patients with obstructive lung diseases 1. To review indications for and basic modes of mechanical ventilation, (asthma, bronchospasm), unevenly distributed lung diseases (lobar possible complications that can occur, and nursing observations and pneumonia), or hyperinflated lungs (emphysema). procedures to detect and/or prevent such complications. 2. To provide a systematic nursing assessment procedure to ensure C. Nosocomial Pneumonia early detection of complications associated with mechanical 1. Cause – invasive device in critically ill patients becomes colonized ventilation. with pathological bacteria within 24 hours in almost all patients. 2060% of these, develop nosocomial pneumonia. Indication for Intubation 2. Treatment – aimed at prevention by the following: 1. Acute respiratory failure evidenced by the lungs inability to maintain Avoid cross-contamination by frequent handwashing arterial oxygenation or eliminate carbon dioxide leading to tissue Decrease risk of aspiration (cuff occlusion of trachea, positioning, use hypoxia in spite of low-flow or high-flow oxygen delivery devices. of small-bore NG tubes) (Impaired gas exchange, airway obstruction or ventilation-perfusion Suction only when clinically indicated, using sterile technique abnormalities). Maintain closed system setup on ventilator circuitry and avoid pooling 2. In a patient with previously normal ABGs, the ABG results will be as of condensation in the tubing follows: Ensure adequate nutrition PaO2 > 50 mm Hg with pH < 7.25 Avoid neutralization of gastric contents with antacids and H2 blockers PaO2 < 50 mm Hg on 60% FIO2 : restlessness, dyspnea, confusion, anxiety, tachypnea, tachycardia, and diaphoresis D. Positive Water Balance PaCO2 > 50 mm Hg : hypertension, irritability, somnolence (late), 1. Syndrome of Inappropriate Antidiuretic Hormone (SIADH) – due to cyanosis (late), and LOC (late) vagal stretch receptors in right atrium sensing a decrease in venous 3. Neuromuscular or neurogenic loss of respiratory regulation. return and see it as hypovolemia, leading to a release of ADH from the (Impaired ventilation) posterior pituitary gland and retention of sodium and water. Treatment 4. Usual reasons for intubation: Airway maintenance, Secretion control, is aimed at decreasing fluid intake. Oxygenation and Ventilation. 2. Decrease of normal insensible water loss due to closed ventilator circuit preventing water loss from lungs. This fluid overload evidenced Types of intubation: Orotracheal, Nasotracheal, Tracheostomy by decreased urine specific gravity, dilutional hyponatremia, increased Preparing for Intubation heart rate and BP. 1. Recognize the need for intubation. 2. Notify physician and respiratory therapist. Ensure consent obtained E. Decreased Renal Perfusion – can be treated with low dose dopamine if not emergency. therapy. 3. Gather all necessary equipment: a. Suction canister with regulator and connecting tubing F. Increased Intracranial Pressure (ICP) – reduce PEEP b. Sterile 14 Fr. suction catheter or closed in-line suction catheter c. Sterile gloves G. Hepatic congestion – reduce PEEP d. Normal saline e. Yankuer suction-tip catheter and nasogastric tube H. Worsening of intracardiac shunts –reduce PEEP f. Intubation equipment: Manual resuscitator bag (MRB), Laryngoscope and blade, Wire guide, Water soluble lubricant, 2. Associated with ventilator malfunction: Cetacaine spray A. Alarms turned off or nonfunctional – may lead to apnea and g. Endotracheal attachment device (E-tad) or tape respiratory arrest h. Get order for initial ventilator settings Troubleshooting Ventilator Alarms i. Sedation prn Low exhaled volume: Cuff leak, Tubing disconnect, Patient j. Soft wrist restraints prn disconnected k. Call for chest x-ray to confirm position of endotracheal tube Evaluate cuff; reinflate prn; if ruptured, tube will need to be replaced. l. Provide emotional support as needed/ ensure family notified of Evaluate connections; tighten or replace as needed; check ETT change in condition. placement, Reconnect to ventilator High pressure: Secretions in airway, Patient biting tubing, Tube kinked, Intubation Cuff herniation, Increased airway resistance/decreased lung compliance (caused by bronchospasm, right mainstem bronchus intubation, Types of Ventilators pneumothorax, pneumonia), Patient coughing and/or fighting the Ventilator Settings ventilator; anxiety; fear; pain. Modes of Mechanical Ventilation Suction patient, Insert bite block, Reposition patient’s head/neck; check Complications of Mechanical Ventilation all tubing lengths, Deflate and reinflate cuff, Auscultate breath sounds, 1. Associated with patient’s response to mechanical ventilation: Evaluate compliance and tube position; stabilize tube, Explain all procedures to patient in calm, reassuring manner, Sedate/medicate as A. Decreased Cardiac Output necessar 1. Cause - venous return to the right atrium impeded by the Low oxygen pressure: Oxygen malfunction dramatically increased intrathoracic pressures during inspiration from Disconnect patient from ventilator; manually bag with ambu; call R.T positive pressure ventilation. Also reduced sympatho-adrenal stimulation leading to a decrease in peripheral vascular resistance and 3. Other complications related to endotracheal intubation. reduced blood pressure. A. Sinusitis and nasal injury – obstruction of paranasal sinus drainage; 2. Symptoms – increased heart rate, decreased blood pressure and pressure necrosis of nares perfusion to vital organs, decreased CVP, and cool clammy skin. 1. Prevention: avoid nasal intubations; cushion nares from tube and 3. Treatment – aimed at increasing preload (e.g. fluid administration) tape/ties. and decreasing the airway pressures exerted during mechanical 2. Treatment: remove all tubes from nasal passages; administer ventilation by decreasing inspiratory flow rates and TV, or using other antibiotics. methods to decrease airway pressures (e.g. different modes of B. Tracheoesophageal fistula – pressure necrosis of posterior tracheal ventilation). wall resulting from overinflated cuff and rigid nasogastric tube 1. Prevention: inflate cuff with minimal amount of air necessary; B. Barotrauma monitor cuff pressures q. 8 h. 1. Cause – damage to pulmonary system due to alveolar rupture from 2. Treatment: position cuff of tube distal to fistula; place gastrostomy excessive airway pressures and/or overdistention of alveoli. 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 airway 1. 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 invasion 1. 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.

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 status Monitor lymphocytes and albumin. Indicates adequate visceral protein. . Provide nutrition as ordered, e.g. TPN, lipids or enteral feedings. PLAN OF CARE FOR THE VENTILATED PATIENT Calories, minerals, vitamins, and protein are needed for energy and Patient Goals: tissue repair. Patient will have effective breathing pattern. . Patient will have adequate gas exchange. Obtain nutrition consult. Patient’s nutritional status will be maintained to meet body needs. Provides guidance and continued surveillance. Patient will not develop a pulmonary infection. Potential for pulmonary infection r/t compromised tissue integrity. Patient will not develop problems related to immobility. Secure airway and support ventialtor tubing. Patient and/or family will indicate understanding of the purpose for Prevent mucosal damage. mechanical ventilation. . Provide good oral care q. 4 h.; suction when need indicated using Nursing Diagnosis sterile technique; handwashing with antimicrobial for 30 seconds Nursing Interventions before and after patient contact; do not empty condensation in tubing Rationale back into cascade. Ineffective breathing pattern r/t ____________________________. Measures aimed at prevention of nosocomial infections. Observe changes in respiratory rate and depth; observe for SOB and . use of accessory muscles. Use disposable saline irrigation units to rinse in-line suction; ensure An increase in the work of breathing will add to fatigue; may indicate ventilator tubing changed q. 7 days, in-line suction changed q. 24 h.; patient fighting ventilator. ambu bags changes between patients and whenever become soiled. . IAW Infection Control Policy and Respiratory Therapy Standards of Observe for tube misplacement- note and post cm. Marking at Care for CCNS. lip/teeth/nares after x-ray confirmation and q. 2 h. Potential for complications r/t immobility. Indicates correct position to provide adequate ventilation. Assess for psychosocial alterations. . Dependency on ventilator with increased anxiety when weaning; Prevent accidental extubation by taping tube securely, checking q.2h.; decreased ability to communicate; social isolation/alteration in family restraining/sedating as needed. dynamics. Avoid trauma from accidental extubation, prevent inadequate . ventilation and potential respiratory arrest. Assess for GI problems. Preventative measures include relieving . anxiety, antacids or H2 receptor antagonist therapy, adequate sleep Inspect thorax for symmetry of movement. cycles, adequate communication system. Determines adequacy of breathing pattern; asymmetry may indicate Most serious is stress ulcer. May develop constipation. hemothorax or pneumothorax. . . Observe skin integrity for pressure ulcers; preventative measures Measure tidal volume and vital capacity. include turning patient at least q. 2 h.; keep HOB < 30 degrees with a Indicates volume of air moving in and out of lungs. 30 degree side-lying position; use pressure relief mattress or turning . bed if indicated; follow prevention of pressure ulcers plan of care; Asses for pain maintain nutritional needs. Pain may prevent patient from coughing and deep breathing. Patient is at high risk for developing pressure ulcers due to immobility . and decreased tissue perfusion. Monitor chest x-rays . Shows extent and location of fluid or infiltrates in lungs. Maintain muscle strength with active/active-assistive/passive ROM and . prevent contractures with use of span-aids or splints. Maintain ventilator settings as ordered. Patient is at risk for developing contractures due to immobility, use of Ventilator provides adequate ventilator pattern for the patient. paralytics and ventilator related deficiencies. . Knowledge deficit r/t intubation and mechanical ventilation Elevate head of bed 60-90 degrees. Explain purpose/mode/and all treatments; encourage patient to relax This position moves the abdominal contents away from the diaphragm, and breath with the ventilator; explain alarms; teach importance of deep which facilitates its contraction. breathing; provide alternate method of communication; keep call bell within reach; keep informed of results of studies/progress; demonstrate Impaired gas exchange r/t alveolar-capillary membrane changes confidence. Monitor ABG’s. Reduce anxiety, gain cooperation and participation in plan of care. Determines acid-base balance and need for oxygen. . Assess LOC, listlessness, and irritability.

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

* 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 WILSON SYNDROME: Congenital defect in Ceruloplasmin, leading going to sleep; twitch in legs causing insomnia. to buildup of copper mental retardation, cirrhosis, hepatolenticular degeneration. Herbal Plants AMENNORRHEA-GALACTORRHEA SYNDROME: Nonphysiologic 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

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 PREMENSTRUAL SYNDROME: Abnormal sensation in breasts, bronchitis. It has also been shown to ease rheumatic inflammation, to abdominal pain, thirst, headache, pelvic congestion, nervous irritability. regulate menstrual flow and as an appetite stimulant. The stems are candied for culinary use. Ocassionally nausea and vomiting. MAIN PROPERTIES: Antispasmodic, promotes menstrual flow. GUILLAN-BARRE SYNDROME: Infectious Polyneuritis of unknown 3) ANISE cause. Pimpinella 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 REYE'S SYNDROME: Loss of consciousness and seizures in kids, their ability to reduce flatulence and colic, to settle the digestion, to after a viral infection treated by aspirin. 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 REITER'S SYNDROME: Symptom cluster. Etiology is thought to be hormonal action of anise seeds may explain its ability to increase Chlamydial or post-chlamydial. breast-milk production and its reputation for easing childbirth and Urethritis treating impotence and frigidity. Anise essential oil is used externally to Iridocyclitis (Conjunctivitis) treat lice and scabies. Arthritis Skin lesions like karatoderma blenorrhagicum MAIN PROPERTIES: Reduces colic and flatulence, promotes Also can see fatty liver or liver necrosis. digestion, antispasmodic STEVENS-JOHNSON SYNDROME: Erythema Multiforme complication. Large areas of skin slough, including mouth and anogenital membranes. Mucous membranes: stomatitis, urethritis, conjunctivitis. Headache, fever, malaise.

4) ARNICA Arnica 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.

TOXIC SHOCK SYNDROME: Caused by superabsorbent tampons. Infection with Staph Aureus and subsequent toxicity of exotoxin TSST 5) ARROWROOT systemic anaphylaxis. Maranta arundinacea (Marantaceae) * Fever, vomiting, diarrhea

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.

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, digestive, antiseptic.

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

6) ARTEMISIA, WORMWOOD Artemisia 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.

12) BOLDO Peumus 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 MAIN PROPERTIES: Bitter, carminative, muscle relaxant, antiseptic. properties which help in combating cystitis. 7) BASIL, HOLY BASIL MAIN PROPERTIES: Bile and liver activity stimulant, digestive. Ocimum sanctum (Labiatae) The herb has very important medicinal properties - notably its ability to 13) CALENDULA, MARIGOLD reduce blood sugar levels. It also prevents peptic ulcers and other stress Calendula officinallis (Compositae) related conditions like hypertension, colitis and asthma. Basil is also Marigold is one of the best herbs for treating local skin problems. used to treat cold and reduce fever, congestion and joint pain. Due to its Infusions or decoctions of Calendula petals decrease the inflammation anti-bacterial and fungicide action, basil leaves are used on itching of sprains, stings, varicose veins and other swellings and also soothes skin, insect biting and skin affections. burns, sunburns, rashes and skin irritations. These remedies are excellent for inflamed and bruised skin, their antiseptic and healing MAIN PROPERTIES: Lowers blood sugar levels, antispasmodic, properties helping to prevent the spread of infection and accelerate the analgesic, lowers blood pressure, reduces fever, fungicidal, antihealing. Marigold is also a cleansing and detoxifying herb, and the inflammatory. infusion and tincture are used to treat chronic infections. Taken internally, it has been used traditionally to promote the draining of 8) BELLADONA, DEADLY NITIGHTSHADE swollen lymph glands such as tonsillitis. Atropa belladonna (Solanaceae) Herba bella dona, or "herb of the beautiful lady" is known for its MAIN PROPERTIES: Anti-inflammatory, astringent, heals wounds, poisonous effects (belladonna increases heartbeat and can lead to antiseptic, detoxifying. death), like many other plants it is an important and beneficial remedy when used correctly. Belladonna contains atropine used in conventional 14) CAMPHOR medicine to dilate the pupils for eye examinations and as an anesthetic. Cinnamomum camphora syn. Laurus camphora (Lauraceae) In herbal medicine, deadly nightshade is mainly prescribed to relieve Camphor crystals have strong antiseptic, stimulant and antispasmodic intestinal colic, to treat peptic ulcers and to relax distended organs, properties and are applied externally as unguents or balms as a counterespecially the stomach and intestine. Deadly nightshade is also used as irritant and analgesic liniment to relieve arthritic and rheumatic pains, an anaesthetic in conventional medicine. 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 MAIN PROPERTIES: Smooth muscle, antispasmodic, narcotic, other chest infections. reduces sweating, sedative. MAIN PROPERTIES: Antiseptic, antispasmodic, analgesic, 9) BENZOIN GUM expectorant. Styrax benzoin (Styraceae) Its trunk exudes a gum well known for its strong astringent and 15) CARDAMOM antiseptic action. For this reason it is used externally to fight tissue Elettaria cardamomum (Zingiberaceae) inflammation and disinfection of wounds. When taken internally, Cardamom is an excellent remedy for many digestive problems, benzoin gum acts to settle griping pain, to stimulate coughing, and to helping to soothe indigestion, dyspepsia, gastralgia, colon spasms and disinfect the urinary tract. Benzoin gum is widely used in cosmetics as flatulence. It has an aromatic and pungent taste and combines well with an antioxidant in oils, as a fixative in perfumes and as an additive to other herbs and helps to disguise the less pleasant taste of other herbs. soaps. When steam inhaled, it helps healing sore throats, head and chest colds, asthma and bronchitis. MAIN PROPERTIES: Eases stomach pain, carminative, aromatic, antispasmodic. MAIN PROPERTIES: Antiseptic, astringent, anti-inflammatory. 16) CARDUS, MILK THISTLE, MARY THISTLE 10) BERGAMOT Carduus marianus syn. Silybum marianum (Compositae) Citrus bergamia syn. C. aurantium var. bergamia (Rutaceae) Milk thistle has been in use as a remedy for liver problems for Bergamot oil, expressed from the peel, assists in avoiding infectious hundreds, if not thousands, of years. It is used in a whole range of liver diseases. In cosmetics it is used in preventing oily skin, acne, psoriasis and bladder conditions including hepatitis and cirrhosis. Recent and acne. The oil (or constituents of it) is sometimes added to sunresearch has confirmed that the herb has a remarkable ability to protect tanning oils. Bergamot oil is also used to relieve tension, relax muscle the liver from damage resulting from alcoholic and other types of spasms and improve digestion. poisoning. Today, milk thistle is widely used in the West for the treatment of a range of liver conditions. MAIN PROPERTIES: Disinfectant, muscle relaxant. MAIN PROPERTIES: Digestive, liver tonic, stimulates secretion of bile, increases breast-milk production, antidepressant. 11) BITTER ORANGE Citrus aurantium (Rutaceae) 17) CELERY, SMALLAGE Its oil contains flavonoids which are anti-inflammatory, antibacterial Apium graveolens (Umbelliferae) and antifungal. Bitter orange juice is rich in vitamin C which helps the More familiar as a vegetable than as a medicine, celery find its main immune system. As an infusion, it helps to relieve fever, soothe use in the treatment of rheumatism, arthritis and gout. Containing apiol, headaches and lower fever. It yields neroli oil from its flowers, and the the seeds are also used as a urinary antiseptic. Celery is a good oil known as petitgrain from its leaves and young shoots. Both cleansing, diuretic herb, and the seeds are used specifically for arthritic

complaints where there is an accumulation of waste products. The 24) CYMBOPOGON, LEMON GRASS seeds also have a reputation as a carminative with a mild tranquilizing Cymbopogon citratus (Gramineae) effect. The stems are less significant medicinally. Its oil is used as a culinary flavoring, a scent and medicine. Lemon grass is principally taken as a tea to remedy digestive problems MAIN PROPERTIES: Anti-rheumatic, antispasmodic, diuretic, urinary diarrhea and stomach ache. It relaxes the muscles of the stomach and antiseptic. gut, relieves cramping pains and flatulence and is particularly suitable for children. In the Caribbean, lemon grass is primarily regarded as a 18) CHAMOMILE, GERMAN CHAMOMILE fever-reducing herb. It is applied externally as a poultice or as diluted Chamomilla recutita syn. Matricaria recutita (Compositae) essential oil to ease pain and arthritis. Its flowers help to ease indigestion, nervousness, depressions and headaches, being ideal for emotion related problems such as peptic MAIN PROPERTIES: Digestive, antispasmodic, analgesic. ulcers, colitis, spastic colon and nervous indigestion. Chamomile's essential oil have anti-inflammatory, anti-spasmodic and anti-microbial 25) DAMIANA activity. It is an excellent herb for many digestive disorders and for Turnera diffusa syn. T. diffusa var. aphrodisiaca (Turneraceae) nervous tension and irritability. Externally, it is used for sore skin and It has an ancient reputation as an aphrodisiac and is an excellent eczema. Roman chamomile (Chamaemelum nobile) is a close relation, remedy for the nervous system acting as a stimulant and tonic in cases used in a similar way. of mild depression. Damiana has a strongly aromatic, slightly bitter taste. The leaves are used to flavor liqueurs and are taken in Mexico as MAIN PROPERTIES: Anti-inflammatory, antispasmodic, relaxant, a substitute for tea. carminative, bitter, nervine. MAIN PROPERTIES: Nerve tonic, antidepressant, urinary antiseptic. 19) CHICORY Cicorium intybus (Compositae) 26) DANDELION As a tea or extract, chicory root is a bitter digestive tonic that also Taraxacum officinale (Compositae) increases bile flow and decrease inflammation. Its roasted root is Known principally as a weed, dandelion has an astonishing range of commonly used as a coffee substitute. Chicory is an excellent mild health benefits. The leaves, which can be eaten in salads, are a powerful bitter tonic for the liver and digestive tract. The root is therapeutically diuretic. The roots act as a "blood purifier" that helps both kidneys and similar to dandelion root supporting the action of the stomach and liver the liver to remove impurities from the blood. This effect seems to be and cleansing the urinary tract. Chicory is also taken for rheumatic due to its potassium content. It also acts like a mild laxative and conditions and gout, and as a mild laxative, one particularly appropriate improves appetite and digestion. for children. An infusion of the leaves and flowers also aids the digestion. MAIN PROPERTIES: Diuretic, digestive, antibiotic, bitter. MAIN PROPERTIES: Digestive, liver tonic, anti-rheumatic, mild laxative.

27) DILL Anethum graveolens syn. Peucedanum graveolens (Umbelliferae) Dill has always been considered a remedy for the stomach, relieving 20) CINNAMON wind and calming the digestion. Dill's essential oil relieves intestinal Cinnamomum verum syn. C. zeylanicum (Lauraceae) spasms and griping and helps to settle colic, hence it is often used in The infusion or powder is used for stomach pains and cramps. gripe water mixtures. Chewing the seeds improves bad breath. Dill Traditionally, the herb was taken for colds, flu and digestive problems. makes a useful addition to cough, cold and flu remedies, and is a mild diuretic. Dill increases milk production, and when taken regularly by MAIN PROPERTIES: Warming stimulant, carminative, antispasmodic, nursing mothers, helps to prevent colic in their babies. antiseptic, anti-viral. MAIN PROPERTIES: Digestive, antibacterial, antispasmodic, diuretic. 21) CLOVE Eugenia caryophyllata syn. Syzgium aromaticum (Myrtaceae) 28) EUCALYPTUS, BLUE GUM The dried flower buds, clove, are extensively used as spice. The buds, Eucalyptus globulus (Myrtaceae) leaves and stems are used for the extractions of clove's oil. The oil Eucalyptus is a powerful antiseptic used all over the world for relieving contains eugenol, a strong anesthetic and antiseptic substance. Cloves coughs and colds, sore throats and other infections. The leaves cool the are also well known for their antispasmodic and stimulant properties. body and relive fever. Inhaling the vapors of the essential oils heated in water, clears sinus and bronchial congestions. Eucaliptol, one of the MAIN PROPERTIES: Antiseptic, mind and body stimulant, analgesic, substances found in the essential oil, is one of the main constituents of antibacterial, carminative. the many existing commercial formulas of chest rubs for colds. The essential oil has also strong anti-biotic, anti-viral and anti-fungal action. 22) COMFREY, KNITBONE Eucalyptus is a common ingredient in many over-the-counter cold Symphytum officinale (Boraginaceae) remedies. Comfrey leaves and roots contain allantoin, a cell multiplication agent that increases the healing of wounds. Today, it is still highly regarded MAIN PROPERTIES: Antiseptic, expectorant, stimulates local blood for its healing properties. Externally it is used for rashes, wounds, flow, anti-fungal. inflammations and skin problems. Internally, comfrey has action over the digestive tract helping to cure ulcers and colitis. It is also used for a 29) FENNEL variety of respiratory problems. Foeniculum vulgare (Umbelliferae) The primary use of fennel seeds is to relieve flatulence, but they also MAIN PROPERTIES: Digestive problems, anti-inflammatory, wound settle colic, stimulate the appetite and digestion. Fennel is also diuretic healing, astringent. and anti-inflammatory. Like anise (Pimpinella anisum) and caraway (Carum carvi), it has a calming effect on bronchitis and coughs. An 23) CORIANDER infusion of the seeds may be taken as a gargle for sore throats and as a Coriandrum sativum (Umbelliferae) mild expectorant. Fennel increases breast-milk production and the herb It aids digestion, reduce flatulence and improves appetite. It helps is still used as an eye wash for sore eyes and conjunctivitis. Essential relieving spasms within the gut and counters the effects of nervous oil from the sweet variety is used for its digestive and relaxing tension. Coriander is also chewed to sweeten the breath, especially afterproperties. consumption of garlic (Allium sativum). It is applied externally as a lotion for rheumatic pain. Coriander essential oil is used in the MAIN PROPERTIES: Digestive, antispasmodic, anti-inflammatory. manufacture of perfumes, cosmetics and dentifrices. 30) GARLIC MAIN PROPERTIES: Digestive, antispasmodic, anti-rheumatic. 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 Crataegus oxyacantha & C. monogyna (Rosaceae) most effective anti-biotic plants available, acting on bacteria, viruses It has been shown that its effects are only present when a whole plant and alimentary parasites. It counters many infections, including those preparation is used. Its applications are: the loss of cardiac function, of the nose, throat and chest. Garlic is also known to reduce feelings of congestions and oppression in the hearth region. Western cholesterol, helps circulatory disorders, such as high blood pressure, herbalists consider it literally to be a "food for the heart", increasing and lower blood sugar levels, making it useful in cases of late-onset blood flow to the heart muscles and restoring normal heart beat. Recent diabetes. research has confirmed the validity of these uses. MAIN PROPERTIES: Antibiotic, expectorant, diaphoretic, hypotensive, antispasmodic, expels worms.

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

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.

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, tightchestedness, 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: 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: Anti-spasmodic, expectorant, diaphoretic, antiinflammatory, 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 MAIN PROPERTIES: Diaphoretic, carminative, circulatory stimulant, externally to soothe dry and sensitive skin. inhibits coughing, anti-inflammatory, antiseptic. MAIN PROPERTIES: Aromatic, anti-spasmodic, expectorant. 33) GINKGO Ginkgo biloba (Ginkgoaceae) 40) JUNIPER Traditionally known as an anti-microbial and anti-tubercular action, it Juniperus communis (Cupressaceae) has now been shown that ginkgo as a profound activity on brain It is a valuable remedy for cystitis, and helps relieve fluid retention, but function and cerebral circulation. This action is useful to prevent should be avoided in cases of kidney disease. In the digestive system, dizziness, tinnitus, short-term memory loss, depression and other juniper is warming and settling, easing colic and supporting the symptoms related to poor brain circulation. Its effect on poor function of the stomach. Taken internally or applied externally, juniper circulation also used to treat other related disorders like diabetes, is helpful in the treatment of chronic arthritis, gout and rheumatic hemorrhoids and varicose veins. Ginkgo is also valuable for asthma. 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 MAIN PROPERTIES: Circulatory stimulant and tonic, anti-asthmatic, waste products from underlying tissues. antispasmodic, anti-allergenic, anti-inflammatory. MAIN PROPERTIES: Diuretic, anti-microbial, carminative, anti34) GINSENG rheumatic. Panax ginseng (Araliaceae) Ginseng increases mental and physical efficiency and resistance to 57) RADISH stress and disease. It often shows a dual response like sedating or Raphanus sativus (Cruciferae) stimulating the central nervous system according to the condition it is Radish stimulates the appetite and the digestion. The juice of the black being taken to treat. In the West, ginseng is regarded as a life-enhancingradish is drunk to counter gassy indigestion and constipation. Black tonic. radish juice has a tonic and laxative action on the intestines, and indirectly stimulates the flow of bile. Consuming radish generally MAIN PROPERTIES: Tonic, stimulant, physical and mental results in improved digestion, but some people are sensitive to its enhancement. acridity and strong action. In China, radish is eaten to relieve abdominal distention. 35) GUMPLANT Grindelia camporum syn. G. robusta var. rigida (Compositae) MAIN PROPERTIES: Digestive, mild laxative. Its anti-spasmodic, expectorant and hypotensive actions find applications in treating heart conditions, asthmatic and bronchial 58) RAUVOLFIA, INDIAN SNAKEROOT conditions. It has been employed in the treatment of wooping cough, Rauvolfia serpentina (Apocynaceae) hay fever and cystitis. Externally in relieves and heals skin irritations Indian snakeroot contains reserpine, a substance now widely used to and burns. lower blood pressure and lessen some symptoms of mental illness. The MAIN PROPERTIES: Anti-spasmodic, expectorant, hypotensive. root has a pronounced sedative and depressant effect on the sympathetic nervous system. By reducing the system's activity, the herb 36) HAMAMELIS, WITCH HAZEL brings about the lowering of blood pressure. It may also be used to treat Hamamamelis virginiana (Hamamelidaceae) anxiety and insomnia, as well as more serious mental health problems Witch hazel acts mostly on the veins and circulation. For this reason it such as psychosis. has been used to decrease the inflammation and pain of bruises, sore muscles, bleeding, hemorrhoids, varicose veins, phlebitis, and insect MAIN PROPERTIES: Antidepressant, lowers blood pressure. bites. American indians used poultices soaked in a decoction of bark to treat tumors and inflammations, especially of the eye, and took the herb 59) RHUBARB, CHINESE RHUBARB internally for hemorrhaging and heavy menstrual bleeding. Rheum palmatum (Polysonaceae) Its main use is as a laxative safe even for young children due to its MAIN PROPERTIES: Astringent, anti-inflammatory, stops external gentle action. It is also extremely effective in the treatment for many and internal bleeding. digestive problems. Paradoxically, it is a laxative when taken in large doses but has a constipating effect in small measures. The rhizome has 37) HAWTHORN an astringent, unpleasant taste.

the wood is used to soothe rashes and itchy skin. In China, sandalwood MAIN PROPERTIES: Laxative, constipating, astringent, eases stomachis held to be useful for chest and abdominal pain. pain, antibacterial. MAIN PROPERTIES: Antiseptic, aromatic. 60) ROSE Rosa gallica (Rosaceae) 66) SARSAPARILLA The essential oil, called "attar of rose", is used in aromatherapy as a Smilax spp. (Liliaceae) mildly sedative, antidepressant and anti-inflammatory remedy. Rose Sarsaparilla is anti-inflammatory and cleansing, and can bring relief to petals and their preparations have a similar action. They also reduce skin problems such as eczema, psoriasis and general itchiness, and help high cholesterol levels. Rosewater is mildly astringent and makes a treat rheumatism, rheumatoid, arthritis and gout. Sarsaparilla also has a valuable lotion for inflamed and sore eyes. progesterogenic action, making it beneficial in pre-menstrual problems, and menopausal conditions such as debility and depression. MAIN PROPERTIES: Aromatic, antidepressant,, sedative, antiinflammatory. MAIN PROPERTIES: Diuretic, anti-inflammatory, anti-rheumatic. 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 longstanding reputation as a tonic, invigorating herb, imparting a zest for life that is to some degree reflected in its distinctive aromatic taste.

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.

MAIN PROPERTIES: Tonic, stimulant, astringent, nervine, antiinflammatory, carminative.

68) SESAME Sesamum indicum (Pedaliaceae) 62) RUE The seeds are prescribed for problems such as dizziness, tinnitus Ruta graveolens (Rutaceae) (ringing in the ears), and blurred vision. Owing to their lubricating The rutin contained in the plant helps to strengthen fragile blood effect within the digestive tract, the seeds are also considered a remedy vessels and alleviates varicose veins. Rue is also used due to its for constipation. Sesame seed oil benefits the skin and is used as a base antispasmodic properties, especially in the digestive system where it for cosmetics. A decoction of the root is used in various traditions to eases griping and bowel tension. The easing of spasms gives it a role in treat coughs and asthma. the stopping of spasmodic coughs. In European herbal medicine, rue has also been taken to treat conditions as varied as hysteria, epilepsy, MAIN PROPERTIES: Digestive, aromatic, antispasmodic. vertigo, colic, intestinal worms, poisoning and eye problems. The latter use is well founded, as an infusion used as an eyewash brings quick 69) ST JOHN'S WORT relief to strained and tired eyes, and reputedly improves the eyesight. Hypericum perforatum (Guttiferae) St. John's wort flowers at the time of the summer solstice, and in MAIN PROPERTIES: Antispasmodic, increases peripheral blood medieval Europe it was considered to have powerful magical properties circulation, relieves eye tension. 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. 63) SAGE, CLARY CLARY SAGE It is taken to relieve the pain of menstrual cramps, sciatica and arthritis. Salvia sclarea (Labiatae) The oil is applied to inflammations, sprains, bruises and varicose veins. Clary sage has been perceived both as a weaker version of its close St. John's wort is also used to treat circulation problems, bronchitis and relative, sage (S. officinalis), and as a significant herb in its own right. gout. Since the seeds were once commonly used to treat eye problems, it was also known as "clear eye". An antispasmodic and aromatic plant, clary MAIN PROPERTIES: Antidepressant, antispasmodic, astringent, sage is used today mainly to treat digestive problems such as wind and sedative, relieves pain, anti-viral. indigestion. It is also regarded as a tonic, calming herb that helps relieve period pain and premenstrual problems. Owing to its estrogen- 70) TARRAGON stimulating action, it is most effective when levels of this hormone are Artemisia dracunculus (Compositae) low. 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 MAIN PROPERTIES: Astringent, antiseptic, aromatic, carminative, bites. While tarragon stimulates the digestion, it is reputed to be a mild estrogenic, reduces sweating, tonic. sedative and has been taken to aid sleep. With its mild menstruationinducing properties, it is taken if periods are delayed. The root has 64) SAGE traditionally been applied to aching teeth. Salvia officinalis (Labiatae) Its leaves are a well-known cold germ and flu fighter. It has been found MAIN PROPERTIES: Anti-inflammatory, digestive. to be very effective to reduce many physical emissions like sweating and is an excellent remedy for sore throats, poor digestion and irregular 71) TEA TREE periods. It is also taken as a gently stimulating tonic. It has a slightly Malaleuca alternifolia (Myrtaceae) warm, noticeably bitter and astringent taste. Tea tree, and in particular its essential oil, is one of the most important natural antiseptics. Useful for stings, burns, wounds and skin infections MAIN PROPERTIES: Astringent, antiseptic, aromatic, carminative, of all kinds, the herb merits a place in every medicine chest. Its estrogenic, reduces sweating, tonic. therapeutic properties were first researched during the 1920s and it is now widely used in Europe and the US, as well as in Australia. 65) SANDALWOOD Santalum album (Santalaceae) MAIN PROPERTIES: Antiseptic, antibacterial, anti-fungal, anti-viral. 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 72) THYME essential oil are used for their antiseptic properties in treating genito- Thymus vulgaris (Labiatae) urinary conditions such as cystitis and gonorrhea. In India, a paste of 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: 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 -YLANG Canananga 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, MAIN PROPERTIES: Stimulates secretion of bile, anti-inflammatory, and its main therapeutic uses are to slow an excessively fast heart rate eases stomach pain, antioxidant, antibacterial. and to lower blood pressure. With its reputation as an aphrodisiac, ylang-ylang may be helpful in treating impotence. 74) VALERIAN Valeriana officinalis (Valerianaceae) MAIN PROPERTIES: Antiseptic, aromatic, regulates blood pressure. 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 Preventing Clogged Feeding Tubes and menstrual cramps. Valerian helps relieve stress and has become an increasingly popular remedy in recent decades. It is a safe, nonGoing with the flow. (preventing clogged feeding tubes) addictive relaxant that reduces nervous tension and anxiety and Author/s: Karen Brennan Krupp promotes restful sleep. Issue: April, 1998 MAIN PROPERTIES: Sedative, relaxant, relieves muscle spasm, relieves anxiety, lowers blood pressure.

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

75) VERBENA A clogged enteral feeding tube that can't be cleared must be replaced Verbena officinalis (Verbenaceae) an unwelcome prospect for you and your patient. At the very least, Verbena is used in mouth washes for infected gums and as a poultice he'll miss getting some of the fluid and nutrition he needs. At for hemorrhoids. A tea has been used as a nerve tonic, to treat insomnia worst, if he's homebound or a nursing home resident, he'll need to and to help digestion. It has tonic, restorative properties, and is used to travel to an appropriate facility for tube reinsertion and X-ray relieve stress and anxiety, and to improve digestive function. confirmation of placement. The expression An ounce of prevention is worth a pound of cure could have been coined by a nurse managing MAIN PROPERTIES: Nervine, tonic, mild sedative, stimulates bile feeding tubes. secretion, mild bitter. In this article, we'll describe two simple ways you can keep feeding 76) WHITE WILLOW tubes patent: pump-assisted infusion of enteral formulas and frequent Salix alba (Salicaceae) tube flushing. But first, let's review factors that can increase the White willow is an excellent remedy for arthritic and rheumatic pain, risk of a clogged feeding tube. affecting the joints like knees and hips. Problems in the pipeline MAIN PROPERTIES: Anti-inflammatory, analgesic, reduces fever, anti-rheumatic, astringent. Feeding tubes can become clogged for one of these reasons: 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.

* calorically dense formulas. When a dense formula is delivered in a slow, uneven infusion (as by gravity drip), formula coagulation and tube occlusion are more likely. * small-bore feeding tubes. Small-bore tubes are more flexible and less irritating to patients and can be left in place longer than larger ones. But their smaller lumens make them more likely to clog. * gravity drip. An imprecise roller clamp adjustment may increase or decrease the amount of formula delivered by as much as 50%. When formula 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 decrease 78) WILD THYME because there's less nutritional liquid to dilute the stomach acid. Thymus serpyllum (Labiatae) This excess acid may then flow into the tube, causing the formula to Like its close relative thyme (Thymus vulgaris), wild thyme is strongly clump. antiseptic and anti-fungal. It may be taken as an infusion or syrup to treat flu and colds, sore throats, coughs, whooping cough, chest * medications. Bulk-forming agents such as psyllium (Metamucil), infections, and bronchitis. Wild thyme has anti-catarrhal properties and antacids, and medications that haven't been properly crushed or helps clear a stuffy nose, sinusitis, ear congestion and related reconstituted can also clog a tube. The combination of crushed complaints. It has been used to expel thread worms and roundworms in medications and a small-bore feeding tube is a common cause of children, and is used to settle wind and colic. Wild thyme's slowed antispasmodic action makes it useful and is used to settle wind and or blocked formula flow. Whenever possible, administer the liquid colic. Wild thyme is also used in herbal baths and pillows. formulation of a medication rather than creating a mixture from crushed tablets.

* gastric residuals. When you check gastric residuals through a feeding tube, gastric acid mixes with the formula in the tube and causes formula coagulation, which can lead to tube clogging. This problem is more common when small-bore feeding tubes are used to aspirate gastric residuals. An ounce of prevention Now let's look at the two steps you can take to prevent feeding tubes from clogging. A pump-assisted infusion is especially helpful for administering a calorically dense formula. The slight degree of pump-generated pressure means the formula is delivered in a continuous, even infusion, avoiding the problems associated with an uneven administration rate.

· 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.

Regular tube flushing with water is, the simplest way to prevent tube clogging--and the most often neglected. The most common practice is to instill 50 to 100 ml of water every 4 hours; before, after, and For Manipulative clients between multiple doses of medications; and when stopping and starting · Set clear limits a feeding. If you flush the tube consistently, you can clear even · Hold client responsible for behavior viscous enteral formulas from the tube lumen. Also flush before and after you check gastric residuals. For Dependent clients · Don’t reward dependent behavior Continued from page 1 · Client should share responsibility for treatment Cranberry juice, carbonated beverages, meat tenderizers, enzymatic solutions ... over the years, nurses have tried all sorts of remedies for clogged enteral tubes. But researchers who've studied various preventive irrigants have learned something surprising: Nothing beats plain water. In fact, acidic colas and cranberry juice can actually cause an obstruction by promoting formula coagulation. The bottom line? Flushing the tube regularly with water remains the most effective and practical way to prevent enteral, feeding tube clogs.

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 A heavy nursing workload and lack of written policies and procedures · Help client express anxiety for tube flushing can lead to inconsistency in tube flushing. So some enteral pumps also have an automatic flush feature, which delivers a preprogrammed amount of fluid, typically water, every hour. This DEFENSE MECHANISMS: simulates the flushing action of a syringe and helps minimize residue 1. Conversion: A college student develops diarrhea on day of exam buildup. 2. Regression: Returning to immature ways of dealing with stress: crying, tantrums… Automatic flushing doesn't just save nursing time--it's also more 3. Repression: Blocking of unacceptable urges and feelings from effective. Two studies found clogging in 75% of gastrostomy tubes in awareness. the manually flushed group, compared with only 5% in the 4. Denial: Blocking of unacceptable information or perceptions from automatically flushed group. The results were even more dramatic for awarness. nasogastric tubes: 91% in the manually flushed group clogged; none 5. Dissociation of affect: A girl laughs when telling about her failed clogged in the automatic flush group. exam 6. Rationalization: Substituting an acceptable motive for attitudes or Smooth sailing behavior for an unacceptable motive 7. Reaction formation: you want to “kick your bosses ass” but end up By knowing which, factors predispose an enteral tube to clogging and kissing it. taking a few preventive measures, you can keep your patient 8. Identification: A teenager dresses like Madonna and mimics her comfortable- -and save yourself some time. behavior. 9. Projection: “ you are acting like a teenager, not I” 10. Introjection: A boy yells at his dog like his father does him 11. Displacement: Client is upset about disease and yells at nurse. Psyche Nursing Nurse gets upset and yells at nursing assistant 12. Undoing: “ magic,” For Withdrawn clients · Allow client to set pace SIGNS AND SYMPTOMS · Encourage social activities or games Making it automatic

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

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

For Suicidal clients Crisis intervention to assess suicide protential. · Communicate intent “ are you tired of living?” · Previous attempts

Apraxia Failure to do, despite intact motor function Agnosia

Failure to recognize

5. Confabulation: invents stories to fill memory gaps: Korsakoff encephalopathy.

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

DELIRIUM Ø Acute onset Ø Fluctuating consciousness Ø Disorientation Ø Optical hallucinations

Delirium Acute, organic, short lasting Clouded consciousness Confusion, disorientation, anxiety Sometimes hallucinations

DEMENTIA Ø Gradual onset Ø No impairment of consciousness Ø Loss of intellectual functions: memory, orientation, language.

Delusions Persistent false belief despite invalidating evidence Grandeur Paranoia Somatic delusions

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

illusions Misperception of external stimuli Hallucinations Perception without external stimuli

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

TERMS: 1. Neologisms: invents new words: Schizophrenia 2. Echolalia: echoes words or sentences: Schizophrenia 3. Word Salad: jumble of words without meaning: Schizophrenia 4. Flight of ideas: rapid switching from topic to topic: Mania

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

Feeling of hopelessness

Illusions/hallucinations may occur

Feeling of worthlessness

Low risk of suicide

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 closely

Not 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 dyskinesia

Choreoathetosis 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.

ALCOHOL

INTOXICAITON

WITHDRAWAL

Euphoria

Nausea

Disorientaion

Delusions, hallucinations

Unsteady gait

Delirium Tremor, seizures

BARBITURATES

Sedation

Delirium Epilepsy Coma, death

BENZODIAZEPINES

Antianxiety

Anxiety

Sedation

Irritability insomnia

AMPHETAMINES, COCAINE

OPIOIDS

Arousal

Fatigue

Euphoria

Dysphoria

Euphoria

Nausea, vomiting

Apathy

Sweating, fever Muscle aches

LSD

Hallucinations Anxiety Paranoid ideas

NONE