C OMPLICATION OF EACH DISEASE CONDITION

LETS HAVE AN EXAMPLE FOR THIS CONCEPT. A PATIENT WAS DIAGNOSED TO BE SUFFERING FROM PHENYLKETONURIA . INTERVENTIONS BY THE NURSE SHOULD BE AIMED AT MONITORING THE PATIENTS GROWTH AND DEVELOPMENT DUE TO WHICH POSSIBLE COMPLICATIONS?

A.HYDROCEPHALUS C.MALNUTRITION B.PARALYSIS D.MENTAL RETARDATION

THE CORRECT ANSWER IS (D) MENTAL RETARDATION.IT IS A COMMONCOMPLICATION OF UNTREATED PHENYLKETONURIA.NOW LETS IDENTIFY THECOMMON COMPLICATION OF CERTAIN DISEASES.

DISEASES AND THEIR COMMON COMPLICATION

DehydrationBleedingShockPeripheral neutritisCerebrovascular accidentCongestive heart failureMale: sterility; female: difficulty conceivingCholecystitusCongestive heart failurePelvic inflammatory diseases (PID)Cervical cancerCerebrovascular accidentSplenic ruptureParalysis

CholelithiasisComplete heart blockGonorrheaHerpesHypertensionInfectious mononucleosisLymes disease

DISEASESCOMMON COMPLICATIONAcute gastroenteritisAcute lymphocytic leukemiaAddisons diseaseAnemia, perniciousAnemia, sickle cellCardiac valvular disorderCystic fibrosis

Mental retardationHearing impairmentAcute glomerulonephritisPremature ventricular contractionsHypocalcemia/ hyperglycemiaMental retardationCerebrovascular accidentAbruptio placentaPelvic inflammatory diseases (female)Rheumatic heart disease Mitral valve stenosisAcute glomerulonephritis

Pre-eclampsiaSexually transmitted diseaseSore throat

DISEASESCOMMON COMPLICATIONLead poisoningMeningistisMitral valve stenosisMyocardial infarctionPancreatitisPhenylketonuriaPolycythemia vera

D IET IS APPROPRIATE TO YOUR PATIENT!

NOW,LETS MOVE ON TO THE CONCEPT ON THERAPEUTIC DIET

LETS HAVE AN EXAMPLE WHICH OF THE APPROPRIATE DIET FOR A CHILD WITH FIBROSIS?

A.HIGH PROTEIN,LOW CARBOHYDRATEB.HIGH CALORIE C.LOW PROTEIN,HIGH CARBOHYDRATE,MODERATE FATD.HIGH RESIDUE,LOW FAT,LOW CALORIE

WHATS YOUR GUESS?...........OK THE ANSWER IS(B).WHY? A PATIENT WITH CYSTIC FIBROSIS SHOULD BE ON A HIGH CALORIE,HIGH SODIUM DIET BECAUSE PATIENTS WITH CYSTIC FIBROSIS TEND TO LOSE MORE SODIUM IN THEIR SWEAT AND WOULD NEED ADDITIONAL CALORIES AS A SOURCE OF ENERGY.ALTHOUGH THRE IS NO OPTION THAT EXACTLY STATES THIS TYPE OF DIET, THE OTHER OPTIONS CONTAIN WRONG INFORMATION, SO THE BEST ANSWER IS (B) HIGH CALORIE!

REMEMBER: IF A PART OF A POSSIBLE OPTION IS WRONG THE ENTIRE OPTION IS CONSIDERED WRONG

THERAPEUTIC DIET FOR SPECIFIC DISEASE CONDITIONS

Low fatClear liquidLow Na, Low proteinHigh Na, Low KHigh IronHigh Protein, Vitamin BHigh fluidLow cholesterolPurine RestrictedFinger foodsFinger foodsHigh calorie, High proteinGluten-freeHigh Protein, High carbohydrate, Low fat

Angina pectorisArthritis, goutAttention deficit hyperactivity disorderBipolar disorderBurnCeliacs diseaseCholecystitis

Acne Acute gastroenteritis (diarrhea)Acute glomerulonephritisAddisons diseaseAnemia, iron deficiencyAnemia, perniciousAnemia, sickle cell

Low Na, Low CholesterolHigh protein, High calciumHigh Protein, High carbohydrate, Low fatHigh K, Low NaHigh calorie, High NaAcid Ash (for alkaline stones)Alkaline Ash (for acid stones)High protein, High Vitamin CWell balancedHigh K, High NaHigh residue with no seedsLow residueHigh fat, High protein, dry

Diabetes mellitusDiarrheaDiverticulitisDiverticulosisDumping syndrome

Congestive heart failureCretinismCrohns diseaseCushings diseaseCystic fibrosisCystitisDecubitus ulcer (bedsore)

Low proteinHigh protein, High calorieHigh calorie, Low residue, High proteinSalt restrictedHigh calcium, Low phosphorusLow calorie, Low cholesterol, Low saturated fatLow proteinLow fat, Low cholesterol, Low NaHigh calorie, High proteinLow calciumClear liquidLow Na

HypothyroidismKawasakis diseaseLiver cirrhosisMenieres diseaseMyocardial infarction

Hepatic encephalopathyHepatitisHirschsprungs diseaseHyperparathyroidismHypertension HyperthyroidismHypoparathyroidism

Low Na, High protein, High calorieHigh calcium, High Vitamin DLow fatHigh fat, High carbohydrate, Low proteinLow proteinHigh proteinLow sodium, Low proteinLow protein, High carbohydrate,Low Na (Oliguric phase)High protein, High calorieand Restricted fluid (Diuretic phase)Low protein, Low Na, Low KClear liquid

Renal failure (acute)Renal failure (chronic)Tonsilitis

Nephrotic syndromeOsteoporosisPancreatitisPeptic ulcer (duodenal/gastric)PhenylketonuriaPregnancy induced hypertensionRenal colic

Low protein, High carbohydrate,Low Na (Oliguric phase)High protein, High calorieand Restricted fluid (Diuretic phase)Low Na, High protein, High calorieHigh calcium, High Vitamin DLow fatHigh fat, High carbohydrate, Low proteinLow proteinHigh proteinLow sodium, Low proteinClear liquidLow protein, Low Na, Low K

Renal failure (acute)Renal failure (chronic)Tonsilitis

Nephrotic syndromeLow Na, High protein, High calorieOsteoporosisPancreatitisPeptic ulcer (duodenal/gastric)PhenylketonuriaPregnancy induced hypertensionRenal colic

KNOW WHAT EQUIPMENT TO PREPARE AT THE BEDSIDE

In foreign nursing exams, some of the most frequently asked questions are those that require the nurse to anticipate the type of equipment that needs to be at the patients bedside. Consider the example belowIn a patient with Sengstaken Blakemore tube, which of the following equipment should the nurse keep at the bedside? A. Wirecutter C. Clamp B. Torniquet D. Scissors

One of the dangers of having a Senstaken- Blakemore tube in place, is accumulation of blood above the level of the bleeding esophageal varices. This can possibly lead to aspiration. When this occurs, the nurse should deflate the esophageal balloon by cutting the port that leads to the balloon, in order to promote the drainage of the blood to the stomach. The nurse should therefore have a pair of SCISSORS ready at the patients bedside. So the answer is (D).

HERES A LIST OF CONDITIONS THAT REQUIRE AN EQUIPMENT AT THE BEDSIDE.

TorniquetCatheterExtra bottleClamp/forcepVaselanized gauzeSunctioning equipmentTracheostomy/endotracheal tubeTape measureTracheostomy/Endotracheal tubeTape measureTracheostomyEndotracheal tubeSuction apparatusPadded mouth gagLead container, forcepsScissors

HydrocephalusLaryngotracheobronchitisMyasthenic crisisParkinsons diseasePregnancy-induced hypertensionRadium implantSenstaken-Blakemore tube

AmputationAutonomic dysreflexiaChest tube drainageCerebrovascular accidentCholinergic crisisDeep vein thrombosisEpiglotitis

TracheostomyFlashlightTracheostomyObturator, hemostatWire cutter

Spinal cord injuryThyroidectomyTonsillectomyTracheostomy tubeWired jaw

FACILITATE PROPER POSITIONING OF YOUR PATIENT!

In order for you to be able to position your patient appropriately, the first thing that you should do is to ask yourself: What position will I use? Will it aggravate or lessen the condition? And what is the purpose of the position? Will it promote something or will it prevent something?Lets have an exampleImmediately after a supratentorial craniotomy, in what position should the patient be placed? A. Side-lying C. Semi-Fowlers B. Supine D. TrendelenburgAfter craniotomy, the usual goal of care is to prevent the accumulation of fluid at the surgical site. It is therefore essential for you to promote venous drainage and this is best accomplished by placing the patient in the Semi-fowlers position. The answer therefore is letter (C).

SO HERES A LIST OF APPROPRIATE POSITIONING FOR SPECIFIC CONDITIONS

Fowlers, to prevent pressure on the gaftTurn the patient on left side and lower head of the bed, this will cause the air to rise to the right atriumIf unruptured: any position of comfort; If ruptured: semi-fowlers, to prevent the upward spread of infection Sitting position, leaning forward, to facilitate breathingHigh fowlers, to prevent hypertensive strokeSemi-fowlers, post procedure, to prevent aspirationTripod position, to facilitate breathing

Abdominal aneurysm surgeryAir embolismAppendicitisAsthmaAutonomic dysreflexiaBronchoscopyBronchiolitis

Keep insertion site extended for 4-6 hours, to prevent arterial occlusionElevate extremity, to prevent edemaSemi-fowlers postoperatively, to prevent edema at the operative siteSemi-fowlers, to prevent pressure in the aneurysm siteSupine, to prevent pressure on the suture lineProne, to prevent aspirationHigh fowlers, to improve oxygenization

Cardiac catheterizationCastCataract surgery Cerebral aneurysmCleft lip (post op)Cleft palateCongestive heart failure

If supratentorial: semi-frowlers; If infratentorial: flat, to facilitate venous drainage from the headElevate the head, to reduce ICPSupine after meals, to prevent rapid emptying of the stomachLeaning forward, to prevent aspiration of bloodKeep on the affected side, to facilitate expansion of the unaffected lungKeep the affected extremity extended, to promote circulationSide lying, to prevent pain

CraniotomyCVADumping syndromeEpistaxisFlail chestFemoro-popliteal by-pass graftHemorroidectomy

Upright position after meals, to prevent reflux of stomach contentsKeep the legs in abduction, to prevent dislodge of the head of the femur from the acetabulumElevate the head of the bed, to prevent increased ICPElevate the head of the bed, to prevent further increase in ICPKeep the back as straight as possible, to prevent twisting the spineSemi-fowlers, to maintain patent airway and minimize edemaRight side lying post procedure, to prevent bleeding

Hiatal herniaHip surgeryHypophysectomyIncreased ICPLaminectomyLaryngectomyLiver biopsy

Semi-fowlers, to promote breathingLateral side lying, during the procedure, to facilitate the entry of the needle between L3-L4; flat position after the procedure, to prevent spinal headacheElevate on pillow the extremity on the affected side, to prevent lymphedemaIf water based dye (Amipaque) was used: Elevate the head of the bed, to prevent upward dispersion of the dye; If oil based dye (Pantopaque) was used, keep the patient flat on bed, to prevent leakage of CSF.Sitting position, to minimize bleedingLung segment to be drained should be in the uppermost position, to facilitate drainageKnee-chest, to prevent pressure on the cord

LobectomyLumbar punctureMastectomyMyelogramPlacenta previaPostural drainageProlapsed cord

Fowlers, to facilitate breathingRight side lying on an infant car seat after meals, to facilitate entry of stomach contents into the intestinesFlat on bed, to prevent dislodgeKeep the affected side towards the bed, so gravity will help the detached retina to fall back in placeSide lying, to prevent backward falling of the tongue which may obstruct the airwayModified trendelenburg, to promote venous return to the heartImmobilize the patient, to prevent twisting the spine

Pulmonary edemaPyloric stenosisRadium implant in the cervixRetinal detachmentSeizureShockSpinal cord injury

Place the patient on bedrest and elevate the affected leg, to promote circulationFowlers (during the procedure), to facilitate removal of fluid from the chest wall, after the procedure you may position the patient in any position of comfortSemi-fowlers and avoid hyperflexion and hyper-extension of the neck, to prevent tension on the suture lineSidelying or prone, to promote drainage of secretionTrendelenburg during tube insertion, to prevent air embolismSupine with the head elevated on an inclined plane of at least 30 degrees, to minimize the reflux of gastric secretionsElevate the legs above the level of the heart, to facilitate venous return to the heartKeep the legs elevated, to prevent venous stasis

Vein stripping and ligation

ThoracentesisThrombophlebitisThyroiddectomyTonsillectomyTotal parental nutritionTracheoesophageal fistula (TEF)Varicose veins

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