ms notes 1
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MS NOTES 1
SNS : Adrenergic Agents Epinephrine (adrenaline)
Anticholinergic , Sympathomimetic, Parasympatholytic
-Atropine sulfate
PNS: Cholinergics, Beta Adrenergic blockers, Sympatholitic, Parasympathomimetic
Beta adrenergic blocking agents (opposite of adrenergic agents) (all end in lol) Blocks release of norepinephrine. Decrease body activities except GIT (diarrhea)Ex. Propanolol, MetopanololSE:B broncho spasm (bronchoconstriction)E elicits a decrease in myocardial contractionT treats HPN
A AV conduction slows down
DEMYELLENATING DISEASE
1.) ALZHEIMERS DISEASE atrophy of brain tissue due to a deficiency of acetylcholine.
S&Sx:
A amnesia loss of memory A apraxia unable to determine function & purpose of object A agnosia unable to recognize familiar object A aphasia - Expressive broccas aphasia unable to speak- Receptive wernickes aphasia unable to understand spoken wordsCommon to Alzheimer receptive aphasiaDrug of choice ARICEPT (taken at bedtime) & COGNEX.Mgt: Supportive & palliative.
Microglia stationary cells, engulfs bacteria, engulfs cellular debris.
Bronchoscopyo AtSO4
Anticholinergic mimics SNRDecreases saliva dry mouth
o NPO 6 to 8 hourso Local anesthesia check gag reflex before feeding
ABGo Hyperventilation decreased CO2 increased blood pH respiratory alkalosiso Hypoventilation increased CO2 decreased blood pH respiratory acidosiso Diarrhea decreased HCO3 decreased blood pH metabolic acidosiso Vomiting gastric content decreased HCL increased blood pH metabolic alkalosiso Vomiting blood decreased O2 anaerobic metabolism formation of lactic acid
decreased blood pH metabolic acidosiso Blood pH normal 7.35 to 7.45 If increased alkalosis; If decreased acidosiso Partial CO2 normal 35 to 45 If increased Respiratory Acidosis; if decreased Respiratory
Alkalosiso Partial HCO3 normal 22 to 26 If increased Metabolic alkalosis; If decreased metabolic
acidosis
Cancer of the larynx CS, alcohol and over usage of voice (choir member)o A - nterior neck masso B urning sensation with hot beverages / Bad breatho C - hange in the voice (hoarseness)o D ysphagia/dyspnea
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o R esult of DM lipolysis increased fatty acids atherosclerosiso S ex gender males > female (before menopausal because estrogen decreases PVR)
after menopausal female eversible}[inverted T wave] Injury [elevated ST segment] > male
Decreased TP in heart Ischemia (Angina) {r necrosis (MI) {irreversible}[pathologic Qwave/permanent in the ECG]
Eating a heavy meal, strenuous exercise, sex, exposure to cold Decreased blood flow (heart) decreased TP (heart) decreased O2 (heart) anaerobic respiration production of lactic acid PAIN management decreased O2 demand by rest and SFF
Anginao Pain relieved by rest and NTGo NTG
Vasodilation orthostatic hypotension move gradually Monitor BPStore in a dark and amber container Effective tingling sensation no need to notify physicianMaximum of 3 tablets with 5 minute interval
MIo Pain relieved by Morphine SO4
Narcotic analgesicCan cause respiratory depression monitor RR and O2 saturationAntidote narcan
Cardioversion synchronous
Defibrillation unsynchronous
Buergers disease CS vasoconstriction stop CS common in men
Raynaud s stress and cold vasoconstriction common in female
Congestive heart failureo Left sided pulmonary
DyspneaCracklesPolycythemia due to decrease O2 to the kidneysClubbing of the fingers due to prolonged hyxiaOrthopnea
o Right sided systemicHepatomegalyDistended neck veinsEdemaPortal hypertensionAscites weight gainVaricose veins
o DigoxinCardiac glycosidePositive inotrophic effect increased strength of myocardial contractionNegative chronotrophic effect decreased cardiac rate monitor CR never give if CR below 60 bpmAdverse effect
V omitting A norexia N ausea D iarrhea A bdominal pain REMEMBER : earliest GI; late halo vision Antidote Digibind
Decreased RBC Activity in tolerance, Fatigue, provide rest, Anemia
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Decreased Platelets Prone to bleeding, avoid parenteral injection, appl pressure on injectionsite, high risk for injury
Decreased WBC prone to infection, reverse isolation
Increased WBC presence of infection
First Day/Newly diagnosed Knowledge deficit
Heparin anticoagulant prevent further enlargement of clot not dissolve them monitor APTT/PTT antidote protamine SO4
Coumadin anticoagulant prevent further enlargement of clot not dissolve it monitor PT vitamin K is the antidote
Urokinase/Streptoase dissolves the clot
Pernicious anemia absence of intrinsic factor (gastric surgery) problem in absorption of VitaminB12 beefy red t ongue schillings test definitive test 24 hour urine collection life long Vitamin
B12
Gastritis LUQ pain
Gastric ulcer affected area stomach pain (precipitated by food intake increased HCl) painrelieved by antacids
Duodenal ulcer affected area duodenum pain (2 hour after eating) pain relieved by food
Ulcers bleeding (+) occult blood test (guiac) high fiber diet, avoid red meat, iron, steroids,NSAIDs, indomethacin
Vagotomy resection of vagus nerve decreased cholinergic stimulation decreased HCl andgastric movement
Dumping syndrome tachycardia and weakness 3 Ds (diarrhea, diaphoresis and dizziness) fluids after meals, lie down after meals and SFF
Appendicitis RLQ pain avoid heat pads cause rupture signs of ruptured appendix sudden cessation of pain, elevation of temperature and WBC
Diverticulitis LLQ pain low fiber diet
Diverticulosis high fiber diet
Ulcerative colitis bloody diarrhea 15 to 20 times a day fluid volume deficit, anemia
Liver cirrhosis alcohol and malnutrition (laen necs) , infection and drugs (post necrotic) , RSCHF(cardiac) and biliary obstruction (biliary)
o Portal hypertention can lead toBlood shifted to the different collateral
Esophageal varicesSpider angioma (face and neck)Caput medusae (abdomen)Hemorrhoids (rectal)
Management avoid rupture avoid shouting, valsalva maneuver Increased hydstatic pressure fluid shifting asciteso Decreased albumin decreased oncotic / colloidal osmotic pressure fluid shifting ascites
management high protein dieto CHON metabolism by product ammonia liver cannot convert to urea increased level of
ammonia in the brain Alteration of LOC and changes of behavior and asterexis hepaticencephalopathy management low CHON diet and lactulose for removal of ammonia
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Hepatitis A fecal oral prone plumber
Hepatitis B body secretion prone working in a dialysis
Cholecystitis 5 Fs (fair, female, fat, fertile and forty) RUQ pain after ingestion of fatty food demerol to relieved pain
Cholecystectomy T tube level of the incision site drain excess bile
Pancreatitis alcohol autodigestion LUQ pain
Anterior Pituitary glando Growth hormone
Increased before the closure of the epiphysis of the long bones gigantism tallIncreased after the closure of the epiphysis acromegaly big hands (big gloves), bigfeet (big shoes) and big head (big hat)Decreased dwarfism
o ProlactinIncreased galactorrheaDecreased decreased milk production
o ACTHIncreased secondary cushings Decreased secondary addisons
o TSHIncreased secondary hypethyroidismDecreased secondary hypothyroidism
Posterior pituitary glando ADH
Increased water retention oliguria edema (fluid volume excess) and weight gainconcentrated urine increased urine specific gravity
Decreased water excretion polyuria dehydration (fluid volume deficit and weightloss) diluted urine decreased urine specific gravity
Parathyroid glando Parathormone
Increased increased calcium in the blood and decrease calcium in the bones stoneformation and decreased bone mass osteoporosis management increased water intakeDecreased hypocalcemia calcium supplement
Thyroid Glando Increased (hyperthyroidism)
T3 and T4 increased BMR hyperactive inability to focus insomia increasedcatabolism weight loss increased appetite increased peristalsis Diarrhea fluid volume deficit Increased CR and RR (due to increased BMR)
Increased T3 heat intoleranceCalcitonin decreased calcium in the blood tetany compensatory calciumwithdraws from the bones bone destruction (complication)PTU decreased synthesis of TH watch out for SE (similar to signs and symptomsof hypothyroidism) watch out for agrunulocytosis (fever, skin rash and sore throat)
Lugols solution decreased released of TH before thyroidectomy decreasedvascularity of the thyroid gland
o Decreased (hypothyroidism)T3 and T4 decreased BMR hypoactive sleeps a lot decreased metabolism weight gain anorexia decreased peristalsis constipation decreased CR andRR due to decreased BMRT3 cold intoleranceCalcitonin hypercalcemia stone formationSynthroid and Proloid increased TH
Adrenal Glando Incresead (cushings)
Glucocorticoids hyperglycemia and decrease wound healingMineral corticoids increased aldosterone sodium retention and potassium excretion
hypernatremia and hypokalemia
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Hypernatremia water retention oliguria edema (moon face,buffalohump,fluid volume excess and weight gain) concentrated urine increased urinespecific gravity low sodium dietHypokalemia weakness Prominent U wave high potassium diet
Epinephrine and Norepinephrine Increased BP and CRSex hormones
Males gynecomastia and falling of hair Females hirsutism and deepening of the voice
o Decreased (addisons)Glucocorticoids hypoglycemia and inability to cope with stressMineralcorticoids decreased aldosterone sodium excretion and potassium retention
hyponatremia and hyperkalemiaHyponatremia water excretion polyuria (dehydration, fluid volume deficitand weight loss) diluted urine --. Decreased urine specific gravity increasedfluids and NaHyperkalemia weakness tall or peaked T waves low K diet
Epinephrine and Norepinephrine decreased BP and CR
Diabetes Mellituso Type I absolutely no insulin thin insulino
Type II insufficient insulin obese OHAo Diet 50% CHO, 30% Fats, 20% CHONo Exercise Increased uptake of glucose Decreased insulin requiremento Oral hypoglycemic agent (OHA)
Stimulates pancreas to produce insulin
o InsulinSC; IV if DKANever massage the areaNever administer cold insulinRotate the site of injection
PREVENTS LIPODYSTROPHYMix
Aspirate clear firstInject air to cloudy first
o DKA increased lipolysis increased ketones o Hyperglycemia polyuria, polydipsia, polyphagia, kussmaul breathing, glycosuria, ketonuria
and warm flush skino Glycosylated hemoglobin reflect BSL for the past 3 to 4 months most accurateo Foot care
Podiatrist
Avoid removing corns and callusesCut toe nails straight acrossAvoid walking bare foot
Hepatitis A fecal oral
Hepatitis B body and bloody secretions (hemodialysis)
Peritoneal Dialysiso Diasylate output is decreased turn patient from side to sideo Complication infection monitor WBC and temperature, diasylate is cloudy boardlike and
rigid abdomen peritonitiso Dont include diasylate solution in the output of the cliento Expected decreased weight monitor weight before and after decreased createnine and
BUN
Heart block decreased tissue perfusion
Parkinsons diasease
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o Decreased dopamine in the basal ganglia levodopa to increased dopamine avoid Vit B6foods
o Cardinals signs tremors (non intentional) muscle rigidity bradykinesia o Pill rolling o Microphonia ask your client to speak aloud to be aware o Artane and Cogentin anticholinergic decreased muscle rigidity
Myasthenia Graviso
Tensilon test confirmatory test o Decreased Acetylcholine and increased cholinesterase o Muscle weakness priority airway o NO tranquilizer, Morphine SO4, Muscle relaxant and neomycin o Cholinergics (mestinon) increased muscle strength antidote ATSO4
Undermedication myasthenic crisis give cholinergics Over medication cholinergic crisis give ATSO4
Multiple Sclerosiso Demyelinization of the myelin sheath o Charcoats triad
Intentional tremors Scanning of speech Nystagmus
o Visual disturbances diplopia
Pancreatitis autodigestion alcohol bleeding shock o Elevated amylase
Rheumatoid Arthritiso No specific diagnostic test o NSAIDs and ASA (antipyretic, analgesic and anti-inflammatory)o Synovitis Pannus formation fibrous ankylosis (limited joint movement) Bony ankylosis
(joint fixation) o Avoid flexion and promote prone position
Gouty Arthritiso Increased uric acid allopurinol and avoid organ meats (liver) tophi (ears)
Osteoarthritiso Most common related with aging o Pain after weight bearing exercise or activity rest to relieved pain weight reduction
Diverticulitis LLQ pain and low fiber diet
Cyclophosphamide (Cytoxan) can cause hemorrhagic cystitis to avoid increased fluid intake
Vincristine (Oncovin) increased fiber in the diet
Iron supplement When is the best time to take (empty stomach), How is best taken (with orange juice)
Steroids and NSAIDs o DEATH inflammationo BIRTH side effects
B one marrow depression prone to infection monitor temperature and WBC I ncreased gastric irritation take it with food or after meals R enal toxicity T innitus H epato toxic
Cataract common cause is aging (senile) opacity of the lens position on the unaffected side
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Glaucoma increased IOP decreased of peripheral vision first halo, tunnel and gun barrel visionmiotics (constricts pupils) avoid ATSO4 (dilates pupil)
Retinal detachment trauma blood clots floating spots dependent position scleral buckling
Avoid Increased Intraocular pressure PRIORITYo Avoid vomiting, coughing, valsalva maneuver, lifting heavy objects, bending, crying
Menieres Triad tinnitus, impaired hearing loss and vertigo low Na dieto Vertigo imbalance high risk for injury decreased vertigo by focusing on one side of theroom assume a flat or reclining position
ASA 8 th cranial nerve damage tinnitus, impaired hearing loss and vertigo
Antibiotics allergic reactions
Normal Valueso BUN = 10 20 mg/dlo Calcium = 9 to 10.5 mg/dlo Creatinine = 5 to 1.5 mg/dlo GTT = 70 to 115 mg/dlo O2 sat = 97 to 98%