Adult Medical File PDF

‫‪ADULT FILE‬‬ ‫مستر احمد السيد‬ ‫‪0503327640‬‬ Pulmonary TB low-grade afternoon fever. PNEUMONIA rusty sputum. ASTHMA – wheezing on expiration. EMPHYSEMA – barrel chest. KAWASAKI SYNDROME – strawberry tongue. DOWN SYNDROME – protruding tongue. CHOLERA – rice watery stool.. MALARIA – stepladder li...

‫‪ADULT FILE‬‬ ‫مستر احمد السيد‬ ‫‪0503327640‬‬ Pulmonary TB low-grade afternoon fever. PNEUMONIA rusty sputum. ASTHMA – wheezing on expiration. EMPHYSEMA – barrel chest. KAWASAKI SYNDROME – strawberry tongue. DOWN SYNDROME – protruding tongue. CHOLERA – rice watery stool.. MALARIA – stepladder like fever with chills. TYPHOID – rose spots in abdomen. DIPTHERIA – pseudo membrane formation MEASLES – koplik’s spots. SLE – butterfly rashes. LIVER CIRRHOSIS – spider like varices. BULIMIA – chipmunk face. APPENDICITIS – rebound tenderness. MENINGITIS – Kernig’s sign (leg flex then leg pain on extension), Brudzinski sign (neck flex = lower leg flex). TETANY – hypocalcemia (+) Trousseau’s sign/carpopedal spasm; Chvostek sign (facial spasm). PANCREATITIS – Cullen’s sign (ecchymosis of umbilicus); (+) Grey turners spots. PYLORIC STENOSIS – olive like mass. ADDISON’S DISEASE – bronze like skin pigmentation. CUSHING’S SYNDROME – moon face appearance and buffalo hump. HYPERTHYROIDISM/GRAVE’S DISEASE – exopthalmus. INTUSSUSCEPTION – sausage shaped mass, Dance Sign (empty portion of RLQ) Guillain Barre Syndrome – ascending muscle weakness DVT – Homan’s Sign CHICKEN POX – Vesicular Rash (central to distal) dew drop on rose petal ANGINA – Crushing stubbing pain relieved by NTG MI – Crushing stubbing pain which radiates to left shoulder, neck, arms, unrelieved by NTG TEF – 4Cs’ Coughing, Choking, Cyanosis, Continous Drooling EPIGLOTITIS – 3Ds’ Drooling, Dysphonia, Dysphagia HODGEKIN’S DSE/LYMPHOMA – painless, progressive enlargement of spleen & lymph tissues, Reedstenberg Cells PARKINSON’S – Pill-rolling tremors CYSTIC FIBROSIS – Salty skin DM – polyuria, polydypsia, polyphagia DKA – Kussmauls breathing (Deep Rapid RR) RETINAL DETACHMENT – Visual Floaters, flashes of light, curtain vision GLAUCOMA – Painfull vision loss, tunnel/gun barrel/halo vision (Peripheral Vision Loss) CATARACT – Painless vision loss, Opacity of the lens, blurring of vision INCREASE ICP – HYPERtension BRADYpnea BRADYcardia (Cushing’s Triad) SHOCK – HYPOtension TACHYpnea TACHYcardia MENIERE’S DSE – Vertigo, Tinnitus HYPOCALCEMIA – Chvostek & Trosseaus sign ULCERATIVE COLITIS – recurrent bloody diarrhea LYME’S DSE – Bull’s eye rash 1. Process food substances 2. Absorb the products of digestion into the blood 3. Excrete unabsorbed materials 4. Provide an environment for microorganisms to synthesize nutrients, such as vitamin K Pepsin  is the chief coenzyme of gastric juice, which converts proteins into proteoses and peptones  The largest gland in the body  Stores vitamins A, D, and B and iron secretes bile to emulsify fats (500 to 1000 mL of bile/day).  Aids in the digestion of fats, carbohydrates, and Proteins Exocrine gland  Secretes sodium bicarbonate to neutralize the acidity of the stomach contents that enter the duodenum  Pancreatic juices contain enzymes for digesting carbohydrates, fats, and protein Endocrine gland  Secretes glucagon to raise blood glucose levels  secretes somatostatin to exert a hypoglycemic effect  The islets of Langerhans secrete insulin which is important for carbohydrate metabolism. Diagnostic Procedures Barium swallow  Examination of the upper GI tract under fluoroscopy after the client drinks barium sulfate Postprocedure  Instruct the client to increase oral fluid intake to help pass the barium. Upper GI endoscopy  Informed consent needs to be obtained.  The client must be NPO for 6 to 8 hours before the test.  avoid anticoagulants and nonsteroidal anti inflammatory drugs for several days before the test position  on the left side to facilitate saliva drainage and to provide easy access of the endoscope. Fiberoptic colonoscopy Position  left side with the knees drawn up to the chest  Adequate cleansing of the colon is necessary  A clear liquid diet is started on the day before the test.  avoid Red, orange, and purple (grape) liquids  Informed consent needs to be obtained. post procedure position  Maintain left lateral position to promote passing of flatules Liver biopsy  Informed consent needs to be obtained.  Withhold food and fluid for 8 to 12 hours before the procedure.  Assess results of coagulation tests (PT,PTT, platelet count), and obtain blood typing and cross matching position during the procedure  supine or left lateral position to expose the right side of the upper abdomen post operative  right side with a pillow under the costal margin for 2 hours to decrease the risk of bleeding  instruct the client to avoid coughing and straining Urea breath test  detects the presence of Helicobacter pylori, the bacteria that cause peptic ulcer disease. The client consumes a capsule of carbon-labeled urea and provides a breath sample 10 to 20 minutes later. H. pylori can also be detected by assessing serum antibody levels.  The backflow of gastric and duodenal contents into the esophagus Causes  incompetent lower esophageal sphincter (LES),  pyloric stenosis, or motility disorder.  Overweight or obesity increases intra-abdominal pressure contributing to reflux Assessment        Heartburn, epigastric pain, chest pain Voice hoarseness Dyspepsia Nausea, regurgitation Pain and difficulty with swallowing (odynophagia) Globus (feeling of something in the back of the throat) Hypersalivation Interventions  avoid factors that decrease LES pressure or cause esophageal irritation, such as peppermint, chocolate, coffee and caffeine,  avoid eating and drinking 2 hours before bedtime  elevate the head of the bed  Small, frequent meals will help to prevent gastric distention  instruct the client not to lie down for 2 to 3 hours after eating and not to bend over after eating. Surgery  involves a fundoplication (wrapping a portion of the gastric fundus around the sphincter area of the esophagus by laparoscopy.  an ulceration in the mucosal wall of the stomach, pylorus, duodenum Types o gastric, duodenal,or esophageal, depending on its location Gastric ulcers  ulceration of the mucosal lining that extends to the submucosal layer of the stomach. Predisposing factors  stress, smoking,  the use of corticosteroids, NSAIDs, alcohol,  infection with H. pylori. Complications include hemorrhage, perforation, and pyloric obstruction. Assessment:  Gnawing, sharp pain in or to the left of the midepigastric region occurs 1 to 2 hours after a meal (food ingestion accentuates the pain).  Hematemesis is more common than melena. Surgical interventions Total gastrectomy Removal of the stomach with attachment of the esophagus to the jejunum or duodenum Vagotomy Removal of the lower half of the stomach Pyloroplasty: Enlargement of the pylorus to prevent or decrease pyloric obstruction, thereby enhancing gastric emptying Duodenal ulcers  a break in the mucosa of the duodenum. Risk factors and causes  infection with H. pylori  alcohol intake; smoking; stress; caffeine  the use of aspirin, corticosteroids, and NSAIDs. Complications  include bleeding, perforation, gastric outlet obstruction assessment  Burning pain occurs in the midepigastric area 2 to 5 hours after a meal and at night (often awakens the client).  Melena is more common than hematemesis.  Pain is often relieved by the ingestion of food. Interventions  Administer small, frequent bland feedings during the active phase.  Administer H2-receptor antagonists or proton pump inhibitors to decrease the secretion of gastric acid.  Administer antacids as prescribed to neutralize gastric secretions.  Administer anticholinergics as prescribed to reduce gastric motility.  Administer mucosal barrier protectants 1 hour before each meal.  Administer prostaglandins as prescribed for their protective and antisecretory actions.  Administer treatment for Helicobacter pylori  Avoid consuming alcohol and substances that contain caffeine or chocolate because it contains peptides that stimulate gastric release.  Avoid smoking.  Avoid aspirin or NSAIDs Dumping syndrome  The rapid emptying of the gastric contents into the small intestine that occurs following gastric resection Assessment  Symptoms occurring 30 minutes after eating  Nausea and vomiting  Surgical reduction of gastric capacity  performed on a client with morbid obesity to produce long-term weight loss Dietary Measures for the Client Following Bariatric Surgery  Avoid alcohol, high-protein foods, and foods high in sugar and fat.  Eat slowly and chew food well.  Progress food types and amounts as prescribed.  Take nutritional supplements an esophageal or diaphragmatic hernia.)  A portion of the stomach herniates through the diaphragm and into the thorax. Causes  weakening of the muscles of the diaphragm and is aggravated by factors that increase abdominal pressure such as pregnancy, ascites, obesity, tumors, and heavy lifting. Complications  ulceration, hemorrhage, regurgitation aspiration of stomach contents,  incarceration of the stomach in the chest with possible necrosis,  peritonitis, Assessment       Heartburn Chest pain Regurgitation or vomiting Dysphagia Feeling of fullness Worsening of symptoms when lying down Interventions  similar to those for gastroesophageal reflux disease.  Provide small frequent meals and limit the amount of liquids taken with meals.  Inflammation of the gallbladder  occur as an acute or chronic process Acute inflammation o associated with gallstones (cholelithiasis). Chronic cholecystitis  results when inefficient bile emptying and gallbladder muscle wall disease cause a fibrotic and contracted gallbladder. Acalculous cholecystitis o occurs in the absence of gallstones o caused by bacterial invasion via the lymphatic or vascular system. assessment  Epigastric pain that radiates to the right shoulder or scapula  Pain localized in the right upper quadrant and triggered by a high-fat or high-volume meal  Guarding, rigidity, and rebound tenderness  Mass palpated in the right upper quadrant Murphy’s sign (cannot take a deep breath when the examiner’s fingers are passed below the hepatic margin Assessment  Jaundice  Dark orange and foamy urine  Steatorrhea and clay-colored feces  Pruritus Interventions         Maintain NPO status during nausea and vomiting episodes. Maintain NG decompression for severe vomiting. antiemetics analgesics antispasmodics (anticholinergics) relax smooth muscle. eat small, high-fiber, low-fat meals. avoid gas-forming foods. Surgical interventions Cholecystectomy removal of the gallbladder. Choledocholithotomy  requires incision into the common bile duct to remove the stone. Surgical procedures are commonly performed by laparoscopy.  A chronic, progressive disease of the liver characterized by diffuse degeneration and destruction of hepatocytes  Repeated destruction of hepatic cells causes the formation of scar tissue. Causes  Chronic damage and injury to liver cells;  chronic hepatitis C, alcoholism, nonalcoholic fatty liver disease (NAFLD),  nonalcoholic steatohepatitis (NASH) Complications Portal hypertension  A persistent increase in pressure in the portal vein that develops as a result of obstruction to flow Ascites  Accumulation of fluid in the peritoneal cavity that results from venous congestion of the hepatic capillaries Bleeding esophageal varices  Fragile, thin-walled, distended esophageal veins that become irritated and rupture Coagulation defects  Decreased synthesis of bile fats in the liver prevents the absorption of fat-soluble vitamins.  Dilated and tortuous veins in the submucosa of the esophagus Causes  portal hypertension, often associated with liver cirrhosis Assessment  Hematemesis  Melena  Ascites  Jaundice  Hepatomegaly and splenomegaly  Dilated abdominal veins Interventions       Elevate the head of the bed. Monitor for orthostatic hypotension. Maintain NPO status. Monitor hemoglobin and hematocrit values and coagulation factors. Administer blood transfusions Assist in inserting an NG tube or a balloon tamponade balloon (not used frequently because it is very uncomfortable for the client) Hepatitis  Inflammation of the liver caused by a virus, bacteria, or exposure to medications or hepatotoxing (known as infectious hepatitis) Route of Transmission 1. Fecal-oral route 2. Person-to-person contact 3. Parenteral 5. Contaminated water or food Incubation period  15 to 50 days. Infectious period  2 to 3 weeks before and 1 week after development of jaundice. Complication  Fulminant (severe acute and often fatal) hepatitis Prevention  Strict handwashing, especially after handling shellfish  Avoid contaminated food.  Stool and needle precautions Hepatitis A vaccine:  Two doses are needed at least 6 months apart for lasting protection Transmission  Blood or body fluid contact  Infected blood products  Infected saliva or semen  Contaminated needles  Sexual contact  Parenteral  Perinatal period  Blood or body fluid contact at birth  Hemodialysis  Sharing razors or toothbrushes with an infected individual Incubation period: 60 to 180 days Complications  Fulminant hepatitis  Chronic liver disease  3. Cirrhosis  Primary hepatocellular carcinoma Prevention      Strict hand washing Screening blood donors Testing of all pregnant individuals Needle precautions Avoiding intimate sexual contact and contact with body fluids if test for HBsAg is positive.  Infection with HCV is common among IV drug users and is the major cause of post transfusion hepatitis. Incubation period: 2 weeks to 6 months Complications  Chronic liver disease  Cirrhosis  Primary hepatocellular carcinoma  Prevention  Strict hand washing  Needle precautions  Screening of blood donors  Hepatitis E is a waterborne virus.  Hepatitis E is prevalent in areas where sewage disposal is inadequate or where communal bathing in contaminated rivers is practiced. Individuals with increased risk  Travelers to countries that have a high incidence of hepatitis E, such as India, Burma (Myanmar),  Eating or drinking of food or water contaminated with the virus Incubation period: 2 to 9 weeks Complications  High mortality rate in pregnant individuals  Fetal demise Prevention  Strict handwashing  Treatment of water supplies and sanitation measures Pancreatitis  Acute or chronic inflammation of the pancreas, with associated escape of pancreatic enzymes into surrounding tissue Acute pancreatitis occurs suddenly as one attack or can be recurrent, with resolutions. Chronic pancreatitis  continual inflammation and destruction of the pancreas, with scar tissue replacing pancreatic tissue. Precipitating factors  trauma, the use of alcohol, biliary tract disease, viral or bacterial disease, hyperlipidemia, hypercalcemia, cholelithiasis, hyperparathyroidism, ischemic vascular disease, and peptic ulcer disease Acute pancreatitis Assessment  sudden onset at a midepigastric or left upper quadrant location with radiation to the back  Pain aggravated by a fatty meal, alcohol, or lying in a recumbent position  Elevated serum lipase and amylase levels Cullen’s sign  discoloration of the abdomen and periumbilical area. Turner’s sign  bluish discoloration of the flanks. Irritable Bowel Syndrome (IBS)  Functional disorder characterized by chronic or recurrent diarrhea, constipation, and/or abdominal pain and bloating Causes is unclear but may be influenced by environmental, immunological, genetic, hormonal, and stress factors Interventions 1. Increase dietary fiber. 2. Drink 8 to 10 cups of liquids per day. 3. Medication therapy: Depends on the predominant symptoms of IBS Ulcerative Colitis An ulcerative and inflammatory disease of the bowel that results in poor absorption of nutrients Commonly begins in the rectum and spreads upward toward the cecum The colon becomes edematous and may develop bleeding lesions and ulcers which may lead to perforation. Assessment          Anorexia Weight loss Malaise Abdominal tenderness and cramping Severe diarrhea that may contain blood and mucus Malnutrition, dehydration, and electrolyte imbalances Anemia Vitamin K deficiency Intermittent fever Surgical imtervention Restorative proctocolectomy with ileal pouch–anal anastomosis (RPC-IPAA) a. Allows for bowel continence b. May be performed through laparoscopic procedure Crohn’s Disease  An inflammatory disease that can occur anywhere in the gastrointestinal tract but most often affects the terminal ileum and leads to thickening and scarring, a narrowed lumen, fistulas, ulcerations, and abscesses Characterized by remissions and exacerbations Assessment  Cramplike and colicky pain after meals  Diarrhea (semisolid), which may contain mucus, pus, or the presence of blood in the stool  Abdominal pain and distention  Anorexia, nausea, and vomiting  Weight loss  Anemia  Dehydration Diverticulosis and Diverticulitis Diverticulosis  an outpouching or herniation of the intestinal mucosa. most common in the sigmoid colon. Diverticulitis  inflammation of one or more diverticula that occurs from penetration of fecal matter through the thin-walled diverticula;  it can result in local abscess formation and perforation. complication  intra-abdominal perforation with generalized peritonitis Assessment  Left lower quadrant abdominal pain that increases with coughing, straining, or lifting  Nausea and vomit  Cramplike pain  Abdominal distention and tenderness  Palpable, tender rectal mass may be present.  Blood in the stools Interventions 1. Provide bed rest during the acute phase. 2. Maintain NPO status or provide clear liquids during the acute phase nutrition.          When the diverticulitis is active, provide a low-fiber diet when the inflammation resolves, provide a high-fiber diet. antibiotics, analgesics, and anticholinergics to reduce bowel spasms Instruct the client to refrain from lifting, straining, coughing, and bending to avoid increased intra-abdominal pressure, Abdominal x-rays may be done to evaluate for free air and fluid, indicating perforation. Instruct the client to increase fluid intake to 2500 to 3000 mL daily, unless contraindicated. Instruct the client to eat soft high-fiber foods, such as whole grains; the client should avoid high-fiber foods when inflammation occurs, because these foods will irritate the mucosa avoid gas-forming foods  Instruct the client to consume a small amount of bran daily and to take bulk-forming laxatives as prescribed to increase stool mass.  avoiding the use of laxatives or enemas unless prescribed. Surgical interventions  Colon resection with primary anastomosis  Temporary or permanent colostomy may be required for increased bowel inflammation A normal response to stress may result when values are threatened or preceding new experiences. Types of anxiety Normal: A healthy type of anxiety Acute: Precipitated by imminent loss or change that threatens one’s sense of security Chronic: persists as a characteristic response to daily activities Interventions: o Provide a calm environment, decrease environmental stimuli, and stay with the client. o Ask the client to identify what and how he or she feels. o Help the client to identifythe causes of the feelings . o Listen to the client for expressions of helplessness and hopelessness. The immediate nursing action for a client with anxiety is to decrease stimuli in the environment and provide a calm and quiet environment. o Irrational fear of an object or situation that persists Associated with panic level anxiety. o Defense mechanisms commonly used include repression and displacement. Types Acrophobia: Fear of heights Agoraphobia: Fear of open spaces Astraphobia: Fear of electrical storms Claustrophobia: Fear of closed spaces Monophobia: Fear of being alone Mysophobia: Fear of dirt or germs Nyctophobia: Fear of darkness Pyrophobia: Fear of fires Social Phobia: Fear of situations in which one might be embarrassed or criticized; fear of making a fool of oneself Xenophobia: Fear of strangers Zoophobia: Fear of animals Interventions o Identify the basis of the anxiety. o Allow the client to verbalize feelings about the anxietyproducing object or situation; o Talking frequently about the feared object is the first step in the desensitization process. o Teach relaxation techniques, such as breathing exercises, muscle relaxation exercises, and visualization of pleasant situations. o The performance of repetitive behaviors designed to prevent some event, divert unacceptable thoughts, and decrease anxiety. Defense mechanisms include repression, displacement, and undoing. Interventions for Obsessive-Compulsive o Identify situations that precipitate compulsive behavior; o encourage the client to verbalize concerns and feelings. o Be empathetic toward the client and aware of his or her need o Do not interrupt compulsive behaviors unless they jeopardize ‫يتعرض للخطر‬ o provide for client safety related to the behavior o set limits on behaviors that may interfere with the client’s physical wellbeing to protect the client from physical harm. o Implement a schedule for the client that distracts from the behaviors (structure simple activities, games, or tasks for the client). o characterized by episodes of mania and depression with periods of normal mood and activity in between. o The medication of choice lithium carbonate Antianxiety, Atypical antipsychotic medications (clozapine) Interventions for mania o o o o o o o o o o o Remove hazardous objects from the environment use comfort measures to promote sleep. Encourage the client to ventilate feelings. Use calm, slow interactions. Help the client to focus on 1 topic during the conversation. Ignore or distract the client from grandiose thinking Do not argue with the client. Limit group activities Reduce environmental stimuli. Set limits on inappropriate behaviors. Provide physical activities and outlets for tension. o can occur after a loss( loss of self-esteem, the end of a significant relationship,the death of a loved one, or a traumatic event) o Depression may be mild, moderate, or severe. For a client at risk for self-harm, ask the client directly, “Have you thought of hurting yourself?” Interventions for Depressed Clients Risk for Harm o Assess for suicidal ideation. o Provide safety from suicidal actions (be certain that there are no harmful objects in the environment). o Do not leave the client alone for extended periods. o If the client has a suicidal plan, place on one-to-one supervision. o Form a “no-suicide contract” with the client as appropriate. effective treatment for depression (not a cure) o The usual course is 6 to 12 treatments given every 2 to 5 days o maintenance ECT once a month may help to decrease the relapse ratefor a client with recurrent depression.  The goal of the nurse-client relationship is assist the client to develop problem-solving abilities and coping mechanisms.  Appropriate limits and boundaries facilitate a therapeutic nurse-client relationship.  Honest and open communication is important for the development of trust  uses therapeutic communication techniques to encourage the client to express thoughts and feelings  respects the client’s confidentiality  includes verbal and nonverbal expression Communication Techniques Reflecting Reflects back to clients their emotions, using their own words Example: C: John never helps with the housework. MHP: You’re angry that John doesn’t help Open-ended questions Encourages client to take responsibility for direction of session; avoids yes/no responses MHP: What would you like to deal with in this session? Paraphrasing Repeat the main idea to ensure that patient understood I have been tossing and turning all night You mean you have difficulty sleeping Restating, using different words to ensure you have understood the client; helps clarify C: My grandkids are coming over today and I don’t feel Well MHP: Your grandkids are coming over, but you wish they weren’t, because you are not well. Is that what you are saying? Focusing Use when a client is covering multiple (bipolar/anxious) and needs help focusing topics rapidly MHP: A lot is going on, but let’s discuss the issue of your job loss, as I would like to hear more about that Acceptance Positive regard and open to communication Defense mechanisms an effort to protect the individual from feelings of anxiety Types of Defense Mechanisms Conversion: The expression of emotional conflicts through physical symptoms Denial: refuse to accept thoughts and impulses Displacement: Feelings about one person are directed to another who is less threatening, satisfying an impulse with a substitute object Identification: The unconscious attempt to change oneself to resemble an admired person Projection: Transferring one’s internal feelings, thoughts, and unacceptable ideas and traits to someone else Rationalization: An attempt to make unacceptable feelings and behaviors acceptable by justifying the behavior Reaction Formation: Developing conscious attitudes and behaviors and acting out behaviors opposite to what one really feels Regression: Returning to an earlier developmental stage to express an impulse to deal with anxiety Repression: An unconscious process in which the client blocks undesirable and unacceptable thoughts from conscious expression Sublimation: Replacement of an unacceptable need, attitude, or emotion with one more socially acceptable. Hallucination False sensory perception not associated with real external stimuli. Illusion : Misperception or misinterpretation of real external sensory stimuli Example :seeing iv tube as snake Echolalia: Repeating the speech of another person ‫معناه المريض بيكرر الكالم اللي ببسمعه‬ Echo-praxia: Repeating the movements of another person Waxy Flexibility: Having one’s arms or legs placed in a certain position and holding that same position for hours ‫معناه المريض بيظل في وضع معين لمده طويله‬ Clang association: association of words similar in sound but not in meaning; words have no logical connection. Example: Pt say:hat ,cat,fat,rat Neologisms: Client makes up unknown words. He only able to understand it Palilalia When the psychiatric patient repeats his words example: boat, boat, boat Circumstantiality Excessive and irrelevant detail in descriptions with the person eventually making his/her point. Example We went to a new restaurant.The waiter wore several earrings and seemed to walk with a limp…yes,we loved the restaurant. Tangentiality Digressions in conversation from topic to topic and the person never makes his/her point. Example Went to see Joe the other day.By the way, bought a new car. Mary hasn’t been around lately. Word Salad: Combination of words that have no meaning orconnection. Example:Inside outside blue market calling. ‫مزيج من الكلمات بدون ترابط‬ stage of detachment 1. Protest )Screem,cry,inconsolable ‫ال عزاء له‬ 2. Despair (Sadness ,depression) 3. Detachment (Lack of protest when parent leaves) respiratory  Elevated Head of bed  Semi fowler's Position  High fowler's Position  Orthopneic Position Stridor  Indicates upper airway obstruction. Disease: Croup or epiglottitis or anyone with an airway obstruction Wheezes  Heard in narrowed airway diseases. "bronchoconstriction" (Inflamed lung disease) Asthma attack & COPD exacerbation. Crackles (Rales)  Indicates lower airway obstruction. Air passing through fluid or mucous. ‫مثل صوت الشيشة‬ Disease: pulmonary edema, COPD,CHF, Pneumonia. Rhonchi Causes Mucous secretions or obstructions of the trachea or bronchus. Disease: Chronic bronchitis.  Inflammation of the pulmonary parenchyma or alveoli or both Types Viral pneumonia  occurs more frequently than bacterial pneumonia Bacterial pneumonia  is serious infectionrequiring hospitalization Aspiration pneumonia  occurs when food, secretions, liquids, or other materials enter the lung and cause nflammation Vaccine  immunization of infants and children with heptavalent pneumococcal conjugate vaccine. Mode of transimition  Droplet symptoms  Coughing, sputum production, chest pain, rapid shallow breathing, fever, and shortness of breath. Nursing duagnosis:  Ineffective Airway Clearance • Nursing intervention  Elevate head of bed, change position frequently.  Teach deep-breathing exercises.  Good hydration Caustive agent:  Mycobacterium tuberculosis.  Airborne Infection  TB Vaccine is BCG Differences between latent TB VS active Tb Latent TB:  -NOT contagious ‫غير معدي‬  -Does NOT have signs and symptoms.  -Normal chest x-ray  -Negative sputum test Active TB:      -Contagious -Has signs & symptoms -ABNORMAL chest x-ray -Positive sputum culture. -Positive PPD or blood test. Testing for Tuberculosis     PPD test ,Mantoux Test, Tuberculin skin test "TST" result after 48-72 hours Sputum cultures Definite and most accurate Best in the morning before breakfast. Classification of the Tuberculin Skin Test Reaction:  0_5 negative  6_15 suspected  more than 15 positive 5 mm or more Positive if person have HIV, in contact with someone with TB,organ transplant patient, or immunosuppressed. Nursing diagnosis  ineffective airway clearance Interventions  Initiate airborne isolation precautions  negative _ve pressure room  (N95mask) for every one entering the room.  Strict hand hygiene Medications for Tuberculosis  Isoniazid(Rifampin) [Cause hepatitis symptoms] Pulmonary disease that causes chronic obstruction of airflow from the lungs. Types of COPD:  Emphysema “pink puffers”  Chronic bronchitis “blue bloaters” Interventions  O2 Keep oxygen saturation (88%-93%)  Given oxygen as prescribed in low amounts 1-2 liters  Encourage fluid intake up to 3000 mL/day to keep secretions thin, unless contraindicated.  Pursed-lip & Diaphragmatic breathing teaching Complications .  Cor pulmonale  Pneumothorax Chronic lung disease (no cure) that causes narrowing and inflammation of the airways leads to difficulty breathing. Signs & Symptoms  Shortness of breath & Dyspnea & Cyanosis  Tight chest & Tachypnea ,  High pitched *wheezing Complications  Hypoxia Earliest sign" agitation, restlessness, drowsiness"  Hypercapnia indication  Pneumothorax  Pleural Effusion  Hemothorax Intermittent bubbling [ fluctuation] >>NORMAL Continuous " Constant" >>ABNORMAL( airleak) Amount of drainage  not exceed 100ml exept in first hour after insertion then 70 ml for each hour If the tube be disconnected from drainage system: 🤔🤔  Connect the end in sterile saline or water to maintain the seal. If the chest tube accidentally pulled out: 🤔🤔🤔  Apply sterile occlusive dressing the chest tube site When transporting and ambulating the client:  Keep the water seal unit below the chest level and upright.  Ask the patient to used valsalva maneuver during chest tube removal . Tidaling:  Is an Increase in the water level with inspiration and return to the baseline level during exhalation. It’s normal. The Chambers of the Hearts The heart is made up of four chambers. Right atrium and the left atrium Receive Blood from the pulmonary and systemic circulatory system. Right ventricle and left ventricle The right ventricle pumps blood through the pulmonary circulatory system. The left ventricle pumps blood through the systemic circulatory system. The two ventricles are separated by interventricular septum. The Heart Valve Anatomy Four valves maintain the unidirectional flow of blood through the heart. Two Valves located between each atrium and ventricle The Tricuspid valve (right atroventricular) The bicuspid valve mitral (left atrioventricular) 2 Semilunar valves Pulmonic valve direct blood flow from the ventricles into the pulmonary trunk artery Aorta valve direct blood flow from the ventricles into the aortic artery for body The coronary arteries supply blood, oxygen and nutrients to your heart Heart rate . Heart beats per minute . For regular rhythm = 300/ number of big squares between 2 R waves . For irregular rhythm = Number of QRS in 10 big squares X 30 . Atrial fibrillation . Heart condition that causes an irregular and often abnormally fast heart beat . No P wave , just fibrilatory waves . irregular rhythm May range from 100-170 beats/min . Premature contraction . An extra heart beats that begin in atrium or ventricles of the heart. Narrow QRS after regular waves represent premature atrial contraction ( PAC ) . Wider QRS after regular wave represent premature ventricle contraction (PVC ) SVT It's a condition where the heart suddenly beats much faster than Normal Sinus tachycardia Sinus BRADY CARDIA ATRIAL FLUTTER VENTRICULAR TACHYCARDIA (VT) VENTRICULAR FIBRILATION ASYSTOLE  It's a hospital emergency code used to describe the critical status of a patient . Indications .  Cardiac arrest .  Respiratory arrest .  Presyncope . Code blue team .     Physician ( ICU or Anesthesia or Cardiologist or internal medicine ) . Nurse ( ICU nurse , Emergency Nurse , Unit nurse , Nurse supervisor ) . Respiratory therapist . Security guard .  A lifesaving technique used in many emergencies such as a heart attack , drowning , breath or heartbeat has stopped We stop CPR if  person revive or he is dead or emergency arrive to take over . Indications.  Respiratory arrest ( drowning , foreign body aspiration , toxic inhalation , trauma).  Cardiac arrest ( MI , pulmonary embolism , cardiac tampnade) . Contraindication to CPR .  Do not resuscitate order ( DNR ) ( patient desire ) .  Medical staff feeling that Intervention will be useless .  Head injury.  Severe trauma to the cervical spine .  Signs of imminent death ( rigor mortis , livor mortis ) . Before starting CPR .       Check is the safety for the person Check ,is the person conscious or unconscious ? . shake patient's shoulder and ask loudly "Are You Ok " ? . If patient doesn't respond call emergency . Check vital signs and breathing . Start CPR and other person get AED . Compression ( restore blood flow )  place hand over the center of the person's chest  Push straight down 5 cm depth by your body weight Push hard at rate of 100-120 compression per minute . Airway  Use head-tilt-chin-lift maneuver unless in case of spinal cord injury  Jaw thrust maneuver . breathing  Give 2 breath every 30 compressions and notice chest rises  If AED is available , apply it , give one shock then resume compressions for 2 mins before giving a second shock  A portable life saving devices designed to treat people experiencing sudden cardiac arrest . Steps to switch it on  Power on .  Attach paddle .  Analyse rhythm – stand .  Shock – stand clear Indications . clear  Feeding or administration of medication .  Drainage of the upper gastrointestinal tract . Confirming position .  Measurement of NG aspirate PH using PH indicator paper .  Chest X-ray .  Auscultation of air inflated through the feeding tube . Complications .     Diarrhea , vomiting , constipation . Lung aspiration . Tube dislodgement . Tube clogging . Hyperglycemia and electrolyte alterations . Tissue trauma . Contraindications .  Facial trauma . heart is unable to pump blood around the body properly because the heart has become too weak or stiff. Check BNP and BP (should NOT be increasing)HOB position & elevate legs with “pillow  Acute chest pain” Caused by severe narrowing of the coronary arteries.less O2 to the heart muscle. Nitroglycerine is giving to open these coronary artery in the heart. to provide O2 to the heart muscle” Common types of Angina Stable angina Occurs with activities that involve exertion or emotional stress. relieved with rest or nitroglycerin. Unstable angina  Occurs with an unpredictable degree of exertion or emotion and increases in occurrence, duration, and severity over time  Pain may not be relieved with nitroglycerin. intervention  Nitroglycerin 3doses every 5 min sublingual Always check BP before giving nitroglycerine  Give Dilators but be cautious because of Decrease BP (  Occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle.  The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck or jaw Location of Mi Inferior MI ST elevation at L2,L3,avf Lateral MI St elevation at L1, avl, V5,V6 Anterior MI ST elevation at V3, V4 Septal MI ST elevation at V1, V2 Intervention (Get ECG Troponin to confirm Give O2 Nitroglycerine Asprin to prevent new clot Morphine Heparin  It occurs when fluid build up in the pericardium (the sac around the heart) resulting in compression of the heart . Causes and risk factors .  Uncontrolled pericardial effusion .  Chest trauma ( gun shot , stabbing ) .  Myocardial infarction .  Uremia , Pericarditis . Signs and symptoms . BEC’s Triad  Big jugular veins distension (JVD)  Extreme low BP “Hypotension  Can’t hear heart sound “muffled heart sound Treatment.  Emergency thoractomy ( withdraw fluids around the heart ) .  Pericardiocentesis ( insert needle to withdraw fluids ) . It's an air in the pleural cavity Types . spontaneous pneumothorax .  no clear cause.  Risk factors such as ( smoke , family history , the rupture of the bulla ) Secondary ( non traumatic )  Referred to as non spontaneous or complicated pneumothorax .  It occurs as a result of underlying lung pathology ( COPD Asthma , TB , Cystic fibrosis ) . Tension pneumothorax  Deviated trachea Traumatic pneumothorax .  Caused by trauma to the lung (stabbing , gunshot , broken ribs) or incorrect medical procedure ( CVC insertion Signs and symptoms .      Sudden onset of chest pain . Dyspnea ( shortness of breath ) . Tachycardia ( increased heart rate ) . Tachypnea ( increased inspiration rate ) . Hypotension It's an abnormal build up of fluid in the lung . Causes .  Congestive heart failure .  Kidney failure .  Lung damage ( due to gas or severe infection ) .  Narrowed arteries . Signs and symptoms .  Cough ( frothy pink sputum ) .  Orthopnea ( difficulty breathing when lying down ) .  Shortness of breath .  Wheezing sounds with breathing .  Leg or abdominal swelling .  Pale skin . Treatment .       Oxygenation . Diuretics . Morphine to relieve shortness of breath . Blood pressure drugs . Inotropes ( improve heart pumping function ) . Lifestyle changes ( smoke , control your blood pressure , eat less salt , control your weight ) . A blockage in one of the pulmonary arteries in the lung . Causes .  Blood clots  Air bubbles .  Fat .  Heart diseases .  DVT . Treatment and prevention .      Anticoagulants . Clot dissolvers ( thrombolytics ) . Surgical if clots are large ( clot removal , vein filter ) . Compression stocking in DVT . Lifestyle changes (physical activity , drink plenty of fluids , control weight) .  It occurs when the blood supply to part of brain is interrupted or reduced so brain cells begin to die in minutes . Signs and symptoms .  Trouble speaking and understanding what others say .  Paralysis or numbness of the face , legs , arms .  Problems in one or both eyes .  Headache .  Trouble walking . Causes .  It happens when the brain's blood vessels became narrowed or blocked .  Risk factors ( fatty deposits , blood clots , other debris ) . Hemorrhagic stroke .  It occurs when a blood vessel in your brain leaks or ruptures . Risk factors :  Aneurysms . Trauma . Ischemic stroke . Transient ischemic stroke ( TIA) .  It's known as ministroke , temporary period of symptoms and doesn't cause permanent damage . Diagnosis .  Physical exam .  CT scan . MRI . Treatment . Ischemic stroke .  Emergency IV medications ( IV injection of Alteplase ) .  Endovascular procedures ( medications to brain directly , clot removing with a stent retriever ) .  Carotid end arterectomy ( removes plaque blocking arteries ) .  Angioplasty and stents . Hemorrhagic stroke .  Surgery ( to remove blood and relieve pressure on your brain ) .  Surgical clipping (( to treat aneurysm ) .  A life threatening condition that occurs when the body is not getting enough blood flow . Types Cardiogenic shock  Inability of the heart to act as apump Hypovolemic shock  Too little blood volume due to hge Anaphylactic shock  due to allergic reaction Septic shock due to infection Neurogenic shock  due to damage to nervous system(spinal cord injury) the first sign for shock are :  Increase heart rate, Decrease BP  Cold ,pale ,moist skin  Decrease cardiac output In neurogenic shock there is  brady cardia and warm skin and hypotension Position  Supine with elevated leg Indications  severely dysfunctional or nonfunctional gastrointestinal tracts  Clients with multiple gastrointestinal surgeries gastrointestinal trauma, severe intolerance to enteral feedings, or intestinal obstructions,cancer, burn injuries, or malnutrition,  Administered through a central vein) include the subclavian vein and the internal or external jugular veins). Complications  Pneumothorax and air embolism are associated with central line placement  air embolism is also associated with tubing changes.  infection (catheter related),  hypervolemia and hyperglycemia and hypoglycemia It’s an inflammatory lesion of meninges . Types of meningitis . Infective ( bacterial , viral , parasitic , fungal ) . Non infective ( Cancer . SLE ) . Mode of transmission .  Direct droplet infection .  Indirect ( airborne infection , contaminated articles and fomites) . Clinical picture .  Sudden onset , high fever , severe headache , body aches .  Nasopharyngitis with catarrhal manifestations .  Meningococcemia ( acute septicemia ) .  Meningitis ( stiff neck and back , increased pressure of cerebrospinal fluid , mental irritability and nervous manifestations ) . Complications .  Hydrocephalus .  Involvement of cranial nerves ( Optic neuritis , Ocular nerve palsies , deafness ) .  Temporary arthritis , myocarditis .  Thrombophlebitis and nephritis . Treatment .  Life style change ( wash hands , cover your mouth while coghing , healthy foods) .  Vaccinations .  IV antibiotics and antivirals .  Corticosteroids .  Bed rest .  Drink plenty of fluid .  Avoid crowding .  Diagnosis .  Blood culture .  Imaging ( CT , MRI , X-rays ) .  Lumber puncture cloudy csf