Respiratory & Breath Sounds PDF

# Respiratory ## Breath Sounds 1. Trachial Breath Sounds * Heard at level of trachea * Harsh breath sound 2. Bronchial Breath Sound * Just below the trachea * High pitched, loud 3. Broncho Vesicular * Bet. scapulae * Medium pitched (middle lobe of lungs) 4. Vesicular Breath Sound * Lower lob...

# Respiratory ## Breath Sounds 1. Trachial Breath Sounds * Heard at level of trachea * Harsh breath sound 2. Bronchial Breath Sound * Just below the trachea * High pitched, loud 3. Broncho Vesicular * Bet. scapulae * Medium pitched (middle lobe of lungs) 4. Vesicular Breath Sound * Lower lobe of lungs * Low pitched ## Abnormal Breath Sounds * **Rales** * Produced by moisture of trachiobronchialtube * Non - continuous sound * Discrete * **Crackles** * Accumulation of fluid * Coarse rales * Plenty of rales * **Rhonchi** * Continuous sound produced by secretion * **Friction Rub** * Crackling, grating sound originating in an inflamed pleura * Pericarditis # ABG * **pH** * 7.35 - 7.45 * ↓acid - ↑alka * **Paco2** * 35 - 45 * ↓alka - ↑acid * **Hco3** * 22 - 26 * Acid - Alka * **Fully compensated – normal PH (abnormal: paco2/HcO3)** * **Partially compensated – all is abnormal** * **Uncompensated – PH not normal (Normal: PaCa02/Hc03)** # Respi Acid * Increase ICP (ex: TB/ pneumonia) # Respi Alka * Dec CO2 * Anxiety * Hyperventilate # Metabolic Acid * Kussmaul Breathing * Dehydration # Metabolic Alka * Vomiting # Pneumonia * Inflammation of lungs ## Risk factors * Smoking * Air Pollution * Immunocompromised ## S/S: * Greenish to rusty sputum – pathognomonic sign * Dyspnea, fever * Pleuritic chest pain * Rales/Crackles ## Diagnostic: * Sputum test * X-RAY (Confirmatory Test) * CBG (WBC) >10.000 ## Drug of choice * Amoxicillin ## Nursing Intervention * Deep Breathing & Coughing exercise * Suction * Increase fluid intake * Assist nebulize then chest physiotherapy # Vaccines * Pneumonococal (adult) * Hib vaxx (Children) * Haemophilus influenzae * Prev. diagnosis of pneumonia/ meningitis # Pulmonary Tuberculosis (PTB) * Koch Disease (Robert Koch) * Infection of tissue * Myobacterium Tuberculae ## Risk factor: * Alcoholism * Malnutrition * Overcrowding ## S/s: * Productive cough * Low fever (afternoon/night) * Anorexia * Night Sweat * Weight Loss ## Diagnostic: * Sputum Culture / Gene Expert (Confirmatory) * (+) Mantoux Test (Exposure) * >10 mm * > 5 mm (HIV) * 48-72hrs (result) * Chest Xray (extent ng tb) # Pneumothorax * Accumulation of atmosphere air in the plueral space which result in intra thoracic pressure ## Risk factors: * COPD * Trauma * Tall, thin ## Tension Pneumothorax * Occurs from blunt chest injury/from mechanical ventilation ## S/S: * Dyspnea * Dullness * Dec breath sound in affected side * Dec chest expansion * Trachial deviation – unaffected side ## Diagnostic * Chest X-ray * ABG (Respi acid) ## Management * Thoracentesis * Accumulation of air in lungs * Invasive * Secured informed consent * Chest Tube Thoracostomy * Drainage * Drainage & water sealed drainage * Drainage, water-sealed, & suction * Monitor fluctuation * (+) Inc water lvl * (-) Dec water lvl * Abnormal : * Obstruction * Lung reexpanded * Normal: * Intermittent/ Intact * Abnormal: * Continuous (may air leak) # COPD * Teach Purse Lip Breathing (prev. air trapping) ## 2 Types: * Chronic Bronchitis * Inflammation of bronchi * Blue Buffer * Inc in # & size in mucus gland * 3 mons - 2 yrs * Productive cough * Scattered rales & ronchi * Right Heart failure (Cor Pulmonare) * Pink Puffer (Inc anterio-posterioir diameter Barrel Chest of the chest Air trapping) ## Diagnostic: * Spirometry * ABG (Respi acid) * CXRay ## Management * Dec flow in o2 * Drive to breath * Prev loss of hypoxic drive ## Medications: * Corticosteroids (inflammation) * Anti microbial (for 2 deg infection) * Mucolytics/ expectorant (cause: palpitations) * Ronchodilator * Avoid: * Coffee * Tea * Cola * Chocolate # Empyema * Ineastic alveoli * Risk factors: * Alpha / antitrypsin deficiency * Smoking * Air pollution ## S/S: * Productive cough * Dyspnea @ rest * Rales, crackles, ronchi ## Diagnostic: * ABG * Chest Xray ## Management * Force fluid * Low in flow of o2 * Administering meds * Semi fowler position ## Refer agad if may pnuemonis # Hematology * makes up 7-10% / 5–6L/vol (Normal body weight) ## Plasma * Nutrition, bacteria/ viruses ## WBC/RBC * Produce by bone marrow ## Platelets ## Cellular Compartment of blood * **RBC** * Erythrocytes (Matured) * Reticulocyte (immature) * Hemoglobin * Inside of RBC (matured RBC) * M = 14-16 gldi * **WBC** * Leukocytes * Right against infection * Blast (immature) * **Platelets** * Thrombocytes * Normal Value: 150k-450K * Megalocytes * >450k - Thrombocytosis * Risk for clotting * <150k- Thrombocytopenia * Risk for bleeding * Mgt: electric toothbrush/ razor * **MCV** * Mean Capsular Volume * Size of RBC (normocytic) * CKD * ↑ size of MCV (macrocytic) * Megaloblastic * ↓ size of MCV (microcytic) * IDA ## 3 P's of anemia * Pallor * Fatigue (rest) * Palpitation (avoid caffeine) # Iron deficiency anemia * Poor intake of iron-rich food -nutritional * Bleeding, trauma, melena ## Foods (iron rich) * Meat * Seafood * Eggs * Liver * fish * Dark, green leafy veggies ## S/S: * Cholonekia * Brittle, spoon like nails * Cheilosis ## Diagnostic: * Micro hypochromic anemia * ✓ Ferritin (stored iron) ## Management: * On empty stomach * Stool may appear dark green/ black * Can stain teeth * Use straw * Z track tech * Parenteral iron * Prev. staining of tissue ## Megaloblastic Anemia * Vit B9 & B12 deficiency * Both need for DNA synthesis ## S/S: * Red beefy tongue ## Pernicious Anemia ( B12 def) ## S/s: * Red beefy tongue – pathognomonic Sign * Glossitis * Paresthesia ## Diag: * Schilling's Test (24hr urine) * Intrinsic factor: No absorption of HCL ## Management: * Food rich in B12 (Dairy products) ## Folic Acid Deficiency Anemia (B9) * Need for DNA synthesis ## Drug: Methotrexate ## Causes: * Hemodialysis * Pregnant * Alcohol abuse ## Management * Food rich in B9 * Citrus food, whole grain # Sickle cell anemia * Crescent shape * Clamp to each other (cause thrombosis) ## Causes: * Hypoxia * HBS gene inherited in African race * Obstruction * Skinning ## S/S: * Complication result from chronic hemoloysis/ thrombosis * Jaundice (Inc bilirubin) * Pulmonary HPN ## Complication: * Impotence/ Infection * Stroke * Acute chest syndrome ## Diagnosis: * Pain * Jaundice * Infection ## Hgb Electrophoesis (effective) ## Management * Adequate hydration (at least 3L/day) * Morphine (Drug of choice) ## Jaundis * Infection * Crescent shape * K * L * € * H * O * P * I * A # Aplastic Anemia * Idiopathic (unknown) (most cases) * Damage to bone marrow stem cell ## S/S: * RBC (3 P's) * WBC * Bleeding * Platelets * Pancytopenia ## Autoimmune * Spleen (produce antibody) ## Management: * Remove antibody (Steroid)(Drug) * Splenectomy * Bone marrow transplant * Protein, fiber/ residue * Limit visitors (Reverse isolation) * Oranges (binabalatan) * Monitor bleeding * Avoid contact sports (prone to bruises) # Musculoskeletal ## 1. Ligaments * Connects bone to bone ## Sprain (Stretches) ## Management: (Mild --> Mod) * Rest * Ice * Compress * Elevate ## Severe: Surgery ## 2. Tendon * Muscle to bone ## Strain (excessive stretch of tendn/muscle) (tear) ## Management: Same sa sprain ## 3. Joints * Arthritis * 2 or more bone are connected ## Dislocation ## Subloaction (Partial Disclocation) ## 4. Bones * Inflammation of bones * Osteomyelitis) * Discontinuity (fracture) ## 6 P's (Neuro Vascular status) * Pain (1st complain) * Paresthesia (tingling sensation) * Pulselessness * Pallor * Poikilothermia (cold) * Paralysis (last complain) # Arthritis ## Pain --> NSAID / Steriods ### NSAID (Given after meals ) * Mefenamic * Ibuprofen * Naproxen * Diclofenae * Celecoxib * Etoncoxib * Arcoxia ## 1) Osteoarthritis (OA) * Degenerative * Obese * Old * Cervical * Lumbar * Knee ### S/S: * Pain * Stiffness of joints (<30 mins in morning) * Heberden's & Bouchard nodes * Localized * Asymmetrical * Non- systemical ## Management: * Topical analgesics (methysalicylate) * Intra- articular, steroids * Paracetamol, NSAID # Rheumatoid Arthritis (RA) * Autoimmune * Gender specific: WOMEN * Systemic, symmetrical, bilateral * Stiffness (>30 mins in morning) * Reynaud's phenomenon * Thin (protein – carbs diet) * Weight loss * Swan neck * Deformity ## Management * NSAID/ steriod (pain mgt) * Methotrexate (standard tx for RA) * Splint (immobilize affected extremities) * Cold packs (acute in phas eof pain) * Heat application (inflammation subside) # Gout * Purine metabolic disorder * ↑ uric acid (Bld test) * Podagra (great toe) * Erythematous meto trarsopharyngeal * Tophi ( uric acid crystallization deformity) ## Management: * Avoid pyrazinamide * Fluid intake ## Drug Therapy: * Colchicine * Allopurinol * uric acid * Febuxostat * blocks formation of uric acid * Xanthene Oxidize Enzymes ## Foods (AVOID) * Alcohol/ Anchoives * Shellfish * Organ meat # Fractures * Break continuity of bone ## S/S: * Crepitus * Loss of function * Obvious deformity * Pain ## Diagnostic: * X-ray ## Management: (emergency) * Immobilize any suspected fracture ## Complications: * Shock * Fat embolism syndrome * Compartment syndrome * VT (Hooman's sign) * Lo Prev: Anticoagulant # Fat Embolism Syndrome * RBC red marrow * Dyspnea (Complain) * Fracture * Respi failure (Most common cause of death) * Prepare Endotracheal Tube * Supply respiratory function # Traction * Act of pulling & Drawing ## Cervical * Neck ## Pelvic * Back pain ## Russe * Femur * Lower extremities ## Skin traction * use of elastic bandage * indirect # Cast * Immobilize * Keep cast extremity elevated * Handle wet cast with palms # Osteoporosis * Bone Mass Density * Thin ## Risk factors * Somking * Alcohol * Sedentary lifestyle * Age * Diet (caffeine, alcohol, low cal) * Post mens * Immobiliy ## Surgical induce osteoporosis ## Diagnostic * DEXA scan (Detects BMD) * X-ray (detects fracture) ## Drugs: * Calcium Supplement * Calcitonin * Nasal spray * IM * Sub Q * Biphosponate * Alendronate acid (dec reabsorption) ## MGT: * Stay upright * Given on an empty stomach * S/E: esophageal ulcer ## Management * Diet Therapy ( Diary products, green leafy veggies) * Exercise (Isometric) # Eyes ## Outer Layer * Sclera, Cornea ## Middle Layer * Iris, Ciliary Body, Choroid ## Inner Retina ## Middle: * Center: Pupil * Light - Constrict * Dark - Dilate * Oculomotor (CN 3) * Optic Nerve (CN 2) * Trigeminal (CN 5) * Tonometer * Measure Intra Ocular Pressure * Ishihara Test (Color Vision) ## Error of Reflection * Myopia * Near sightedness * Concave lens * Hyperopia * Far sighted * Convex Lens * Astigmatism * Irregular curvature * Cylindrical Lens * Presbyopia * associated w/ aging ## Ocular Medication * Eye drops * Eye ointment # Cataract * Opacity of Lens * Cloudy / White pupil * Surgery (only treatment) * Painless, blurry vision * Visual acuity ## Risk factors * Corticosteroids * Ging * Retinal Detachment * DM * Smoking ## PRIORITY: * Safety * Monitor IOP ## Managenment: * Lie on unaffected sife * Eye glasses at night to prev. trauma * Avoid increase of IOP * Ex; Valsalva maneuver (iri) (↑ fiber/ residue) * Bending * Coughing/ sneezing * Vomiting # Glaucoma * Irreversible blindness * Painful * ↑ aqueous humor * outflow ## Risk factors * Family History * Aging * Myopia * Steroids ## Treatment: * Betablocker * Acetacolamide * Diamox ( antidiuretic) * Medications: * Pilocarpine * Carbachol * Beetaxolol * Trimolol * (inner pressure) * Tyranoprost, Latanoprost ( Prostaglandin agonist) * Surgery (faci aqueous humor drainage) * iridectomy/ iridotomy * Phacoemulsicatoon ## PRIORITY: * Safety # Retinal Detachment * Flashes of light / floaters * Retinal tear * Painless * Choroid separate to retina * Sense of curtain being drawn over the eyes ## Causes: * DM retinophaty * Aphakia (missing of lens) * Tumor * Inflammation (uvitis) ## Surgery: * Scleral Buckle (promote reattachement) # Ear ## Conductive * Sira Ang external & middle * Sira Ang inner ## Sensorineural * Functional * Due to emotion # Otitis externa * External ear (Skin color) * Erythematous canal * Swimmer's Ear ## Management * Antibiotic/analgesic # Otits Media * Middle ear * Ossicles, usthesian Tube, Stapes * Tympanic membrane (pearly gray color) * Erythematous and bulging * Upper Respi Tract Infection * Cough/colds * Otalgia (ear pain) ## Surgery * Myringotomy # Inner Ear * Labyrinth * Vestibule * Semi circular canal * Cochlea * organ for hearing (degenerative) * Sensorineural hearing loss # Presbycusis * Hearing loss by aging * Talk w/ tone voice on unaffected side # Otosclerosis * Conductive hearing loss * Canal, TM, cochlea * Abnormal bone bet staopes & cochlea ## Treatment: SURGERY ## Risk factors: * Hereditary * Abnormal bone growth * stapes ## Management: * Hearing Aid # Meniere's Disease * Sensorinural Hearing Loss * Idiopathic * ↑ fluid in inner ear/ labyrinth * Tinnitus (Ringing SA ear) * Vertigo (Troublesome symptom) * (Priority: SAFETY) ## DIET: * Veggies, diuretics, sodium * Avoid process Food ## Management: * Endolymphatic Drainage * Vestibular Nerve Rejection * Labyrinthectomy # Cardio ## Heart * 300g * Divided into R & L side * Systemic circulation (oxygenated) * Pulmonary circulation (deoxygenated) * Normal adult: 4-8/min ## Cardiac output * Amount of bld that is being pumped per minute ## Stroke Volume * Amount of bld that is pump per contraction ## Preload, Afterload, Contractility ## TBP * ↑COX TPR * Lo total peripheral Resistance ## Shock * ↓BP = COX TPRO * Constriction HR XSV ## Valves * Located @ endocardium (inner) * Myocardium (muscle) (pump blood) * Epicardium (outside) * Lead to Failure * Pericardium * Parietal * Visceral ## Centesis * Aspiration of fluid ## Sounds * AV * Diaphgram * S1 Close * S2 Semilunor valves * S3 A * S4 * Bell of Stet * Abnormal murmur * Ventricular gallop * Atrial gallop # Pericarditis ## Etiology: * Viral * Post MI (Dressler's Syndrome) * Neoplasms * Renal failure (Radiation) * Connective Tissue Diseases (SLE) ## Assessment * Chest pain (aggravated by breathing, sitting, leaning foward) * WBC, fever, malaise * Friction rub – auscultatory sign * ST elevation (ECG) * Pain * Palpitation ## Diagnosis: * Pain * Risk of Dec Cardiac Output ## Management: * Determine cause * Analgesics/ NSAIDS * Monitor s/s of Cardiac Tamponade * Collection of fluid * Jugular venous Distention w/ clear lungs * Pulsus paradoxus (10mmHg) * Narrowed pulse pressure * Muffled heart sound ## Medical Treatment * Pericardiocentesis * Dialysis (caused by uremia) * Radiation to treat neoplasm # Endocarditis ## Implementation * Monitor Heart sound ## Signs of dec CO ## Medication * Penicillin * Antibiotic for Infectove Endocarditis ## Surgery * Anticoagulant (prev. thrombus) * Warfarin (if appropriate) * Monitor PT/INR ## Heart Failure ## Etiology: * MI * Incomplete valves * Cardiomyopathy ## Right Side Hearth Failure * Distended neck vein * Edema * Hepatomegaly * Jaundice * Diet: No, Limit Fluid ## Left Sided Heart Failure * Pulmonary Edema * PInk frothy sputum * Crackles * Orthopnea * Parastismal Nuctorial Dyspnea ## Diagnostic: * X-ray: cardiomegaly * Echocardiogram * Decrease Ejection fraction * CVP: Elevated in RSHF ## 3 D's * Diuretics * Pulmonary congestion * SE: K * Vasodilators * Preload * Improved cardiac Contractility * Digoxin * 0.5-2 ng/ml * SE: Toxicity * Anorexia * Blurred vision * Bradycardia * Monitor HR * Apical pulse # Valvular Heart Diseases * Can lead to Endocarditis ## Types: * Sub acute * Acute ## Diagnostic * Murmur - 7 Strapt. gereus/ Strep. viridans ## Echocardiogram ## Take note: * Roth sports (Hemorrhage found in the eyes) * Janeway Lesion (painless macules found on palms) * Osler Nodes (Painful lesion found in extremities) ## Medication * Penicillin ## Management: * Avoid vigorous brushing * Soft bristles toothbrush * Wear stocking # Coronary Artery Disease * Atherosclerosis * Lo Fat/plaque ## RCA * Inferior wall * Posterior wall ## LCA * Anterior wall * Septal * Lateral ## Ischemia * ST depression * T wave inversion ## MI * ST elevation # Angina ## 1. Stable Angina * During exertion * Predictable consistent pain * Relive by rest & nitroglycerine ## 2. Unstable Angina * a.k.a pre infarction angina * Crescendo angina (pataas nang pataas yung pain) * Symptoms increase in frequency * Not relieve by rest & nitroglycerine ## 3. Variant/ Prinzmetal's Angina * Cause: vasospasm * pain at rest ## Medications * Nitrates * Vasodilators * Nitro glycerin * Lo 3x 9 5 mins * Lo sublingual (spray * Lo refill after 6 mons * Betablockers (Colol drugs) * SE: Nheezing * Calcium Channel Blockers (dipine drugs) * Antiplatelets * Aspirin, clopidogrel, dipyridamole) * Anticoagulant * "parin" drugs) # Myocardial Infaction ## Main cause: Coronary Artery Disease ## Dyslipidemia * Total Cholesterol: <200mg/dl * LDL (Bad chole) : < 100 mg/dl * Total glycerin : <150 mg/dl * HDL (good) : >4mg/dl ## Pain: * Crushing / substernal * May radiate to jaw, neck, arm * Unrelieved by NGT/rest ## Drug of choice * Morphine (check VS) ## S/S: * Cold clammy skin * Anxiety & sense of impending colon * Restlessness * Diaphoresis ## Priority Nursing Diagnosis * Pain ## ECG finding: * ST elevation - injury * T wave inversion - ischemia * Abnormal Q wave - necrosis ## Complications: * Cardiogenic shock * Arrhythmia * Recurrent chest discomfort * VwT VF = Depilb ## Reperfusion Therapy * Thrombolytic * Streptokinase * SE: bleeding * Door to needle time ## Interventions * Assess pain * O2 * Semi fowler * Bed rest ## Surgical Interventions * Assist in treatment modalities such as: * PTCA (Percutaneous Transluminal Coronary Angioplasty) * Consent * Avoid vigorous coughing * Leg exercises to prev emboli formation * Incentive spirometry * Report * CABGS (Bypass Surgery) * Vessel used * S aphenars vein * I nternal mammary A * R adial A # Oncology ## Cancer * Mutation of abnormal cells & proliferate abnormally ## Benign Neoplasms * Easily growing * Encapsulated & easily removed * Localized * Non-invasive * Does not metastasize ## Malignant * Fast growing * Non encapsulated & hard to removed * Non-localized * Invasive * Metastasize ## Epidemiology * Age, the age, & the risk * Race - Aprican American * Diet ## History & Physical Exam ## S/S: * Palpate mass ## Diagnostic * Biopsy (definitive diagnosis) ## Tumor Staging * T – tumor size * N – lymph Node involvement * M – distant Metastasis ## Tumor Markers * PAP (Prostatic Acid Phosphatase) - blood exam * PSA (Prostate Specific Antigen) ## 7 warning signs of Cancer * Change in bowel habits * A sore that does not heal * Unusual or bleeding discharge * Thickening or lump in breast * Indigestion/ difficulty in swallowing * Obvious change in wart/mole * Nagging cough/ hoarseness ## Prevention * Primary Prevention * Educate and teach patient * Secondary * Tertiary ## Early Detection of Cancer: Recos of ACS * Colon & Rectal CA detection * All 50 yr old (HAVE FOBT) – Fecal occult blood test * Digital Rectal exam & flexible sigmoidoscopy * Should be done every 5 yrs * Colonoscopy w/ barium enema * every 10 yrs # Prostate Cancer ## S/S: * Family history * Age * Heavy metal exposure * Gross painless hematuria * Difficulty in initiating urination * Urinary retention * Bone pain ## Treatment * Surgical * Radical Prostatectomy * Radiation Therapy * Drug * GURH analogs (inhibit Luteinizing Hormone) ## Breast Cancer * BRCA (Gene) – 1 or 2 * Increasing age * Family History * Hormone (Exposure) * F: Estrogen * early Menarche, late meenopause * Nulliparity (no child) * Childbirth after 30 yrs old * M: Festosterone ## S/S: * Non tender * Hard with irregular border * Skin dimpling * Orange peel skin ## Stage * 1 – tumor <2 cm * 2 – tumor <5 cm, (+) Axillary lymph node * 3 – tumor >5 cm, (+) metastasis * 4 – tumor >5 cm, (+) Axillary lymph node ## Breast Cancer Management * Surgery * Lumpectomy/ simple Mastectomy * Modified Radical mastectomy - exercise: Rope Turning * Chemotherapy * Radiation Therapy ## Preoperative: * Psychosocial Support * Arm Exercises ## Post Operative: * Sime fowler * Monitor drainage * Affected arm precaution ## Nursing Intervention * Do BSE (5-7 days after mens) # Lung Cancer ## Surgical Resection * Pneumonectomy - entire lung removal * Lobectomy - Lobe of lung * Segmentectomy – Segment of lung ## Nursing Intervention * Post Lobectomy * Unaffected side to promote drainage * Post Pneumonectomy * Affected Side to promote lung expansion # Multiple Myeloma * Maliganant disease of plasma cell * Prognosis based on * Serum Albumin * Beta-2 microglobulin (indirect measure of tumor burden) ## S/S: * Classic Symploms * Bone pain (back or ribs) * Less on awakening more during the day * Osteoclast activating factor * Hypercalcemia * Renal failure ## Nursing Priority: * SAFETY (risk for fracture) ## Treatment: * No cure for multiple myeloma * Chemotherapy * Radiation ## Chemodrugs: * Alkyllating Agents (Interfere DNA replication) * Example: Busulfan * Cyclophosphamide * ↑pluid intake * Antimetabolities (interfere metabolites) * Example: 5-fluorouracil * Methotrexate * SE: megaloblastic Anemia * Cytotoxic Antibiotics (inhibits DNA & RNA Synthesis) * Example: Bleomycin * Doxorubicin * Carditoxic: monitor chest pain & do ECE * Plant Alkaloids (inhibits cell division) * Example: Vincristine * Vinbiastine * Neurotoxic (dev. paresthesia) * Lotingling sensation # Chemotherapy * Administration of cytotoxic medication to promote your cell death * Route: IV * Complication of IV chemotherapy * Extravasation * Leaking of chemotherapeutic agents * Other route: Intrathecal, Intracavitary, Intravesical * Lumbar puncture/CSP * Abdominal/organ * Peritoneal (ex. bladder) ## Side effects * Alopecia (wash 3x a wk) * Bone marrow suppression * WBC, Hgbl * L/a anemia * Platelet * L/o bleeding * Nausea (give anti emetics before therapy) * L/oOmdamsctron * Diarrhea (↓ Fiber diet) ## Management * Use soft bristle toothbrush * Avoid mouthwash containing alcohol * Avoid smoking/ alcohol ## Radiation Therapy * Reduce tumor Size * Used to kill tumor * Relieve obstruction * Decrease pain ## 2 Types * External - tele * No risk for radiation exposure of other * Protect ski form sun exposure * Avoid rubbing treatment site * Washed marked skin within plain water * Do not use Powder, Lotion, Soap * Wear loose-fitting clothing-treatment area * Internal - Brachytherapy * Side Effects: GI * Tissue damage to target area * Fatigue * Radiation Pneumonia ## Side effects: * Similar to external radiation ## Sealed * Implant ## Unsealed * Systemic * Beads/Seeds * Oral / IV * Needles ## Management * Use long handled forcep to avoid implant dislodge) pick up * Bed rest * Excreted body fluids may be radioactive # Oncologic Emergency ## SVC Syndrome * Compression of Superior Vena Cava ## S/S: * Periorbital Edema * Jugular Vein Distention * Edema Neck, Arms, hands ## Treatment: * Radiation to shrink tumor * Seizure precaution ## Tumor Lysis Syndrome * Same s/s * Result when cancer cell are damaged as result of chemo/ radiation ## S/S: * High Calcium, High uric acid ## Treatment: * Hydration * Meds to lower uric acid (allopurinol/ feboxustast) * Dialysis when needed ## Spinal Cord Compression * From pressure expanding tumor ## S/S: * Back, leg pain paresthesia ## Treatment: * Reduce tumor size ## DIC (Disseminated Intravascular Coagulation) * Sepsis * Clot formation * Depletes clotting factor * Bleeding ## Treatment: * Replace blood loss * Bleeding precaution * Blood transfusion * Fresh Frozen plasma * from donor plasma # Digestive System ## 1. GIT ( Alimentary tract) * Upper GIT * Small intestine - complete digestion * Lower GIT - large intestine, anus - Le no digestion ## Function of GIT * Reabsorption of water * Production of Vit K - production of clotting * Putrifaction * Process by which E. coli act n Fecal materials * Flatus * Factors (10,9,7,27 ## 2. Accessory organ of Digestion ## Inflammatory Disorders * Gastritis * Peptic Ulcers Disease * Inflammatory bowel Dosease * Enteritis & Ulcerative Colitis (LLA) * Relieve by vomitting * Crohn's Disease/ Regional * Appendicitis * Diverticulitis * Cholecystitis * Pancreatitis * Pain ## Non-inflammatory * Irritable Bowel Syndrome * Hiatla Hernia * Liver Cirrhosis # Hiatal Hernia * Protrusion of the stomach into the haitus of the diaphragm ## Etiology: * Congenital * Acquired * increase abd pressure * Obese, pregnant, acts like lifting heavy object/ straining ## Types: * Sliding hernia * Rolling hernia ( Paraesopagheal Hernia) * Mixed Type ## Clinical manifestations * Pyrosis (Heart burn) * Most prominent * Lead to GERD * Esophagitis * HCL acid-> irritation & injury to the esophagus * Dysphagia - Difficulty in Swallowing * Odynophagia - painful swallowing ## Diagnostic Test * Esophagostomy (not iodinated) * Barium Swallow * Check for allergy (for seafood general) * Stay upright * Do not lie down after eating * Give antacid after meals ## Management * Prevent reflux * No bedtime snack * Elevate HOB & inches * Avoid Poods * Idrugs * Avoid constrictive clothing * Give antacid after meals * Surgery # Irritable Bowel Syndrome * Functional disorder ## Etiology: * Idiopathic * 2ndary to neural/hormonal defect * Lo appect the GI function ## Risk factors: * Stress * Family History ## IBS * D (Diarrhea) * Mucoid (Characteristic manifestation) * Indigestion * C (Constipation) * Abt pain * A (Alternating diarrhea & constipation) ## Diagnostic Test: * To rule out other conditions * Colonoscopy * CBC * ESR (Erythrocyte Sedimentation Rate) * Ultrasound ## Management: * Palliative (relieve s/s) * Diarrhea * Fluid replacement: oresol * High protein, low residue * Antidiarrheal drugs : Loperamide * Biet severe * Constipation * Inc fluid intake * Biet severe * High fat, high fiber * Laxatives # Liver Cirrhosis * Fibrosis or scarring of the liver * Irreversible & progressive ## Etiology: * Alcohol (Laennec's) * Infection (Hep B/C) * Drugs (Hepatoxic drugs) * Hepatoma (liver cancer) * Past necrotic Cirrhosis * Idiopathic * Biliary cirrhosis ## S/S * Liver dysfunction * Portal hypertension ## Liver function * Bile production * For emulsification of fats * Bilirubin * Ibile * Jaundice * Fat Metabolism * Lipogenesis * Lipolysis * Gluconeogenesis ---> Weight loss, weakness * Carbohydrates Metabolism * Glycogenesis * Glycogenolysis ---> easily fatigability * Protein Metabolism * Produces albumin ( major protein in the bld exerts oncotic pressure) * Dec albumin production -->> dec oncotic pressure