Nursing Theories

NURSING THEORIES

Anne Boykin and Sarvina O.

Schoenhofer

Nursing As Caring Theory

Betty Neuman

Neuman Systems Model and

Global Applications

Sister Callista Roy

The Roy Adaptation Model

Dorothea Orem

Self-Care Deficit Nursing Theory

Dorothy Johnson

Behavioral System Model

Ernestine Wiedenbach

The Helping Art of Clinical Nursing

Faye Glenn Abdellah

Twenty-One Nursing Problems

Florence Nightingale

Environmental Adaptation Theory

Hildegard Peplau

Theory of Interpersonal Relations

Ida Jean Orlando

Theory of the Nursing Process

Discipline

Imogene King

General System’s Framework

Theory of Goal Attainment

Jean Watson

Theory of Human Caring

Joyce Fitzpatrick

Life Perspective Rhythm Model

Joyce Travelbee

Human-To-Human Relationship

Model

Kari Martinsen

Nursing Philosophy

Katharine Kolcaba

Theory of Comfort

Kristen Swanson

Program of Research on Caring

Logan Roper & Tierney

The Elements of Nursing:

A Model for Nursing Based on a

Model of Living

Lydia Hall

Core, Care and Cure Model

Madeleine Leininger

Theory of Culture Care Diversity

and Universality

Transcultural Nursing Model

Margaret Newman

Theory of Health as Expanding

Consciousness

Marilyn Ray

Theory of Bureaucratic Caring

Martha Rogers

The Science of Unitary Human

Beings

Myra Estrin Levine

The Conservation Model

Nola J. Pender

Health Promotion Model

Patricia Benner

Novice to Expert Model

Ramona T. Mercer

Maternal Role Attainment

Rosemarie Parse

Theory of Human Becoming

Tomlin Erickson & Swain

Modeling & Role-Modeling Theory

Virginia Henderson

Definition of Nursing

NON CORROSIVE

Induce vomitting except when

patient has a decreased LOC

Induce vomitting by giving syrup

of ipecac

Gastric Lavage

Give activated charcoal and

laxative

Charcoal = decrease absorption

of poison

Laxative = flush out poison

Aspirin - acid = kussmaul's

respiration

Tylenol - liver damage, monitor

liver enzymes

Rat poison - made of coumadin =

bleeding

Paint chips - contains lead, assess

children living in old houses (paint)

Plumbism - contains lead, assess

old pipelines

Watusi - give 9 pcs of raw egg

whites (as first aid treatment only)

Drugs and their Antidotes 1. Acetaminophen - Acetylcycteine 2. Benzodiazepine - Flumazenil 3. Coumadin - Vitamin K 4. Curare - Tensilon 5. Cyanide poisoning - Methylene Blue 6. Digitalis - Digibind 7. Ethylene poisoning - Antizol 8. Heparin - Protamine Sulfate 9. Iron - Desferal 10. Lead - Edetate Disodium (EDTA), Dimercaprol (BAL), Succimer (CHEMET) 11. Lovenox - Protamin Sulfate 12. Magnesium sulfate - Calcium Gluconate 13. Morphine sulfate - Naloxone Hydrochloride 14. Methotrexate - Leucovorine 15. Mestinon - Atropine Sulfate 16. Neostigmine - Pralidoxime Chloride (PAM) 17. Penicillin - Epinephrine 18. Vincristine (Oncovin) – Hyaluronidase,also apply moderate heat to disperse drug and minimize sloughing. (Oncovin – IV administration only)

POISON ANTIDOTES

ARSENIC -------------------------- DIMERCAPROL, SUCCIMERBARBITURATES (Phenobarbital)------------------------ Urine alkalinization, dialysis, activated charcoalBETA-BLOCKERS--------------------------------------------- GLUCAGONCaffeine, Metaproterenol, Theophylline------------- ESMOLOL CARBON MONOXIDE -------------------------------------- 100% Oxygen, HYPERBARIC O2CHOLINESTERASE INHIBITORS---------------------------- ATROPINECYANIDE-------------------------------------------------------- NITRITE, SODIUM THIOSULFATEETHYLENE GLYCOL --------------------------------------------ETHANOLGOLD ------------------------------------------------------------DIMERCAPROLHEPARIN --------------------------------------------------------PROTAMINE SULFATEIRON SALTS -----------------------------------------------------DEFEROXAMINEISONIAZID------------------------------------------------------- VITAMIN B6

LEAD ----------------------------------------------------------- CaEDTA, Dimecaprol, SuccimerMETHANOL ------------------------------------------------------ Ethanol, Fomepizole, DialysisMETHEMOGLOBIN/CYANIDE POISONING----------------- METHYLENE BLUEMUSCARINIC RECEPTOR BLOCKERS ------------------------ PHYSOSTIGMINEOPIOIDS ---------------------------------------------------------- NALOXONEOrganophosphate Cholinesterase Inhibitors --------- PRALIDOXIMEPHENCYCLIDINE HYDROCHLORIDE (PCP) ------------------ NG SUCTIONQUINIDINE, TCA’s ----------------------------------------------- SODIUM BICARBONATESALICYLATES -------------------------------------------------

----- Urine Alkalinization,Dialysis, Activated CharcoalSNAKE BITES ------------------------------------------------------ ANTIVENINTissue Plasmogen Activator (tPA), Streptokinase------ Aminocaproic AcidWarfarin ---------------------------------------------------Vitamin K, FFP

01. PTB – low-grade afternoon

fever.

02. PNEUMONIA – rusty sputum.

03. ASTHMA – wheezing on

expiration.

04. EMPHYSEMA – barrel chest.

05. KAWASAKI SYNDROME –

strawberry tongue.

06. PERNICIOUS ANEMIA – red

beefy tongue.

07. DOWN SYNDROME – protruding

tongue.

08. CHOLERA – rice watery stool.

09. MALARIA – stepladder like

fever with chills.

10. TYPHOID – rose spots in

abdomen.

11. DIPTHERIA – pseudo

membrane formation

12. MEASLES – koplik’s spots.

13. SLE – butterfly rashes.

14. LIVER CIRRHOSIS – spider

like varices.

15. LEPROSY – lioning face.

16. BULIMIA – chipmunk face.

17. APPENDICITIS – rebound

tenderness.

18. DENGUE – petechiae or (+)

Herman’s sign.

19. MENINGITIS – Kernig’s sign (leg

flex then leg pain on

extension), Brudzinski sign (neck

flex = lower leg flex).

20. TETANY – hypocalcemia (+)

Trousseau’s

sign/carpopedal spasm; Chvostek

sign (facial spasm).

21. TETANUS – risus sardonicus.

22. PANCREATITIS – Cullen’s sign

(ecchymosis of umbilicus); (+)

Grey turners spots.

23. PYLORIC STENOSIS – olive like

mass.

24. PDA – machine like murmur.

25. ADDISON’S DISEASE – bronze

like skin pigmentation.

26. CUSHING’S SYNDROME – moon

face appearance and buffalo

hump.

27. HYPERTHYROIDISM/GRAVE’S

DISEASE – exopthalmus.

28. INTUSSUSCEPTION – sausage

shaped mass, Dance Sign (empty

portion of RLQ)

29. MS – Charcot’s Triad (IAN)

30. MG – descending muscle

weakness

31. Guillain Barre Syndrome –

ascending muscle weakness

32. DVT – Homan’s Sign

33. CHICKEN POX – Vesicular Rash

(central to distal) dew drop on rose

petal

34. ANGINA – Crushing stubbing

pain relieved by NTG

35. MI – Crushing stubbing pain

which radiates to left shoulder,

neck, arms, unrelieved byNTG

36. LTB – inspiratory stridor

37. TEF – 4Cs’ Coughing,

Choking, Cyanosis, Continous Droo

ling

38. EPIGLOTITIS – 3Ds’

Drooling, Dysphonia, Dysphagia

39. HODGEKIN’S DSE/LYMPHOMA –

painless, progressive enlargement

of spleen & lymph

tissues, Reedstenberg Cells

40. INFECTIOUS MONONUCLEOSIS

– Hallmark: sore throat, cervical

lymph adenopathy, fever

41. PARKINSON’S – Pill-rolling

tremors

42. FIBRIN HYALIN – Expiratory

Grunt

43. CYSTIC FIBROSIS – Salty skin

44. DM – polyuria, polydypsia, poly

phagia

45. DKA – Kussmauls breathing

(Deep Rapid RR)

46. BLADDER CA –

painless hematuria

47. BPH – reduced size & force of

urine

48. PEMPHIGUS VULGARIS – Nikols

ky’s sign (separation of epidermis

caused by rubbing of the skin)

49. RETINAL DETACHMENT – Visual

Floaters, flashes of light, curtain

vision

50. GLAUCOMA – Painfull vision

loss, tunnel/gun barrel/halo vision

(Peripheral Vision Loss)

51. CATARACT – Painless vision

loss, Opacity of the lens, blurring

of vision

52. RETINO BLASTOMA – Cat’s eye

reflex (grayish discoloration of

pupils)

53. ACROMEGALY – Coarse facial

feature

54. DUCHENNE’S MUSCULAR

DYSTROPHY – Gowers’ sign (use of

hands to push one’s self from the

floor)

55. GERD – Barretts esophagus

(erosion of the lower portion of the

esophageal mucosa)

56. HEPATIC ENCEPHALOPATHY –

Flapping tremors

57. HYDROCEPHALUS – Bossing

sign (prominent forehead)

58.

INCREASE ICP – HYPERtension BRA

DYpnea BRADYcardia (Cushing’s

Triad)

59. SHOCK

– HYPOtension TACHYpnea TACHYc

ardia

60. MENIERE’S DSE – Vertigo,

Tinnitus

61. CYSTITIS – burning on urination

62. HYPOCALCEMIA – Chvostek & T

rosseaus sign

63. ULCERATIVE COLITIS –

recurrent bloody diarrhea

64. LYME’S DSE – Bull’s eye rash

MNEMONICS FOR NLEby Yoleen Pulido on Wednesday, May 18, 2011 at 4:36pm

HYPERNATREMIA

FRIED SALT

F - Fever (low), flushed skin

R - Restless (irritable)

I - Increased fluid retention &

increased BP

E - Edema (peripheral and pitting)

D - Decreased urinary output, dry

mouth

SALT

S - Skin flushed

A - Agitation

L - Low-grade fever

T - Thirst

HYPERKALEMIA - Signs &

Symptoms

MURDER

M - Muscle weakness

U - Urine, oliguria, anuria

R - Respiratory distress

D - Decreased cardiac

contractility

E - ECG changes

R - Reflexes, hyperreflexia, or

areflexia (flaccid)

HYPERKALEMIA - Causes

MACHINE

M - Medications - ACE inhibitors,

NSAIDS

A - Acidosis - Metabolic and

respiratory

C - Cellular destruction - Burns,

traumatic injury

H - Hypoaldosteronism/ hemolysis

I - Intake - Excessive

N - Nephrons, renal failure

E - Excretion - Impaired

HYPOCALCEMIA

CATS

C - Convulsions

A - Arrhythmias

T - Tetany

S - Spasms and stridor

BLEEDING - S/Sx

BEEP

B - Bleeding gums

E - Ecchymoses (bruises)

E - Epistaxis (nosebleed)

P - Petechiae (tiny purplish spots)

RESPIRATORY DEPRESSION -

inducing drugs

STOP breathing

S - Sedatives and hypnotics

T - Trimethoprim

O - Opiates

P - Polymyxins

PNEUMOTHORAX - S/Sx

P-THORAX

P - Pleuretic pain

T - Trachea deviation

H - Hyperresonance

O - Onset sudden

R - Reduced breath sounds (&

dypsnea)

A - Absent fremitus

X - X-ray shows collapse

PNEUMONIA - risk factors

INSPIRATION

I - Immunosuppression

N - Neoplasia

S - Secretion retention

P - Pulmonary oedema

I - Impaired alveolar macrophages

R - RTI (prior)

A - Antibiotics & cytotoxics

T - Tracheal instrumentation

I - IV dug abuse

O - Other (general debility,

immobility)

N - Neurologic impairment of

cough reflex, (eg NMJ disorders)

CROUP - S/Sx

SSS

S - Stridor

S - Subglottic swelling

S - Seal-bark cough

SHORTNESS OF BREATH -

Causes

AAAA PPPP

A - Airway obstruction

A - Angina

A - Anxiety

A - Asthma

P - Pneumonia

P - Pneumothorax

P - Pulmonary Edema

P - Pulmonary Embolus

CARDIAC VALVES

"TRI before you BI":

Tricuspid valve is located in left

heart and Bicuspid valve is located

in right heart. Blood flows through

the tricuspid before bicuspid.

FEMORAL HERNIA

FEMoral hernias are more common

in FEMales.

"TRY PULLING MY AORTA":

Tricuspid

http://www.facebook.com/yoleen.pulido

Pulmonary

Mitral

Aorta

PLACENTA-CROSSING

SUBSTANCES

"Want My Hot Dog":

Wastes

Antibodies

Nutrients

Teratogens

Microorganisms

Hormones/ HIV

Drugs

EMERGENCY MEDICINE

ACTIVATED CHARCOAL:

CONTRAINDICATIONS

CHEMICAL CamP:

Cyanide

Hydrocarbons

Ethanol

Metals

Iron

Caustics

Airway unprotected

Lithium

CAMphor

Potassium

IPECAC: CONTRAINDICATIONS

4 C's:

Comatose

Convulsing

Corrosive

hydroCarbon

ATRIAL FIBRILLATION: CAUSES

OF NEW ONSET

THE ATRIAL FIBS:

Thyroid

Hypothermia

Embolism (P.E.)

Alcohol

Trauma (cardiac contusion)

Recent surgery (post CABG)

Ischemia

Atrial enlargement

Lone or idiopathic

Fever, anemia, high-output states

Infarct

Bad valves (mitral stenosis)

Stimulants (cocaine, theo, amphet,

caffeine)

ENDOTRACHEAL TUBE

DELIVERABLE DRUGS

O NAVEL:

Oxygen

Naloxone

Atropine

Ventolin (albuterol)

Epinephrine

Lidocaine

MALARIA: COMPLICATIONS OF

FALCIPARUM MALARIA

CHAPLIN:

Cerebral malaria/ Coma

Hypoglycemia

Anaemia

Pulmonary edema

Lactic acidosis

Infections

Necrois of renal tubules (ATN)

MI: IMMEDIATE TREATMENT

DOGASH:

Diamorphine

Oxygen

GTN spray

Asprin 300mg

Streptokinase

Heparin

PAIN HISTORY CHECKLIST

OLDER SAAB:

Onset

Location

Description (what does it feel like)

Exacerbating factors

Radiation

Severity

Associated symptoms

Alleviating factors

Before (ever experience this

before)

SHOCK: SIGNS AND SYMPTOMS

TV SPARC CUBE:

Thirst

Vomiting

Sweating

Pulse weak

Anxious

Respirations shallow/rapid

Cool

Cyanotic

Unconscious

BP low

Eyes blank

SUBARACHNOID HEMORRHAGE

(SAH) CAUSES

BATS:

Berry aneurysm

Arteriovenous malformation/ Adult

polycystic kidney disease

Trauma (eg being struck with

baseball bat)

Stroke

VENTRICULAR FIBRILLATION:

TREATMENT

"Shock, Shock, Shock,

Everybody Shock, Little Shock,

Big Shock, Momma Shock,

Poppa Shock":

Shock= Defibrillate

Everybody= Epinephine

Little= Lidocaine

Big= Bretylium

Momma= MgSO4

Poppa= Pocainamide

VFIB/VTACH DRUGS USED

ACCORDING TO ACLS

"Every Little Boy Must Pray":

Epinephrine

Lidocaine

Bretylium

Magsulfate

Procainamide

DIABETIC KETOACIDOSIS

MANAGEMENT

KING UFC:

K+ (potassium)

Insulin (5u/hour. Note: sliding scale

no longer recommended in the UK)

Nasogastic tube (if patient

comatose)

Glucose (once serum levels drop

to 12)

Urea (check it)

Fluids (crytalloids)

Creatinine (check it)/ Catheterize

NEUROLOGICAL FOCAL

DEFICITS

10 S's:

Sugar (hypo, hyper)

Stroke

Seizure (Todd's paralysis)

Subdural hematoma

Subarachnoid hemorrhage

Space occupying lesion (tumor,

avm, aneurysm, abscess)

Spinal cord syndromes

Somatoform (conversion reaction)

Sclerosis (MS)

Some migraines

COMA: CONDITIONS TO

EXCLUDE AS CAUSE

MIDAS:

Meningitis

Intoxication

Diabetes

Air (respiratory failure)

Subdural/ Subarachnoid

hemorrhage

MALIGNANT HYPERTHERMIA

TREATMENT

"Some Hot Dude Better Give

Iced Fluids Fast!" (Hot dude =

hypothermia):

Stop triggering agents

Hyperventilate/ Hundred percent

oxygen

Dantrolene (2.5mg/kg)

Bicarbonate

Glucose and insulin

IV Fluids and cooling blanket

Fluid output monitoring/

Furosemide/ Fast heart

[tachycardia]

RESUSCITATION: BASIC STEPS

ABCDE:

Airway

Breathing

Circulation

Drugs

Environment

RLQ PAIN: DIFFERENTIAL

APPENDICITIS:

Appendicitis/ Abscess

PID/ Period

Pancreatitis

Ectopic/ Endometriosis

Neoplasia

Diverticulitis

Intussusception

Crohns Disease/ Cyst (ovarian)

IBD

Torsion (ovary)

Irritable Bowel Syndrome

Stones

Acid-base—"ROME"

(Respiratory Opposite,

Metabolic Equal)

Acidosis

» Respiratory (opposite): pH Pco2

» Metabolic(equal): pH HCO3

Alkalosis

» Respiratory (opposite): pH Pco2

» Metabolic(equal): pH HCO3

Alcohol withdrawal: clinical

features—"HITS"

Hallucinations (visual, tactile)

Increased vital signs and insomnia

Tremens delirium tremens

(potentially lethal)

Shakes/ Sweats/ Seizures/

Stomach pains (nausea, vomiting)

Angina: precipitating factors

—"4E's"

Eating

Emotion

Exertion (Exercise)

Extreme Temperatures (Hot or

Cold weather)

Anorexia nervosa: clinical

features—"ANOREXIC"

Adolescent women/ Amenorrhea

NGT alimentation (most severe

cases)

Obsession with losing weight/

becoming fat though underweight

Refusal to eat (5% die)

Electrolyte abnormalities (e.g., K+,

cardiac arrhythmia)

X - ercise

Intelligence often above average/

Induced vomiting

Cathartic use (and diuretic abuse)

Appendicitis: assessment

—"PAINS"

Pain (RLQ)

Anorexia

Increased temperature, WBC

(15,000–20,000)

Nausea

Signs (McBurney's, Psoas)

Neurovascular Occlusion:

symptoms— "6 P's"

Pain

Pale

Pulseless

Paresthesia

Poikilothermic

Paralysis

Blood glucose (rhyme)

Symptom Implication

Cold and clammy . . . give hard

candy

Hot and dry . . . glucose is high

Blood vessels in umbilical cord

—"AVA" (2 arteries and 1 vein)

Artery

Vein

Artery

Cholecystitis: risk factors

—"5F's"

Female

Fat

Forty

Fertile

Fair

Cleft lip: nursing care plan

(postoperative)—"CLEFT LIP"

Crying, minimize

Logan bow

Elbow restraints

Feed with Brecht feeder

Teach feeding techniques; two

months of age (average age at

repair)

Liquid (sterile water), rinse after

feeding

Impaired feeding (no sucking)

Position—never on abdomen

Cognitive disorders:

assessment of difficulties

—"JOCAM"

Judgment

Orientation

Confabulation

Affect

Memory

Coma: causes—"A-E-I-O-U

TIPS"

Alcohol, acidosis (hyperglycemic

coma)

Epilepsy (also electrolyte

abnormality, endocrine problem)

Insulin (hypoglycemic shock)

Overdose (or poisoning)

Uremia and other renal problems

Trauma; temperature

abnormalities (hypothermia, heat

stroke)

Infection (e.g., meningitis)

Psychogenic ("hysterical coma")

Stroke or space-occupying lesions

in the cranium

Complication of severe

preeclampsia—"HELLP"

syndrome

Hemolysis

Elevated Liver enzymes

Low Platelet count

Cushing's syndrome:

symptoms—"3S's"

Sugar (hyperglycemia)

Salt (hypernatremia)

Sex (excess androgens)

Diabetes: signs and symptoms

—"3P's,"

Polydipsia (very thirsty)

Polyphagia (very hungry)

Polyuria (urinary frequency)

Diet: low cholesterol—avoid

the "3C's"

Cake

Cookies

Cream (dairy, e.g., milk, ice

cream)

Dystocia: etiology—"3P's"

Power

Passageway

Passenger

Dystocia: general aspects

(maternal)—"3P's"

Psych

Placenta

Position

Episiotomy assessment

—"REEDA"

Redness

Edema

Ecchymosis

Discharge

Approximation of skin

Eye medications

Mydriatic = dilated pupils

Miotic = tiny (constricted) pupils

Hypertension: complications

—"4 C's"

CAD (coronary artery disease)

CHF (congestive heart failure)

CRF (chronic renal failure)

CVA (cardiovascular accident; now

called brain attack or stroke)

Hypertension: nursing care

plan— "I-TIRED"

Intake and output (urine)

Take blood pressure

Ischemia attack, transient (watch

for TIAs)

Respiration, pulse

Electrolytes

Daily weight

Hypoglycemia: signs and

symptoms—"DIRE"

Diaphoresis

Increased pulse

Restless

Extra hungry

Infections during pregnancy

—"TORCH"

Toxoplasmosis

Other (hepatitis B, syphilis, group

B beta strep)

Rubella

Cytomegalovirus

Herpes simplex virus

IUD: potential problems with

use—"PAINS"

Period (menstrual: late, spotting,

bleeding)

Abdominal pain, dyspareunia

Infection (abnormal vaginal

discharge)

Not feeling well, fever or chills

String missing

Manipulation: nursing plan—

promote the "3C's"

Cooperation

Compromise

Collaboration

Medication administration

—"six rights"

RIGHT medication

RIGHT dosage

RIGHT route

RIGHT time

RIGHT client

RIGHT technique

Melanoma characteristics

—"ABCD"

Asymmetry

Border

Color

Diameter

Mental retardation: nursing

care plan—"3R's"

Regularity (provide routine and

structure)

Reward (positive reinforcement)

Redundancy (repeat)

Myocardial infarction:

treatment—"MONA"

Monitor/ Morphine

Oxygen

Nitroglycerin

Aspirin

Newborn assessment

components—"APGAR"

Appearance

Pulse

Grimace

Activity

Respiratory effort

Obstetric (maternity) history

—"GTPAL"

Gravida

Term

Preterm

Abortions (SAB, TAB)

Living children

Oral contraceptives: signs of

potential problems—"ACHES"

Abdominal pain (possible liver or

gallbladder problem)

Chest pain or shortness of breath

(possible pulmonary embolus)

Headache (possible hypertension,

brain attack)

Eye problems (possible

hypertension or vascular accident)

Severe leg pain (possible

thromboembolic process)

Pain: assessment—"PQRST"

What Provokes the pain?

What is the Quality of the pain?

Does the pain Radiate?

What is the Severity of the pain?

What is the Timing of the pain?

Pain: management—"ABCs"

Ask about the pain

Believe when clients say they have

pain

Choices—let clients know their

choices

Deliver what you can, when you

said you would

Empower/Enable clients' control

over pain

Postoperative complications:

order—"4W's"

Wind (pulmonary)

Wound

Water (urinary tract infection)

Walk (thrombophlebitis)

Preterm infant: anticipated

problems—"TRIES"

Temperature regulation (poor)

Resistance to infections (poor)

Immature liver

Elimination problems (necrotizing

enterocolitis [NEC])

Sensory-perceptual functions

(retinopathy of prematurity [ROP])

Psychotropic medications:

common antidepressives

(tricyclics)—"VENT"

Vivactil

Elavil

Norpramin

Tofranil

Schizophrenia: primary

symptoms—"4A's"

Affect

Ambivalence

Associative looseness

Autism

Sprain: nursing care plan

—"RICE"

Rest

Ice

Compression

Elevation

Stool assessment—"ACCT"

Amount

Color

Consistency

Timing

Tracheoesophageal fistula:

assessment—"3Cs"

Coughing

Choking

Cyanosis

Traction: nursing care plan

—"TRACTION"

Trapeze bar overhead to raise and

lower upper body

Requires free-hanging weights;

body alignment

Analgesia for pain, prn

Circulation (check color and pulse)

Temperature (check extremity)

Infection prevention

Output (monitor)

Nutrition (alteration related to

immobility)

Transient ischemic attacks:

assessment—"3Ts"

Temporary unilateral visual

impairment

Transient paralysis (one-sided)

Tinnitus = vertigo

Trauma care: complications

—"TRAUMA"

Thromboembolism; Tissue

perfusion, altered

Respiration, altered

Anxiety related to pain and

prognosis

Urinary elimination, altered

Mobility impaired

Alterations in sensory-perceptual

functions and skin integrity

(infections)

Wernicke-Korsakoff syndrome

(alcohol-associated

neurological disorder)—"COAT

RACK"

Wernicke's

encephalopathy (acute

phase) clinical features:

Confusion

Ophthalmoplegia

Ataxia

Thiamine is an important aspect of

Tx

Korsakoff's psychosis (chronic

phase)

characteristic findings:

Retrograde amnesia (recall of

some old memories)

Anterograde amnesia (ability to

form new memories)

Confabulation

Korsakoff's psychosis

SIGNS OF CANCER

Change in bowel /bladder habits

A sore that doesn’t heal

Unusual bleeding/ Discharge

Thickening of lump – breast or

elsewhere

Indigestion/ Dysphagia

Obvious change in wart/ mole

Nagging cough/ hoarseness

Unexplained anemia

Sudden weight loss

FOCUS OF PATIENT CARE IN

CLIENTS WITH CANCER

Chemotherapy

Assess body image disturbance

(related to alopecia)

Nutritional needs when N/V

present

Comfort from pain

Effective response to Tx?

(Evaluate)

Rest (for patient and family)

Basic MI management -

"BOOMAR"

Bed rest

Oxygen

Opiate

Monitoring

Anticoagulation

Reduce clot size

To Remember

Immunoglobulins - "GAMED"

IgG

IgA

IgM

IgE

IgD

Location of the heart valve

from right to left - "A

Permanently Temperamental

Man"

Aortic

Pulmonary

Tricuspid

Mitral

"Cut C4, breathe no more"

The 3rd, 4th and 5th cervical

spinal nerves innervate the

diaphragm.

Types of Joint movements -

"FEEDPIPE CARDSHARP" Flexion

Extension

Eversion

Dorsiflexion

Pronation

Inversion

Plantarflexion

Elevation

Circumduction

Abduction

Rotation

Depression

Supination

Hyperextension

Adduction

Retraction

Protraction

Cranial Nerves - "Oh Ohh Ohhh

To Try And Fit A Gold Velvet So

Heavenly"

Olfactory CN I

Optic CN II

Occulomotor CN III

Trochlear CN IV

Trigeminal CN V

Abducens CN VI

Facial CN VII

Auditory CN VIII

Glasopharyngeal CN IX

Vagus CN X

Spinal/Accessory CN XI

Hypoglossal CN XII

"Point and Shoot!"

For remembering that

Parasympathetics are involved

with erection

and Sympathetics with

ejaculation.

Layers of the scalp - "SCALP"

Skin

Connective tissue

Aponeurosis

Loose areolar tissue

Pericranium

Carpal bones of the hand

(lateral to medial) - "She Looks

Too Proud, Try To Chase Her"

Proximal row:

Scaphoid

Lunate

Triquetrum

Pisiform

Distal row:

Trapezium

Trapezoid

Capitate

Hamate

Viruses causing diarrhea -

"ACNE CAR"

Adeno virus

Corana virus

Norwak virus

Entero virus

Calci virus

Astro virus

Rota virus

The Krebs cycle - "Can I

Actually See Some Filipina

Mothers"

Citrate

Isocitrate

alpha Ketoglutarate

Succinyl CoA

Succinate

Fumarate

Malate

Oxaloacetate

Stages of mitosis/meiosis

including interphase as a

phase - "In Philippines, Men

Are Talented"

Interphase

Prophase

Metaphase

Anaphase

Telophase

Order of prevalence of White

Blood Cells, most prevalent to

least - "Never Let Monkeys Eat

Bananas"

Neutrophils

Lymphocytes

Monocytes

Eosinophils

Basophils

10 essential amino acids -

"PVT. TIM HALL"

Phenylalanine

Valine

Tryptophan

Threonine

Isoleucine

Metheonine

Histidine(semi-essential)

Arginine(semi-essential)

Leucine

Lysine

Uses of Chloroquine (other

than malaria) - "RED LIP"

Rheumatoid arthritis

Extra intestinal amoebiasis

Discoid lupus erythematosus

Lepra reaction

Infectious mononucleosis

Photogenic reactions

Bronchodilators - "TO A SIS"

Terbutaline

Orciprenaline

Adrenaline

Salbutamol

Isoprenaline

Salmeterol

Signs of cor pulmonale -

"Please Read His Text"

Peripheral edema

Raised JVP

Hepatomegaly

Tricuspid incompetence

Portal hypertension features -

"ABCDE"

Ascites

Bleeding (hematemesis, piles)

Caput medusae

Diminished liver

Enlarged spleen

Key questions needed in an

emergency history taking

situation - "AMPLE"

Allergies

Medication

Past medical history

Last meal

Events and environment related to

injury

Malignancies that metastisize

to bone - "Laging Panalo Kung

Taga Bulacan"

Lung

Prostat

Kidney

Thyroid

Breast

Six "S" in Scarlet Fever

Streptococci causal organism

Sorethroat

Swollen tonsils

Strawberry tongue

Sandpaper rash

miliarySudamina vesicles over

hands, feet, abdomen

Signs of anti-cholinergic crisis

- "SLUD"

Salivation

Lacrimation

Urination

Defecation

Causes of huge spleen - "3M's"

Myelofibrosis

Malaria

Myelogenous leukemia

Cardinal Symptoms of

Parkinson's Disease - "TRAP"

Tremor

Rigidity

Akinesia and bradykinesia

Postural Instability

Days of appearance of

rashesVaricella(chickenpox) -

"Very Sick Patients Must Take

Double Exercise"

1st dayScarlet fever

2nd dayPox(smallpox)

3rd dayMumps

4th dayTyphus

5th dayDengue

6th dayEnteric fever(typhoid)

SHOCK – HYPOTACHYTACHY

HYPOTENSION

TACHYPNEA

TACHYCARDIA

INCREASE ICP –

HYPERBRADYBRADY

CUSHINGS TRIAD:

HYPERTENSION (WIDE PULSE

PRESSURE)

BRADYCARDIA

BRADYPNEA

HYPOGLYCEMIA

TREMORS, TACHYCARDIA

IRRITABILITY

RESTLESSNESS

EXTREME

DIAPHORESIS

EARLY SIGNS OF HYPOXIA

RESTLESSNESS

AGITATION

TACHYCARDIA

LATE SIGNS OF HYPOXIA

BRADYCARDIA

EXTREME RESTLESSNESS

DYSPNEA

CYANOSIS

CONGESTIVE HEART FAILURE

DIGOXIN

MORPHINE

AMINOPHYLLINE

DOPAMINE

DIURETICS

O2

GASSES – MONITOR (ABG)

MG SO4 TOXICITY

BP DECREASE

URINE OUTPUT DECREASE

RESPIRATORY RATE DECREASE

PATELLAR REFLEX ABSENT

SICKLE CELL DISEASE

HYDRATION

OXYGENATION

PAIN

INFECTION

AVOID HIGH PLACES

PREGNANCY INDUCED

HYPERTENSION

HEMOLYSIS

ELEVATED LIVER ENZYMES

LOW

PLATELETS

GI SYMPTOMS AND TOXICITY

TO DIGOXIN

VOMITTING

ANOREXIA

NAUSEA

DIARRHEA

ABDOMINAL PAIN

FRACTURE

PRESSURE

REST

ICE

COMPRESSION

ELEVATION

TETRALOGY OF FALLOT

DISPLACED AORTA

RIGHT VENTRICULAR

HYPERTROPHY

OPENING INTO THE SEPTUM (VSD)

PULMONARY STENOSIS

HYPOKALEMIA

SKELETAL MUSCLE WEAKNESS

U-WAVE ON ECG

CONSTIPATION

TOXICITY TO DIGOXIN

IRREGULAR WEAK PULSE

OTOSTASIS

NUMBNESS PARESTHESIA

PAIN ASSESSMENT

PROVOCATION

QUALITY

RADIATION, RELIEF

SEVERITY

TIME

NEUROVASCULAR CHECK

PAIN

PULSELESSNESS

PARESTHESIA

PARALYSIS

PALLOR

VIRCHOW’S TRIAD IN DVT

VENUS STASIS

DAMAGE TO VESSELS

HYPERCOAGUABILITY

ABDOMINAL AORTIC ANEURISM

(4A)

ASSYMPTOMATIC

ABDOMINAL MASS

ABDOMINAL PULSE

ACHES LOW BACK

ANTI TB DRUGS AND SIDE

EFFECTS

RIFAMPICIN – RED-ORANGE URINE

ISONIAZID – PERIPHERAL NEURITIS

PYRAZINAMIDE – INCREASE URIC

ACID

ETHAMBUTOL – EYE PROBLEMS

STREPTOMYCIN – OTOTOXIC

USE STRAW BECAUSE THESE

DRUGS STAIN THE TEETH

L - LUGOL'S SOLUTION

I - IRON

N - NITROFURANTOIN

T – TETRACYCLINE

LR6 - LATERAL RECTUS : CN6

SO4 - SUPERIOR OBLIQUE : CN4

ALL3 - ALL THE REST : CN3

RADIATION TX VIA:

MUSTARD

ESTROGEN

NITROGEN

STEROIDS

ANTIBIOTICS

DILUTE DECREASE OSMOLALITY

HEMATOLOGY – Red Blood

Cells

RBC (Male) 4.2 – 5.6 10^6 / µL

[Scientific Notation: 10^6 =

1,000,000]

RBC (Female) 3.8 – 5.1 10^6 / µL

RBC (Child) 3.5 – 5.0 10^6 / µL

HEMATOLOGY – White Blood

Cells

WBC (Male) 3.8 – 11.0 10^3 /

mm3 [Scientific Notation: 10^3 =

1,000]

WBC (Female) 3.8 – 11.0 10^3 /

mm3

WBC (Child) 5.0 – 10.0 10^3 /

mm3

HEMOGLOBIN

Hgb (Male) 14 – 18 g/dL

Hgb (Female) 11 – 16 g/dL

Hgb (Child) 10 – 14 g/dL

Hgb (Newborn) 15 – 25 g/dL

HEMATOCRIT

Hct (Male) 39 – 54%

Hct (Female) 34 – 47%

Hct (Child) 30 – 42%

MCV 78 – 98 fL

MCH 27 – 35 pg

MCHC 31 – 37%

neutrophils 50 – 81%

bands 1 – 5%

lymphocytes 14 – 44%

monocytes 2 – 6%

eosinophils 1 – 5%

basophils 0 – 1%

CARDIAC MARKERS

troponin I 0 – 0.1 ng/ml (onset: 4-

6 hrs, peak:

12-24 hrs, return to normal: 4-7

days)

troponin T 0 – 0.2 ng/ml (onset:

3-4 hrs, peak:


days)

myoglobin (Male) 10 – 95 ng/ml

(onset: 1-3 hrs, peak:


hrs)

myoglobin (Female) 10 – 65

ng/ml (onset: 1-3 hrs, peak:


hrs)

GENERAL CHEMISTRY

acetone 0.3 – 2.0 mg%

albumin 3.5 – 5.0 gm/dL

alkaline phosphatase 32 – 110

U/L

anion gap 5 – 16 mEq/L

ammonia 11 – 35 µmol/L

amylase 50 – 150 U/dL

AST,SGOT (Male) 7 – 21 U/L

AST,SGOT (Female) 6 – 18 U/L

bilirubin, direct 0.0 – 0.4 mg/dL

bilirubin, indirect total minus

direct

bilirubin, total 0.2 – 1.4 mg/dL

BUN 6 – 23 mg/dL

calcium (total) 8 – 11 mg/dL

carbon dioxide 21 – 34 mEq/L

carbon monoxide symptoms at

greater than or equal to 10%

saturation

chloride 96 – 112 mEq/L

creatine (Male) 0.2 – 0.6 mg/dL

creatine (Female) 0.6 – 1.0

mg/dL

creatinine 0.6 – 1.5 mg/dL

ethanol 0 mg%; Coma:

greater than or equal to 400 –

500 mg%

folic acid 2.0 – 21 ng/mL

glucose 65 – 99 mg/dL

(diuresis greater than or equal to

180 mg/dL)

HDL (Male) 25 – 65 mg/dL

HDL (Female) 38 – 94 mg/dL

iron 52 – 169 µg/dL

iron binding capacity 246 – 455

µg/dL

lactic acid 0.4 – 2.3 mEq/L

lactate 0.3 – 2.3 mEq/L

lipase 10 – 140 U/L

magnesium 1.5 – 2.5 mg/dL

osmolarity 276 – 295 mOsm/kg

parathyroid hormone 12 – 68

pg/mL

phosphorus 2.2 – 4.8 mg/dL

potassium 3.5 – 5.5 mEq/L

SGPT 8 – 32 U/L

sodium 135 – 148 mEq/L

T3 0.8 – 1.1 µg/dL

thyroglobulin less than 55 ng/mL

thyroxine (T4) (total) 5 – 13 µg/dL

total protein 5 – 9 gm/dL

TSH Less than 9 µU/mL

urea nitrogen 8 – 25 mg/dL

uric acid (Male) 3.5 – 7.7 mg/dL

uric acid (Female) 2.5 – 6.6

mg/dL

LIPID PANEL (Adult)

cholesterol (total) Less than 200

mg/dL desirable

cholesterol (HDL) 30 – 75 mg/dL

cholesterol (LDL) Less than 130

mg/dL desirable

triglycerides (Male) Greater than

40 – 170 mg/dL

triglycerides (Female) Greater

than 35 – 135 mg/dL

URINE

color Straw

specific gravity 1.003 – 1.040

pH 4.6 – 8.0

Na 10 – 40 mEq/L

K Less than 8 mEq/L

C1 Less than 8 mEq/L

protein 1 – 15 mg/dL

osmolality 80 – 1300 mOsm/L

24 HOUR URINE

amylase 250 – 1100 IU / 24 hr

calcium 100 – 250 mg / 24 hr

chloride 110 – 250 mEq / 24 hr

creatinine 1 – 2 g / 24 hr

creatine clearance (Male) 100 –

140 mL / min

creatine clearance (Male) 16 – 26

mg / kg / 24 hr

creatine clearance (Female) 80 –

130 mL / min

creatine clearance (Female) 10 –

20 mg / kg / 24 hr

magnesium 6 – 9 mEq / 24 hr

osmolality 450 – 900 mOsm / kg

phosphorus 0.9 – 1.3 g / 24 hr

potassium 35 – 85 mEq / 24 hr

protein 0 – 150 mg / 24 hr

sodium 30 – 280 mEq / 24 hr

urea nitrogen 10 – 22 gm / 24 hr

uric acid 240 – 755 mg / 24 hr

COAGULATION

ACT 90 – 130 seconds

APTT 21 – 35 seconds

platelets 140,000 – 450,000 /ml

plasminogen 62 – 130%

PT 10 – 14 seconds

PTT 32 – 45 seconds

FSP Less than 10 µg/dL

fibrinogen 160 – 450 mg/dL

bleeding time 3 – 7 minutes

thrombin time 11 – 15 seconds

CEREBRAL SPINAL FLUID

appearance clear

glucose 40 – 85 mg/dL

osmolality 290 – 298 mOsm/L

pressure 70 – 180 mm/H2O

protein 15 – 45 mg/dL

total cell count 0 – 5 cells

WBCs 0 – 6 / µL

HEMODYNAMIC PARAMETERS

cardiac index 2.5 – 4.2 L / min /

m2

cardiac output 4 – 8 LPM

left ventricular stroke work index

40 – 70 g / m2 / beat

right ventricular stroke work index

7 – 12 g / m2 / beat

mean arterial pressure 70 – 105

mm Hg

pulmonary vascular resistance

155 – 255 dynes / sec / cm to the

negative 5

pulmonary vascular resistance

index 255 – 285 dynes / sec / cm

to the negative 5

stroke volume 60 – 100 mL / beat

stroke volume index 40 – 85 mL /

m2 / beat

systemic vascular resistance 900

– 1600 dynes / sec / cm to the

negative 5

systemic vascular resistance

index 1970 – 2390 dynes / sec /

cm to the negative 5

systolic arterial pressure 90 – 140

mm Hg

diastolic arterial pressure 60 – 90

mm Hg

central venous pressure 2 – 6

mm Hg; 2.5 – 12 cm H2O

ejection fraction 60 – 75%

left arterial pressure 4 – 12 mm

Hg

right atrial pressure 4 – 6 mm Hg

pulmonary artery systolic 15 – 30

mm Hg

pulmonary artery diastolic 5 – 15

mm Hg

pulmonary artery pressure 10 –

20 mm Hg

pulmonary artery wedge pressure

4 – 12 mm Hg

pulmonary artery end diastolic

pressure 8 – 10 mm Hg

right ventricular end diastolic

pressure 0 – 8 mm Hg

NEUROLOGICAL VALUES

cerebral perfusion pressure 70 –

90 mm Hg

intracranial pressure 5 – 15 mm

Hg or 5 – 10 cm H2O

ARTERIAL VALUES

pH 7.35 – 7.45

PaCO2 35 – 45 mm Hg

HCO3 22 – 26 mEq/L

O2 saturation 96 – 100%

PaO2 85 – 100 mm Hg

BE -2 to +2 mmol/L

VENOUS VALUES

pH 7.31 – 7.41

PaCO2 41 – 51 mm Hg

HCO3 22 – 29 mEq/L

O2 saturation 60 – 85%

PaO2 30 – 40 mm Hg

BE 0 to +4 mmol/L

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