D444 New OA *FINAL BOSS EDITION*

Glaucoma priority

Avoid anything that increases intraocular pressure no bending coughing or straining

Cataracts post op priority

Avoid bending lifting or straining to prevent increased eye pressure

Corneal Abrasions

Scratches on the cornea causing intense pain and photophobia; treated with antibiotic ointment and sometimes patching.

Retinal Detachment

Separation of the retina from the epithelium; characterized by flashing lights, floaters, and a "curtain" over the vision; an ocular emergency.

Meniere's Disease

Inner ear disorder characterized by vertigo, tinnitus, and hearing loss; managed with low-sodium diet and diuretics.

Vertigo

Sensation of spinning or dizziness; nursing priority is safety and fall prevention.

Multiple sclerosis key features

Autoimmune demyelination causing fatigue weakness vision problems and heat sensitivity

Myasthenia gravis key features

Muscle weakness that worsens with activity improves with rest with ptosis and dysphagia

Myasthenia gravis priority

Maintain airway and give pyridostigmine before meals

Parkinson's Disease key features

Resting tremor rigidity slow movement and shuffling gait

Parkinson's priority

Give levodopa on time and prevent falls

Seizure Disorders Priority

Protect airway, turn patient on side, do not restrain

Pulmonary embolism priority

Oxygen first then anticoagulants

Melanoma

Most aggressive skin cancer; identified by the ABCDE rule (Asymmetry, Border, Color, Diameter, Evolving).

Herpes Zoster (Shingles)

Reactivation of varicella-virus; presents as painful vesicles along a dermatome; requires airborne/contact precautions if disseminated.

Hyperkalemia

K > 5.0; causes peaked T-waves and dysrhythmias; treat with Kayexalate, insulin/glucose, or calcium gluconate.

Hypokalemia

K < 3.5; causes U-waves and muscle weakness; treat with oral or IV potassium (never IV push).

Hyponatremia

Na < 135; causes confusion and seizures; treat with fluid restriction or hypertonic saline (3% NaCl).

Hypernatremia

Na > 145; causes extreme thirst and agitation; treat with hypotonic fluids (0.45% NS).

Hypocalcemia

Ca < 8.6; positive Trousseau's (BP cuff) and Chvostek's (facial tap) signs; treat with calcium gluconate.

Thoracentesis

Procedure to remove fluid from the pleural space; nurse monitors for pneumothorax (diminished lung sounds) post-op.

Pulmonary Embolism (PE)

Blockage in pulmonary artery (often from DVT); symptoms include sudden SOB and chest pain; treat with heparin/anticoagulants.

Pneumothorax

Air in pleural space causing lung collapse; treated with a chest tube; observe for tidaling in the water-seal chamber.

Tuberculosis (TB)

Airborne infection; symptoms include night sweats and hemoptysis; treat with RIPE (Rifampin, Isoniazid, Pyrazinamide, Ethambutol).

Asthma

Reversible airway obstruction; treat acute attacks with Albuterol (SABA) and maintenance with inhaled steroids.

Asthma priority

Give albuterol first during acute attack

COPD

Irreversible airflow limitation; symptoms include barrel chest and pursed-lip breathing

GERD

Backflow of gastric acid into the esophagus; treat with PPIs (Omeprazole), small meals, and HOB elevation.

Peptic Ulcer Disease (PUD)

Erosion of GI mucosa; H. pylori is a common cause; treat with antibiotics and PPIs.

Crohn's Disease

IBD affecting any part of the GI tract; "skip lesions" and transmural inflammation; treat with corticosteroids.

Ulcerative Colitis

IBD limited to the colon/rectum; characterized by bloody diarrhea and tenesmus.

Cirrhosis

Scarring of the liver; symptoms include ascites, jaundice, and esophageal varices; monitor for ammonia levels/encephalopathy.

Cholecystitis

Inflammation of the gallbladder; RUQ pain radiating to the right shoulder; treat with cholecystectomy.

Pancreatitis

Autodigestion of the pancreas; severe LUQ pain and elevated amylase/lipase; keep patient NPO.

BPH (Benign Prostatic Hyperplasia)

Enlarged prostate causing urinary retention; treat with Tamsulosin or TURP procedure.

TURP

Surgical treatment for BPH; post-op requires Continuous Bladder Irrigation (CBI) to prevent clots.

Wound Healing (Primary Intention)

Wound edges are approximated (e.g., surgical incision with sutures); heals quickly.

Wound Healing (Secondary Intention)

Wound edges cannot be approximated; heals from "bottom up" with granulation tissue.

Pressure Injury (Stage 1)

Non-blanchable erythema of intact skin.

Pressure Injury (Stage 2)

Partial-thickness skin loss with exposed dermis (e.g., blister or shallow ulcer).

Pressure Injury (Stage 3)

Full-thickness skin loss; subcutaneous fat is visible.

Pressure Injury (Stage 4)

Full-thickness skin loss with exposed muscle, bone, or tendon.

HIV/AIDS

Infection of CD4+ T-cells; Stage 3 then CD4 < 200 or opportunistic infection; treat with ART (Antiretroviral therapy).

Ocular Chemical Burn Priority

Immediate irrigation with Normal Saline or water for at least 15-20 minutes until pH returns to 7.2-7.4

Corneal Abrasion Contraindication

Never prescribe topical anesthetic drops for home use; they mask worsening pain and can cause "corneal melting" (permanent damage).

Corticosteroids in Eye Injuries

Generally contraindicated in initial corneal scratches/infections as they suppress the immune response and can cause fungal overgrowth or "melting"

Beta-Blockers (Timolol)

Decreases aqueous humor production; monitor for systemic effects like bradycardia (apply pressure to the lacrimal duct)

Miotics (Pilocarpine)

Constricts the pupil to allow for better drainage of aqueous humor

Mydriatics

Contraindicated in closed-angle glaucoma because they dilate the pupil and block drainage, dangerously spiking IOP.

Cataract Post-Op Education

Avoid activities that increase Intraocular Pressure (IOP): no bending at the waist, no lifting >10 lbs, no straining for BM (use stool softeners)

Pneumonia Priority Interventions

ABCs first: 1. Oxygen (if sats low), 2. Sputum Culture (ALWAYS before antibiotics), 3. Start Antibiotics, 4. Hydration (thins secretions)

Pneumonia S/S

Fever, chills, productive cough (yellow/green/rust-colored), pleuritic chest pain, and fine/coarse crackles

Emphysema key feature

Air trapping with barrel chest and pursed lip breathing

Emphysema positioning

Tripod position leaning forward to improve breathing

COPD priority

Maintain oxygen at 88 to 92 percent and monitor for CO2 retention

Asthma/COPD: SABA (Albuterol)

Rescue inhaler; causes tachycardia and tremors. Used for acute attacks.

Asthma/COPD: Steroids (Fluticasone/Beclomethasone)

Rinse mouth after use to prevent Oral Candida (Thrush).

Tuberculosis (TB) Precautions

Airborne precautions (N95 mask, negative pressure room).

TB Medications (RIPE)

Rifampin (orange fluids), Isoniazid (take Vit B6 to prevent neuropathy), Pyrazinamide, Ethambutol (monitor vision/red-green color).

Suctioning Technique

Hyperoxygenate before, suction for max 10-15 seconds, and only apply suction while withdrawing the catheter.

Celiac Disease Diet

Strictly Gluten-Free; No "BROW" (Barley, Rye, Oats, Wheat). Safe: Rice, Corn, Potatoes.

Crohn's Disease Management

During flares: Low-fiber, high-protein, high-calorie diet. Monitor for fistula formation and malnutrition.

Esophageal Varices

Caused by Portal Hypertension (Cirrhosis); high risk for life-threatening hemorrhage. Avoid NSAIDs and rough foods.

GERD/Hiatal Hernia Failure

Nissen Fundoplication is the surgical intervention when medications (PPIs) and lifestyle changes fail.

H. Pylori Contraindicated Meds

NSAIDs (Ibuprofen, Naproxen) and Aspirin, as they degrade the gastric lining and worsen ulcers.

Gallstone Complications

Cholecystitis (RUQ pain radiating to right shoulder) and Pancreatitis (if the stone blocks the common bile duct)

Jaundice

Yellowing of skin/sclera due to high Bilirubin; often causes severe pruritus (itching)—keep nails short and use cool baths.

Lactulose

Given to Cirrhosis patients to excrete Ammonia via stool (2-3 soft BMs/day is the goal).

Multiple sclerosis priority

Avoid triggers like heat stress and infection

Multiple sclerosis teaching

Avoid hot baths overheating and stress to prevent flare ups

HIV/AIDS Progression

Diagnosed as AIDS when CD4 count < 200 or an opportunistic infection (like PCP or Kaposi Sarcoma) is present.

Tinea Pedis

Fungal infection; keep feet dry, wear cotton socks, and use antifungal creams (Clotrimazole).

Wound Dressings

Alginates (for heavy drainage), Hydrocolloids (for Stage 2 pressure ulcers/moist healing)

Ketorolac (Toradol)

Potent NSAID; nephrotoxic. Do not use for >5 days or in patients with kidney disease.

Vancomycin

Monitor for "Red Man Syndrome" (infuse slowly) and check Trough levels before the 4th dose.

Oseltamivir (Tamiflu)

Must be started within 48 hours of flu symptom onset to be effective.

Hepatotoxic Drugs

Acetaminophen (Tylenol), Isoniazid, and Methotrexate. Avoid alcohol.

Quick Tips for Acid-Base (ROME)

Respiratory Opposite:

pH ↑ & CO2 ↓ (Alkalosis)

pH ↓ & CO2 ↑ (Acidosis)

Metabolic Equal:

pH ↑ & HCO3 ↑ (Alkalosis)

pH ↓ & HCO3 ↓ (Acidosis).

pH meaning

Low pH = acidosis, high pH = alkalosis

High CO2 indicates

Respiratory acidosis

Low CO2 indicates

Respiratory alkalosis

High HCO3 indicates

Metabolic alkalosis

Low HCO3 indicates

Metabolic acidosis

ABG interpretation order

pH first, then CO2, then HCO3

Respiratory vs metabolic rule

CO2 = lungs, HCO3 = kidneys

Respiratory acidosis cause

Hypoventilation

Respiratory alkalosis cause

Hyperventilation

Metabolic acidosis cause

DKA, kidney failure

Metabolic alkalosis cause

Vomiting, antacids

Hypokalemia ECG

Flattened T waves, U waves, ST depression

Hyperkalemia ECG

Peaked T waves, widened QRS, cardiac emergency

Potassium IV rule

Never give IV push, must dilute and use pump

Hypercalcemia signs

Constipation, kidney stones, bone pain

Hypomagnesemia signs

Hyperactive reflexes, tremors, seizures

Hypermagnesemia signs

Decreased reflexes, bradycardia, respiratory depression

Dumping syndrome cause

Rapid gastric emptying after gastric surgery

Dumping syndrome timing early

15 to 30 minutes after eating

Dumping syndrome timing late

1 to 3 hours after eating

Early dumping syndrome symptoms

Diarrhea, dizziness, tachycardia, abdominal cramping

Late dumping syndrome symptoms

Hypoglycemia, weakness, sweating, confusion