COMFORT:
Exemplar: OSTEOARTHRITIS: CHRONIC PAIN
Caused by cartilage breakdown →bone-on-bone friction
RISK FACTORS:
Age, obesity, females, joint injury, occupation (repetitive stress), smoking
Signs and symptoms : Joint pain (more with activity, relief with rest), stiffness(morning), swelling, crepitus(cracking sound), bone spurs, ↓ & flexibility
Management: Pain control with medications, weight loss, PT/OT, Assistive devices, Low impact exercise, joint replacement surgery
COMPLICATIONS:
Chronic disability, limited mobility, sleep disturbance, ↓ quality of life, depression, anxiety, & social isolation.
Exemplar: DDD (degenerative Disk Disease): Neuropathic Pain
disk degeneration → loss of cushioning→ nerve root compression→ neuropathic pain
RISK FACTORS:
Aging, heavy lifting, obesity, smoking, genetics
Signs and symptoms
Burning/shooting leg pain, numbness/tingling, weakness, limited mobility, Chronic low back pain
MANAGEMENT:
NSAIDs, muscle relaxants, neuropathic meds (gabapentin/Pregabalin), steroid injections, PT/OT, Discectomy, Spinal fusion.
Exemplar: Total Joint Arthroplasty (TJA): Acute Procedural Pain
OBJECTIVE | KEY POINTS |
NURSING PROCESS | ASSESSMENT: Pain scale, incision, perfusion. Planning: Pain <3/10. Interventions: Administer analgesics on schedule, PCA management, ice, elevation, & early ambulation. |
PCA CARE PUMP | Two-nurse verification, monitor resp. rate, pulse ox, PATIENT-CONTROLLED ONLY, document vs. deliveries |
INDEPENDENT | Distraction, positioning, deep breathing, topical numbing agents,& emotional support. |
COLLABORATIVE | Premedicate, sedation if ordered, local anesthesia |
COMFORT PHARMACOLOGY
MEDICATION | USE | SE & AE | NURSING CONSIDERATION & PATIENT TEACHING |
NSAIDs (non-opioid analgesics) | Inflammation, mild/moderate pain | GI upset, n/v GI bleed, renal damage | PT: Take with food, report black stools (GI bleed), no alcohol & other NSAIDs. Don't take in the 3rd trimester. NC: Monitor renal labs (BUN/Cr), no anticoagulants. Low dose & GI bleed assess. |
Opioids (opioid analgesics) | Moderate/severe pain | Constipation, sedation Resp depression | PT: Avoid drinking/driving, ↑ stool softeners. NC: Hold if RR<12.Fall precautions, Naloxone (half-life) |
Naloxone (opioid antagonist) | Reverse opioid OD | Agitation, N/V, ↑ BP Arrhythmias, acute withdrawal | PT: EMERGENCY ONLY, may need repeat dosing. NC: Monitor VS q15 min; reassess LOC & pain after use |
Gabapentin/Pregabalin (adjuvant | Neuropathic pain | Drowsy, dizzy, edema Suicidal thoughts, angioedema | PT: Don't stop abruptly. NC: Assess mood changes; taper gradually; monitor edema/weight; fall risks |
MOBILITY:
Exemplar: HIP FRACTURE & TOTAL HIP ARTHROPLASTY
Often due to falls + osteoporosis
Complications: Hemorrhage, DVT/PE, fat embolism, infection, & Avascular necrosis. Prophylaxis: Early mobilization, anticoagulants (enoxaparin/Warfarin), antibiotics
THA Complications & Prevention
Complications: bleeding, infection, dislocation, VTE (DVT/PE), & Prosthesis loosening. Prevention: Hip precautions( correct positioning), DVT prophylaxis (anticoagulants, SCDs), early PT day 1
THA positioning
Hip precautions: NO crossing legs/ankles. No Hip flexion> 90 degrees(avoiding bending at the waist. Maintain abduction (legs apart)
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Risk factors: Non-modifiable: postmenopause ( ↓estrogen), aging, female, white/asian. Modifiable: low Ca/ Vit D, smoking, alcohol, chronic steroid use
ASYMPTOMATIC until fracture, height loss, kyphosis
Management:
Risk Factors: Non-modifiable: Age > 50, genetics, female Modifiable: Obesity, Smoking, repetitive stress, joint injury.
Pain (worse↑activity, better ↑ rest), Stiffness(worse in AM), Crepitus,↓ ROM
Pain Management: Weight loss, low-impact exercises, PT/OT, NSAIDs, APAP
MOBILITY PHARMACOLOGY
MEDICATION | USE | SE & AE | NURSING CONSIDERATION & PATIENT TEACHING |
Heparin (anticoagulant) | prevention/treatment of thromboembolic disorders | Bruising at injection site, Bleeding, HIIT | PT: Report bleeding/bruising; avoid NSAIDs. NC: Monitor aPTT, platelet count. Antidote: Protamine sulfate. ↑ Bleeding in elderly |
Warafarin PO(anticoagulant) | DVT prevention LMWH | GI Upset/ Bleeding | PT: Report bleeding, no rubbing site. NC: Monitor INR. Avoid high Vit k foods. Dose adjustment in elderly Antidote= Vit k |
Enoxaparin (anticoagulant) | DVT prevention/treatment | Injection site reaction, Bleeding, Thrombocytopenia | PT: Don't rub after injection; report bleeding. NC: DO not expel air bubble. Monitor CBC. Adjust dose in renal impairment |
Apixaban (anticoagulant) | DVT, PE prevention in post-arthoplasty | Bleeding, Bruising | PT: Take as prescribed, dont stop abruptly. NC: No routine lad monitor. Educate on bleeding risk. Use caution in elderly |
Alendronate (Bisphosphonate) | Osteoporosis treatment & prevention | GI upset, Esophageal irritation, osteonecrosis of the jaw (Rare) | PT: Take with a full glass of water. Sit upright for 30 minutes after dose. Used in postmenopausal women |
ELIMINATION:
Exemplar: BENIGN PROSTATE HYPERPLASIA (BPH)
PATHO Enlarged prostate obstructs urethra → urinary changes
RISK FACTORS : Aging (older adults), men
Signs and symptoms ↑ Frequency (q1-2h), urgency, weak stream, hesitancy, straining, incomplete emptying, retention (emergency obstruction)
Medications: Tamulosin, Finasteride
Interventions: Bladder training, encourage sitting to void, Post-op TURP: Catheter care. Hematuria/spasms up to 1-3 weeks post-surgery are normal. Call provider for clots, inability to void, fever, flank pain.
COMPLICATIONS: UTI, Pyelonephritis, acute/chronic kidney injury
MEDICATIONS: Tamulosin: Relaxes smooth muscles; fast relief. Finasteride: Shrinks prostate; +6 months
Exemplar: DIARRHEA/BOWEL INCONTINENCE
RISK FACTORS
Infections, medications (antibiotics), tube feeding, IBD, IBS
S/S
>3 loose stools/day, urgency, incontinence, cramps, borborygmi (growling), tenesmus (painful sensation)
MANAGEMENT: Medical: Address underlying cause, rehydrate, & antidiarrheal meds. Nursing: Rest, hydration, electrolyte replacement, skin care. Avoid caffeine, carbonated, very hot/cold foods
COMPLICATIONS: Dehydration, electrolyte imbalance (dysrhythmias), Dermatitis (skin breakdown)
MEDICATIONS: Psyllium(Bulk-forming): Safe for long-term use. Diphenoxylate/atropine(opioid agonist): Slows peristalsis. Loperamide: Slows intestinal motility. Aluminum hydroxide(antacid): csn cause constipation
Exemplar: URINARY INCONTINENCE
PATHO: Weakness of sphinters/Pelvic floor, retention, neurogenic causes
RISK FACTORS: Age-related changes (muscle weakness/sphincter ↓). Gender (Women ↑ risk).Pregnancy & childbirth (pelvic floor changes).Neurological impairment, dementia.
Signs and symptoms: Incontinence. Signs of retention, dysuria, urgency, frequency, nocturia, oliguria, anuria, polyuria
NURSING PROCESS: Interventions: Bladder training/Scheduled toileting. Pelvic floor exercises. Reduce fluids/diuretics in the PM. Habit Training (Scheduled toileting, timed voiding.)
COMPLICATIONS: Skin breakdown, infection, ↓ self-esteem
Exemplar: COLISTIDIUM DIFFICILE (C. DIFF)
PREVENTION: STRICT H&WASHING (soap & water, no alcohol gels). Hygiene, hydration, nutrition
PATHO: Overgrowth after antibiotic use→ toxin release→ colitis
RISK FACTORS: Recent antibiotic use
Sign and symptoms: Watery diarrhea, resistant to usual treatment, Positive stool culture
MANAGEMENT: Oral vancomycin, Metronidazole (Flagyl), fecal transplant
NURSING PROCESS: Monitor renal function, assess stool. Teaching: Complete full course of Vanco/Metro. Metronidazole: AVOID ALCOHOL during & 48 hrs later
COMPLICATIONS: Dehydration, colitis, sepsis
Exemplar: CONSTIPATION/IMPACTION
PATHO: Slowed transit, dehydration, low fiber, inactivity, medications (opioids, anticholinergics)
RISK FACTORS (AGE-RELATED): ↑ Risk in older adults due to ↓ peristalsis, weakened muscles, & polypharmacy effects
Signs and symptoms: < 3 BMs/week, distention, bloating, straining, hard/dry stool
MANAGEMENT
NONPARM: ↑ Fluids, fiber, activity. Fruits/vegetables.
Medical: Enemas (tap water, saline, mineral oil), disimpaction, laxatives
NURSING PROCESS
Teaching: Respond promptly to urge. Encourage ↑ fluids/fiber/exercise. Avoid chronic laxative use
COMPLICATIONS: Impaction, hemorrhoids, fissures, rectal prolapse.
ELIMINATION PHARMACOLOGY
MEDICATION | USE | SE & AE | NURSING CONSIDERATION & PATIENT TEACHING |
Diphenoxylate & Atropine (antidiarrheal) | Treats diarrhea | Drowsiness, dry mouth, toxic megacolon, resp. Depression in high doses | Avoid in infectious diarrhea. Monitor hydration. Do not exceed 20mg/day |
Bisacodyl, Sennosides (simulant laxative) | Treats constipation | Cramping, diarrhea, electrolyte imbalance, & dependence | Use short-term only. Avoid milk/antacids (Bisacodyl), add fiber to diet |
Docusate Sodium (stool softener) | Prevents straining during defecation | Mild GI cramping, diarrhea (rare) | Best for prevention, not severe constipation. ↑ fluid intake |
Polyethylene Glycol 3350 (osmotic laxative) | Constipation, bowel prep | Diarrhea, bloating, nausea, electrolyte imbalance | Ensure adequate hydration. It may take 2-4 days for the effect. Safe for long-term use |
Psyllium (bulk-forming laxative) | Constipation promotes regularity | Bloating gas, GI obstruction (if not enough water) | Take with a full glass of water (8oz). ↑ Fluids/fiber. Safe long-term |
Aluminum Hydroxide (antacid) | Neutralizes stomach acid | Constipation, Hypophospatemia | Monitor phosphate & Ca levels. Separate from other meds by 2 hrs. |
Tamulosin (Alpha-Adrenergic Antagonist) | BPH, urinary retention Relaxes smooth muscle | Dizziness, headaches, & nasal congestion.Hypotension syncope | Monitor BP. Teach the patient to rise slowly |
Finasteride (alpha inhibitor) | BPH, male baldness Shrinks prostate | ↓ libido, gynecomastia (man boobs), Sexual dysfunction | Pregnant women should not handle crushed tablets. Takes 6+ months for effect |
Oxybutynin (antispasmodic) | Overactive bladder, urge incontinence | Dry mouth, constipation, blurred vision, Urinary retention, heat stroke | Encourage fluids. Monitor urine output. Caution with the elderly (↑ confusion) |
Metronidazole (antibiotic, CDIFF) | Treats c diff. Anaerobic infections | Metallic taste, dark urine, GI upset, seizures, neuropathy | Avoid alcohol (during + 48 hrs after). Monitor neurological status |
Vancomycin PO (C diff) | Treats c diff. & MRSA | Hypotension, rash, nephrotoxicity, ototoxicity, red man syndrome | Monitor trough levels (IV/systemic use). PO used for c.diff, Report ↓ urination. |
FUNCTIONAL ABILITY:
Exemplar: ALZHEIMER’S DISEASE (AD)
Progressive, neurodegenerative disorder.
RISK FACTORS : Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease.
S/S
Anomia (inability to recall names), Apraxia (inability to perform purposeful movements), Agnosia (inability to recognize objects), Aphasia (language impairment), Amnesia
STAGES & SIGNS
Stage 1: Memory lapses, aphasia, sundowning (confusion, agitation in evening hours). Stage 2: Cannot perform IADLs. Stage 3: Cannot perform basic ADLs, personality changes, dysphagia
NURSING PROCESS
Safety interventions (critical): address FALL RISK. Remove rugs/clutter, use grab bars, & secure outside exits to prevent wandering. Communication: Use clear, short sentences. Use yes or no questions. DO NOT present reality when hallucinating/delusional. Redirect when agitated.
Exemplar: DOWN SYNDROME
PATHO: Trisomy 21 (extra chromosome). Leads to developmental delays & systemic complications.
Signs and symptoms: Intellectual disability, Hypotonia (decreased muscle tone), flat social profile, upward slant eyes, single palmar crease alopecia. Cardiac murmur
MANAGEMENT : Early interventions: PT/OT/ speech therapy. Regular screenings for cardiac, vision, hearing, thyroid, & sleep apnea.
COMPLICATIONS: Atlantoaxial instability (C1 & C2 joint risk). Congenital heart defects. ↑ risk for Alzheimer’s
HEALTH PROMOTION: Genetic counseling. Adherence to screening & early intervention programs
Exemplar: PARKINSON’S DISEASE (PD)
PATHO: Progressive loss of dopamine in the substantial nigra. Creates LOW DOPAMINE, HIGH ACETYLCHOLINE imbalance
MANAGEMENT: Medication: Carbidopa-levodopa (dopamine replacement. Surgical: Thalamotomy ( ↓ Tremor), Pallidotomy (↓rigidity/dyskinesias), Deep brain stimulation (DBS)
NURSING PROCESS: Safety: Suction drool at bedside (airways risk), ↑ fluids/fiber for constipation risk, Dysphagia: Puree diet, thickening agents, monitor swallowing. Encourage stretching & ROM exercises.
COMPLICATIONS: Falls, aspiration pneumonia (due to dysphagia/drooling), severe depression/dementia
SAFETY:Address orthostatic hypotension. Use proper shoes & assistive devices.
Exemplar: CARDIOVASCULAR ACCIDENT (CVA)
OBJECTIVES | Ischemic Stroke | Hemorrhagic Stroke |
PATHO | Clot (thrombosis/embolism) blocks blood flow →Ischemia | Blood vessel rupture → bleeding into brain→↑ ICP |
RISK FACTORS | Hypertension, diabetes, atherosclerosis, smoking, high LDLs | Hypertension, auerysm, anticoagulant therapy. |
S/S | F.A.S.T(face, arm, speech, time). Gradual or sudden onset | Severe headache, early & sudden ↓ LOC, vomiting, bleeding |
ACUTE MANAGEMENT | Thrombolytics (“-ase”) within 4.5 hours. Endovascular therapy (clot retrieval in cath lab) | NO anticoagulants, NO blood thinners, NO clot busters. Elevate HOB to 30 degrees. Surgical evacuation |
KEY TERMS | Agnosia (inability to recognize objects), Apraxia (inability to perform purposeful movements | Dysarthria(slurred speech).Hemiparesis (weakness) / Hemiplegia (paralysis).Hemianopsia (loss of ½ vision) |
L VS. R BRAIN | Left brain (language & logic): Dysphasia, reading/writing problems, RIGHT hemiparesis, aware of defects (→ anxiety, depression) | Right brain (“reckless”): lack of impulse control, behavioral changes, LEFT hemiparesis, poor space perception. |
COMPLICATIONS | ↑ ICP, Dysphagia.↓LOC, seizures (requires seizure precautions), depression. Rehab goal: Restore mobility. Use a transfer belt (strongest aide first) | Increased ICP , Seizures , Hydrocephalus , Hyponatremia , & Rebleeding. |
FUNCTIONAL ABILITY PHARMACOLOGY
MEDICATION | USE | SE & AE | NURSING CONSIDERATION & PATIENT TEACHING |
Carbidopa-levodopa (Dopamine replacement) | First line for parkinson’s motor symptoms | n/v, OT, Dyskinesias (toxicity), Hallucinations | NO HIGH PROTEIN MEALS, report uncontrolled movements, do stop suddenly |
Selegiline (antiparkinsonian) | Adjunct to levodopa in Parkinson’s | Insomnia, dry mouth, nausea, Hypertensive crisis with tyramine foods | Avoid tyramine-rich foods (such as aged cheese & wine). Monitor for serotonin syndrome |
Benztropine (antiparkinsonian) | Parkinson’s tremor/rigidity | Dry mouth, blurred vision, urinary retention, confusion, & hallucinations in elderly | Monitor bowel/bladder function. ↑ Fluids/fiber. Avoid overheating. |
Aspirin (antiplatelet) | Prevention/treatment of ischemic stroke, TIA | GI upset, heartburn, nausea, GI bleeding, hemorrhagic stroke, tinnitus (toxicity) | Take with food. Report unusual bleeding. Avoid in children/adolescents |
Clopidogrel (antiplatelet) | Prevention of stroke, MI | Rash, diarrhea, abdominal pain, GI bleed, hemorrhage, thrombocytopenia | Stop 5-7 days before surgery. Monitor CBC/platelets. Report bleeding |
Alteplase tPA (thrombolytic) | Acute ischemic stroke, MI, massive PE | Mild bleeding at IV site, fever, hypotension, IC hemorrhage, systemic bleeding | Given 3-4.5 hours of stroke onset. NO IM injections. Frequent neuro checks |
Donepezil (Anti-Alzheimer’s) | Slows progression of mild to severe Alzheimer’s (Not curative) | Nausea, diarrhea, insomnia, fatigue, Bradycardia, syncope, GI bleed | Take at bedtime. Monitor HR. Contraindicated in COPD/Asthma |
SENSORY PERCEPTION:
Exemplar: CATARACTS
PATHO
Clouding of the lens due to clumping of lens proteins
RISK FACTORS & PREVENTION: Risk factors: aging, DM, chronic steroid use, sun exposure, smoking. Prevention: wear UV-preventive sunglasses, manage DM, and avoid smoking
Signs and symptoms:Blurred or dim vision. Glare and halos around lights. Poor night vision, faded color perception.
TEACHING POINTS : AVOID bending, lifting, or straining (prevents ↑IOP). Report severe pain, vision loss, or flashes of light. Use eye drops correctly (punctual occlusion)
COMPLICATIONS: Infection, retinal detachment (floaters, cobweb vision, flashes of light), ↑ IOP, falls
Exemplar: GLAUCOMA
PATHO: ↑Intraocular pressure (IOP) from impaired aqueous humor drainage → optic nerve damage → Irreversible vision loss
RISK FACTORS : Aging, heredity, African American race, DM, Infection, and steroid use.
Signs and symptoms: Open-angle (most common): Gradual peripheral vision loss (→ tunnel vision), ↑IOP. Closed-angle(emergency): Sudden, severe pain, blurred vision, headaches, N/V, ↑ IOP
NURSING PROCESS | Post-op/Interventions: Avoid anything that ↑ IOP(coughing, sneezing, straining/valsava). No bending at the waist, no heavy lifting. NO anticholinergics (atropine, Benadryl) |
COMPLICATIONS | Progressive, irreversible blindness. Optic nerve atrophy. |
MEDiCATIONS | Beta-blockers (Timolol): ↓ aqueous humor. Prostaglandin analogs (laranoprost): ↑ Outflow. Carbonic anhydrase inhibitors (Dorzolamide): ↓ Production (avoid in sulfa allergy). Cholinergics (pilocarpine): ↑ outflow via pupil constriction. |
TEACHING POINTS | Use punctual occlusion. Wait 5 minutes between different drops. Dont stop abruptly |
Exemplar: PERIPHERAL NEUROPATHY
OBJECTIVES | DESCRIPTION |
PATHO | Damage to peripheral nerves (sensory/motor/autonomic) → disrupts normal transmission. Results in loss of sensation, pain, or weakness in “Stocking-glove” pattern. Common cause: Chronic hyperglycemia (diabetes). |
RISK FACTORS | Chronic diseases (DM, kidney disease). Alcohol use, poor nutrition ( B defiency). Chemotherapy |
S/S | Numbness or tingling (“pins and needles”). Burning or sharp pain. Loss of sensation, unsteady gait. Autonomic: Orthostatic Hypotension, ↓ sweating. |
MANAGEMENT | Primary: Control underlying cause (especially blood glucose in DM). Meds: Anticonvulsants (Gapapentin), Antidepressents, topical agents (capsaicin, lidocaine path) |
COMPLICATION | Foot ulcers, infections, aputations. Burns or injuries due to lack of sensation. Falls |
INTERVENTIONS | Non-pharm: Teach daily foot care and proper footwear. Inspect bathwater temperature. Remove tripping hazards |
SENSORY PERCEPTION PHARMACOLOGY
MEDICATION | USE | SE & AE | NURSING CONSIDERATION & PATIENT TEACHING |
TImolol (beta blocker) | Open-angle glaucoma | Stinging, blurred vision, Bradycardia, hypotension, bronchospasm | Use Punctual occlusion. Monitor HR and BP. Report SOB |
Dorzolamide (Carbonic anhydrase inhibitor) | Open-angle glaucoma | Burning, stinging, bitter taste, Allergic conjunctivitis | Avoid in sulf allergy. Use punctual occlusion |
Pilocarpine (Cholinergic) | Open-angle/ close-angle glaucoma | Blurred vision, brow pain, retinal detachment (rare) | Expect temporary blurred vision. Avoid driving at night |
Brolucizumab (VEGF inhibitor) | Wet (exudative) MD | Eye pain, floaters, redness, retinal detachment, endophthalmitis | Report pain, vision changes immediately. Administered intravitreal |
Capsaicin (Topical analgesic) | Peripheral neuropathy, osteoarthritis | Burning, stinging, erythema, severe irritation (rare) | Apply consistently for full effect. Use gloves. Burning is common. |
Lidocaine Patch (Topical anesthetic) | Peripheral neuropathy, localized pain relief | Local redness, irritation, systemic toxicity | 12 hrs on, 12 hrs off. Avoid heat over patch. Apple only to intact skin. |
*NUTRITION
Diagnostics: ↓Albumin (long-term protein status), ↓ Prealbumin (short term protein status), Hgb/Hct, BUN/Creatinine, UA (hydration/protein loss).
Micro vs. macronutrients: Macro: Protein, carbs, lipids, water, fiber. Purpose: energy, gorwith, tissue building. Micro: vitamins and minerals. Purpose: metabolism, hormones, nervous system function.
Bmi parameters: Underweight: <18.5. Normal: 18.5-24.9 Overweight: 25-29.9. Obese: equal or > 30
Health promotion: Emphasize whole grains, fruits, & vegetables, adequate protein. Limit simple sugars & processed foods. Control portion sizes
Exemplar: OBESITY
OBJECTIVES | DESCRIPTION |
PATHO | Hypertrophic (↑ size) vs. hypercellular (↑ number) adipose cells. Adipose tissue is involved in hormonal regulation and inflammation |
RISK FACTORS | Age, Cultural/family diet patterns, food accessibility, genetics |
ACCOMADATIONS | Appropriate bed/wheelchair size. Nonjudgmental care. Screening for eating disorders |
MANAGEMENT | Dietican/social referral. Bariatric surgery (last resort). Statins if high cholesterol . |
NURSING PROCESS | Reduce calories by 500/day. Increase physical activity. |
COMPLICATIONS | High cholesterol and co-existing conditions. Respiratory issues (sleep apnea). Psychological impacts and bias in healthcare |
PATIENT TEACHING | Focus on lifestyle modifications (diet + exercise). Limit simple sugars. |
Exemplar: IRON DEFICIENCY ANEMIA
OBJECTIVES | DESCRIPTION |
PATHO | Not enough iron for RBC production. Causes : inadequate intake, chronic bleeding, malabsorption |
RISK FACTORS | Low red-meat/beans/greens intake. Lack of iron-fortified foods, |
S/S | Fatigue, pallor, tachycardia, dyspnea, Brittle nails, glottis (tongue inflammation), stomatitis (mouth and lip infammagtion), PICA |
DIANOSTICS | ↓Hgb/Hct. ↓Ferritin and Transferrin. RBC indices abnormal. Occult blood in stool. |
MANAGEMENT | Iron supplement awith vitamin C . DIetician reffereal. O2/blood if needed |
DIET RECS | ↑ red meats, beans, leafy greens |
COMPLICATIONS | ↑ fatigue, ↓physical performnce, possible developmental delays in children. |
Exemplar: DYSPHAGIA
OBJECTIVES | DESCRIPTION |
PATHO | Impaired swallowing. Caused by neurologic dysfunction ( stroke, parkinsons), Aging, cancer, dental issues |
RISK FACTORS | Stroke, Parkinson’s, tumor |
S/S | Coughing after swallowing , slow eating, food residue in mouth (pocketing). Gurgling, hoarse voice. |
DIAGNOSTICS | Swallow study (videofluoroscopy) → evaluates aspiration risk. Chest XR →infiltrates (for aspiration pneumonia) |
NURSING PROCESS | HOB in High-fowler’s, fully awake to feed. Small bites, allow rest. Use thickened liquids (nectar/honey). NPO until swallow screening |
COMPLICATIONS | Aspiration pneumonia, choking, malnutrition |
NUTRITION PHARMACOLOGY
MEDICATION | USE | SE & AE | NURSING CONSIDERATION & PATIENT TEACHING |
Atorvastin (Statin) | OBESITY Lowers cholesterol, | Muscle aches, GI upset, Rhabdomylosis(muscle breakdown), hepatotoxicity | Monitor LFTs (AST/ALT); assess muscle pain. Avoid grapefruit. Report dark urine |
Pantoprazole (Proton pump inhibitor ) | Malnutrition, GERD, ulcers | Headache, diarrhea, C. diff, osteoporosis (long-term). | Give 30 minutes before meals. Monitor magnesium. Report black/tarry stools. |
Famotidine (H2 antagonist) | Malnutrition, GERD, ulcers | Heacahce, constipation, confusion in elderly | Take 30 minutes before meals, monitor renal function. Avoid smoking, alcohol, NSAIDs. |
Cyanocobalamin (B12) | B 12 deficiency, pernicious anemia | Headache, GI upset, Hypokalemia (rare) | Monitor b12 levels. |
Ferrous SUlfate (iron supplement) | Iron deficiency anemia | COnstipation, black stools, iron toxicity. | Balck sttols is normal , administer with Vit C for absorption. ↑ fluids/fiber. Toxic to children. |
Ascorbic Acid(Vit C) | Aids iron absorption | GI upset, kidney stones (high doses) | Encourage dietary sources(citric, berry, fruits) . Take with iron. |
Exemplar: IMPETIGO (BACTERIAL)
OBJECTIVES | DESCRIPTION |
PATHO | Bacterial infection (strep/staph). Enters though break in skin. Highly contagious |
S/S | Honey colored crusts . Itchy blisters, oozing lesions. |
NURSING/TEACHING | Interventions: Topical antibiotics, hygiene. Teaching: handwashing, no sharing towels. Can return to school after starting antibiotics for 24 hours. Shorten fingernails |
Exemplar: PSORAISIS (AUTOIMMUNE)
OBJECTIVES | DESCRIPTION |
PATHO AND RISK | Autoimmune, chronic. Epidermal hyperplasia. Triggered by stress, trauma, infection. |
S/S | Silvery plaques (elevated). Itchy, scales, red lesions. Joint pain |
NURSING/TEACHING | Treatments: moisturizers, UV therapy (sun limits skin cell division), immunosuppressants. Teaching: Avoid skin trauma, manage stress, moisturize. |
Exemplar: TRUAMATIC AND SURGICAL WOUNDS
OBJECTIVES | DESCRIPTION |
HEALING INTENTIONS | Primary: Sutured/approximated edges. Secondary: Open, heals by granulation. Tertiary: delayed closure (infection) |
DEHISCENCE VS. EVISCERATION | Dehiscence: Surgical wound reopens. Evisceration: Internal organs protrude |
NURSING INTERVENTIONS | Dehiscence prevention: Splint abdominal wounds (“ support your incision every time you cough or move”) Avoid valsava. Eviceration care: Cover with saline soaked gauze |
Exemplar: TINEA PEDIS (FUNGAL)
OBJECTIVES | DESCRIPTION |
PATHO & RISK FACTORS | Fungal infection(athlete’s foot). Grows in warm moist areas. Contagious |
S/S | Scaling, redness, maceration between toes. Vesicles possible. Pruritus |
NURSING/TEACHING | Interventions: Apply antifungals. Teaching: keep feet clean and dry |
Exemplar: CANDIDIASIS (FUNGAL)
OBJECTIVES | DESCRIPTION |
PATHO & RISK FACTORS | Fungal Infection (Candida). Common in moist skin fold and mouth. ↑ in immunocompromised |
S/S | Thrush: White plaques that DO NOT wipe off. Skin: Red rash with defined borders, itching. |
NURSING/TEACHING | Interventions: Nystatin (topical or oral). Keep areas dry. Oral care: swish & swallow Nystatin, no eating/drinking for 30 min |
Exemplar: PEDICULOSIS CAPITIS (LICE)
OBJECTIVES | DESCRIPTION |
PATHO & RISK FACTORS | Lice infestation. Spread via contact (hats, brushes, bedding). |
S/S | Nits on hair shafts. Itching behind ears and neck. |
NURSING/TEACHING | Interventions: Permethrin treatment. Remove nits with a comb. Repeat in 7 days if needed. Teaching: wash bedding and clothing in HOT water. Do not share personal items. |
TISSUE INTEGRITY PHARMACOLOGY
MEDICATION | USE | SE & AE | NURSING CONSIDERATION & PATIENT TEACHING |
Ketoconazole (topical Antifungal) | Tinea Pedis, cutaneous candidiasis | Burning,stinging,itching, allergic contact dermatitis | Apply to clean,dry skin. Continue for full duration. |
Nystatin (Topical antifungal) | Oral thrush, candidiasis | Mild burning, dryness, severe rash | For oral thrush: Swish & swallow, no eating/drinking 30 mins after. Keep areas clean & dry. |
Acyclovir (topical antiviral ) | Herpes simplex 1 -cold sores | Burning, stinging, local irritation. | Use gloves for application. Use at first sign of tingling. DOes not prevent future outbreaks. |
Permethrin | Head lice | Itching, burning, Local inflammation. | Leave on for 10 mins, rinse, comb out nits. Repeat in 7 days. Treat entire household |
THERMOREGULATION:
Attributes: Stable core temp (36.5-37.5 C OR 97.7-99.5 F)
Exemplar: HYPOTHERMIA/FROSTBITE
OBJECTIVES | DESCRIPTION |
PATHO & RISK | Core temp < 35 degrees C. Heat loss> Heat production. Risk factors: Aging (systemic) |
S/S | Apathy, confusion drowsiness →coma, ↓HR, ↓BP,→ arrhythmias. Frostbite (local): white, cold, waxy skin, redness |
INTERVENTIONS | Independent: Remove wet clothing, warm blankets, ↑ oral fluids. Collaborative: warm IV fluids, forced -air warming blankets. Frostbite: rapid rewarming (warm bath water ) DO NOT RUB. |
Exemplar: NEONATAL HYPOTHERMIA
OBJECTIVES | DESCRIPTION |
DEVELOPMENT & DANGER | Thin skin, large surface area →lose heat quickly. Rely on brown fat and non-shivering thermogenesis. Danger: ↑ oxygen consumption, acidosis, hypoglycemia. |
PREVENTION STAGES | Skin-to-skin contact, immediately dry infant. Place under radiant warmer, hat on head |
Exemplar: HYPERTHERMIA/HEAT STROKE, ELDERLY
OBJECTIVES | DESCRIPTION |
Heat exhaustion vs. heat stroke | Exhaustion: sweating, thirst, dizziness. Stroke(emergency): Temp>105 F.(40.55 C) Hot dry skin, NO SWEATING, Neuro changes (confusion, seizure) |
RIsk factors: elderly | ↓sub fat,↓sweat gland function, ↓BMR |
Interventions | Independent: Cool environment/clothing,hydration encouragement. Collaborative: cool IV fluids, cooling blankets, ice packs |
Prevention | Adequate hydration, AC, limit sun/heat. |
Exemplar: PEDIATRIC FEVER
OBJECTIVES | DESCRIPTION |
PATHO & S/S | Immune response to infection (hypothalamus rests temp). Higher temps in PM. Signs: ↑HR, tachypnea, shivering, irritability |
INTERVENTIONS | Non-pharm: ↑ fluids =, light clothing, cool bath/cloth. Pharm: acetaminophen or NSAIDs. Call provide if : rash, oliguria , trouble breathing |
Exemplar: MALIGNANT HYPERTHERMIA
OBJECTIVES | DESCRIPTION |
PATHO & RISK | Genetic, life-threatening reaction to anesthesia. Uncontrolled calcium release in muscles → hypermetabolic state. Risk: family history, bulky muscles. |
S/S | Early: Hypercapnia (↑CO2 ), tachycardia, muscle rigidity, acidosis. Late: fever, myoglobinuria (muscle protein in urine), organ failure |
INTERVENTIONS | Immediately administer Dantrolene IV. Stop trigger agents, Continue supportive cooling and electrolyte correction. Monitor LFTs |
THERMOREGULATION PHARMACOLOGY
MEDICATION | USE | SE & AE | NURSING CONSIDERATION & PATIENT TEACHING |
Dantrolene (Muscle relaxant) | Malignant hyperthermia (emergency ) | Drowsiness, weakness, Hepatotoxicity (major risk). Resp Depression | Ensure immediate IV administration. Monitor liver enzymes (AST/ALT). Avoid CNS depressants. |
NSAIDs (non-opioid analgesics) | Fever | GI upset, n/v GI bleed, renal damage | PT: Take with food, report black stools (GI bleed), no alcohol & other NSAIDs.. NC: Monitor renal labs (BUN/Cr), |
Acetaminophen (antipyretic) | Fever, mild moderate pain | GI upset, Hepatotoxicity | MAX DOSE 4g/day . Monitor liver enzymes |
SLEEP
OBJECTIVES | DESCRIPTION |
Types and risks | Types: REM, NREM, or combined deprivation. Risk factors: long hospitalizations, chronic illness, stress, age. |
s/s | Excessive daytime sleepiness, fatigue. ↓attention & concentration, irritability, slowed responses. |
interventions | Cluster care to ↓ interruptions. Reduce noise and light. Adjust timing of medications. Promote comfort. |
Patient teaching | Exercise regularly. Maintain a consistent sleep schedule. Avoid naps, late meals/drinks, caffeine/alcohol. Optimize bedroom temp/lighting. |
complications | Confusion,psychosis, seizures. Postoperative delirium. |
Exemplar: INSOMNIA
OBJECTIVES | DESCRIPTION |
Types & consequences | Types: difficulty falling asleep, early morning awakening. Consequences: Daytime sleepiness, poor concentration, ↓accident risk |
Non-pharm interventions | Sleep hygiene CBT-1 (behavioral therapy). Relaxation techniques. Limit screens before bed. Cool, quiet dark room |
Pharm interventions | Hypnotics (Zolpidem). Antidepressants (trazodone). |
Exemplar: SLEEP APNEA
OBJECTIVES | DESCRIPTION |
Tyoes & definitions | Obstructive (OSA): Pharynx collapses, blocking airway. Central(CSA): Brain fails to send signal to breathe. Apnea: Period of +10 seconds without breathing |
s/s | Loud snoring. Extreme daytime sleepiness. ↑ CO2 (Hypercapnia → respiratory acidosis.) Headaches on awakening. |
Collab interventions | CPAP/BiPAP. Weight loss. Oral appliances, tonsillectomy/surgery |
Nursing | Elevate HOB. Avoid sleeping on back. Encourage exercise. Limit alcohol reinforce CPAP use |
complications | Hypertension, dysrhythmias, pulmonary hypertension→ right sides heart failure.MI, Stroke |
SLEEP PHARMACOLOGY
MEDICATION | USE | SE & AE | NURSING CONSIDERATION & PATIENT TEACHING |
Zolpidem (hypnotic) | Insomnia (short term) | Drowsiness,dizzy, sleepwalking/driving | Must have 6-8 hours available for sleep, take on empty stomach . avoid alcohol. |
Trazodone (serotonin modulator) | Insomnia | Sedation dry mouth, serotonin syndrome, priapism. | GIve at bedtime due to sedation. Monitor for dizziness/ orthostatic hypotension. Report prolonged erection immediately |
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