LETS DO SOME DRILLS

Complications

Diarrhea
Leukemia
Addisons
Cushings
Sickle cell anemia
Valvular disease
Cystic fibrosis
Gonorrhea
Herpes and HPV
Kissing disease
Meningitis
Pancreatitis
Phenylketonuria and
cretinism
Polycythemia vera
PIH and Preeclampsia
vomiting

Dehydration and met

acidosis
Infection and bleeding
Shock
Fluid overload (anasarca)
MI and CVD
CHF
Permanent sterility
Pelvic inflammatory disease
Cancer of the cervix
Spleenic rupture
Auditory damage
Destruction of beta cells
Mental retardation
MI and CVD
Abruptio placenta
Met alkalosis

Diets

AGN
Addisons
Cushings
Pernicious anemia
Sickle cell anemia
Angina
Gouty arthritis
ADHD and bipolar
Burns
Bedsores
DM
Dumping syndrome
Hepatic encephalopathy
Hepatitis
Liver cirrhosis

Low Na, Low CHON

High Na, low K
Low Na, high K
Vit B12 injections monthly
High fluids
Low cholesterol
Purine restricted
Finger foods
high CHON, high Cal, high
vit
High CHON, high vit
Well balanced
Low CHO, dry diet
Low CHON
High CHON
Low CHON

Diets
Hyperthyroidism
Hypothyroidism
Hyperparathyroidi

m
Hypoparathyroidis
m
Menieres dse
Cholecystitis
Pancreatitis
Phenylketonuria
PIH
Renal Failure
Tonsillitis

High cal, low

residu
Low cal, low chol
Low Ca
High Ca
Low Na
Low fat
Low fat
Low phenylalanine
High protein
Low CHON, Na, K
Soft diet

Bedside

Amputation
Autonomic dysreflexia
CTT
CVA
Parkinson's
Myasthenia gravis
Epiglotitis and Croup
Thyroidectomy
DVT and ascites
Radium implant
Sengstakenblakemore
Tonsillectomy
Tracheostomy tube

Tourniquet
Catheter
Clamp, bottle,

vasgauze
Suction
Suction
ET and tracheostomy
ET and tracheostomy
Tracheostomy, Ca
Tape measure
Lead container, forceps
Scissors
Flashlight
Obturator and
hemostat

Positioning

AAA
Air embolism
Appendicitis, unruptured
Appendicitis ruptured
Asthma
Cardiac catheterization
Casting
Cleft lip
Cleft palate
CHF
CVA
Dumping syndrome
GERD
Epistaxis
Flail chest
Hemorroidectomy
Hip replacement

High fowlers
Trendelenburg, slightly left
Position of comfort
High fowlers
Orthopneic
Affected extremity extended
Elevate extremity
Opposite side or Supine
Prone
High fowlers
Elevate HOB or side lying
Supine after meals
Upright position after meals
Leaning forward
Affected side on bed
Side-lying
Abduction of legs

Positioning

Laminectomy, slip disk

Liver biopsy
Lobectomy
Pneumonectomy
Lumbar puncture
Mastectomy
Placenta previa bleed
Postural drainage
Prolapsed cord
Pulmonary edema
Pyloric stenosis
Seizure
Shock
Thrombophlebitis
Varicose veins
Thyroidectomy
Tracheoesophageal fistula

Keep as straight as possible

Left during, Right after
Unaffected side down
Affected side down
Knee-chest, flat on bed after
Elevate affected extremity
Bed rest
Segment to drain upwards
Knee-chest
High fowlers
Right side lying
Side lying or prone
Trendelenburg
Elevate extremity
Elevate extremity
No flexion or hyperextension
upright

Laboratory data

AGN
Leukemia
Addisons
Cushings
AIDS
Gouty arthritis
Rheumatoid arthritis
Prostate cancer
Colorectal cancer
Cystic fibrosis
DM
Hemophilia
Hepatic
encephalopathy
Hyperthyroidism
hypothyroidism

High ASO titer, BUN, Crea

High WBC, low RBC & PLT
Low Na & glucose, high K
High Na & glucose, low K
(+) ELISA and western
blot
High uric acid
High RF & ANA, high ESR
High PSA
High CEA
High NaCl on sweat
Hyperglycemia
Prolonged bleeding time
Elevated BUN
High T3, T4
Low T3, T4

Laboratory data

Hypoparathyroidism
Hyperparathyroidism
Liver cirrhosis
Multiple myeloma
MI
Pancreatitis
Polycythemia vera
Renal failure
Rheumatic heart dse
Met acidosis
Met alkalosis
Respi acidosis
Respi alkalosis

Low Ca
High Ca
High SGPT, SGOT
Low WBC, RBC, PLT, High Ca
High troponin, Ck, LDH, SGOT
Hyperglycemia, high amylase
High RBC
High BUN, Crea, Na, K low Ca
High ASO titer
Low pH, low bicarbonate
High pH, high bicarbonate
Low pH, high CO2
High pH, low CO2

History

AAA
AGN
AIDS or HIV
Breast cancer
Cervical cancer
Laryngeal cancer
Cystic fibrosis &
hirschprungs
Cholecystitis
Liver cirrhosis &
pancreatitis
PID
RHD

Hypertension
Sore throat
Multiple sexual partners
1st child after 35
Herpes or HPV infection
Smoking, teacher
Meconium ileus
Intolerance to fatty food
Alcoholism
STD
Sore throat

Initial manifestation

AGN
Alzeimers
Anemia
Sickle cell anemia
Angina
Arthritis
BPH
Bladder cancer
Breast cancer
Cervical cancer
Esophageal cancer
Laryngeal cancer
Cataract
CHF
Congenital hip
dislocation

Edema & tea colored

urine
Memory loss,
forgetfulness
Fatigue
Growth retardation
Chest pain
Morning stiffness
Dec force & flow of urine
Painless hematuria
Lump or mass
Painless vaginal bleeding
Dysphagia
Hoarseness
Blurred vision, glare
Dyspnea or edema
Affected leg is shorter

Initial manifestation

Cystitis
DM
GBS
MS
MG
Liver failure
GERD
Hypocalcemia
Hypokalemia
Hypoxia
Increased ICP
Menieres dse
Parkinsons dse
Retinal detachment
Tardive dyskinesia

Burning upon urination

Polyuria, polydipsia
Clumsiness
Diplopia
Muscle weakness
Personality change,
asterixis
Heartburn after eating
Tingling and muscle
twitch
Parasthesia
Restlessness
Widening pulse pressure
Vertigo
Pill rolling movement
Visual floaters
Lip smacking

LETS INTEGRATE SIGN AND

SYMPTOMS

PAIN
Dull abdominal or low back pain

associated with a pulsating abd mass

Ans : AAA
Squeezing, burning, choking pain relieved
by rest or nitroglycerine
Ans: Angina
Squeezing, burning, choking pain relieved
by morphine
Ans : MI

PAIN
Rebound tenderness at Mcburneys point
Ans : Appendicitis
RUQ pain radiating to R shoulder,
associated with fat intake
Ans: Cholelithiasis
LUQ pain radiating to L shoulder
Ans : Spleenic rupture

PAIN
Gnawing, burning aching pain 3hrs after

eating relieved by food intake

Ans : duodenal ulcer
Gnawing, burning aching pain 30min after
eating relieved by vomiting
Ans: gastric ulcer
Sudden sharp knife like unilateral abd pain
Ans : ectopic pregnancy

Alopecia
Endocrine disorder

Hypothyroidism

Cancer therapy

Chemotherapy and
radiation therapy

amenorrhea
Endocrine disorder

Hypothyroidism

Psychiatric d/o

Anorexia nervosa
and bulimia
nervosa

Amnesia
Psych d/o
Psych treatment
alcoholism

Alzheimer's(demen
tia)

ECT
Wernickes and
korsakoffs

 Barrel chest
Absent bowel

sounds
Brudzinski & kernigs
Buffalo hump
Butterfly rash

Paradoxical chest

movement
Chvosteks &
trousseaus
Carpopedal spasm
Cogwheel rigidity

COPD
Paralytic Ileus
Meningitis, brain
hemorrhage
Cushings
SLE

Flail chest
Hypocalcemia
Hypocalcemia

 Diplopia
Vertigo (ear dse)
Absent Dolls eye
Exopthalmos
Halo vision
Green halo vision
Heat intolerance
Painless Hematuria
Hoarseness of voice
Hiccups
Hirsutism & virilism
Homans sign

MS and MG
Menieres
Brain stem damage
Hyperthyroidism
Glaucoma
Digitalis toxicity
Hyperthyroidism
Bladder cancer
Laryngeal cancer
Pacemaker failure
Cushings
DVT

 Moon face
Night blindness
Nuchal rigidity
Orthostatic

hypotension
Chest retractions

Sunset eyes
Bossing sign

Cushings
Vit A deficiency
Meningitis and

encephalitis
Hypovolemia and
Addison's
Asthma,
epiglottitis, croup
Hydrocephalus
hydrocephalus

 Intention tremors
Resting tremors or

pill rolling tremors

Flapping tremors
Trismus
Decreased caliber
of urine
Projectile vomiting

MS
Parkinsons
Asterixis
Tetanus & rabies
BPH
Inc ICP & pyloric
stenosis

Stool
Clay or gray colored
Steatorrhea
Currant jelly
Ribbon like
Hematochezia
Melena
Alternating diarrhea
and constipation

Biliary dse
Pancreatitis
Intussuception
hirshprungs
Lower GI bleed
Upper GI bleed
CA of the colon

LETS COMBINE EVERYTHING

Abdominal aortic aneurism

Problem:
Pulsating abdominal mass
S/S:
Pulsating abd mass on palpation
Best Lab:
UTZ
Intervention: Dont perform?
Abd palpation

Abruptio placenta
Problem:
Premature separation of the placenta
S/S:
Dark red vaginal bleeding, peritonitis
Best Lab:
UTZ
Complication:
Shock and DIC

Diarrhea
Problem:
Increased passage of liquid stools
S/S:
Loose watery stools
Lab:
Met acidosis
Intervention:
Fluid replacement (pedialyte and Oresol)

AGN

Problem:
Damage to kidneys filtering system
S/S:
Cola urine, edema
Lab:
High crea, BUN, ASO titer
Interventions:
Infection and injury precautions
Diet:
Low CHON, Low Na
DOC:
Steroids

Leukemia
Problem:
Carcinoma of the WBC
S/S:
Fatigue, bruising, freq infxn
Best Lab:
Biopsy of bone marrow (WBC high)
Interventions:
Infection and bleeding precautions

AIDS
Problem:
Degeneration of the immune system
S/S:
Non-specific catarrhal symptoms for 1 month
Lab:
ELISA and Western blot, CD4 counts
Intervention:
Infection precautions, Safe sex

Addisons disease
Problem:
Hypo functioning of the adrenal glands
S/S:
Thin, hypovolemia, bronze discoloration of

skin
Lab:
Low Na and glucose, high K
Intervention:
Prevention of shock, infection precautions,
fluids and electrolytes, hypotension
DIET:
High Na, Low K

Cushings disease
Problem:
Hyper functioning of the adrenal glands
S/S:
Edema, hypervolemia, buffalo hump, moon

face
Lab:
high Na and glucose, low K
Intervention:
Infection and injury precautions, Hypertension
DIET:
low Na, high K

Alzheimer's
Problem:
Progressive degeneration of cerebral cortex
S/S:
Forgetfulness, confusion, confabulation, sun
downing
Lab:
No specific (ACTH high)
Intervention:
5Cs: clock, calendar, color, caregiver,
cognex

Angina
Problem:
Ischemia of myocardium
S/S:
Squeezing, crushing chest pain relieved by

rest or nitroglycerine, last for no more than

30min
ECG:
ST segment depression
DOC:
Nitroglycerine
DIET:
Low cholesterol

Appendicitis
Problem:
Inflammation of the appendix
S/S:
Rebound tenderness, RLQ pain, Mcburneys
point
Position:
Before rupture - Position of comfort
After rupture - High fowlers
NO:
pain relievers, laxatives, enema, warm
compress

Asthma
Problem:
Hyperactivity of the bronchial airway
S/S:
Dyspnea and wheezing
Lab:
Respiratory acidosis
Intervention:
Orthopneic position, pursed-lip breathing
Drugs:
Bronchodilator 1st then corticosteroids

BPH
Problem:
Overgrowth of prostate (benign)
S/S:
Decreased caliber of urine
Lab:
High acid phosphatase
surgery:
TURP No incision
Post-op:
Cystoclysis: OUT must always be more than IN

BURNS

Problem:
Thermal, electric, chemical injury to skin
S/S:
1st degree: pink and red
2nd degree: vesicles
3rd degree: charred, white, with eschar
Lab:
Initially Inc K & dec Na then becomes both dec K &
Na
Intervention:
Fluid resuscitation (rule of 9s), Pain control, infxn,
contractures
DIET:
High cal, CHON, Vit

Cataract
Problem:
Opacity of the lens
S/S:
Blurring of vision, glare
Lab: (slit-lamp)
Red reflex absent
Intervention:
Injury precautions
Surgery:
PECLE or PHACO : prevent inc IOP

CVA
Problem:
Disruption of blood supply to the

brain (hemorrhagic or thrombotic)

S/S:
Hemiplegia, hemi paresis, speech
problems, hemianopsia
Positioning:
ICP : Elevate HOB
Aspiration : Side-lying

Chicken pox
Problem:
Infection by varicella zoster
S/S:
Fever, fluid filled vesicles
Intervention:
Isolate for 2 weeks, treat pruritus
DRUGS: Never give
aspirin

Cholecystitis
Problem:
Inflammation of the gall bladder
S/S:
Pain in the RUQ radiates to shoulder ass with
fat intake
Steatorrhea and jaundice if severe
obstruction
Surgery:
Cholecystectomy: high abd incision
DIET:
Pre-op: Low fat
Post-op: No more fat restriction

Chronic bronchitis
Problem:
Copious mucus secretion on the

bronchioles (smoking number 1 risk factor)

S/S:
Blue bloater
Lab:
Respiratory acidosis
Intervention:
Max O2 at 4L/min
Purse lip breathing, chest physiotherapy

CHF
Problem:
Cardiac pump failure due to cardiomegaly
S/S:
RSHF: systemic
LSHF: Pulmonary
Lab:
Elevated CVP, PAWP
Positioning:
High fowlers position
DOC:
Digitalis (+)inotropic, (-)chronotropic

Croup
Problem:
Inflammation of the airway

(laryngotracheobronchitis)
S/S:
Barking cough, inspiratory stridor
Intervention:
Mist inhalation
Bedside:
ET and tracheostomy

Cystic fibrosis
Problem:
genetic disorder of the exocrine glands
S/S:
Sweat glands: high NaCl
Respi glands: copious sputum
Digestive glands: steatorrhea
Reproductive: permanent sterility
Lab:
Sweat chloride test (40meq/L or higher)
DIET:
Low fat, high cal, high Na

Cystitis
Problem:
Inflammation of the urinary bladder
S/S:
Dysuria, urgency, frequency
Lab:
High WBC, ESR (culture : E.Coli)
Intervention:
EOF, Acidify urine
NO:
Tight fitting underwear, bubble baths

Diabetes insipidus

Problem:
Hyposecretion of ADH
S/S:
Polyuria and polydipsia, hypotension
Lab:
Low urine spec. grav
Intervention:
EOF, monitor for shock
DOC:
Desmopressin
NSG DX:
Fluid volume deficit
Sleep pattern disturbance

SIADH

Problem:
Hypersecretion of ADH
S/S:
Edema, anasarca, hypertension
Lab:
high urine spec. grav
Intervention:
monitor for fluid overload
DOC:
Demeclocycline (furosemide may also be used)
NSG DX:
Fluid volume excess
Risk for injury

Dumping syndrome
Problem:
Rapid entry of carbohydrate rich chyme to
duodenum
Long term complication of
billroth(gastrectomy)
S/S:
Shock like symptoms, diaphoresis
Intervention:
Supine position after meals
DIET:
Small frequent feedings, Low CHO, dry

Ectopic pregnancy
Problem:
Implantation outside the uterus (fallopian
tubes)
S/S:
Sharp, stabbing, unilateral abd pain with
spotting
Lab:
UTZ
Intervention:
Prepare client for surgery

Emphysema

Problem:
Loss of alveolar elasticity thus trapping of air
S/S:
Pink puffer, barrel chest
Labs:
Respiratory acidosis
Interventions:
Breathing technique: Pursed lip
Position: Orthopneic
Max oxygen: 2-4L/min

Epiglotitis
Problem:
Complete airway obstruction due to infxn
of epiglotis
S/S:
sore throat
Positioning
Tripod position
Bedside:
ET and tracheostomy

Epilepsy/seizure
Problem:
Excessive electrical discharge in the brain
S/S:
rapid flexion and extension of skeletal
muscles, aura and prodrome
Labs:
EEG
Goals:
During seizure: Safety
After seizure: Aspiration

Glaucoma
Problem:
Increased IOP
S/S:
PAIN, tunnel vision, permanent vision
loss
Labs:
Tonometry = 25mmHg and up
Interventions:
Prevent inc IOP
Eye gtts: Miototics

Guillain-barre syndrome
Problem:
Inflammation of motor neurons
S/S:
Paralysis = Ascending
Complication: Respiratory failure
-Prevent Respi infxn
-Suction and Tracheostomy at
bedside

Hemophilia
Problem:
X-linked recessive d/o of clotting
S/S:
bruising, abnormal bleeding
Labs:
prolonged INR (PT,PTT, bleeding time)
Risk for:
bleeding use RICE
Question on PUNNET SQUARE

Hepatic encephalopathy
Problem:
progressive loss of consciousness due to

nitrogenous waste
S/S:
asterixis, personality changes, dec level of
consciousness
Labs:
inc BUN
diet:
low CHON
DOC to dec ammonia levels in GIT:
-Neomycin and lactulose

Hip Fracture

Problem:
break in continuity of hip bone
S/S:
pain, shortening and external rotation of leg
Complication:
fat embolus
TTT:
Splint and immobilize
surgery ORIF
post-op goal:
maintain leg in alignment
Abduction pillow-to keep head of femur inside
Acetabulum
Trochanter rolls-to prevent external rotation

Hirschsprung's dse
problem:
no nerve innervations on colon
S/S:
meconium ileus, constipation, ribbon
like stool
Diet:
low residue
TTT:
Surgery (rectal pull through)

Hydatidiform mole
AKA: Gestational Mole
Problem:
abN number of chromosomes in

fertilization
S/S:
rapid growing uterus, passage of grape fruit
like vesicles, no fetal movement or heart
beat
TTT:
surgery (D and C)
Complication:
choriocarcinoma - levels of HCG will be
monitored for 2yrs

Hydrocephalus
Problem:
excessive CSF in the brain. Can be

communicating or non-communicating
S/S:
bulging fontanels, sunset eyes, inc ICP
Position:
elevate HOB
TTT: A-V shunt; watch for:
shunt failure dilated scalp veins

infxn temp and foul drainage

Shock
Problem:
decreased circulating blood volume
leading to inadequate tissue
perfusion
S/S:
dec BP, inc PR, RR, dec CVP
Position:
trendelenburg

Increased intracranial
pressure
Problem:

ICP greater than 15mmHg

S/S:
inc BP (widening pulse pressure), dec
PR, RR, projectile vomiting
Position:
elevate HOB
TTT:
Strongest diuretic - mannitol
Strongest anti-inflam - steroid
Surgery - craniotomy

Infectious mononucleosis
Problem:
infxn of lymphatic system by Epstein

Barr virus
S/S: lymph edema, sore throat,
fatigue
Transmission:
saliva no sharing of kitchen utensils
Complication:
splenic rupture (pain at LUQ)

Meniere's dse
Problem:
over production of endolymph in inner ear
S/S:
vertigo, tinnitus, hearing loss
Risk for:
injury
Diet:
low Na
Position:
Supine on attack

Multiple myeloma
Problem:
Carcinoma of plasma cells which invade bone

marrow
S/S:
Bone pain, myelosuppresion
Labs:
dec rbc, wbc, plt, inc Ca
Confirmatory:
Bone marrow biopsy
Risk for:
bleeding, infxn, fracture, kidney stones
Interventions:
EOF, prevent immobility

Parkinson's Dse
Problem:
degeneration of substancia nigra leading

to diminished dopamine levels

S/S:
mask like face, bradykinesia, shuffling gait,
drooling, resting tremors, constipation
Risk for:
injury and aspiration
DOC: levodopa
CHON and vit B6 antagonize levodopa
Bedside: Suction

Polycythemia Vera
Problem:
overproduction of rbc
Labs:
inc rbc, inc plasma osmolarity
S/S:
hypervolemia, hypertension
Complication:
thrombus formation - CVA, MI

PIH
Problem:
hypertension after 1st trimester of

pregnancy (inc in 30-50% of BV)

Triad S/S:
inc BP, proteinuria, edema
NSG:
limit environmental stimulation, monitor
for epigastric pain, seizure precautions
DOC:
MgSO4 -CNS depressant, assess: DTR

Pyloric stenosis
Problem:
hypertrophy of pylorus
S/s:
projectile Vomiting
Position:
R side lying

Retinal detachment
Problem:
separation of the retina from the

pigment layer
S/S:
visual floaters, curtain falling down,
painless
Emergency TTT:
patch both eyes

Reye's syndrome

Problem:
degeneration of brain, liver, and kidneys

due to concurrent viral infxn and aspirin use

S/S:
inc ICP, elevated SGPT SGOT, dec urine
output
Monitor for worsening of dse:
dec LOC, crushing's triad, RUQ pain,
Jaundice, Oliguria

SKIN TRACTION ASSESS

THE
PATIENT
Head Halter head, ears, chin and neck
Bryants Traction
both legs
Bucks Extension
one or both legs
Dunlops Traction
arm and forearm
Pelvic Belt Lower back and abdomen
Pelvic Sling Back and abdomen
Russells
Lower limbs
Traction