Milestone study Flashcards by Bethany Rivera

● Reorient them to reality
● Ensure medication adherence
● Help family recognize early signs and symptoms

Schizophrenia care

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● If needed, refer to grief counseling or a support group.
● Encourage activities that allow the individual to use past coping strategies
that will promote a feeling of self-worth and increased self-esteem.
● Encourage the individual to share his or her feelings.
● Encourage socialization with family peers and reminiscing about significant
life experiences.

Grief therapeutic response

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● Address the underlying issue
● Safety
● Monitor vitals
● Keep patient oriented to environment as much as possible
● Reduce environmental stimuli (Keep environment calm and quiet and well
lit)
● Explain procedures
● Excellent table in this module
● Safety is priority
● Respond quickly to calls for assistance

Delirium care

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● Middle to late stage of the disease
● Have patient close to nurse’s station
● Reorientate the person
● Safety
● Part of the neurodegenerative disease process in advance of dementia
during the mild cognitive impairment stage or even earlier

Alzheimer’s hallucinations

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Develops 48 to 72 hours after cessation of alcohol and decrease within 4 to 5 days
● Elevated vitals
● Delirium tremens (DTs); may appear 12 to 36 hours after last drink
● Transient visual, auditory, or tactile hallucinations or illusions
● CIWA will determine if medication and what kind is needed
● Symptoms of withdrawal usually begin 4 to 12 hours after cessation or
marked reduction of alcohol intake
● Alcohol withdrawal usually peaks on the second day and is over in about 5
days. This can vary, however, and withdrawal may take 1 to 2 weeks.
● Safe withdrawal is usually accomplished with the administration of benzodiazepines, such as lorazepam (Ativan), chlordiazepoxide (Librium),
or diazepam (Valium), to suppress the withdrawal symptoms

Alcohol withdrawal

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may appear 12 to 36 hours after last drink

Delirium tremens (DTs)

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● is an opioid
● Also used to treat addiction & withdrawl
● can be used as a replacement for opioids, and the dosage is
then decreased over 2 weeks. Substitution of methadone during
detoxification reduces symptoms to no worse than a mild case of flu
● Treat narcotic drug addiction

Methadone

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decreased level of consciousness respiratory depression constricted pupils

Methadone OD signs

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● Assess verbal and nonverbal cues for escalating behavior
● Have patient talk about about what triggered them
● Use seclusion or have others leave the room

Aggression response

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● Tort law
● A patient has communicated an explicit threat of imminent serious physical
harm or death to a clearly identified or identifiable victim or victims, and the patient has the apparent intent and ability to carry out such a threat

Duty to warn

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● Antipsychotic medication is first-line treatment
● Safety
● Are they able to successfully function in society

Schizophrenia- treatment evaluation

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● Never stop taking abruptly
● Must taper before a new medication can be started
● Sedation
● Respiratory decline
● Seizure
● Loss of consciousness

Anxiety drugs risk

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● Reports mainly by family and teacher
● Vision and hearing test will be conducted too
● Failure to listen to and follow instructions
● Difficulty playing quietly and sitting still
● Disruptive, impulsive behavior
● Distractibility to external stimuli
● Excessive talking
● Shifting from one unfinished task to another
● Underachievement in school performance

ADHD exam

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● Obsessions are recurrent, persistent, intrusive, and unwanted thoughts, images, or impulses that cause marked anxiety and interfere with interpersonal, social, or occupational function. The person knows these thoughts are excessive or unreasonable but believes he or she has no control over them. But still acts on them
● CBT help along with medications

Obsessive compulsive disorder

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● Gain trust
● Show no judgement
● Do not give advice
● Offer support

Therapeutic communication abuse victim

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● Complete baseline vitals.
● NPO eating and drinking at least 8hrs before the surgery.
● Education about expectations, incentive spirometry q2h
● Continued pain assessment

Appendicitis pre op prep

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● Physical assessment
● Growth milestones reached
● Oral
● Ask about food
● Ask about self image
● Vitals signs are low
● Forced vomiting or use of diuretics and laxatives

Anorexia report findings

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● Alcohol
● Diabetes
● Cholesterol
● Preexisting heart condition
● Obesity
● Sedentary lifestyle
● Smoking
● Target organ disease (brain, heart, peripheral artery disease, kidneys, eyes

Complication hypertension high risk

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●Extreme fatigue, hair loss, brittle nails, and dry skin are common, and numbness and tingling of the fingers may occur. The voice may become husky, and the patient may complain of hoarseness.
● Hyponatremia, hypoglycemia, hypoventilation, hypotension, bradycardia, and hypothermia

Hypothyroidism

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●Used to treat hypothyroidism.
●People should take in the morning on an empty stomach.
● If the pulse rate prior to administering the drug is more than 100 beats/min, it is important to notify the prescriber.
●Therapeutic Effects: Increased energy and decreased sleep

Levothyroxine (Synthroid)

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● Some patients may have mild signs and symptoms that include bowel irregularity with intervals of alternating constipation and diarrhea, with nausea, anorexia, and bloating or abdominal distention.
● up to 70% of patients report an acute onset of mild to severe pain in the left lower quadrant. This may be accompanied by a change in bowel habits, most typically constipation, with nausea, fever, and leukocytosis

Diverticulosis signs and symptoms

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● Rest, oral fluids, and analgesic medications are recommended. Initially, a clear liquid diet is consumed until the inflammation subsides; then, a high- fiber, low-fat diet is recommended.
● Keep NPO until pain resolved
● Allows bowels to rest
● If there is a blockage nothing can get past the blocked or swollen area

Diverticulosis interventions

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● Failure to take more than two doses of anti-diabetic medication over a period of last 15 days
● Target organ damage
● Coma
● Amputation
● Death

Diabetes poor compliance

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● Pulmonary congestion
● Dyspnea
● Orthopnea
● Crackles
● Cough
● Fatigue
● Tachycardia
● Anxiety
● Restlessness
● Confusion
● Paroxysmal nocturnal dyspnea
● Peripheral edema
● Weight gain
● JVD
● Anorexia
● Nausea
● Nocturia
● Weakness
● Hepatomegaly
● Ascites
● Dyspnea
● Orthopnea
● Paroxysmal nocturnal dyspnea
● Cough (recumbent or exertional)
● Pulmonary crackles that do not clear with cough
● Weight gain (rapid)
● Dependent edema
● Abdominal bloating or discomfort
● Ascites
● Jugular venous distention
● Sleep disturbance (anxiety or air hunger)
● Fatigue

Heart Failure symptoms

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● NPO ● Decompression ● Monitor I&O ● Decompression of the bowel through an NG tube is necessary for all patients with small bowel obstruction; this may be tried for up to 3 days for patients with partial obstructions; resting the bowel in this manner can result in resolution of the obstruction. ● Nursing management of the patient with a small bowel obstruction who does not require surgery includes maintaining the function of the NG tube, assessing and measuring the NG output, assessing for fluid and electrolyte imbalance, monitoring nutritional status, and assessing for manifestations consistent with resolution (e.g., return of normal bowel sounds, decreased abdominal distention, subjective improvement in abdominal pain and tenderness, passage of flatus or stool). ● Maintaining fluid and electrolyte balance is a priority area to monitor in the patient with a small bowel obstruction. ● The presence of the NG tube in conjunction with the patient's nothing-by-mouth (NPO) status places the patient at significant risk of fluid imbalance. ●measures to promote fluid balance are critically important. ● The nurse reports discrepancies in I&O, worsening of pain or abdominal distention, and increased NG output. If the patient's condition does not improve, the nurse prepares him or her for surgery. Nursing care of the patient after surgical repair of a small bowel obstruction is similar to that for other abdominal surgeries

Small bowel obstruction actions

● Airway patency ● Increase fluid intake ● Encourage effective cough and deep-breathing techniques ● Vitals ● Focused respiratory assessment

Pneumonia action

● Administer O2 at 1 to 2 L per nasal cannula ● Know the patients baseline 02 status

COPD oxygen flow rate

● Do not give if HR lower than 60 ● Used for atrial fibrillation ● Toxicity causes anorexia, nausea, vomiting and neurological symptoms. ● Clinical manifestations of toxicity include anorexia, nausea, visual disturbances, confusion, and bradycardia. The serum potassium level is monitored because the effect of digoxin is enhanced in the presence of hypokalemia and digoxin toxicity may occur. A serum digoxin level is obtained if the patient's renal function changes or there are symptoms of toxicity.

HF digoxin

● improves cardiac contractility and decreases signs and symptoms of HF. ● Patients with renal dysfunction and older patients should receive smaller doses as it is excreted through the kidneys

Digoxin (Lanoxin)

● 3% Normal Saline ● Treatment of sodium deficiency (severe hyponatremia) ● Hypertonic solutions exert an osmotic pressure greater than that of the ECF. ● When normal saline solution or lactated Ringer solution contains 5% dextrose, the total osmolality exceeds that of the ECF ● Saline 3% or 5%

IV fluids hypertonic

● Morning stiffness lasting more than 30mins ● Bilateral joint swelling ● Low grade fever ● Rheumatoid factor (RF) ● Anti-citrullinated peptide antibody (ACPA) ● treated with NSAIDs and specifically the cyclo-oxygenase 2 (COX-2) enzyme blockers are used for pain and inflammation relief. NSAIDs, such as ibuprofen (Motrin) and naproxen (Naprosyn), are commonly prescribed because of their low cost and analgesic properties.

Rheumatoid arthritis diagnosis

the nurse monitors fluid and electrolyte balance and assesses the patient for localized infection or peritonitis (increased temperature, abdominal pain, paralytic ileus, increased or absent bowel sounds, abdominal distention). Antibiotic therapy is given as prescribed.

Peptic ulcer disease NG tube

● TURP: surgical procedure of clearing the swelling ● Increased frequency of voiding, with a decrease in amount of each voiding ● Nocturia ● Hesitancy ● Terminal dribbling ● Decrease in size and force of stream ● Acute urinary retention ● Bladder distention ● Recurrent UTIs

Prostatic hyperplasia

● Rescue inhalers and inhaled or oral steroids can help control symptoms and minimize further damage.

Type I diabetes tight control

● Teach diaphragmatic and pursed-lip breathing ● Administer O2 at 1 to 2 L per nasal cannula ● Teach prevention of secondary infections. ● Teach about medication regimen ● Smoking cessation is imperative. ● The goal of supplemental oxygen therapy is to increase the baseline resting partial pressure of arterial oxygen (PaO2) to at least 60 mm Hg at sea level and an arterial oxygen saturation (SaO2) to at least 90% ● Long-term oxygen therapy (more than 15 hours per day) has also been shown to improve quality of life, reduce pulmonary arterial pressure and dyspnea, and improve survival. Long-term oxygen therapy is usually introduced in very severe COPD, and indications generally include a PaO2 of 55 mm Hg or less or evidence of tissue hypoxia and organ damage such as cor pulmonale, secondary polycythemia, edema from right-sided heart failure, or impaired mental status. ● Although the hypoxic drive is often cited as a concern in administering supplemental oxygen to patients with COPD, in actuality it is a very small part of the overall stimulus driving the respiratory system ● Therapeutic strategies for the patient with COPD include promoting smoking cessation as appropriate, prescribing medications that typically include bronchodilators and may include corticosteroids, managing exacerbations, and providing supplemental oxygen therapy as indicated ● When the patient arrives in an ED, the first line of treatment is supplemental oxygen therapy and rapid assessment to determine if the exacerbation is life-threatening. A short-acting inhaled bronchodilator may be used to assess response to treatment. Oral or intravenous (IV) corticosteroids, in addition to bronchodilators, are recommended in the hospital management of a COPD exacerbation. Antibiotics also benefit patients with COPD because bacterial infections often follow viral infections. ● Administer O2 at 1 to 2 L per nasal cannula ● Know the patients baseline 02 status

COPD treatment

tenderness, Distension, Rigidity, Anorexia, Nausea, Vomiting, Fever

IBD peritonitis symptoms

Long term inflammation from IBD can put the patient at risk of a bowel perforation and therefore peritonitis. Long-term inflammation and ulcers in the colon can weaken the intestinal wall. Over time, these weaknesses may develop into a perforation. A perforation can allow bacteria and other intestinal contents to leak out into the abdomen, causing a serious condition called peritonitis.

IBD peritonitis

● Infections like sinusitis, colds, and the flu ● Allergens such as pollens, mold, pet dander, and dust mites ● Cockroaches ● Irritants like strong odors from perfumes or cleaning solutions ● Air pollution ● Tobacco smoke ● Exercise ● Cold air or changes in the weather, such as temperature or humidity ● Gastroesophageal reflux disease (GERD) ● Strong emotions such as anxiety, laughter, sadness, or stress

Asthma triggers

● Blood or Pus with diarrhea followed by a period of constipation ● LLQ abdominal pain ● Pseudopolyps that resemble stilagtes

Ulcerative colitis symptoms

● Peripheral arterial disease (PAD) happens when buildup on the walls of blood vessels causes them to narrow. ○ Most likely to develop in the legs ○ Asymptomatic. ○ Claudication. ○ Critical limb ischemia. ○ Acute limb ischemia ○ Cause for amputation if not treated

Arterial insufficiency diabetic

● Stay at a healthy weight ● Don't lie down after meals. ● Don't eat late at night. ● Raisetheheadofyourbedby4to6 inches ● Don't wear tight-fitting clothes. ● Don't eat foods that cause GERD ● Encourage small, frequent meals ● Management begins with educating the patient to avoid situations that decrease lower esophageal sphincter pressure or cause esophageal irritation. The patient is instructed to eat a low-fat diet; avoid caffeine, tobacco, beer, milk, foods containing peppermint or spearmint, and carbonated beverages; avoid eating or drinking 2 hours before bedtime; maintain normal body weight; avoid tight-fitting clothes; and elevate the head of the bed by at least 30 degrees

GERD instructions

● Blood ● Electrolytes ● Urinalysis ● ECG

Pre op labs

● Maintain airway (roll on side) ● Cushion head ● Loosen restrictive clothing ● Suction ready ● Keep them safe away from objects ● Document seizure (time and behavior)

Seizure unconscious client

● A procedure that uses shock waves to break up stones in the kidney and parts of the ureter ● Monitor urine after (see stone particles amount or urine and blood) ● Administer pain medication

Uroliathiasis lithotripsy

● Neurological Assessment ● Vitals ● LOC ● Pain management

General anesthesia – post anesthesia care

Low platelet count- less than 150,000 platelets per microliter of blood.

thrombocytopenia

● A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood. Bleeding and petechiae usually do not occur with platelet counts greater than 50,000/mm3, although excessive bleeding can follow surgery or other trauma. When the platelet count drops to less than 20,000/mm3, petechiae can appear, along with nasal and gingival bleeding, excessive menstrual bleeding, and excessive bleeding after surgery or dental extractions. When the platelet count is less than 5000/mm3, spontaneous, potentially fatal central ● nervous system or GI hemorrhage can occur

Thrombocytopenia labs

● Alternative treatments in exercise- induced asthma ● Preventing leukotriene release from mast cells and eosinophils or by blocking the specific leukotriene receptors on bronchial tissues ● Oral asthma medication

Asthma-leukotriene inhibitors

● 1. Shake well immediately before each use. ● 2. Remove the cap from the mouthpiece. ● 3. Exhale to the end of a normal breath. ● 4. With the inhaler in the upright position, place the mouthpiece just inside the mouth, and use the lips to form a tight seal or hold the mouthpiece approximately two finger widths from the open mouth. ● 5. While pressing down on the inhaler, take a slow, deep breath for 3 to 5 seconds, hold the breath for approximately 10 seconds, and exhale slowly. ● 6. Wait 3 to 5 minutes before taking a second inhalation of the drug. ● 7. Rinse the mouth with water after each use. ● 8. Rinse the mouthpiece and store the inhaler away from heat.

asthma inhaler

● Obtain tested and approved blood ● Take baseline vitals - 15 minutes after ● 2 person verifier ● Obtain consent ● Transfusion must be done within 4 hours

Transfusion action (blood)

● Pain ● Edema ● Decreased SPO2 ● Low grade fever ● Sickling may be triggered by any stress or traumatic event, such as infection, fever, dehydration, physical exertion, excessive cold exposure, or hypoxia ● Immediately report symmetric swelling of the hands and feet in the infant or toddler

sickle cell signs of crisis

● Murmur (present or absent; thrill or rub) ● Cyanosis, clubbing of digits (usually after age 2) ● Poor feeding, poor weight gain, failure to thrive ● Frequent regurgitation ● Frequent respiratory infections ● Activity intolerance, fatigue ● The following are assessed: ○ Heart rate and rhythm and heart sounds ○ Respiratory status/difficulty ○ Pulses (quality and symmetry) ○ Blood pressure (upper and lower) ○ Feeding difficulties; tires easily

infant congenital heart defect assessment

● Irritable, distressed infant ● Paroxysmal coughing ● Poor eating ● Nasal congestion ● Nasal flaring ● Prolonged expiratory phase of respiration ● Wheezing, rales can be auscultated ● Deteriorating condition that is often indicated by shallow, rapid respirations

RSV distress

● Weight loss. ● Ravenously hungry despite vomiting. ● Lack of energy. ● Fewer bowel movements. ● Constipation ● Projectile vomiting occurs within minutes after eating. ● Frequent, mucous stools ● Palpate for a hard, moveable "olive" in the right upper quadrant ● Forceful, non bilious vomiting, unrelated to feeding position ● Hunger soon after vomiting episode ● Weight loss due to vomiting ● Progressive dehydration with subsequent lethargy

Pyloric stenosis symptoms

● is a process that occurs when a proximal segment of bowel "telescopes" into a more distal segment, causing edema, vascular compromise, and, ultimately, partial or total bowel obstruction. A barium enema is successful at reducing a large percentage of intussusception cases; other cases are reduced surgically. ● Disorder where the intestine telescopes (folding into self) ● Disorder in infants and children ● Bloody jelly like stool ● Diarrhea ● Vomiting ● Fatigue, lethargy, or loss of appetite ● Cramping or lump in the abdomen

Intussusception

● Premature separation of the placenta from the wall of the uterus ● Fetus is in jeopardy due to lack of O2 supplied placental connection ● Bedrest or C-section ● Uterine contraction ● Uterine tenderness ● Vaginal bleeding ● Fetal distress, or premature labor ● Separation of the placenta from the uterine wall ● Emergency measures include starting two large-bore IV lines with normal saline or lactated Ringer's solution to combat hypovolemia, obtaining blood specimens for evaluating hemodynamic status values and for typing and cross-matching, and frequently monitoring fetal and maternal well-being ● Depending on severity the women can be monitored through a vaginal birth but if it is a risk they will do c-section

Placenta abruption

painful, dark-red vaginal bleeding (port-wine color) because the bleeding comes from the clot that was formed behind the placenta; "knife-like" abdominal pain; uterine tenderness; contractions; and decreased fetal movement. Rapid assessment is essential to ensure prompt, effective interventions to prevent maternal and fetal morbidity and mortality

Placenta abruption manifestations

● Above 160 bpm after a contraction ● Caused by decreased fetal oxygen supply ● Turn client onto left side ● Discontinue oxytocin (Pitocin) if infusing. ● Administer O2 at 10 L by tight facemask. ● Maintain intravenous (IV) line ● Notify health care provider

Fetal heart rates tachycardia

● Any type of fetal or maternal distress that cannot be relieved by medication or maneuvering fetus or mother. ● Prolonged/obstructed labour ● Postpartum hemorrhage ● Fetal distress ● Severe pregnancy-induced hypertension/eclampsia ● Antepartum hemorrhage

Obstetrical emergencies

● Fracture of the collarbone or upper arm ● Nerve damage affecting the shoulders, arms, hands or fingers ● Brain damage or speech disability ● May need to be used vacuum extractor or forceps during delivery ● McRoberts Manuver and Superpubic ● The technique is performed by flexing the mother's thighs toward her shoulders while she is lying on her back. No specific degree of elevation or flexion of the patient's legs has been defined for the McRoberts maneuver.

Shoulder dystocia

● V variable decelerations ● E early deceleration ● A acceleration ● L Late deceleration ● C Cord Compression ● H Head Compression ● O O- okay! ● P- Placental insufficiency

Fetal heart rate patterns - deceleration

● Tone: uterine atony, distended bladder ● Tissue: retained placenta and clots; uterine subinvolution ● Trauma: lacerations, hematoma, inversion, rupture ● Thrombin: coagulopathy (preexisting or acquired) ● Traction: too much pulling on umbilical cord ● 1000mL for C-section ● 500mL for vaginal

Post-partum hemorrhage

● Try to determine the underlying cause ● Slowly rehydrate ● Rehydrate with items rich in calories water may not be enough ● Do not give antidiarrheal medication want the virus run its course and not stay inside

Vomiting and diarrhea- infant

● Will detect if the fetus has proper growth in accordance to amount of blood and oxygen supply ● low oxygen levels ● High level of distress during labor and delivery ● Increased risk of infectious disease after birth ● intrauterine growth restriction ● Currently, an NST is recommended twice weekly (after 28 weeks' gestation) for clients with diabetes and other high-risk conditions, such as intrauterine growth restriction (IUGR), preeclampsia, post-term pregnancy, renal disease, and multifetal pregnancies ● A nonreactive test has been correlated with a higher incidence of fetal distress during labor, fetal mortality, and IUGR. Additional testing, such as a biophysical profile, should be considered

IUGR ultrasound

● Breasts feel very full, hard, swollen and painful ● Occurs shortly after mother has given birth ● Can lead to mastitis ● Slightly swollen and tender lymph nodes in your armpits ● Resolve: ○ Using a warm compress, or taking a warm shower to encourage milk let down. ○ Feeding more regularly, or at least every one to three hours. ○ Nursing for as long as the baby is hungry. ○ Massaging your breasts while nursing. ○ Applying a cold compress or ice pack to relieve pain and swelling.

Engorgement

● Respiratory (Infections, hemoptysis, pneumothorax, pulmonary hypertension, and chronic hypoxic and hypercapnic respiratory failure) ● Malabsorption of protein, fat, & fat- soluble vitamins ● Salt losses in sweat

Cystic fibrosis complications

● For the first pregnancy: The mother receives two doses of RhoGAM, one at 28 weeks' gestation and the second dose within 72 hours after childbirth ● For any subsequent pregnancies, RhoGAM is administered regularly during the second half of the pregnancy

Rhogam

● usually clears up within 2 weeks in formula-fed babies ● more than 2 to 3 weeks in breastfed babies ● Close monitoring - lab draws ● Billi lights or blanket ● No clothes only diaper when using therapy devices ● Physiologic jaundice is very common in newborns, with the majority demonstrating yellowish skin, mucous membranes, and sclera within the first 3 days of life. ● Advise mothers to nurse their infants at least eight to 12 times per day for the first several days

24-hour jaundice

● primary goal of managing hemophilia is to prevent bleeding. This is best accomplished by instructing the child to avoid activities with a high potential for injury (e.g., football, riding motorcycles, skateboarding). Instead, encourage the child to participate in activities with the least amount of contact (e.g., swimming, running, tennis) ● No contact sports ● Exercise to strengthen joint and protect ● Soft bristle toothbrushes ● Medical alert bracelet ● Medication administration routine

Hemophilia safety

● Blood clots (which may be in the brain causing stroke) ● Infection in the lining of the heart and heart valves (bacterial endocarditis) ● Abnormal heart rhythms (arrhythmias) ● Heart failure. ● Death ● From Google: ● Blood clots (which may be in the brain causing stroke) ● Infection in the lining of the heart and heart valves (bacterial endocarditis) ● Abnormal heart rhythms (arrhythmias) ● Heart failure. ● Death.

Tetralogy of fallot complications

● Body does not make insulin at all ● Only injection insulin no pill form ● Education is important for children ● Insulin pump may be an option to manage DM 1 ● DKA can cause coma

Type I DM- Hyperglycemia

● Large for gestation age ● Will be born hypoglycemic ● Could cause still-birth, abortion, premature ● Delivery complications due to large size

Diabetes- fetal risk

● Tearfulness ● Insomnia ● Lack of appetite ● Sleep disturbances ● Anxiety ● Crying ● Over obsession with the baby ● Typically resolve in 10 days without intervention

Postpartum blues

● Decreased blood flow to the placenta ● Lower the head of the bed and turn the mom on her left side to take the pressure off the vena cava ● NS bolus ● Turn off Pitocin ● Give o2

Late decelerations

● Fetus has swallowed first stool and it has gotten lodged in airway or lung(s) ● Lack of first birth will decrease O2 and fetal heart rate ● Acute or chronic hypoxic event (fetal distress makes them pass meconium)

Meconium stain- decreased FHR

● Fetal distress ● Prolapsed cord ● Active genital herpes ● malposition or malpresentation of fetus

Pitocin contraindication

● Assess lochia ● How many perineal pads she has used in the past 1 to 2 hours and how much drainage was on each pad ● Massage the uterus to help contract ● Check bladder for distention ● May be placenta left preventing contractions ● Check for large blood clots that may prevent atony ● Oxytocin (Pitocin) (help the uterus to contract down)

Postpartum bleeding- action

● Counseling/therapy ● SSRIs (selective serotonin reuptake inhibitors) first line ● Medication management is similar to major depression: a combination of antidepressant medication, antianxiety and or antidepressants medication, adequate sleep and rest, and psychotherapy in an outpatient or inpatient setting ● Ask about SI and harming baby ● Secure bond with your baby ● Self-care : reconnect with friends and family

Postpartum depression- action

● Low bicarbonate levels in the blood are a sign of metabolic acidosis ● Slows the rate of progression of renal failure to ESRD ● Improves nutritional status

CKD metabolic acidosis; decreased bicarb level

● Shortness of breath ● Fatigue or sweating ● Pink tinged sputum ● Sign of heart failure ● Edema ● Diuretics ● Oxygen ● Anticoagulation.

Pulmonary edema

directed toward reducing volume overload, improving ventricular function, and increasing oxygenation. These goals are accomplished through a combination of oxygen and ventilatory support, IV medication, and nursing assessment and interventions. Non-rebreather mask

Clinical management of a patient with acute pulmonary edema due to left ventricular failure

●P ● QRS ●T ● Electrical conduction that begins in the SA node generates a sinus rhythm. Normal sinus rhythm occurs when the electrical impulse starts at a regular rate and rhythm in the SA node and travels through the normal conduction pathway. Normal sinus rhythm has the following characteristics: ● Ventricular and atrial rate: 60 to 100 bpm in the adult ● Ventricular and atrial rhythm: Regular ● QRS shape and duration: Usually normal, but may be regularly abnormal ● P wave: Normal and consistent shape; always in front of the QRS ● PR interval: Consistent interval between 0.12 and 0.20 seconds ● P:QRS ratio: 1:1

Rhythm Strip Analysis

1:1

P:QRS ratio

Consistent interval between 0.12 and 0.20 seconds

PR interval

Normal and consistent shape; always in front of the QRS

P wave

Usually normal, but may be regularly abnormal

QRS shape and duration

● Lack of ADH ● Polydipsia ● Nocturia ● Low urine specific gravity ● Polyuria ● Dehydration ● Confusion ● Hypernatremia

Diabetes insipidus

○ Insufficiency of ADH or loss of sensitivity in nephrons circulating ADH ○ Head Trauma, Brain Tumor, Brain Surgery, CNS Infection

Diabetes insipidus causes

○ Peeing non-stop, crystal clear, cannot have concentrated urine ○ Low urine osmolarity (concentration) ○ Serum Osmolality High ○ Hypokalemia & Hypernatremia ○ Polyuria & Polydipsia ○ 1.001-1.005 Urine Specific Gravity (normal for them)

Diabetes insipidus Signs/Symptoms:

○ Desmopressin (replaces ADH)

Diabetes insipidus treatment

Fluid Deprivation Test (withhold fluid)

Diabetes insipidus testing

● Dyspnea ● Chest pain ● Tachycardia or palpitations ● Early ambulation after surgery ● Compression stockings ● Anticoagulant

Pulmonary Embolism

● Pressure or pain in the eyes ● Visual disturbances ● Headaches ● Seeing halos around lights ● Loss of peripheral vision ● patient may not seek health care until he or she experiences blurred vision or "halos" around lights, difficulty focusing, difficulty adjusting eyes in low lighting, loss of peripheral vision, aching or ● discomfort around the eyes, and headache.

Glaucoma signs and symptoms

● The patient is monitored for life- threatening complications (respiratory failure, cardiac dysrhythmias, VTE [including DVT or PE]) so that appropriate intervention can be initiated. Because of the threat to the patient in this sudden, potentially life- threatening disease, the nurse must assess the patient's and family's ability to cope and their use of coping strategies. ● Maintain respiratory function ● Enhancing physical mobility ● Promote adequate nutrition ● Improving communication ● Decreasing fear and anxiety ● Managing potential complications ● Deep tendon reflexes ● Breathing (SpO2) ● Degree of muscle weakness ● Neurosensory for numbness and tingling ● Ability to swallow and speak

Guillain barre assess

● Numbness or weakness of the face, arm, or leg, especially on one side of the body ● Confusion or change in mental status ● Trouble speaking or understanding speech ● Visual disturbances ● Difficulty walking, dizziness, or loss of balance or coordination ● Sudden severe headache ● Quit smoking ● Anticoagulant and Statin

Ischemic Stroke

● Vital signs ● Calculation of pulse pressure and identification of pulsus paradoxus ● Current weight and any weight gain or loss ● Detection by palpation of the point of maximal impulse, often shifted to the left ● Cardiac auscultation for a systolic murmur and S3 and S4 heart sounds ● Pulmonary auscultation for crackles ● Measurement of jugular vein distention ● Assessment of edema and its severity ● Improve cardiac output & peripheral blood flow ● Increase activity tolerance and improve gas exchange ● Quit smoking ● Medication ● Health diet ● antihypertensives

Cardiomyopathy care plan

● Edema ● Caused by trauma or cast ● Muscle weakness ● Can cause nerve injury ● Pallor ● Sensation of pins and needles ● Can lead to amputation ● Diagnosis of compartment syndrome is based on clinical suspicion, assessment of the 6 P's (pain, poikilothermia, pallor, paresthesia, pulselessness, and paralysis)

Compartment syndrome

● Injury to the frontal regions of the left hemisphere impacts how words are strung together to form complete sentences ● Frontal lobe damage ● Possible right-sided weakness or paralysis of the arm and leg ● Speech ● The cortical area that is responsible for integrating the myriad pathways required for the comprehension and formulation of language is called Broca area. It is located in a convolution adjoining the middle cerebral artery. This area is responsible for control of the combinations of muscular movements needed to speak each word.

Stroke broca’s area

● Severe midepigastric pain. Pain is frequently acute in onset, occurring 24 to 48 hours after a very heavy meal or alcohol ingestion, and it may be diffuse and difficult to localize. It is generally more severe after meals and is unrelieved by antacids. ● Severe midepigastric pain radiating to back ● Nausea and vomiting ● Low serum calcium levels (check for Chevotech and trousseau) ● Abdominal guarding; rigid, board-like abdomen, and abdominal pain

Acute pancreatitis assessment

● Stop drinking alcohol ● Sodium restriction ● Start detox in order to completely stop drinking alcohol and may need an alcohol treatment program. ● Eat a sodium diet, avoid infections, use over the counter medications carefully

Alcoholic hepatitis teaching

● Ascites enlargement causes difficulty breathing ● Edema will have fluid trapped in the body closes to affected area leading to dyspnea

cirrhosis ascites dyspnea

● kidneys are no longer properly removing wastes and extra fluid from the body. ● Swelling, SOB, weight gain ● Acute or urgent dialysis is indicated when there is a high and increasing level of serum potassium, fluid overload, or impending pulmonary edema, increasing acidosis, pericarditis, and advanced uremia. It may also be used to remove medications or toxins (poisoning or medication overdose) from the blood or for edema that does not respond to other treatment, hepatic coma, hyperkalemia, hypercalcemia, hypertension, and uremia.

Dialysis hypertension edema

● Difficulty moving the leg. ● Inability to stand or walk. ● Pain ● Edema ● Bruising. ● Deformity (abnormal shape) of the thigh

Fractured femur assessment

● 5% dextrose and normal saline (0.9%) ● loss of glucocorticoids results in hypoglycemia with complaints of muscle weakness, lethargy, and GI symptoms including anorexia, weight loss, nausea and vomiting. ● Must take medications daily

Addison’s crisis hypoglycemia

● Nausea ● Vomiting ● Myelosuppression ● SIADH, decrease renal perfusion, precipitate end products after cell lysis, and cause interstitial nephritis ● Cardiac Toxicity ● Testicular and ovarian function can be affected by chemotherapeutic agents, resulting in possible sterility. ● Chemotherapy-induced neurotoxicity, a potentially dose-limiting toxicity, can affect the central nervous system, peripheral nervous system, and/or the cranial nerves ● Fatigue ● Nausea and vomiting ● Bone marrow suppression ● Alopecia and nail loss ● Weight gain or loss ● Anorexia ● Fatigue ● Decline in functional status ● Mucositis ● "Chemo" Brain

Chemo side effects

● Many patients with cancer experience difficulty with remembering dates, multitasking, managing numbers and finances, organization, face or object recognition, inability to follow directions, feeling easily distracted, and motor and behavioral changes.

Chemo Brain

● A neurogenic bladder results in urinary retention or leakage. The patient may describe a sensation of bladder fullness or incomplete bladder emptying. The pharmacological treatment of urinary retention is administration of a cholinergic agonist ● From Google: ● Many multiple sclerosis (MS) patients are affected by urinary retention. Common causes include neurogenic underactive bladder and/or bladder outlet obstruction from detrusor sphincter dyssynergia ● Muscle weakness/spasticity cause urinary rention ● May need to self cath ● Baclofen (antispasmodic medication) reduce spasms and bladder spasm ● Chronic UTI

Multiple sclerosis urinary retention

● Give antibiotics (after labs show bacterial) ● Low lighting ● Treat fever ● prevent Intercranial pressure (promote fluids) ● prevent respiratory problems ● Broad Spectrum Antibiotics

Meningitis care

● Correct or eliminate any reversible causes of kidney failure ● I&O ● Monitor vital signs ● Maintain proper electrolyte balance ● Fluid & Electrolyte Imbalances

Acute renal failure priorities

● Respiratory assessment ● Possibility for mechanical breathing

Acute respiratory distress priority findings

● Make them comfortable ● Manage pain. ● Palliative and hospice care. ● No life saving efforts

End of life plan of care

● Hypersecretion of cortisol (hydrocortisone) by the adrenal gland ● Moon-faced appearance ● Hyperglycemia ● Weight gain, slow healing of minor cuts, and bruises. ● Thin skin ● Muscle wasting and osteoporosis ● Hirsutism (excessive growth of hair on the face) ● Ecchymoses (bruises) and striae develop ● Dexamethasone ● Ketoconazole ● High Cortisol

Cushing syndrome

○ Moon Face & Buffalo Hump ○ Central Obesity (thin extremities) ○ Thin Fragile Skin, Easily Bruised, Abdominal Stretch Marks ○ Acne ○ Hirsutism ○ Hypertension & Hyperglycemia ○ Infertility

Cushing syndrome Signs/Symptoms

closely resembles severe pulmonary edema. The acute phase of ARDS is marked by a rapid onset of severe dyspnea that usually occurs less than 72 hours after the precipitating event. Arterial hypoxemia that does not respond to supplemental oxygen is characteristic.

Acute respiratory distress syndrome - ARDS

● pH under 7.35 ● PCO2 over 45 ● HCO3 over 30

Respiratory acidosis

● Loss of gastric secretions ● Loss of hydrochloric acid (HCI) ● pH over 7.45 ● HCO3 higher than 26

NGT suction - metabolic alkalosis

● Opioid therapy (morphine, fentanyl, codeine, oxycodone, hydromorphone). IV and oral. ● Most common plan of care is palliative sedation

Cancer intractable pain plan of care

● Patients who have undergone surgical valvuloplasty or valve replacements are admitted to the ICU. Care focuses on recovery from anesthesia and hemodynamic stability. Vital signs are assessed every 5 to 15 minutes and as needed. After the patient has recovered from anesthesia and sedation, is hemodynamically stable without IV medications, and has stable physical assessment parameters, he or she usually is transferred to a telemetry unit, typically within 24 to 72 hours of surgery. The nurse educates the patient about anticoagulant therapy, explaining the need for frequent follow-up appointments and blood laboratory studies ● Pig- lifelong; cow 3 months. ● Weekly INR draws to determine if dose should be increased or decreased to maintain therapeutic range. ● Report bruising and excessive bleeding ● Teach the necessity for prophylactic antibiotic therapy before any invasive procedure (Even to the dentist)

Valve replacement teaching

● Establish rapport and trust ● Asks about hallucinations ● Distract ● Lower environment stimuli ● Monitor suicidal ideation ● 1st or 2nd generation antipsych - MED

Schizophrenia care

● Allow the 5 steps of grieving (DABDA) ○ Denial ○ Anger ○ Bargaining ○ Depression ○ Acceptance ● Active listening ● Offer supportive presence

Grief therapeutic response

○ Denial ○ Anger ○ Bargaining ○ Depression ○ Acceptance

5 steps of grieving

○ triggering (event) ○ escalation (movement toward a loss of control) ○ crisis (loss of control) ○ Recovery (Regain control) ○ Post crisis (reconciliation)

Aggression response

■ Approach in a nonthreatening, calm manner ■ Convey empathy ■ Encourage verbal expression of angry feelings ■ Use clear, simple, short statements ■ Allow client time for self-expression ■ Suggest client go to a quieter area ■ Offer PRN medications if ordered ■ Suggest physical activity, such as walking

○ triggering (event)

■ Take control withdrawal ■ Provide directions in a firm, calm voice ■ Direct client to time-out in quiet room or area ■ Communicate that aggressive behavior is not acceptable ■ Offer medication if refused in triggering phase ■ Show of force

○ escalation (movement toward a loss of control)

■ Management of aggressive behavior: crisis phase ■ Take charge of situation for safety ■ Restraint ● Only staff with training should participate in restraint. ● 4-6 trained staff members are needed. ● Inform client that behavior is out of control and staff is taking measures for safety

○ crisis (loss of control)

● failure to listen/follow direction ● difficulty playing quietly/sitting still ● disruptive, impulsive behavior ● distractibility to external stimuli ● excessive talking shifting from one unfinished task to another

ADHD exam

■ Talk about situation or trigger ■ Help client relax or sleep ■ Help client explore alternatives to aggressive behavior ■ Assess and document any injuries ■ Debrief staff ■ Encourage other clients to talk about feelings ● Do not discuss aggressive client in detail with other clients

○ Recovery (Regain control)

■ Remove patient from restraint or seclusion as soon as criteria met ■ Calmly discuss behavior (no lecturing or chastising) ■ Give client feedback for regaining control ■ Reintegrate client as soon as he or she is able to participate

○ Post crisis (reconciliation)

● pH:7.35-7.45 ● PCO2(Respiratory):35-45mmHg ● HCO3(kidneys):22-26mmHg

ABGs

● Patient repeatedly does things multiple times and can’t fight the urge to complete them ● Patient has persistent thoughts about bacteria, germs and dirt ● Help encourage participation in social activities

Obsessive compulsive disorder

Out of touch w/ reality

psychosis

- Delusions - Anxiety/agitation - Hallucinations - Auditory (most common) - Jumbled speech - Disorganized behavior

Schizophrenia Positive S/S

- Flattened/bland effect ( Affective Flattening) - Lack of energy - Reduced speech - Avolition (lack of motivation) - Anhedonia ( Not capable of feeling joy or pleasure) - Lack of social interaction

Schizophrenia Negative S/S

- Don’t address the hallucinations - Be compassionate - Bring the conversation back to reality - Do not argue with the client - Provide safety for the client & the staff

Schizophrenia therapeutic communication

indicates that the fetus has passed meconium (first stool) before birth

Meconium-stained amniotic fluid

the development of meconium aspiration syndrome (MAS) in the newborn

The major risk associated with meconium-stained amniotic fluid is ...

used in neonatal with MAS can lead to improved oxygenation, decreased severity of respiratory failure, and reduced need for ECMO

surfactant

FHR is defined as a visually abrupt (onset to nadir less than 30 seconds) decrease in FHR below the baseline

Variable deceleration

The decrease is at least 15 beats/minute or more below the baseline, lasts at least 15 seconds, and returns to baseline in less than 2 minutes from the time of onset

Variable deceleration 15x15

occur any time during the UC phase caused by compression of the umbilical cord

Variable decelerations

indicate repetitive disruption in the fetus’s oxygen supply. This can result in hypoxemia and metabolic acidemia.

Recurrent variable decelerations

most commonly found during the transition phase of first stage labor or the second stage of labor as a result of umbilical cord compression and stretching during fetal descen

Variable decelerations

* Maternal position with cord between fetus and maternal pelvis * Cord around fetal neck, arm, leg, or other body part * Short cord * Knot in cord * Prolapsed cord

Umbilical cord compression caused by

1. Change maternal position (side to side, knee-chest). 2. Discontinue oxytocin if infusing. 3. Administer oxygen at 8 to 10 L/minute by nonrebreather face mask. 4. Notify physician or nurse-midwife. 5. Assist with vaginal or speculum examination to assess for cord prolapse. 6. Assist with amnioinfusion if ordered. 7. Assist with birth (vaginal assisted or cesarean) if the pattern cannot be corrected.

Variable Decelerations interventions

* Administer oxygen by nonrebreather face mask at a rate of 10 L/minute for approximately 15 to 30 minutes. * Assist the woman to a side-lying (lateral) position. * Increase maternal blood volume by increasing the rate of the primary IV infusion.

Abnormal Fetal Heart Rate Patterns interventions (basic)

* Increase the rate of the primary IV infusion. * Change to lateral or Trendelenburg positioning. * Administer ephedrine or phenylephrine per unit protocol or standing order if other measures are unsuccessful in increasing blood pressure.

Maternal hypotension interventions

* Reduce or discontinue the dose of any uterine stimulants in use (e.g., oxytocin [Pitocin]). * Administer a uterine relaxant (tocolytic) (e.g., terbutaline [Brethine]).

Uterine tachysystole interventions

* Use open-glottis pushing. * Use fewer pushing efforts during each contraction. * Make individual pushing efforts shorter. * Push only with every other or every third contraction. * Push only with a perceived urge to push (in women with regional anesthesia).

Abnormal fetal heart rate pattern during the second stage of labor

baseline rate baseline variability accelerations decelerations changes or trends over time

five essential components of the FHR tracing

baseline FHR greater than 160 beats/minute for 10 minutes or longer

Tachycardia FHR

* Fetal tachycardia (>160 beats per minute [bpm]) * Maternal fever (≥38° C [100.4° F]) * Foul- or strong-smelling amniotic fluid * Cloudy or yellow amniotic fluid

Signs Associated With Intrapartum Infection

* Verbal expression of tiredness, fatigue, or exhaustion * Verbal expression of frustration with a prolonged, unproductive labor (“I can't go on any longer. Why doesn't the doctor just take the baby?”) * Ineffectiveness of or inability to use coping techniques (e.g., patterned breathing) that she previously used effectively * Changes in her pulse, respiration, and blood pressure (increased or decreased)

Assess the mother for signs and symptoms of exhaustion:

* Autonomic hyperactivity (e.g., tachycardia, diaphoresis, elevated blood pressure) * Severe disturbance in sensorium (e.g., disorientation, clouding of consciousness) * Perceptual disturbances (e.g., visual or tactile hallucinations) * Fluctuating levels of consciousness (e.g., ranging from hyperexcitability to lethargy) * Delusions (paranoid), agitated behaviors, and fever (temperatures of 100° to 103° F)

alcohol withdrawal delirium

Provides safe withdrawal and has anticonvulsant effects; chlordiazepoxide and diazepam are cross-addicting

Chlordiazepoxide (Librium)

Has anticonvulsant qualities

Diazepam (Valium)

Not metabolized in the liver

Oxazepam (Serax) Lorazepam (Ativan)

Oxazepam (Serax) Lorazepam (Ativan) Diazepam (Valium) Chlordiazepoxide (Librium)

Benzodiazepines- sedative

Carbamazepine (Tegretol), or valproic acid (Depakote) Magnesium sulfate Thiamine (vitamin B1)

Seizure Control

Helps reduce withdrawal symptoms and the risk of seizures

Carbamazepine (Tegretol), or valproic acid (Depakote)

Increases effectiveness of vitamin B1 and helps reduce postwithdrawal seizures

Magnesium sulfate

Given intramuscularly or intravenously before glucose loading to prevent Wernicke’s encephalopathy

Thiamine (vitamin B1)

Beta-blockers (propranolol) or alpha-blockers (clonidine) Folic acid Multivitamins

Alleviation of Autonomic Nervous System (ANS)

May help reduce ANS hyperactivity (e.g., tremor, tachycardia, elevated blood pressure, diaphoresis)

Beta-blockers (propranolol) or alpha-blockers (clonidine)

Most effective in short time

Folic acid

Malabsorption due to heavy long-term alcohol abuse causes deficiencies in many vitamins

Multivitamins

intense tremors; cramps; vomiting; increases in heart rate, blood pressure, and temperature; and, in some individuals, grand mal seizures, particularly in people with a history of seizures.

Early symptoms of withdrawal (ETOH)

appear 7 to 48 hours after cessation of alcohol intake and continue for 5 to 7 days

Early symptoms of withdrawal

* Alone: Tell survivors they are not alone. Intimate partner violence happens to many others, and help is available. * Believe in the survivors; they are not to blame for what happened to them. Believing in them helps empower them to take the first step toward caring for themselves. * Confidentiality counts. Limit access to the patient’s personally identifiable information to a need-to-know basis. * Document the situation thoroughly. * Educate the survivor. Teach about the legal aspects and available community resources. * Safety is the highest priority, especially if the survivor is planning to leave the relationship. Ensure that the survivor has a safety plan.

INTERVENTIONS FOR SURVIVORS OF INTIMATE PARTNER VIOLENCE

reduce isolation, empower through accurate knowledge about abuse and about community resources, and attend to safety needs.

Effective nursing interventions intimate partner violence

Dull, puffy skin; coarse, sparse hair; periorbital edema; and prominent tongue.

Common features of myxedema.

severe hypothyroidism

myxedema

Diagnostic studies often show osteopenia or osteoporosis, iron-deficiency anemia, and an elevated blood urea nitrogen level from marked intravascular volume depletion and abnormal renal function. ▪ Lack of potassium in the diet and loss of potassium in the urine lead to potassium deficiency. Manifestations of potassium deficiency include muscle weakness, cardiac dysrhythmias, and renal failure. ▪ Leukopenia, hypoglycemia, hyponatremia, hypomagnesemia, and hypophosphatemia may also be present.

Anorexia Nervosa

metabolic and endocrine abnormalities result from the reaction of the body to the malnutrition associated with starvation.

anorexia nervosa

potassium depletion and hypokalemia often are seen as a result of vomiting and laxative or diuretic abuse.

bulimia nervosa

associated with hypertension, cardiac problems, sleep apnea, difficulties with mobility, and diabetes mellitus.

Excess weight

a. Mild: BMI over or equal to 17 kg/m2 b. Moderate: BMI 16 to 16.99 kg/m2 c. Severe: BMI 15 to 15.99 kg/m2 d. Extreme: BMI under 15 kg/m2

under weight BMI

Obstruction of appendix associated with inflammation, perforation, and peritonitis; patient often lies on back or side with knees flexed to decrease pain

Appendicitis

Sharp pain directly over irritated peritoneum 2-12 hours after onset. Often pain localizes in right lower quadrant between anterior iliac crest and umbilicus. Associated with rebound tenderness. Accompanied by anorexia, nausea, and vomiting.

Appendicitis

Obstruction of the cystic duct causing inflammation or distention of gallbladder

Cholecystitis

Murphy's sign: Apply gentle pressure below right subcostal arch and below liver margin. Sharp pain and increased respiratory rate occur when patient takes a deep breath (Seidel et al., 2015).

Cholecystitis

Damage to small intestinal mucosa from ingestion of barley, oats, rye, and wheat

Celiac disease

Foul-smelling diarrhea, abdominal distention, and symptoms of malnutrition may be present.

Celiac disease

Disruption in normal bowel pattern that may occur with opioid use or inadequate fiber and fluid intake

Constipation

Generalized discomfort accompanied by distention and palpation of a hard mass in left lower quadrant. Nausea and vomiting may begin after several days.

Constipation

Gastric ulcer: Dull epigastric pain, localized midline. Early satiety; not usually relieved by food or antacids. Duodenal ulcer: Pain is episodic, lasting 30 minutes to 2 hours. Pain is located in midline epigastric region; described as aching, burning, or gnawing. Typically occurs 1-3 hours after meals and at night (12 midnight to 3 am). Often relieved by food or antacid.

Peptic ulcers (gastric and duodenal)

Damage of GI mucosa at any area of GI tract; may be caused by bacterial infection (Helicobacter pylori) or nonsteroidal antiinflammatory drugs; thought to be unrelated to stress; aggravated by smoking and excessive alcohol use

Peptic ulcers (gastric and duodenal)

Generalized severe abdominal distention, nausea, and vomiting. Decreased or absent bowel sounds.

Paralytic ileus

Obstruction of small bowel that occurs after abdominal surgery or use of anticholinergic medications

Paralytic ileus

Steady severe epigastric pain close to the umbilicus radiates to the back. Associated with abdominal rigidity and vomiting. Pain is unrelieved by vomiting and worsens by lying supine.

Pancreatitis

Inflammation of pancreas associated with alcoholism and gallbladder disease

Pancreatitis

Inflammation of stomach and intestinal tract

Gastroenteritis

Generalized abdominal discomfort accompanied by anorexia, nausea, vomiting, diarrhea, and abdominal cramping.

Gastroenteritis

Steady colicky pain in right lower quadrant, with cramping, tenderness, flatulence, nausea, fever, and diarrhea. Often associated with bloody stools, weight loss, weakness, and fatigue.

Crohn's disease

Chronic inflammatory lesion of the ileum

Crohn's disease

Dull epigastric pain, localized midline. Early satiety; not usually relieved by food or antacids.

Gastric ulcer

Pain is episodic, lasting 30 minutes to 2 hours. Pain is located in midline epigastric region; described as aching, burning, or gnawing. Typically occurs 1-3 hours after meals and at night (12 midnight to 3 am). Often relieved by food or antacid.

Duodenal ulcer

heart rate is 40 to 60 beats/minute

AV node block

HR is 20 to 40 beats/minute.

His-Purkinje system block

free