I. AGINA/MI/IV THERAPY
CORONARY
HEART - PUMP BLOOD - REQT: O2
INCREASE WORKLOAD OF THE HEART - INCREASE O2 DEMAND - MYOCARDIAL ISCHEMIA (DECREASE O2
SUPPLY TO THE HEART)
MOTHER TERM OF ANGINA/MI - ACS - ACUTE CORONARY SYNDROME
WHAT: MYOCARDIAL ISCHEMIA
CLINICIAL SYMPTOM - LEVINE SIGN - CHEST CLINCHING\
TYPES: ANGINA/MI
PRIORITY: OXYGENATION OF THE HEART
ANGINA - CHEST PAIN
WHY: MYCARDIAL ISCHEMIA
RFX: *ATHEROSCLEROSIS - CORNARY ARTERY DISEASE (CAD) - NARROWING AND HARDENING OF
CORONARY ARTERIES - DECREASE BLOOD FLOW - ANAEROBIC RESPIRATORY - LACTIC ACID - TOXIC TO
THE TISSUE
A. INFLAMMATION - PAIN - AGINA - REVERSIBLE
B. INJURY - NECROSIS - INFARCTION - MI - IRREVERSIBLE
3 Es OF ANGINA (BLOOD FLOW AWAY FROM THE HEART - MYOCARDIAL ISCHEMIA) - SITUATIONS THAT
INCREASES CHANCES OF ANGINA
EMOTIONAL STRESS - DIRECTS THE BLOOD FLOW TO THE BRAIN
EXCESSIVE EXERCISE/ACTIVITY - DIRECTS THE BLOOD FLOW TO THE MUSCLES
EXCESSIVE EATING - DIRECTS BLOOD FLOW TO THE GIT
PRIORITY PROBLEM THAT CAUSES ANGINA?
CAD
EMOTIONAL STRESS
DX: ANGIOGRAPHY - VISUALIZE WITH THE USE OF DYE/CONTRAST MEDIUM - RADIOACTIVE IODINE CHECK SEAFOOD ALLERGY
TREATMENT:
1.OXYGEN, REST
2.DRUG OF CHOICE - NITROGLYCERIN - VASODILTOR
A. CORONARY VASODILATION - INCREASE O2 FLOW TO THE HEART
B. PERIPHERAL VASODILATION - DECREASE BLOOD PRESSURE - DECREASE WORKLOAD - DECREASE O2
DEMAND
SIDE EFFECTS (EXPECTED) - (VASODILATION(HOT) BLURRY VISION, DIZZINESS , HEADACHE
(PARACETAMOL)
MGT: SAFETY - AVOID DRIVING, OPERATING HEAVY MACHINERIES, ALCOHOL
ADVERSE EFFECT (UNEXPECTED): ORTHOSTATIC HYPOTENSION - DROP IN BP WTH RESPECT TO RAPID
CHANCE IN POSITION (MIN: 20 MMHG)
MGT: CHANGE POSITION SLOWLY, DANGLE LEGS AT THE BEDSIDE
FORMS OF NITROGLYCERIN :
1.SUBLINGUAL - FASTER ABSORPTION (HIGHLY VASCULARIZED, NO FIRST PASS (PASSES THE LIVER)
-MAX 3 TABS, 5 MIN INTERVAL : RATIO: >15MINS MI! - MORPHINE
2.PATCH - INTADERMAL - LONGER AND SUSTAINED
ROTATE SITES - RATIO: PREVENT OVERDOSE - HYPOTENSION
3.INTRAVENOUS - FASTEST ROUTE - RULE: ACCURATE ADMINISTRATION: USE INFUSION PUMP REQUIRED
ANGINA TREATMENT
BETA BLOCKERS, CALCIUM CHANNEL BLOCKERS, ISDN/ISMN
LIFESTYLE MODIFICATIONS
PTCA - PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOGRAPHY/PLASTY (REPAIR OF THE CORONARY
BLOOD VESSEL)
MI - CHEST PAIN
WHY: MYOCARDIAL INFRACTION
3 Is OF MI
1.ISCHEMIA (ANEROBIC)
2.TISSUE INJURY
3.INFARCTION (PERMANENT DAMAGE)
DX: CARDIAc ENZYMES - BEST TEST FOR MI
TROP I (RETURNS TO NORMAL 2-3 WEEKS) AND CKMB (RETURNS TO NORMAL 24-48HRS
MGT FOR MI: MONA
1.MORPHINE - DEPRESSANT - DECREASE BP AND HR - DECREASE WORKFLOAD OF THE HEART DECREASE CHANCES OF FURTHER DAMAGE
2.O2
3.NITROGLYCERIN
4.ANTICOAGULANTS - HEPARIN, ASPIRIN, ENOXAPARIN, WARFARIN
PRIORITY NURSING ACTION FOR MI: MORPHINE (KUNG ANONG MAS MAKAKATULONG IS THE
PRIORITY)
ANGINA
MYOCARDIAL INFARCTION
MYOCARDIAL ISCHEMIA
MYOCARDIAL NECORSIS
REVERSIBLE
IRREVERSIBLE
<15 MINS
>15 MINS
LEFT SIDED RADIATION (JAW, NECK, SHOULDER, ARM
AND BAC
LEFT SIDED RADIATION, HAVE LEFT AND RIGHT
RADIATION IF SEVERE
MAIN MGT: NITROGLYCERIN
MAIN MGT: MORPHINE
INTRAVENOUS THERAPY
WHAT: INTRAVENOUS ROUTE FOR FLUIDS OR MEDICATIONS
WHY: FASTEST ROUTE – EMERGENCY CASES, IMMEDIATE EFFECT
WHERE: IDEAL VEIN – NON DOMINANT, DISTAL, AWAY FROM THE JOINT, SOFT AND ELASTIC VEINS
TYPES OF IV FLUIDS – FLUID MOVE VIA OSMOSIS – LOWER TO HIGHRT CONCENTRATION
1. ISOTONIC – EQUAL CONCENTRATION – NO MOVEMENT OF WATER
PNSS - UNIVERSAL DILUENT
PLR – VOLUME EXAPANDER – INCREASES FLUIDS – SHOCK, CONTAINS SODUIN BICARB (ALAKLINE) –
TREAT METABOLIC ACIDOSIS – CARDIAC ARREST
D5W – CONTAINS GLUCOSE – FOR PATIENTS WITH HYPOGLYCEMIA
2. HYPERTONIC – HIGHER CONCENTRATION – SHRINK
EXAMPLES: D5 PLUS OTHER SOLUTIONS (D10W, D5LR, D5NSS)
3. HYPOTONIC – LOWER CONCENTRATION – CELLS SWELL
EXAMPLES: SOL <0.9%NACL = 0.33, 0.67, 0.45% NSS
IV REACTIONS
4 PX WITH IV RXNS. WHO IS YOUR PRIORITY PATIENTS?
1.
2.
3.
4.
PATIENT WITH RASHES AT THE CHEST – SIGN OF AIR EMBOLISIS
PATIENT WITH DOB AND CRACKLES – AIRWAY BREATHING – FLUID OVERLOAD
PATIENT WITH RED AND WARM TO TOUGH IV SITE - PHLEBITIS
PATIENT WILL COOL AND WET DRESSING – INFILTRATION
IV REACTIONS – MOST SEVERE FIRST
1. AIR (MIN 10 ML) OR CATHETHER EMBOLISMS – OBSTRUCTS BLOOD FLOW – NO BLOOD NO O2 –
ISCHEMIA
SSX: RASHES/PETICHAE – AT THE CHEST, CHEST PAIN, DIAPHORESIS, DOB, TACHYCARDIA, AND
TACHYPNEA
MGT: STOP, POSITION: LEFT SIDE LYING TRANDELENBURG POSITION (TRAP EMBOLI AT THE RIGHT
ATRIUM), O2, MORPHINE, VS, REPORT, CXR – TO CONFIRM LOCATION
2. FLUID OVERLOAD – RAPID INFUSION
MGT: PREVENTIVE POTENTIAL – (NO SSX YET) – INFUSION PUMP
MGTL IF =SSX = SLOW DOWN/KVO – 10-15 DROPS/MIN
SSX: CRACKLES, DISTENDED J.VIEN, HYPERTENSION, TACHYCARDIA, TACHPNEA
3. PHEBITIS – INFLAMMATION OF VEIN
WHY: POOR HYGIENE – BOTH RN AND PX
SSX: REDNESS (RUBOR), WARM TO TOUCH (CALOR), SWELLING (TUMOR), PAIN (DOLOR)
MGT: STOP. REMOVE. RESTART – OPPOSITE HAND (IF DON’T HAVE AV FISTULA) OR SAME HAND
PROXIMAL, WAM COMPRESS (VASODILATION – PROMOTES BLOOD FLOW – INCREASE HEALING)
4. INFILTRATION – OUT OF THE VEIN
WHY: TOO MUCH MOVEMENT OF PATIENT – SPLINT/PADDED BOARD
SSX: COLD TO TOUCH, WET DRESSING, SWELLING AND PAIN
MGT: STOP, REMOVE, RESTART, OPPSITE
ENDOCRONE
DIABETES MILLETUS

THE NUMBER OF PEOPLE WITH DIABEES ROSE FROM 108 MILLION IN 1980 TO 422 MILLION IN
2014
DIABETES IS A MAJOR CAUSE





BLINDNESS
KIDNEY FAILURE
HEART ATTACKS
STROKE
LOWER LIMB AMPUTATION

BETWEEN 2000 AND 2016, THERE WAS A 5% INCREASE IN PREMATURE MORTALITY FROM
DIABETES

IN 2019, AN ESTIMATED 1.5 ILLION DEATHS WERE DIRECTLY CAUSED BY DIABETES. ANOTHER 2.2
MILLION DEATHS WERE ATTRIBUTABLE TO HIGH BLOOD GLUCOSE IN 2012.
ISLETS OF LANGERHANS
CLASSIFIED WITH CELLS
ALPHA – 20% GLUCAGON – INCREADSE BLOOD GLUCOSE LEVEL
BETA – 70% - INSULIN – LOWER BLOOD SUGAR LEVEL – TRANSPORT GLUCOSE TO THE CELLS
DELTA – SOMATOSTATIN –
MOST IMPORTANT CARBOHYDRATES – GLUCOSE
TAKING LOT OF GLUCOSE WILL NOT MAKE YOU SUFFER HYOPERGLYCEMIA – RULE INSULIN –
GLYCOGENESIS – FORM CONVERT GLUCOSE THAT BECOME GLYCOGEN – GO TO MUSCLES – LIVER
WHEN WE SUFFER HYPOGLYCEMIA – IT ACTIVATED A-GLUCAGON – UNDERGO GLYCOGENOLYSIS –
RECONVERT GLYCOGEN TO GLUCOSE
DIABETES MILLETUS – MOST COMMON METABOLIC DISORDER
ESCAT CAUSE: UNKNOWN
CLASSIFICATIONS:
A. ACQUIRED-
TYPE I
TYPE II
ZERO INSULIN
THIN
UNSTABLE
DIABETIC KETOACIDOSIS
INCREASE BLOOD SUGAR
OBESE
STABLE
HYPERGLYCEMIC,
HYPEROSMOLAR, NONKETOTIC
B. SECONDARY
GESTATIONAL
3RD MONTHS PREGNANCY –
INCREASE HUMAN PLACENTAL
LACTOGEN – ANTAGONIST OF
INSULIN – DECREASE LEVEL OF
INSULIN – INCREASE BLOOD
SUGAR – HYPERGLYCEMIA
CUSHING’S RELATED
INCREASE GLUCOCOTICOIDS –
COME FORM ADRENAL CORTEX
– CORTISOL
*INCREASE GLUCOCORTICOIDS
– INCREASE GLUCONEOGENISIS
– FORMATION OF GLUCOSE
FROM NEW SOURCES –
CONVERTS FATS AND PROTEIN
TO GLUCOSE - HYPERGLYCEMIA
4 CARBOHYDRATES – GLUCOSE - GLUCOGENESIS
9 FATS – FATTY ACIDS
4 PROTEIN – AMINO ACIDS
PATHOPHYSIOLOGY OF DIABETES MILLETUS
GLUCOSE DOES NOT GO INTO CELL
KULANG PAGPASOK
GLUCOSE STAYS ON THE BLOOD THAT CAUSES HYPERGLYCEMIA
3PS
POLYURIA – osmotic diuresis because of glucosuria
POLYDIPCIA – TOTAL DEHYDRATION
POLYPHAGIA – CELLULAR STARVATION
INCREASE GLUCOSE LEVEL – INCREASE VISCOSITY – INCREASE OSMOLARITY – CAN CREATE OSMOTIC
CHANGES OR FLUID SHIFTING
OSMOSIS – MOVEMENT OF SOLVENT OR WATER FROM LOWER CONCENTRATION TO AREA OF HIGHER
CONCENTRATION
HIGHER CONCENTRATION IS IN THE BLOOD BECAUSE OF GLUCOSE
OSMOSIS – DECREASE WATER – INCREASE BLOOD VOLUME – FLUID VOLUME EXCESS
INTRACELLULAR DEHYDRATION – CELL TO BLOOD
FLUID VOLUME EXCESS – INCREASE FUNCTIONING OF SYSTEM – TACHYCRDIA - INCREASE PRESSURE OF
KIDNEYS – URINATION OF PATIENT – GLUCOSE WILL COME OUT – GLUCOSURIA –
GLUCOSE CAN EXERT OWN OSMOTIC PRESSURE – POLYURIA
EVERY PUMP OF HEART 22% OF BLOOD GOES DIRECTLY TO KIDNEY
EXTRACELLULAR DEHYDRATION – EXPEL OF WATER
ICD AND ECD – TOTAL DEHYDRATION – THIRST IS FIRST DEFENSE
Cellular Starvation
G
Type 1 – no insulin – no glucose to cell – cellular starvation or deprivation – cause a patient to be weak –
BODY WILL ACTIVATE PRIMARY COMPENSATORY MECHANISM BUT FALSE COMPENSATION – THE
PRIMARY COMPENSATION AGAINST STARVATION IS HUNGER – PERSISTENT OR EXCESSIVE HUNGER
THAT WE CALL POLYPHAGIA – GIVE SUBCU INSULIN WITHIN 30 MINS TO 3 HOURS – IF DID NOT GIVE
INSULIN , ACTIVATIO OF SECONDARY DEFENSE AGAINST CELLULAR STARVATION
SECONDARY DEFENSE AGAINST CELLULAR STARVATION – GLUCOCORTICOIDS – GLUCONEOGENESIS –
PROTEIN AND FATS BECOME GLUCOSE THAT MIGHT CAUSE HYPERGLYCEMIA
ws
FATS COVNERT TO GLUCOSE – WASTE PRODUCT IS KETONES – INCREASE KETONE BODY TO BLOOD –
KETONE LOW PH – ACIDOSIS – SUFFER METABOLIC ACIDOSIS – DIABETIC KETOACIDOSIS
PROFOUND WEAKNESS – ADDISON AND TYPE 1 DM
GIVE TYPE 1 INSULIN
DIABETIC KETOACIDOSIS – IS BECAUSE OF CELLULAR STARVATION
SYMPTOMS
1.
2.
3.
4.
5.
6.
ABDOMINAL PAIN
WEAK AND THREADY PULSE
3PS
FRUITY ODOR BREATH OR ACETONE BREATH
KUSSMUS BREATHING – DEEP AND RAPID BREATHING – RESPIRATORY DEPRESSION
ALTERED LEVEL OF CONSCIOUSNESS – KETOTIC COMA
ABNORMAL ACID – KETONES – NEEDED 300 TO 600 CC OF URINE TO BE FLUSHED
PRIMARY ACID – CARBONIC ACID – WATER DISSOLVES CARBON DIOXIDE RESULT IS H2CO3 (CARBONIC
ACID) – CONTROLS ACID WASTE BALANCE ABG – MANY CARBON DIOXIDE – RESP ACIDOSIS – PRIMARY ACID IS CARBONIC ACID
MGT OF INSULIN: IV INSULIN – REGULAR INSULIN – HAS LEAST ALLEGIC REACTION AND CLEAR INSULIN
COMPLICATIONS:
HYPOGLYCEMIA
HYPOKALEMIA
EDEMA
COMLICATIONS FOR DM
*100% OF UNCONTROLLED DM HAS HYPERTENSION
ACUTE COMPLICATIONS
TYPE I DKA – CAUSE CELLULAR STARVATION – COMA – KETOTIC COMA
TYPE II – H(YPERGLYCEMIC)H(YPEROSMOLAR)N(ONKETOTIC)C(OMA) – BLOOD SUGAR LEVEL 600 – 1000
MG/DL – MIGHT DEHYDRATE ALL CELLS EVEN BRAIN – CEREBRAL DEHYDRATION – POSSIBLE COMA –
MGT: HYPOTONIC SOLUTION
CHRONIC COMPLICATIONS
HYPERGLYCEMIA – HIGH VISCOSITY (SLUGGISH BLOOD FLOW) – LEAD TO MACRO AND MICRO
SECRETION
*CIRCULATION PROBLEMS – BECAUSE OF HIGH PRESSURE OF HEART AND HIGH VISCOSITY OF BLOOD –
HYPERTENSION -*ATHEROSCLEROSIS – CAUSE OF HIGH VISCOSITY OF BLOOD THERE CHANCE THAT FATS
MAYBE DEPOSITED IN BLOOD VESSEL – CVA – CORONARY ARTERY DISEASE – PERIPHERAL VASCULAR
DISORDER - * NEPHROPATHY – MICRO CIRCULATION – POSSIBLE KIDNEY FAILURE - *DIABETIC
IMPOTENCE (PENIS) – BECAUSE OF VISCOSITY OF BLOOD THERE WILL BE DECREASE OF BLOOD SUPPLY
IN THE PENIS DURING SEXUAL INTERCOURSE - *DIABETIC FOOT ULCERS – BECAUSE IT IS FAR FROM
HEART - *RETINOPATHY - *NEUROPATHY – PARESTHESIA
TRIAD OF MANAGEMENT OF DM
DIET – LOW CALORIC - HIGH FIBER (THAT CAN DECREASE SUGAR LOW CAUSE THEY FLUSH OUT EXCESS
GLUCOSE) – COMPLEX CARBOHYDRATES – BROWN RICE HAS HIGH FIBER
BEST DIET FOR DIABETICS
1.
2.
3.
4.
PRUDENT DIET (CARBS 50%, FATS 30% AND PROTEIN 20%)
CALORIC SUBSTITUTION
CALORIC COUNTING (*1 CUP OF RICE IS 200 CALORIES)
INVERTED
ACTIVITY –
1. ENHANCES GLUCOSE UPTAKE BY THE CELLS
2. DECRESES INSULIN REQUIREMENTS
MUST BE DONE: WITHIN 2 HOURS AFTER EATING
3. OTHER BENEFITS – ALLOWS ADDITIONAL SNACKS – MAINTAINS BLOOD CHEM
MEDICATIONS
TYPE II
ORAL HYPOGLYCEMIC AGENTS – IF PANCREAS IS FUNCTIONAL – GIVE WITHIN MEALS
BETA – INCREASE INSULIN
ALPHA – DECREASES GLUCAGON
EXAMPLES:
DIABENESE – ORINASE – TOLINASE – MICRONASE – GLUCOTROL – DIAMICRON – GLUCOPHAGE
SIDE EFFECTS – GI UPSET – HYPOPGLYCEMIA
MANIFESTATIONS OF HYPOGLYCEMIA
G – GAIT DISTURBANCES (DIZZINESS)
U – UNSUAL PERSPERATION
T – TACHYCARDIA
O – OBVIOUS TREMORS
M – MOODINESS/IRRITABILITY
MGT : ALWAYS CHOSE LIQUID FORM (ORANGE JUICE)
INSULIN
RAPID – ACTING
(CLEAR)
SHORT ACTING
INTERMEDIATE –
ACTING (CLOUDY)
LONG-ACTING
(CLOUDY)
EX
HUMULIN R
SEMILENTE
CRYSTALINE
ZINC
NOVOLIN R
HUMULIN R
NPH
HUMULIN N
LENTE
MONOTARD
PZI
ULTRALENTE
ONSET
15 MINS
PEAK
1 HOUR
DURATION
3 HOURS
30 MINS
2 HOURS
8 HOURS
2 HOURS
8 HOURS
16 HOURS
2 HOURS
NONE
28 HOURS
Peak of action you observe most severe hypoglycemic reaction
When you mix insulin (A and B or A and C) inject air first to cloudy insulin by make sure not to touch the
solution do not aspirate first – transfer to clear inject then aspirate then go to cloudy and aspirate
NURSING RESPONSIBILITIES: INSULIN ADMINISTRATION
ROUTE: SUBCU – WHEN IN HOSP ROUTE IS SUBCU WITH 45 DEGREES ANGLE – SELF ADMINISTRATION
OF PATIENT TEACH 90 DEGREE ANGLE BUT GIVE PROPER NEEDLE (LENGTH: IF THIN INCH AND PINCH
THE TISSUE; OBESE 1/5, 5/8 IN AND STRECH THE TISSUE) SO IT WILL NOT REACH THE MUSCLES – SUBCU
BECAUSE LESS PAINFUL THAN IV BUT SLOWER THAN IM – IF INSULIN IS FAST IT MAY CAUSE IMMEDIATE
HYPOGLYCEMIC REACTION – AVOID MASSAGING PROMOTE RAPID ABSORPTION THAT MIGHT CAUSE
IMMEDIATE HYPOGLYCEMIC
REFRIGERATE UNUSED INSULIN
NEVER SHAVE THE VIAL – ROLL IN THE PALMS OF THE HAND TO AVOID BUBBLES
PREVENT LIPODYSTOPHY – ROOM TEMPERATURE (NEVER ADMINISTER COLD INSULIN) – ROTATE THE
SITE
SIDE EFFECTS
LOCALIZED – REDNESS/INDURATION (AVOID USING THE AREA FOR 4-6 WEEKS) – SWELLING – LESION –
LIPODYSTROPHY
SYSTEMIC EFFECTS/GENERALIZED – HYPOGLYCEMIA (WATCH OUT FOR PEAK OF ACTION) – SOMOGYI
PHENOMENON
SOMOGYI PHENOMENON – WHEN TOOK WAY TO MUCH INSULIN OR IF PATIENT TOOK INSULIN AND
UNDERGO HEAVY ACTIVITY
INCREASE INSULIN – UNDERGO HEAVY ACTIVITY – AGLYCEMIA – COMPENSATE – GLUCAGON –
GLUCOCORTICOIDS – REBOUND HYPERGLYCEMIA
FOOT CARE
INSPECT THE FEET DAILY’
WASH FEET WITH WARM WATER AND MILD SOAP
WEAR COMFORTABLE PROPERLY – FITTED PAIR OF SHOES
BREAK – IN NEW PAIR OF SHOES (1-2 / DAY)
USE WHITE COTTON SOCKS (MALE)
AVOID GOING BAREFOOTED – TRIMMING THE TOESNAILS LATERALLY – WEARING KNEE-HIGH/STAY-UP
STOCKINGS
APPLY LOTION ON THE FEET
EXERCISE / MASSAGE THE FEET TO PROMOTE CIRCULATION
FOR ANY SSX OF INJURY; CONSULT A PODIATRIST.
MED-SURG RENAL PROBLEMS AND FLUID IMBALANCES
FLUID IMBALANCES
NURSE EVE IS CARING FOR A CLIENT WHO HAD MS. WHICH NURSING INTERVENTION TREATS URINARY
INCONTINENCE
CHOICES:
ENCOURAGING FLUIDS ATLEAST 2L PER DAY
GIVING THE CLIENT A GLASS OF SODA BEFORE BEDTIME
TAKING THE CLIENT TO THE BATHROOM TWICE PER DAY
CONSULTING WITH DIETITIAN
RETENTION - NAIIWAN
FREQUENCY – GO ALOT
URGENCY – GO NOW
INCONTINENCE – URGE INCONTINENCE
-
FUNCTIONAL INCONTINENCE – WEAKNESS
OVERFLOW INCONTINENCE – CAN’T CONTRACT WELL
STRESS INCONTINENCE – WHEN INTRA ABDOMINAL PRESSURE INCREASE
MANAGEMENT IF FURI – NOTE SPECIFIC TIME OF ELIMINATION – REGULARIZE BOWEL AND BLADDER
ELIMINATION – INCREASE ORAL FLUID INTAKE – SHOULD BE 3-4 LITERS PER DAY
IF WANT TO REGULARIZE BOWEL MOVEMENT – INCREASE FIBER IN DIET
NURSE HARRY IS AWARE THAT THE FF IS AN APPROPRIATE NURSING DIAGNOSIS FOR A CLIENT WITH
RENAL CALCULI (OBSTRUCTION IN URINE FLOW)?
CHOICES:
INEFFECTIVE TISSUE PERFUSION
FUNCTIONAL URINARY INCONTINENCE
RISK FOR INFECTION
BRADYCARDIA
A CLIENT WITH HEAD TRAUMA DEVELOPS A URINE OUTPUT OF 300 ML/HR, DRY SKIN, AND DRY
MUCOUS MEMBRANES. WHICH OF THE FF NURSING INTERVENTIONS IS THE MOST APPROPRIATE TO
PERFORM INITIALLY?
CHOICES:
EVALUATE URINE SPECIFIC GRAVITY – DECREASE – URINE SPECIFIC GRAVITY IS INVERSELY
PROPORTIONATE TO URINE OUTPU – SHOULD BE 1.010-1.030 – HIGH SERUM SODIUM 135-145MEQ/L –
HIGH SERUM OSMOLARITY TIME 2 TO SODIUM – INVERSELY PROPORTIONATE TO SPECIFIC GRAVITY
ANTICIPATE TREATMENT FOR RENAL FAILURE
PROVIDE EMOLLIENTS TO THE SKIN TO PREVENT BREAKDOWN
SLOW DOWN THE IVF AND NOTIFY THE PHYSICIAN
ABNORMAL URINE OUTPUT BECAUSE OF HEAD TRAUMA:
ADH – ANTI-DIURETICS HORMONES – PRODUCED BY POSTERIOR PITUITARY GLAND
HOLDS URINE
SIADH – SYNDROME OF INAPPROPRIATE ADH
DI - DIABETES INSIPIDUS
HIGH ADH – RETENTION OF FLUIDS –
DECREASE IN URINARY OUTPUT
LOW ADH – INCREASE URINARY OUTPUT –
POLYURIA – 5-20 L/DAY
CEREBRAL EDEMA
CANNOT LET THE KIDNEY COMPENSATE IF THE
CELLS ARE DEHYDRATED
HYPONATREMIA
DRYNESS SKIN, MOUTH AND MUCOUS
MEMBRANE
HYPERNATREMIA
DECREASE HEMHEM – HEMATOCRIT 36-54% –
HEMOGLOBIN 12-18 G/DL
INCREASE OF HEMHEM
IN NORMAL SCENARIO IF THE CELLS IS DEHYDRATED THE COMPENSATORY MECHANISM IS THE
REABSORPTION OF URINE BY CELLS
Cardiovascular
SHOCK
Insufficient blood flow such as we have lack of perfusion through the body’s organs. Organs not getting
the oxygen and nutrients that they need. Circulatory failure is caused by hypovolemic shock – blood loss
associated with trauma of surgery – git losses – diarrhea vomiting – fluid loss diuresis – cardiogenic
shock – heart pump failure – MI – obstructive shock – blockage of great vessles or heart – PE, tension
pneumo
Pathophysiology