3 P’s of Diabetes Mellitus - Type 1 Signs & Symptoms

P- Polyuria (excessive urination)
P- Polydypsia (excessive thirst)
P- Polyphagia (excessive hunger)

Right-Sided Heart Failure (HEAD)

H- Hepatomegaly
E- Edema (Bipedal)
A- Ascites
D- Distended Neck Vein

Left-Sided Heart Failure (CHOP)

C- Cough
H- Hemoptysis
O- Orthopnea
P- Pulmonary Congestion (crackles/ rales)

Eating Disorder: ANOREXIA

A-menorrhea delayed
N-o organic factors accounts for weight loss
O-bviously thin but feels FAT
R-efusal to maintain normal body weight
E-pigastric discomfort is common
X-symptoms (peculiar symptoms)
I-ntense fears of gaining weight
A-lways thinking of foods

Eating Disorder: BULIMIA

B-inge eating
U-nder strict dieting
L-acks control over-eating
I-nduced vomiting
M-inimum of to binge eating episodes
I-ncrease/Persistent concern of body size/shape
A-buse of diuretics & laxatives

ACTIVITY THERAPY 
- group members work on specific tasks together to promote socialization and increase self-esteem

Common S/E of NSAIDS:
-headache
-drowsiness
-dizziness
-heartburn and nausea

Less common but life threatening side effects are GI bleeding and agranulocytosis.
Any stomach pain lasting more than two days may indicate bleeding and should be investigated

CARE OF A FISTULA
-do not Take blood pressures
-perform venipunctures or start IVs in the extremity
-teach client not to sleep on affected extremity or compress extremity by carrying heavy objects

 CYTOXAN
Is an alkylating type of chemotherapy used to treat cancer
It acts by interfering with RNA replication that causes an imbalance of growth that leads to cell death.

S/E:
-cardiotoxicity
-nausea & vomiting
-leukopenia (low WBC)
-anemia (low RBC)
-reversible alopecia (hair loss)
-hepatotoxicity

This medication should not be administered by a nurse who is pregnant
Preparation and administration of this medication is associated with cardiogenic, mutagenic and teratogenic abnormalities

AMPHOTERICIN B 
Is an anti fungal medication that alters cell permeability
It is used for systemic fungal infections such as HISTOPLASMOSIS 

S/E:
-cardiac dysrhythmias
-Hemorrhagic gastroenteritis 
-thrombocytopenia 
-renal impairment
-acute liver failure 

RIFAMPIN 
Is a medication used to treat TB

S/E:
-acute renal failure
-thrombocytopenia
-hepatotoxicity 
-shock

It should be given 1hr ac or 2 hrs pc for maximum absorption

SULFAMYLON
Is a local anti-infective used in the treatment of second and third degree burns to prevent infection.
You should clean the area before applying the cream

S/E:
-metabolic acidosis
-tachypnea
-burning sensation
 

HEPATIC ENCEPHALOPATHY 
-brain dysfunction and damage caused by increased ammonia in the blood, resulting from severe liver disease
-usually ammonia is detoxified and converted to urea by the liver cells
 Liver dysfunction -causes ammonia accumulation
Elimination of dietary protein and administration of antibiotics decreases serum ammonia

ANTIBIOTICS
-act as an intestinal antiseptic by reducing the number of intestinal bacteria capable of converting urea to ammonia

S/S:
-progressive mental and motor disturbances including COMA

NURSING RESPONSIBILITY:
-assess neuro status, I&O, VS
-assess for infection 
-monitor electrolytes
-decrease protein in diet
-give antibiotic as ordered

BLADDER ( internal inflatable balloon)
Must be correct length and width for patient’s arm
If it is too wide, readings will be abnormally low
The width of the cuff should cover approximately 2/3 of the upper arm.
When wrapped around arm, it should be 1/5 longer than circumference of arm

ERB’s POINT
-is located in the third inter coastal space just to the left of the sternum.
-The left fifth inter coastal space at the mid-clavicular line is the site of the apex of the heart, and the location of the apical impulse, or what was previous called the point of maximal impulse (PMI)
-it is called the mitral area is where you listen for the first heart sound, S1, created by the closure of the mitral a d tricuspid valves (AV VALVES)
-on,y the right lung has a middle lobe
-it is found at the fifth and sixth inter coastal space at the right mid clavicular line

FETAL HEART RATE (FHR): at term usually from 120-160bpm 

DECELERATIONS-reduction in FHR, occur during contraction

3TYPES OF DECELERATION
Early
Late
Variable

They are described by their relationship to the onset and the end of a contraction and by their shape

Early and variable decelerations are normal and usually do not indicate fetal distress
Late deceleration are associated with fetal hypoxia and acidosis

NITROGLYCERIN 
-is used in the treatment of ANGINA PECTORIS to reduce ischemia and relieve pain by decreasing myocardial O2 consumption 
-the medication acts to dilate veins and arteries

S/E:
Throbbing headache
Flushing
Hypotension 
Tachycardia

NURSING RESPONSIBILITY
-teach appropriate administration (time,technique,dosage) 
-storage
-expected pain relief 
-possible side effects

ointment is applied to skin, with sites rotTed to avoid skin irritation
It has a prolonged effect up to 24hrs

ADDISON’s DISEASE
-deficiency of adrenocortical hormone.
-caused by surgical removal of the adrenal cortex or destruction of it idiopathically or by infections; inadequate pituitary ACTH; sudden stopping of exogenous adrenocortical hormone therapy
S/S:
Weakness
Hypoglycemia
Hypotension
Anorexia
GI symptoms
Emaciation
Dark pigmentation of skin
Low serum sodium
Low blood glucose
High serum potassium
Dehydration

ADDISONIAN CRISIS (adrenal crisis) 

Precipitated by:
Stress,surgery,trauma and infection

S/S:
Hypotension
Cyanosis
Fever
Classic shock symptoms
Headache
Abdominal pain
Nausea
Diarrhea
Confusion

Treatment-hormone replacement therapy 

Nursing responsibility 
-monitor for balance of fluid and electrolytes
-VS
-weight and BP
-teaching about diet
-medication
-activity level

THERAPEUTIC COMMUNICATION 
-use of silence
-broad opening question
-reflection
-summarizing
-restatement
-focusing
-open ended questions and statements 

major goal is to encourage verbalization of feelings, behaviors and experiences of patient with goal of resolving problematic areas.

 Nurse should convey acceptance, honesty, respect,interest,assistance,permission,and protection 

NONTHERAPEUTIC COMMUNICATION 
-closed ended question
-Advice-giving
-talking about self
-arguing 
-false reassurance “why” questions
-judgment responses
-changing the subject
-belittling