Download echocardiogram-used to assess heart valves. valve disorders

echocardiogram-used to assess heart valves.
valve disorders require prophylactic antibiotics before invasive procedures.
avoid IM injections when suspecting MI can affect CK levels
hemodynamic measurements-transducer placed @ the midaxillary line at the fourth or fifth
intercostal space phlebostatic axis.
calcium channel blockers-assess for constipation
1. Neuroleptic malignant syndrome (NMS):
-NMS is like S&M;
-you get hot (hyperpyrexia)
-stiff (increased muscle tone)
-sweaty (diaphoresis)
-BP, pulse, and respirations go up &
-you start to drool
2. I kept forgetting which was dangerous when you're pregnant; regular measles (rubeola), or German measles
(rubella), so remember:
-never get pregnant with a German (rubella)
3. When drawing up regular insulin & NPH together, remember:
-RN (regular comes before NPH)
4. Tetralogy of fallot; remember HOPS
H- hypertrophy of right ventricle
O- over-riding aorta
P- pulmonary stenosis
S- septal defect
5. MAOI's that are used as antidepressants:
weird way to remember, I know. pirates say arrrr, so think; pirates take MAOI's when they're depressed.
- explanation; MAOI's used for depression all have an arrr sound in the middle (Parnate, Marplan, Nardil)
Autonomic dysreflexia: potentially life threatening emergency
- elevate head of bed to 90 degree
- loosen constrictive clothing
- assess for bladder distention and bowel impaction (triger)
- Administer antihypertensive meds (may cause stroke, MI, seisure )
Normal ICP : 0 - 15mmHg
Pulmonary embolus: S/S
- pleuritic chest pain, dyspnea, low-grade fever, tachycardia, blood-tinged sputum.
COPD : S/S
- dyspnea on exertion, barrel chest, clubbed fingers and toes, tachypneic with prolonged expiratory phase.
Tension pneumothorax - tracheal shift to opposite side, decreased venous return, neck vein bulge, tachycardia and
tachypnea.
--In complete heart block, the AV node blocks all impulses from the SA node, so the atria and ventricles beat
independently, b/c Lidocaine suppresses ventricular irritability, it may diminish the existing ventricular response,
cardiac depressant are contraindicated in the presence of complete heart block.
--administrate Glucagon when pt is hypoglycemia and unresponsive
--Bromocriptine (Parlodel) or Dantrolene (Dantrium) is used for CNS toxicity
--Ibuprofen (Motrin) S/E includes epigastric distress, nausea, occult blood loss, peptic ulceration, use cautiously
with history of previous gastrointestinal disorders.
--Aminophylline (Truphylline) use with Propranolol (Inderal) may decrease metabolism and lead to toxicity
--Antianxiety medication is pharmacologically similar to alcohol, is used effectively as a substitute for alcohol in
decreasing doses to comfortably and safely withdraw a client from alcohol dependence
-- Tagamet decrease gastric secretion by inhibiting the actions of histamine at the H2-receptor site, constipation is
a common side effect of this med, should increase fiber in diet. Take with meals and at bedtime.
--elderly clients and clients with renal problems are most susceptible to CNS side effects (confusion, dizziness) of
the medication
1st TRIMESTER (Chorionic villis sampling, US scan)
2nd TRIMESTER (AFP screening or Quad Screening,Amniocentesis)
3rd TRIMESTER (kick counts,Nonstress Test,Biophysical Profile, Percutaneous Umbilical Blood
sampling, Contraction Stress Test )
Ultrasound screening -can be vaginal or Abdominal (in latter make Her drink water to fill bladder)
-Confirms viability
-Indicates fetal presentation
-Confirms multiple gestation
-Identifies placental location
-Measurements can be taken to confirm/estimate gestational age
-Identify morphologic anomalies
Chorionic villis sampling
8-12 weeks
for early diagnosis of genetic, metabolic problems
Amniocentesis -13-14 weeks
Is done under US scan to obtain a sample of amniotic fluid for direct analysis of fetal chromosomes,
development, viability and lung maturity
AFP
15-18 weeks-Maternal Blood Drawn
AFP also called =Quad marker screening:
-maternal serum alpha fetoprotein (MSAFP),
-human chorionic gonadotropin (HcG),
-unconjugated estriol (UE),
-and inhibin A
low AFP-Down syndrome
high-Spina bifida
it is not an absolute test if it is abnormal -further investigation is recommended
Kick counts (tests Uretro placental capability)
Same time every day mother records how often she feels the fetus move
if mininum 3 movements are not noted within an hour's time, the mother is encouraged to call her
physician immediately!
Nonstress Test
checks FHR and mother detects Fetal movements.
Contraction Stress Test -tests perfusion between Placenta and Uterus (basically O2 and CO2 exchange)
-IV accessed and performed in a labor and deliver unit under electronic fetal monitoring
contractions initiated by Pitocin or nipple stimulation
the desired result is a "negative" test which consists of three contractions of moderate intensity in a 10
minute period without evidence of late decelerations
the test is done to detect problems so if it is Positive (persistent late decelerations
) then-CS
how is done:
The electronic fetal monitor is placed on the maternal abdomen for 20-30 minutes
Each time the fetus moves, FHR should accelerate 15 beats/min above the baseline for 15 seconds
A reactive (good) test =>2 accelerations in FHR occur with associated fetal movement
Biophysical Profile (BPP)
identification of a compromised fetus and consists of 5 components:
-fetal breathing movement
-fetal movement of the body or limbs
-fetal tone (extension or flexion of the limbs)
-amniotic fluid volume index (AFI) visualized as of fluid around the fetus
-reactive non-stress test
each component 0-2, 8-10-desirable.
Percutaneous Umbilical Blood sampling -like amniocentesis but cord punctured
-chromosomal anomalies, feta karyotyping, and blood disorders
Evrywhere where woman's abdomen is punctured informed consent is needed, and risks like amnionitis
spontaneous abortion, preterm labor/delivery, and premature rupture of membranes must be explained. If
she Rh--she may be RHoGAM given.
compartment syndrome...significant increase in pain not responsive to pain meds.
Plaquenil-tx of Rhem Arthritis...recommend eye exam every 3 mo.
Statins- tx of high cholesterol...ASSESS FOR MUSCLE PAIN...moniter liver enzymes.
Nicotinic Acid (Niacin)-tx of high cholesterol- flushing occurs in most pt. will diminish over several weeks.
stages of shock (its more but i made it simple "KISS" keep it simple stupid lol!)
early- increase in pulse...normal urine output
intermediate-RAS (renin-angioten system), low urine output, cool skin, pallor
late-no urine output, low BP irreversible stage!
Myxedema/hypothyroidism: slowed physical and mental function, sensitivity to cold, dry skin and hair
Graves’ disease/hyperthyroidism: accelerated physical and mental function; sensitivity to heat, fine/soft
hair
Thyroid storm: increased temp, pulse and HTN
Post-thyroidectomy: semi-Fowler’s, prevent ncek flexion/hyperextension, trach at bedside
Hypo-parathyroid: CATS – convulsions, arrhythmias, tetany, spasms, stridor (decreased calcium), high
Ca, low phosphorus diet
Hyper-parathyroid: fatigue, muscle weakness, renal calculi, back and joint pain (increased calcium), low
Ca, high phosphorus diet
Hypovolemia – incrased temp, rapid/weak pulse, increase respiration, hypotension, anxiety, urine
specific gravity >1.030
Hypervolemia – bounding pulse, SOB, dyspnea, rares/crackles, peripheral edema, HTN, urine specific
gravity <1.010; Semi-Fowler’s
Diabetes Insipidus (decreased ADH): excessive urine output and thirst, dehydration, weakness,
administer Pitressin
SIADH (increased ADH): change in LOC, decreased deep tendon reflexes, tachycardia, n/v/a, HA;
administer Declomycin, diuretics
Hypokalemia: muscle ewakness, dysrhythmias, increase K (raisins, bananas, apricots, oranges, beans,
potatoes, carrots, celery)
Hyperkalemia: MURDER – muscle weakness, urine (oliguria/anuria), respiratory depression, decreased
cardiac contractility, ECG changes, reflexes
Hyponatremia: nausea, muscle cramps, increased ICP, muscular twitching, convulsion; osmotic
diuretics, fluids
Hypernatremia: increased temp, weakness, disorientation/delusions, hypotension, tachycardia;
hypotonic solution
Hypocalcemia: CATS – convulsions, arrhythmias, tetany, spasms and stridor
Hypercalcemia: muscle weakness, lack of coordination, abdominal pain, confusion, absent tendon
reflexes, sedative effect on CNS
HypoMg: tremors, tetany, seizures, dyrshythmias, depression, confusion, dysphagia; dig toxicity
HyperMg: depresses the CNS, hypotension, facial flushing, muscle ewakness, absent deep tendon
reflexes, shallow respirations, emergency
Addison’s: hypoNa, hyperK, hypoglycemia, dark pigmentation, decreased resistance to stress, fractures,
alopecia, weight loss, GI distress
Cushings: hyperNa, hypoK, hyperglycemia, prone to infection, muscle wasting, weakness, edema, HTN,
hirsutism, moonface/buffalo hump
Addisonian crisis: n/v, confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration,
decreased BP
Pheochromocytoma: hypersecretion of epi/norepi, persistent HTN, increased HR, hyperglycemia,
diaphoresis, tremor, pounding HA; avoid stress, frequent bating and rest breaks, avoid cold and
stimulating foods, surgery to remove tumor
When the high-pressure alarm sounds on a ventilator, it is most likely due to an obstruction. The obstruction can
be caused by the client biting on the tube, kinking of the tubing, or mucus plugging requiring suctioning
Constant bubbling occurring in the water seal chamber may indicate a leak in the system. Among the options
provided, the appropriate action is to notify the physician
CO2 acts as an acid in the body. Therefore, in a respiratory disorder with a rise in CO2, a corresponding fall in pH
occurs
Pleural friction rub is auscultated early in the course of pleurisy, before pleural fluid accumulates. Once fluid
accumulates in the inflamed area, friction between the visceral and parietal lung surfaces decreases, and the
pleural friction rub disappears.
Hemiparesis is a weakness of one side of the body that may occur after a stroke
Homonymous hemianopsia is loss of half of the visual field. The client with homonymous hemianopsia should have
objects placed in the intact field of vision, and the nurse also should approach the client from the intact side.
Myasthenic crisis often is caused by undermedication and responds to the administration of cholinergic
medications, such as neostigmine (Prostigmin) and pyridostigmine (Mestinon). Cholinergic crisis (the opposite
problem) is caused by excess medication and responds to withholding of medications. Too little exercise and fatty
food intake are incorrect. Overexertion and overeating possibly could trigger myasthenic crisis.
The changes in neurological signs from an epidural hematoma begin with loss of consciousness as arterial blood
collects in the epidural space and exerts pressure.
atropine is contraindicated in paralytic ileus, ulcerative colitits, obstructive GI disorders, benign prostatic
hypertrophy, myasthenia gravis and narrow angle glaucoma
withdrawal s/s of benzos: agitation, nervousness, insominia, anorexia, sweating, muscle cramps.....basically about
the same as alcohol withdrawal s/s.
thrombophlebitis s/s: redness, warmth, and induration along the vein, tenderness on palpation of the vein.
hypokalemia-prominent U WAVE (u is down hypo), hyperkalemia-tall T wave (T is tall hyper)
superior vena cava syndrome s/s: nosebleeds, edema in the eyes, edema of hands, dyspnea, mental status
changes.
s/s of rheumatic fever: painful swollen joints, jerky movements, enlarged heart, heart murmur, nontender lumps
on bony areas, white painful lesions on the trunk
s/s of vit B12 deficiency: pallor, slight jaundice, smooth beefy red tongue, tingling hands and feet, and difficulty
with gait
good pasture syndrome affects the lungs and kidneys so expect pulmonary symptoms and kidney symptoms
(failure symptoms)
Cerebrospinal fluid (CSF) leakage after cranial surgery may be detected by noting drainage that is serosanguineous
surrounded by an area of straw colored or pale drainage. The physical appearance of CSF drainage is that of a halo.
The major action of vasopressin is constriction of the splanchnic blood flow.
The normal serum amylase level ranges from 53 to 123 Somogyi units/dL
The normal range for the serum protein level in the adult client is 6.0 to 8.0 g/dL
Clinical signs and symptoms of portal hypertension are identical to those of heart failure and include jugular vein
distention, lung crackles, and decreased perfusion to all organs. Initially, the client may have hypertension, flushed
skin, and a bounding pulse.
Asterixis is a flapping tremor of the hand that is an early sign of hepatic encephalopathy. The exact cause of this
disorder is not known, but abnormal ammonia metabolism may be implicated. Increased serum ammonia levels
are thought to interfere with normal cerebral metabolism. Tremors and drowsiness would also be noted
Neomycin may be prescribed for the client with portosystemic encephalopathy. It is a broad-spectrum antibiotic
that destroys normal bacteria found in the bowel, thereby decreasing protein breakdown and ammonia
production
Lactulose is prescribed for the client with hepatic encephalopathy to reduce bacterial breakdown of protein in the
bowel. The medication creates an acidic environment in the bowel and causes the ammonia to leave the
bloodstream and enter the colon. Ammonia then becomes trapped in the bowel. Lactulose also has a laxative
effect that allows for the elimination of the ammonia.
Tacrolimus-Prograf- is an immunosuppressant medication used in the prophylaxis of organ rejection in clients who
receive allogeneic liver transplants. Frequent side effects include headache, tremors, insomnia, paresthesia,
diarrhea, nausea, constipation, vomiting, abdominal pain, and hypertension.
A low-residue (low-fiber) diet is less irritating to the intestines than are other diets because this type of food is
easier to digest. This diet may be used for ulcerative colitis, diverticulitis, and irritable bowel syndrome.
Diphenoxylate hydrochloride-Lomotil- with atropine sulfate is an antidiarrheal product that decreases the
frequency of defecation, usually by reducing the volume of liquid in the stools
Sulfasalazine- Azulfidine- is an anti-inflammatory sulfonamide. It can cause photosensitivity, and the client should
be instructed to avoid sun and ultraviolet light. It should be administered with meals if possible to prolong
intestinal passage.
Prepreparation for a barium enema includes maintaining a low-fiber diet for 1 to 3 days before the test. Clear
liquids or water may be allowed 12 to 24 hours before the test. Laxatives and enemas may be prescribed before
the test to cleanse the bowel. The client is encouraged to drink liquids after the procedure to facilitate the passage
of barium.
A client undergoing liver biopsy with use of a local anesthetic will be positioned supine with the client’s right hand
placed under the head
Cholecystogram-The nurse instructs the client to eat a fat-free meal the evening before the procedure and then to
avoid oral intake except for water on the day of the procedure. The client may be given a high-fat meal or drink
during the test to stimulate the emptying of the gallbladder
Intrinsic factor is produced in the stomach but is used to aid in the absorption of vitamin B12 in the small intestine.
Vagotomy is a procedure that can reduce innervation to the stomach, thereby reducing the production of gastric
acid.
Lactulose is an osmotic laxative. The desired effect is two or three soft stools per day with an acid fecal pH.
Lactulose creates an acid environment in the bowel, resulting in a fall of the colon’s pH from 7 to 5. This causes
ammonia to leave the circulatory system and move into the colon
The most typical finding with duodenal ulcer is pain that is relieved by food intake. The pain is often described as a
burning, heavy, sharp, or “hunger pang” pain that often localizes in the mid-epigastric area.
Billroth I surgery involves removing one half to two thirds of the stomach and reanastomosing the remaining
segment of the stomach to the duodenum. With the loss of this much of the stomach, development of pernicious
anemia is not uncommon
Ulcerative colitis is an inflammatory disease of the large colon. The signs and symptoms of ulcerative colitis include
diarrhea with up to 10 to 20 liquid bloody stools per day, weight loss, anorexia, fatigue, increased white blood cell
count, increased erythrocyte sedimentation rate, dehydration, hyponatremia, and hypokalemia
RENAL
The normal blood urea nitrogen level is 8 to 25 mg/dL.
The normal serum creatinine level for adults is 0.6 to 1.3 mg/dL
The diet for a client with renal failure who is receiving hemodialysis should include controlled amounts of sodium,
phosphorus, calcium, potassium, and fluids.
Following renal biopsy, the nurse ensures that the client remains in bed for at least 24 hours.
The client with uric acid stones should avoid foods containing high amounts of purines. This includes limiting or
avoiding organ meats such as liver, brain, heart, kidney, and sweetbreads. Other foods to avoid include herring,
sardines, anchovies, meat extracts, consommés, and gravies
Bladder trauma or injury is characterized by lower abdominal pain that may radiate to one of the shoulders.
Bladder injury pain does not radiate to the umbilicus, costovertebral angle, or hip.
Urethritis in the male client often results from chlamydial infection and is characterized by dysuria, which is
accompanied by a clear to mucopurulent discharge.
Typical signs and symptoms of epididymitis include scrotal pain and edema, which often are accompanied by fever,
nausea and vomiting, and chills. Epididymitis most often is caused by infection, although sometimes it can be
caused by trauma.
The client who experiences epididymitis from urinary tract infection should decrease intake of acidic foods and
increase fluid intake to flush the urinary system.
The client with prostatitis has a swollen and tender prostate gland that is also warm to the touch, firm, and
indurated. Systemic symptoms include fever with chills, perineal and low back pain, and signs of urinary tract
infection, which often accompany the disorder
Decreased force in the stream of urine is an early sign of benign prostatic hyperplasia. The stream later becomes
weak and dribbling. The client then may develop hematuria, frequency, urgency, urge incontinence, and nocturia.
If untreated, complete obstruction and urinary retention can occur
Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness,
nausea, vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of
solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient
removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient,
causing brain swelling and onset of symptoms. The syndrome most often occurs in clients who are new to dialysis
and is prevented by dialyzing for shorter times or at reduced blood flow rates.
Steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and a
diminished pulse distal to the fistula. The client also complains of pain distal to the fistula, caused by tissue
ischemia.
Measuring the blood urea nitrogen level is a frequently used laboratory test to determine renal function. The
blood urea nitrogen level starts to rise when the glomerular filtration rate falls below 40% to 60%
Pain during the inflow of dialysate is common during the first few exchanges because of peritoneal irritation;
however, the pain usually disappears after 1 to 2 weeks of treatment. The infusion amount should not be
decreased, and the infusion should not be slowed or stopped
In the client with benign prostatic hyperplasia, episodes of urinary retention can be triggered by certain
medications, such as decongestants, anticholinergics, and antidepressants
Nitrofurantoin (Furadantin) produce a harmless brown color to the urine and the medication should not be
discontinued until the client’s symptoms are alleviated or the prescribed dose is completed
The normal urine myoglobin level is negative. After extensive muscle destruction or damage, myoglobin is released
into the bloodstream, where it is cleared from the body by the kidneys. When there is a large amount of
myoglobin being cleared from the body, there is a risk of the renal tubules being clogged with myoglobin, causing
acute tubular necrosis. This is one form of acute renal failure.
ARF caused by glomerulonephritis is classified as intrinsic or intrarenal failure. This form of ARF is commonly
manifested by hypertension, tachycardia, oliguria, lethargy, edema, and other signs of fluid overload.
Hemodialysis typically lowers the amounts of fluid, sodium, potassium, urea nitrogen, creatinine, uric acid,
magnesium, and phosphate levels in the blood. Hemodialysis also worsens anemia, because RBCs are lost in
dialysis from blood sampling and anticoagulation during the procedure, and from residual blood that is left in the
dialyzer. Although all of these results are expected, only the lowered RBC count is nontherapeutic and worsens the
anemia already caused by the disease process
The client with renal failure is almost certain to have a problem with constipation as a result of factors such as fluid
restriction, fatigue that limits exercise, and dietary restrictions. In addition, phosphate-binding antacids such as
aluminum hydroxide gel cause constipation as a side effect.
Aluminum intoxication can occur when there is accumulation of aluminum, an ingredient in many phosphatebinding antacids. It results in mental cloudiness, dementia, and bone pain from infiltration of the bone with
aluminum
Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic
cystitis, structural abnormalities of the urinary tract, presence of urinary stones, and presence of an indwelling
urinary catheter or frequent catheterization.
The normal ratio of BUN to creatinine is approximately 10:1 to 15:1. A value lower than 10:1 would indicate
diminished urea concentration. A value greater than 15:1 would indicate inadequate renal function.
An excretory urogram is an invasive test that uses contrast radiopaque dye to assess the ability of the kidneys to
excrete dye in the urine. Bowel preparation is necessary to permit adequate visualization of the kidneys, ureters,
and bladder.
Aluminum hydroxide binds with phosphate in the intestines for excretion in the feces, thus lowering phosphorus
levels. It can cause constipation, and it does not promote the elimination of potassium.
Specific gravity evaluates the kidneys’ ability to regulate fluid balance and evaluates the hydration status of the
body. The BUN and creatinine more specifically evaluate renal function.
Clinical manifestations associated with ARF occur as a result of metabolic acidosis. The nurse would expect to note
Kussmaul’s respirations as a result of the metabolic acidosis because the bodily response is to exhale excess carbon
dioxid
Gross, painless hematuria most frequently is the first manifestation of bladder cancer. As the disease progresses,
the client may experience dysuria, frequency, and urgency.
Kock’s pouch is a continent internal ileal reservoir. The nurse instructs the client about the technique of
catheterization. There is no external pouch.
Gross hematuria and proteinuria are the cardinal signs of glomerulonephritis.
The client with acute glomerulonephritis commonly experiences fluid volume excess and fatigue. Interventions
include fluid restriction, as well as monitoring weight, intake, and output. The client is placed on bedrest, or at
least encouraged to rest, because there is a direct correlation between proteinuria and hematuria and increased
activity levels. The diet is high in calories but low in protein.
Foods that are allowed on an acid-ash diet include meat, fish, shellfish, cheese, eggs, poultry, grains, cranberries,
prunes, plums, corn, lentils, and foods with high amounts of chlorine, phosphorus, and sulfur.
After ureterolithotomy, a ureteral catheter is put in place. Urine flows freely through it for the first 2 to 3 days. As
ureteral edema diminishes, urine leaks around the ureteral catheter and drains directly into the bladder. At this
point, drainage through the ureteral catheter diminishes.
Renal artery embolization may be done instead of radiation therapy to shrink the kidney tumor by cutting off its
blood supply and impairing its overall vascularity. A secondary benefit is that it reduces the risk of hemorrhage
during surgery.
Individuals with polycystic kidney disease seem to waste rather than retain sodium. Thus, they need increased
sodium and water intake. Aggressive control of hypertension is essential. Genetic counseling is advisable because
of the hereditary nature of the disease.
After intravesical chemotherapy, the nurse increases fluids to help flush the medication out of the bladder after
the period of retention.
The client who has a radiation implant is placed in a private room and has limited visitors
After intravesical chemotherapy, the client treats the urine as a biohazard. This involves disinfecting the urine and
the toilet with household bleach for 6 hours after the treatment
Bloody or clear drainage from either the nasal or the auditory canal after trauma could indicate a cerebrospinal
fluid leak. The appropriate nursing action is to notify the physician because this finding requires immediate
intervention
Homonymous hemianopsia is a loss of half of the visual field. The client should have objects placed in the intact
fields of vision and the nurse should approach the client from the intact side.
Normal ICP readings range from 5 to 15 mm Hg pressure. Pressures greater than 20 mm Hg are considered to
represent increased ICP, which seriously impairs cerebral perfusion.
To obtain accurate ICP pressure readings, the transducer is zeroed at the level of the foramen of Monro, which is
approximated by placing the transducer 1 inch above the level of the ear
Hyperventilation with a PaCO2 of 25 to 30 mm Hg causes cerebral vasoconstriction, which decreases intracranial
blood volume and ICP. The PaO2 is not allowed to fall below 80 mm Hg, to prevent cerebral vasodilation from
hypoxemia.
Astereognosis is the inability to discern the form or configuration of common objects using the sense of touch
The normal serum osmolality is 285 to 295 mOsm/kg H2O. A higher value indicates dehydration;
The cerebellum is responsible for balance and coordination.
An ataxic gait is characterized by unsteadiness and staggering
A mydriatic medication produces mydriasis or dilation of the pupil. Mydriatic medications are used preoperatively
in the cataract client. These medications act by dilating the pupils. They also constrict blood vessels.
Severe pain or pain accompanied by nausea is an indicator of increased intraocular pressure and should be
reported to the physician immediately.
Complaints of a sudden burst of black spots or floaters indicates that bleeding has occurred as a result of the
detachment of the retina
If the laceration is the result of a penetrating injury, an object may be noted protruding from the eye. This object
must never be removed except by the ophthalmologist because it may be holding ocular structures in place.
Application of an eye patch or irrigation of the eye may disrupt the foreign body and cause further tearing of the
cornea.
Tonometry is the method of measuring intraocular fluid pressure using a calibrated instrument that indents or
flattens the corneal apex. Pressures between 10 and 21 mm Hg are considered within the normal range
When an eye drop and an eye ointment are scheduled to be administered at the same time, the eye drop is
administered first
Multiple myeloma is a B-cell neoplastic condition characterized by abnormal malignant proliferation of plasma cells
and the accumulation of mature plasma cells in the bone marrow.
Findings indicative of multiple myeloma are an increased number of plasma cells in the bone marrow, anemia,
hypercalcemia caused by the release of calcium from the deteriorating bone tissue, and an elevated blood urea
nitrogen level.
Hodgkins- reed Sternberg cells
The time that the nurse spends in a room of a client with an internal radiation implant is 30 minutes per 8-hour
shift. The dosimeter badge must be worn when in the client’s room. Children younger than 16 years of age and
pregnant women are not allowed in the client’s room.
Hodgkin’s disease is a chronic progressive neoplastic disorder of lymphoid tissue characterized by the painless
enlargement of lymph nodes with progression to extralymphatic sites, such as the spleen and liver. Weight loss is
most likely to be noted.
Clinical manifestations of ovarian cancer include abdominal distention, urinary frequency and urgency, pleural
effusion, malnutrition, pain from pressure caused by the growing tumor and the effects of urinary or bowel
obstruction, constipation, ascites with dyspnea, and ultimately general severe pain.
Abnormal bleeding, often resulting in hypermenorrhea, is associated with uterine cancer.
Conization procedure involves removal of a cone-shaped area of the cervix. Complications of the procedure
include hemorrhage, infection, and cervical stenosis
Hypercalcemia is a serum calcium level higher than 10 mg/dL, most often occurs in clients who have bone
metastasis, and is a late manifestation of extensive malignancy. The presence of cancer in the bone causes the
bone to release calcium into the bloodstream
. Vague abdominal discomfort or crampy, colicky abdominal pain is a characteristic symptom of a right colon
tumor.
Hormone therapy (androgen deprivation) is a mode of treatment for prostatic cancer. The goal is to limit the
amount of circulating androgens because prostate cells depend on androgen for cellular maintenance. Deprivation
of androgen often can lead to regression of disease and improvement of symptoms.
A blood test is available to detect Lyme disease; however, the test is not reliable if performed before 4 to 6 weeks
following the tick bite.
Prevention, public education, and early diagnosis are vital to the control and treatment of Lyme disease. A 3-week
course of oral antibiotic therapy is recommended during stage I. Later stages of Lyme disease may require therapy
with intravenously administered antibiotics, such as penicillin G.
Skin lesions or rash on the face across the bridge of the nose and on the cheeks is an initial characteristic sign of
systemic lupus erythematosus (SLE). Fever and weight loss may also occur. Anemia is most likely to occur later in
SLE.
The client with systemic lupus erythematosus (SLE) is at risk for cardiovascular disorders such as coronary artery
disease and hypertension. The client is advised of lifestyle changes to reduce these risks, which include smoking
cessation and prevention of obesity and hyperlipidemia. The client is advised to reduce salt, fat, and cholesterol
intake
Systemic lupus erythematosus is an inflammatory disease of collagen in connective tissue
The hallmark of stage I Lyme disease is the development of a rash within 2 to 30 days of infection, generally at the
site of the tick bite. The rash develops into a concentric ring, giving it a bull’s-eye appearance. The lesion enlarges
up to 50 to 60 cm, and smaller lesions develop farther away from the original tick bite. In stage I, most infected
persons develop flu-like symptoms that last 7 to 10 days; these symptoms may reoccur later. Neurological deficits
occur in stage II. Arthralgias and joint enlargements are most likely to occur in stage III.
Amikacin (Amikin) is an aminoglycoside. Adverse effects of aminoglycosides include ototoxicity (hearing problems)
confusion, disorientation, gastrointestinal irritation, palpitations, blood pressure changes, nephrotoxicity, and
hypersensitivity
Zalcitabine (ddC, Hivid) is an antiretroviral (nucleoside reverse transcriptase inhibitor) used to manage human
immunodeficiency virus infection in combination with other antiretrovirals.
Foscarnet (Foscavir) is toxic to the kidneys. The serum creatinine level is monitored before therapy, two or three
times per week during induction therapy, and at least weekly during maintenance therapy. Foscarnet also may
cause decreased levels of calcium, magnesium, phosphorus, and potassium. Thus, these levels also are measured
with the same frequency.
Saquinavir(invirase) is an antiretroviral (protease inhibitor) used with other antiretroviral medications to manage
human immunodeficiency virus infection. Saquinavir is administered with meals and is best absorbed if the client
consumes high-calorie, high-fat meals. Saquinavir can cause photosensitivity, and the nurse should instruct the
client to avoid sun exposure.
Stavudine (d4t, Zerit) is an antiretroviral used to manage human immunodeficiency virus infection in clients who
do not respond to or who cannot tolerate conventional therapy. The medication can cause peripheral neuropathy,
and the nurse should monitor the client’s gait closely and ask the client about paresthesia.
Didanosine (Videx) can cause pancreatitis. A serum amylase level that is increased to 1.5 to 2 times normal may
signify pancreatitis in the client with acquired immunodeficiency syndrome and is potentially fatal. The medication
may have to be discontinued. The medication is also hepatotoxic and can result in liver failure.
Hypertension can occur in a client taking cyclosporine (Sandimmune, Gengraf, Neoral) and, because this client is
also complaining of a headache, the blood pressure is the vital sign to be monitoring most closely. Other adverse
effects include infection, nephrotoxicity, and hirsutism.
Ketoconazole (Nizoral) is an antifungal medication. It is administered with food (not on an empty stomach) and
antacids are avoided for 2 hours after taking the medication to ensure absorption. The medication is hepatotoxic
and the nurse monitors liver function studies. The client is instructed to avoid exposure to the sun because the
medication increases photosensitivity.
Zalcitabine(Hivid) slows the progression of acquired immunodeficiency syndrome (AIDS) by improving the CD4+
cell count.
Frequent side effects of pentamidine(Pentam300) include leukopenia, thrombocytopenia, and anemia
If the result of the ELISA is positive, the Western blot is done to confirm the findings. If the result of the Western
blot is positive, then the client is considered to be seropositive for the infection and to be infected with the virus
The client with P. jiroveci infection usually has a cough as the first sign, which begins as nonproductive and then
progresses to productive. Later signs and symptoms include fever, dyspnea on exertion, and finally dyspnea at rest.
Ocular toxicity is an adverse reaction with the use of hydroxychloroquine sulfate(Plaquinil). An eye examination
should be performed when medication therapy is started and after 6 months of therapy.
Pyrimethamine(Daraprim) is an antimalarial and an antiprotozoal medication used to treat toxoplasmosis or
Pneumocyctis jiroveci pneumonia.
Natural resistance, also called innate inherited immunity, is that immunity with which a person is born. It does not
require previous exposure to the antigen.
Acquired immunity includes all antigen-specific immunities that a person develops during a lifetime.
B lymphocytes have the job of making antibodies and mediating humoral immunity.
Eosinophils attack and destroy foreign particles that have been coated with antibodies of the IgE class. Their usual
target is helminths (parasitic worms).
Basophils mediate immediate hypersensitivity reactions. Dendritic cells perform the same antigen-presenting task
as that of macrophages.
Neutrophils phagocytize foreign particles such as bacteria.
The test for rheumatoid factor detects measures the presence of unusual antibodies of the IgG and IgM type,
which develop in a number of connective tissue diseases.
Measuring the ESR can confirm inflammation or infection anywhere in the body. The ESR is particularly useful for
connective tissue disease because the value directly correlates with the degree of inflammation and later with the
severity of the disease
Generally, an ESR value of 30 to 40 mm/hr indicates mild inflammation, 40 to 70 mm/hr indicates moderate
inflammation, and 70 to 150 mm/hr indicates severe inflammation
A negative result on an ELISA indicates that infection is absent. A positive ELISA result must be confirmed with a
Western blot.
A CD4+ lymphocyte count is performed to establish the stage of HIV infection, and to help with decisions regarding
the timing of the initiation of antiretroviral therapy and prophylaxis for opportunistic infections.
Antiretroviral therapy is begun when CD4+ counts are less than 500 cells/μL or when signs or symptoms of HIV
disease appear
The client with cryptosporidiosis will present with signs and symptoms of watery diarrhea, flatus, abdominal
distention, pain, and fever. Diagnostic tests include a stool culture with a bowel biopsy.
Toxoplasmosis manifests with signs and symptoms such as an altered mental status, complaints of headache, and
cognitive impairment.
In the client with SLE, a complete blood count commonly shows pancytopenia, a decrease in the number of all cell
types. This finding is most likely caused by a direct attack of all blood cells or bone marrow by immune complexes
Early clinical manifestations of RA include complains of fatigue, generalized weakness, anorexia, and weight loss.
Cryptococcosis can occur in the lungs or the gastrointestinal tract. Diagnostic tests to confirm its presence include
chest x-ray studies and sputum culture if it occurs in the lungs.
1. to remember blood sugar:
hot and dry-sugar high (hyperglycemia)
cold and clammy-need some candy (hypoglycemia)
2. ICP AND SHOCK HAVE OPPOSITE V/S
ICP-increased BP, decreased pulse, decreased resp.
shock- decreased BP, increased pulse, increased resp.
3. cor pulmonae: right sided heart failure caused by left ventricular failure (so pick edema, jvd, if it
is a choice.)
4. herion withdrawal neonate: irratable poor sucking
5. Jews: no meat and milk together
6. Brachial pulse: pulse area cpr on an infant.
7. Test child for lead poisioning around 12 months of age
8. bananas, potatoes, citrus fruits source of potassium
11. Cultures are obtained before starting IV antibiotics
12. a pt with leukemia may have epitaxis b/c of low platelets
13. best way to warm a newborn: skin to skin contact covered with a blanket on mom.
14. when a pt comes in and she is in active labor...nurse first action is to listen to fetal heart
tone/rate
15. phobic disorders...use systematic desensitiztion.
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Clients of the islam religious group might want to avoid jello, pork and alcohol
Most common side effect of daunorucibin (cerubidine) for a client with leukemia is cardiotoxicity
Patient having a surgery on the lower abdomen should be placed in the trendelenburg position
Flumazenil (Romazicon) is the antidote for versed (Needless to remind you that versed is used for
conscious sedation... Say thank you Jean LOL)
Patients taking isoniazid (INH) should avoid tuna, red wine, soy sauce, and yeast extracts b/c of the side
effects that can occur such as headaches and hypotension
A Patient with gout who is placed on a low-purine diet should avoid spinach, poultry, liver, lobster, oysters,
peas, fish and otmeal
A patient who needs a high-iron diet should eat: sliced veal, spinach salad, and whole-wheat roll
Pegfilgastrin (Neulasta) is a chemotherapeutic drug given to patients to increase the white blood cells count
Amphoteracin B (Fungizone) should be mixed with D5W ONLY!!!
10. Pt with leukemia taking doxorubicin (Adriamycin) should be monitored for toxic effects such as rales and
distended neck veins (carditoxicity manifested by change in ECG and CHF)
11. Cardidopa/levodopa (Sinemet) is given to clients with Parkinson's disease. Watch for toxic effects such as
spasmodic eye winking
12. Nimotop (Nimodipine) is calcium channel blocker that is given to patients with ruptured cerebral
aneurysm. Do you know why? Look it up! Vasospasm...
A possible complication of impetigo is posstreptococcal glomerulonephritis and periorbital edema is indicative of
postreptocccal glomerulonephritis.
client should weight themselves daily when taking lithium-- and after the first dose, client should have his/her
levels checked within 8-12 hours and two times a week for the first month. Lithium also causes polyuria and
dehydration. S&S of toxicity are, ataxia, vomiting, diarrhea, muscular weakness and drowsiness.
Gurie blood test helps determine PKU for neonate.
child can return to school with Hep A, a week after onset of jaundice
bulge test is a test for confirming fluid in the knee
it's important not to touch the bed when using defibrilator in order to prevent accidental countershock!!
Extrusion reflex means is the same meaning as tongue thrust which disappears between 3- 4mos of age.
Administer oral steroids in the morning with food to prevent ulcerogenic effects!
Increased abdominal distention, nausea and vomiting are signs of paralytic ileus that should be reported to the
physician!
It's important for a client with an internal radium implant to be on a low residue diet in order to prevent many
bowel movements because stool can dislodge it.
Heparin is not transmitted to infant from breastfeeding.
Haldol is effective for reducing assaultive behavior, for example, a pt threatening to hurt another.
Narcotic analgesics are contraindicated for pt's with ICP because it can mask symptoms.
Pt's with SLE(lupus) should be in remission for 5 months before becoming pregnant.
Fixed and DIALATED pupil are signs of ICP and should be reported, it is an emergency.
For stabismus, the brain receives two images.
Vomiting is contraindicated for a pt/child who swallows lighter fluid(hydrocarbons) because there's a risk of
aspiration.
Change IV tubing every 48-72hourse(every time I want to choose every 24 hours!)
Extreme tearing and redness are signs of viral conjunctivits and if there is a worker with these signs, make sure
they are sent home because it is contagous!
For amputations after wound has healed..., assess for skin breakdown, wash, rinse and dry stump daily, alcohol
dries so don't apply DARN IT! , no lotion. Elevate stump 24-48 hours after surgery, discourage semi fowler's
position to prevent contractures of the hip.
Flush NG tube with 30ml of air before aspirating fluid.
Turp(transurethral resection of the prostate)--hemorrhage is a complication, bleeding should gradually decrease to
light pink in 24 hrs.
DVT: tx with compression stockings, low dose heparin, discourage sitting for prolonged periods.
Hot and dry=sugar high(symp of hyperglycemia)
cold and clammy=need some candy(hypoglycemia)
Type one diabetes is diagnosed usually before age 15. NO insulin produced
Type 2 diabetes--INSUFFICIENT insulin production. Keto acidosis not common. Affects adults over 40 mostly.
Diabetes insipidus--history of head injury or pituitary tumor or craniotomy...HYPOsecretion of ADH. Polyruria,
decreased specific gravity, decreased osmolarity, HYPOvolemia, increased thirst, tachycardia, decreased bp.
SIADH--excess ADH is released. HYPERvolemia, weightgain, administer diuretics...Declomycin could be prescribed.
Adrenal crisis: Profound fatigue, dehydration, vascular collapse, renal shut down, decreased NA, increased K.
Good ol' Maslow:
1st Physiologic needs
2 Security and safety
3 Love and belonging
4 Self actualization
Sterile field and procedure facts...
For sterile field--never turn your back, avoid talking
field, do not reach over sterile field.
, moisture barriers carries bacteria, open pack away from
Sterile procedures--Surgical procedures, biopsies, caths, injections, infusions, dressing changes.
In regards to surgery, aspirin, antidepressants, steroids, nsaids are drugs that put clients at risk!
The consent for surgery--Dr. gives client explanation, consent signed by Dr., client and witness. Signed prior to pre
op meds, remains a permanent part of client chart.
For pain: PQRST
Provoking
Quality
Region
Severity
Timing
Ask if pain is stabbing, burning crushing.
Narcotics---MORPHINE, MEPERIDINE(DEMEROL), HYDROMORPHONE(DILAUDID), OXYCODONE(OXYCOTIN).
Non-narcotics--ACETOMINOPHEN(TYLENOL), SALICYLATES.
Non steroidal(NSAIDS) TYLENOL, IBPROFEN, NAPROSYN, INDOCIN.
Clozapine(Clozaril) is used for schizophrenic patient's who don't respond to other antipsychotic drugs.
(Benztropin)Congentin is used for the extrapyramidal effects associated with antipsychotic agents.
Chlorpromazine (Thorazine) is used to treat hallucinations, agitation, and thought disorders.
Adenosine(Adenocard) is an antiarrhythmic drug, this drug is good for paroxysmal atrial tachycardia...it slows
conduction from av node.
Atropine for symptomatic bradycardia.
Digoxin for atrial fibrillation.
Lidocaine for ventricular ectopy.
For assessing the abdomen, correct order is INSPECTION, AUSCUTATION, PERCUSSION, PALPATION "I Am Peed
PAAAAA!"
)
Cheyne strokes respirations are periods of apnea for 10-60 seconds then slowly increasing rate and depth... occur
typically with heart failure and cerebral depression.
Bulls eye rash is classic in lymes disease.
To relieve breast engorgement, pt should pump each breast for 10 minutes every 3-4 hours and during the night if
she's awake.
Anticholinergic effects(drugs that block acetylcholine) cause dry mouth, constipation, urine retention.
5 rights of delegation
Right task
Right circumstance
Right communication
Right person
Right feed back
Cystic fibrosis is a recesssive trait, there is a one in four chance that each offspring will have the trait or disorder.
Cushings triad is something to look out for in patient's with increased ICP which is decreased heart rate, decreased
respiratory rate BUT increased blood pressure.
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Terbutaline a beta-2 agonist is given for preterm delivery to relaxe smooth muscle and halt
contractions
High circulating levels of progesterone released by the "corpus luteum" are thought to be
responsible for the immediate post-ovulation rise in body temperature
Geriatrics pts may increase consumption of salt and sweets b/c change in test perception...
Watch for health problems that may result from that!
8 month infant => Recognizes but is fearful of strangers
10-12 months infant => 3-words vocabulary1!!!
12 months infant => stands alone
8-12 weeks infant => can hold head up
Pregnant woman with "Charley horse" pain (pain in the "gastrocnemius muscle" =>the muscle in
the back part of the leg that forms the greater part of the calf; responsible for the plantar flexion of
the foot) is relieved by dorsiflexing the foot, which reduces the muscle spasm
The criteria used to distinguish TRUE from FALSE labor is "evidence of cervical change"...
Wow!
Pediatrics... Lead poisoning primarly affects the CNS, causing increased ICP. This results in
irritability and change of LOC, as well as seizure disorders, hyperactivity and learning
disabilities
4 months infant => palmar grasp
7-9 months infant => can bang 2 cubes together
9-12 months infant => can put a block in a cup
10-12 months infant => can demonstrate pincer grasp
Hydatidiform mole => increased HCG levels, marked nausea and vomiting
VC
EH
AO
LP
V = variable decels; C = cord compression caused
E = early decels; H = head compression caused
A = accels; O = okay, not a problem!
L = late decels = placental insufficiency, can't fill
For cord compression, place the mother in the TRENDELENBERG position because this removes pressure of the
presenting part off the cord. (If her head is down, the baby is no longer being pulled out of hte body by gravity)
If the cord is prolapsed, cover it with sterile saline gauze to prevent drying of the cord and to minimize infection.
For late decels, turn the mother to her left side, to allow more blood flow to the placenta.
For any kind of bad fetal heart rate pattern, you give O2, often by mask...
When doing an epidural anesthesia hydration before hand is a priority.
Hypotension and bradypnea / bradycardia are major risks and emergencies.
NEVER check the monitor or a machine as a first action. Always assess the patient first; for exmaple listen to the
fetal heart tones with a stethoscope in NCLEX land. Sometimes it's hard to tell who to check on first, the mother or
the baby; it's usually easy to tell the right answer if the mother or baby involves a machine. If you're not sure who
to check first, and one of the choices involves the machine, that's the wrong answer.
If the baby is a posterior presentation, the sounds are heard at the sides.
If the baby is anterior, the sounds are heard closer to midline, between teh umbilicus and where you would listen
to a posterior presentation.
If the baby is breech, the sounds are high up in the fundus near the umbilicus. If the baby is vertex, they are a little
bit above the symphysis pubis
Metronidazole (Flagyl)- antiviral: no alcohol (unless you planning on vomiting for awhile)...this drug has a metallic
bitter taste.
Digoxin-check pulse, less than 60 hold, check dig levels and potassium levels.
Amphojel: tx of GERD and kidney stones....watch out for contipation.
Vistaril: tx of anxiety and also itching...watch for dry mouth. given preop commonly
Versed: given for conscious sedation...watch for resp depression and hypotension
PTU and Tapazole- prevention of thyroid storm
Sinemet: tx of parkinson...sweat, saliva, urine may turn reddish brown occassionally...causes drowsiness
Artane: tx of parkinson..sedative effect also
Cogentin: tx of parkinson and extrapyramidal effects of other drugs
Tigan: tx of postop n/v and for nausea associated with gastroenteritis
Timolol (Timoptic)-tx of gluacoma
Bactrim: antibiotic..dont take if allergic to sulfa drugs...diarrhea common side effect...drink plenty of fluids
Gout Meds: Probenecid (Benemid), Colchicine, Allopurinol (Zyloprim)
Apresoline(hydralazine)-tx of HTN or CHF, Report flu-like symptoms, rise slowly from sitting/lying position; take
with meals.
Bentyl: tx of irritable bowel....assess for anticholinergic side effects.
Calan (verapamil): calcium channel blocker: tx of HTN, angina...assess for constipation
Carafate: tx of duodenal ulcers..coats the ulcer...so take before meals.
Theophylline: tx of asthma or COPD..therap drug level: 10-20
Mucomyst is the antedote to tylenol and is administered orally
Diamox: tx of glaucoma, high altitude sickness...dont take if allergic to sulfa drugs
Indocin: (nsaid) tx of arthritis (osteo, rhematoid, gouty), bursitis, and tendonitis.
IF it is a depression med,
AND it look likes it's been in a commercial / you know someone on it (e.g. prozac, paxil, celexa, zoloft)
then it is an SSRI.
IF not,
then it is either a tricylic OR a MAOI...
... common tricylics USUALLY have 3 syllables (pamelor, elavil). (remember: tri = 3)
... common MAOI's USUALLY have two (nardil marplan)
If ya can't remember, go with the syllables.
Serotonin syndrome is a risk for all depression meds, it is marked by vasoconstrictive crisis (hypertension, temp
increase, mentation).
Remember: serum toner (serotonin)... the first discovered role of serotonin was in vasoconstriction!
This is a medical emergency, similar to NMS.
MAOI drugs have a specific risk for tyramine ingestion. Aged cheeses and wine are high in it, fermented / moldy
foods. M for munchies, A for aged.
Synthroid: tx of hypothyroidism..may take several weeks to take effect...notify doctor of chest pain..take in the AM
on empty stomach..could cause hyperthyroidism.
Librium: tx of alcohol w/d...dont take alchol with this...very bad nausea and vomiting can occur.
Oncovin (vincristine): tx of leukemia..given IV ONLY
kwell: tx of scabies and lice...(scabies)apply lotion once and leave on for 8-12 hours...(lice) use the shampoo and
leave on for 4 minutes with hair uncovered then rinse with warm water and comb with a fine tooth comb
Premarin:tx after menopause estrogen replacement
Dilantin: tx of seizures. thera drug level: 10-20
Navane: tx of schizophrenia..assess for EPS
Ritalin: tx of ADHD..assess for heart related side effects report immediately...child may need a drug holiday b/c it
stunts growth.
dopamine (Intropine): tx of hypotension, shock, low cardiac output, poor perfusion to vital organs...monitor EKG
for arrhythmias, monitor BP
the laxative step-ladder....to manage constipation
1. bulk-forming laxatives are first
2. stool softners
3. osmotics
4. stimulants
5. suppositors
6. enemas are last
atropine is contraindicated in paralytic ileus, ulcerative colitits, obstructive GI disorders, benign prostatic
hypertrophy, myasthenia gravis and narrow angle glaucoma
withdrawal s/s of benzos: agitation, nervousness, insominia, anorexia, sweating, muscle cramps.....basically about
the same as alcohol withdrawal s/s.
thrombophlebitis s/s: redness, warmth, and induration along the vein, tenderness on palpation of the vein.
hypokalemia-prominent U WAVE (u is down hypo), hyperkalemia-tall T wave (T is tall hyper)
superior vena cava syndrome s/s: nosebleeds, edema in the eyes, edema of hands, dyspnea, mental status
changes.
s/s of rheumatic fever: painful swollen joints, jerky movements, enlarged heart, heart murmur, nontender lumps
on bony areas, white painful lesions on the trunk
s/s of vit B12 deficiency: pallor, slight jaundice, smooth beefy red tongue, tingling hands and feet, and difficulty
with gait
good pasture syndrome affects the lungs and kidneys so expect pulmonary symptoms and kidney symptoms
(failure symptoms)
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Varicella (chickenpox) requires use of airborne precautions and contact precautions as
well.
If a patient is on contact precautions, have family members and other visitors wear a gown
and gloves as outlined by your facility (hospital).
1) Droplet room assignment: Preferably private, if not available roomate with same illness and same
pathogen. And if thats not an option 3 feet away from roomate with the curtain pulled.
2) When transporting a patient with airborne precautions (for essential purposes only) they must wear a
surgical mask.
2) For contact precautions
diseases/conditions include: C. diff, E. coli, scabies
Room needs to be private unless room has another patient infected with the same organism
For droplet precautions
diseases/conditions include: meningitis, pneumonia, pertussis (whooping cough), rubella, mumps
Room needs to be private unless room has another patient infected with the same organism.
Maintain spacial distance of 3 feet when near patient.
Also remember standard precautions apply to ALL PATIENTS regardless of diagnosis when in
contact with any bodily fluid, blood, secretions/excretions, nonintact skin, and mucous membranes
For LP For 1 hour after the procedure, the client assumes a prone position, if able, with a pillow under the
abdomen to increase intra-abdominal pressure.
After Myelogram Headache is relatively common after the procedure, but neck stiffness, especially on
flexion, and pain should be reported because they signal meningeal irritation.
For an EMG, needle electrodes are inserted into selected skeletal muscles to evaluate changes and
electrical potential of the muscles and the nerves that lead to them. The test is useful in evaluating
suspected lumbar or cervical disk disease, myasthenia gravis, muscular dystrophy, and other motor
neuron diseases
A method of testing for proprioception is to hold the sides of the client’s great toe and while moving it,
asking the client what position it is in.
The normal CSF pressure is 5 to 10 mm Hg.
The therapeutic range for a serum phenytoin level is 10 to 20 mcg/mL
Cushing’s reflex is a late sign of increased ICP and consists of a widening pulse pressure (systolic pressure
rises faster than diastolic pressure) and bradycardia
In an unconscious client, eye movements are an indication of brain stem activity and are tested by the
oculocephalic response. When the doll’s eyes maneuver is intact, the eyes move in the opposite direction
when the head is turned.
Amantadine-Symmetrel- is an antiparkinson agent that potentiates the action of dopamine in the central
nervous system. The expected effect of therapy is a decrease in akinesia and rigidity. Leukopenia, urinary
retention, and hypotension all are adverse effects of the medication.
Divalproex sodium (Depakote), an anticonvulsant, can cause potentially fatal hepatotoxicity. The nurse should
instruct the client about the importance of monitoring the results of liver function studies and ammonia level
determinations
The frontal lobe controls voluntary muscle activity including speech, and an impairment can result in expressive
aphasia.
The parietal lobe contains association areas for concept formation, abstraction, spatial orientation, body and
object size and shape, and tactile sensation.
The occipital lobe contains areas related to vision.
Auditory association and storage areas are located in the temporal lobe and relate to understanding the spoken
language.
The initial symptom of ALS is a mild clumsiness, usually noted in the distal portion of one extremity. The client may
complain of tripping and drag one leg when the lower extremities are involved. Mentation and intellectual function
usually are normal.
Early manifestations of increased ICP are subtle and often may be transient, lasting for only a few minutes in some
cases. These early clinical manifestations include episodes of confusion, drowsiness, and slight pupillary and
breathing changes. Later manifestations include a further decrease in the level of consciousness, a widened pulse
pressure, and bradycardia. Cheyne-Stokes respiratory pattern, or a hyperventilation respiratory pattern, and
pupillary sluggishness and dilatation appear in the later stages.
Acetazolamide is a carbonic anhydrase inhibitor. It is used in the client with or at risk for increased ICP to decrease
cerebrospinal fluid production.
In early Alzheimer’s disease, forgetfulness begins to interfere with daily routines. The client has difficulty
concentrating and difficulty learning new material.
Selegiline hydrochloride is an antiparkinsonian medication. The medication increases dopaminergic action,
assisting in the reduction of tremor, akinesia, and the rigidity of parkinsonism.
Early symptoms of Huntington’s disease include restlessness, forgetfulness, clumsiness, falls, balance and
coordination problems, altered speech, and altered handwriting. Difficulty with swallowing occurs in the later
stages
If a bacterial infection of CSF is present, findings would include a cloudy appearance, CSF pressure over 200 mm
H2O, protein level over 15 mg/dL, increased white blood cells, and reduced glucose level.
In anosognosia, the client neglects the affected side of the body. The client either may ignore the presence of the
affected side (often creating a safety hazard as a result of potential injuries) or may state that the involved arm or
leg belongs to someone els
Global aphasia is a condition in which the affected person has few language skills as a result of extensive damage
to the left hemisphere. The speech is nonfluent and is associated with poor comprehension and limited ability to
name objects or repeat words.
CSF leakage after cranial surgery may be detected by noting drainage that is serosanguineous (due to surgery) and
surrounded by an area of clear or straw-colored drainage. The typical appearance of CSF drainage is that of a
“halo.” The nurse also would further verify actual CSF drainage by testing the drainage for glucose, which would be
positive.
The client with hemianopsia is taught to scan the environment. This allows the client to take in the entirety of the
visual field, which is necessary for proper functioning within the environment and helps to prevent injury to the
client.
Respiratory compromise is a major concern in clients with Guillain-Barré syndrome. Clients often are intubated and
mechanically ventilated when the vital capacity is less than 15 mL/kg.
Caloric testing provides information about differentiating between cerebellar and brainstem lesions. After
determining patency of the ear canal, cold or warm water is injected into the auditory canal. A normal response
that indicates intact function of cranial nerves III, VI, and VIII is conjugate eye movements toward the side being
irrigated, followed by eye movement back to midline. Absent or dysconjugate eye movements indicate brainstem
damage.
Spinal immobilization is necessary after spinal cord injury to prevent further damage and insult to the spinal cord.
Whenever possible, the client is placed on a Stryker frame, which allows the nurse to turn the client to prevent
complications of immobility while maintaining alignment of the spine
Clients with Bell’s palsy should be reassured that they have not experienced a brain attack (stroke) and that
symptoms often disappear spontaneously in 3 to 5 weeks.
Insomnia, agitation, mania, and delirium are due to excessive arousal of the reticular activating system in
conjunction with the cerebral hemispheres. The temporal lobe, hippocampus, and frontal lobe are responsible for
memory. The limbic system is responsible for feelings and affect.
Recall of recent events (such as breakfast) is controlled by the hippocampus. The cerebral hemispheres with
specific regional functions control orientation. The limbic system is responsible for feelings (affect) and emotions.
Calculation ability and knowledge of current events relate to the function of the frontal lobes of the cerebrum.
Wernicke’s area consists of a small group of cells in the temporal lobe whose function is the understanding of
language. Damage to Broca’s area is responsible for aphasia (option 2). The hippocampus is responsible for the
storage of memory (option 3). The motor cortex in the precentral gyrus controls voluntary motor activity (option
4).
The most common earliest manifestation of bladder cancer is hematuria that is not accompanied by pain.
#1. When wearing gown and/or gloves, make sure to take them off and properly dispose of them, before leaving
the patien'ts room.
#2. Pt's with herpes zooster (shingles) that is active should have the same precautions as a patient with chicken
pox---airborne and contact
#3. Pt's on droplet precaution can have their room door left open.
#4. Instruct visitors for pt's with droplet precautions to try to keep a distance of three feet between them and the
pt.
#5. Pt's with croup should be on contact precautions
Bacterial meningitis is transmitted via droplets, and when suctioning pt, wear goggles, eyewear, mask, and gloves.
Pt should wear a face mask when being transported.
The most common earliest manifestation of bladder cancer is hematuria that is not accompanied by pain
The kidneys normally receive 20% to 25% of the cardiac output, even under conditions of rest. For kidney function
to be optimal, adequate renal perfusion is necessary. Perfusion can best be estimated by the blood pressure
The most common findings with polycystic kidney disease are hematuria and flank or lumbar pain that is either
colicky in nature or dull and aching. Other common findings include proteinuria, calculi, uremia, and palpable
kidney masses. Hypertension is another common finding and may be associated with cardiomegaly and heart
failure
Acute rejection usually occurs within the first 3 months after transplantation, although it can occur for up to 2
years after transplantation. The client exhibits fever, hypertension, malaise, and graft tenderness. Treatment with
corticosteroids, and possibly also with monoclonal antibodies and antilymphocyte agents, is begun immediately.
Reduced outflow from the dialysis catheter may be due to the catheter position, infection, or constipation.
Constipation may contribute to a reduced outflow because peristalsis seems to aid in drainage
High protein diet for pt's with COPD(due to increased metabolic demands.)
Document in the client's chart that an incident report was completed, but the incident report itself is not supposed
to be a part of the chart.(the situation or "incident" should be documented with clear facts in the chart though..
but the documentation should not say anything about the "incident report" .)
Orthostatic hypotension is common with tricyclic antidepressants.
Muscular dystrophy is atrophy of the skeletal muscles that's progressive, weaknesss occurs, but with no neuro
involvment.
Hyperparathyrodism is increased secretion of parathyroid hormone which causes DECREASED serum phosphorus
and INCREASED serum calcium levels and increased excretion of calcium and phosphorus.
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S/S croup (child) => hoarse voice, inspiratory stridor, barking cough
Client with hepatic encephalopathy => Neomycin decreases serum ammonia concentration by decreasing
the number of ammonia producing bacteria in the GI tract
A 2 year old can remove one garment
A 2 and half year old can build a tower of eight cubes and point out a picture
A 3 year old can wash and dry his/her hands
S/S perforated colon => severe abdominal pain, fever, decreasing LOC
Hyperglycemia => b/c polyuria assess for signs of deficit fluid volume such as rapid, thready pulse,
decreased BP, and rapid respirations
A child with nephrotic syndrome is at risk of skin breakdown from generalized edema
Tetracycline should be taken on an empty stomach. Avoid dairy products, Ca, Mg, Al and Fe (Iron)
Upper GI series => NPO 6-8 hrs b/f procedure
Mumps is the childhood infectious disease that most significantly affects male fertility
Client allergic to penicillin may be also allergic to cephalosporins
Infants and children up to age 7 are abdominal breathers
Placental transport of substances to/from the fetus begins in the 5th week
Duration of contractions => period from the onset of uterine tightening to uterine relaxation
Frequency of contractions => period b/t one contraction and the beginning of the next contraction
Erbs point => 3rd L ICS; pulmonic and aortic murmurs are best heard there
1.
2.
One of the CHF symptoms is S3 ventricular gallop
Hypertensive crisis => Priority in the first hour is brain damage due to rupture of the cerebral blood vessels.
Neurologic status must be closely monitored
3. Client with A-fib => a cold, pale lower leg suggests the presence of an embolus. Peripheral pulses should
be checked immediately
4. S/S anemia in a 10 months old infant => pale mucosa of eyelids and lips
5. S/S dehydration in 2 years old => sunken eyes, dry tongue, lethargy, irritability, dry skin, decreased play
activity, and increased pulse
6. Pt with anaphylaxis => The entire body may turn bright red b/c massive vasodilation
7. Teaching pt with Zollinger-Ellison syndrome => Report promptly to his/her healthcare provider any
finding of peptic ulcer (night time awakening with burning, cramp-like abdominal pain, vomiting and even
hematemesis, and change in appetite)
8. Infant with epiglottitis : 4 D's => Drooling, Dysphagia, Dysphonia and Distress inspiratory efforts
9. Niacin (Vit B) is a lipid lowering agent. Foods high in Niacin are meats, eggs, milk, dairy products
10. Child with 3 C's (Cough-Choke-Cyanosis) should be assessed for tracheoesophagial fistula
11. Gastric lavage is a priority for an infant who has been identified as suffering from botulism
12. Viral meningitis usually does not require protective measures
13.
14. Myasthenia gravis--muscle weakness that occurs mostly in the throat and face as results from the deficits of
the nerve impulses conducting at the myoneural junction. Pancuronium and succinylcholine are
neromuscular agents that should be used with caution because of the chance of prolonging recovery.
Clients with CRF are to be on a high carbohydrate diet to prevent protein metabolism. Pt's must limit
protein, sodium and potassium and fluids because the kidneys cannot excrete an adequate amount of urine.
ABG's is the best way to monitor pulmonary status by analyzing the level of hypoxia caused by pulmonary
edema and for monitoring effects of treatment.
Cardiogenic shock--there is low cardiac output from heart pump failure such as in heart failure, sever
cardiomyopathy, acute MI.
Pancreatitis-high carb, low fat diet.
IV cimetidine(Tagamant) given as treatment for a bleeding peptic ulcer may experience hyptotention if
given too rapidly.
If the bladder irrigation solution is infusing at a sufficient rate, the urinary drainage will be pale pink.
Epoetin alfa stimulates red blood cell production. Initial effects should be seen within 1 to 2 weeks, and the
hematocrit reaches normal levels (30% to 33%) in 2 to 3 months.
Clients with oxalate stones should avoid foods high in oxalate such as tea, instant coffee, cola drinks, beer,
rhubarb, beans, asparagus, spinach, cabbage, chocolate, citrus fruits, apples, grapes, cranberries, and peanuts and
peanut butter. Large doses of vitamin C may help increase oxalate excretion in the urine
Clients who form uric acid calculi should be placed on a low-purine diet. The intake of fish and meats (especially
organ meats) should be restricted. Dietary modifications also may help adjust urinary pH so that stone formation is
inhibited. Depending on physician prescription, the urine may be either alkalinized by increasing the intake of
bicarbonates or acidified by drinking cranberry, plum, or prune juice.
Controlling edema is a critical aspect of therapeutic management of the client with nephrotic syndrome. A diet
high in protein may help the body restore normal plasma oncotic pressure, thus decreasing edema. Dietary
modifications may include salt restrictions and fluid restriction and is based on the client’s symptoms. Bed rest is
prescribed to promote diuresis when edema is severe
Nephrotic syndrome describes a variety of signs and symptoms that accompany any condition that markedly
impairs filtration by glomerular capillary membranes and results in increased permeability to protein. Hallmark
signs and symptoms of this syndrome include increased excretion of protein in the urine, decreased serum
albumin levels, increased serum lipids, and edema.
In the client with glomerulonephritis, characteristic findings in the urinalysis report are gross proteinuria and
hematuria. The specific gravity is elevated, and the urine may appear dark and smoky
During the oliguric phase of acute renal failure, urine output is less than 100 mL in a 24-hour period. The specific
gravity of the urine is low and fixed, and the urine osmolarity approaches that of the client’s serum level, or about
300 mOsm/L.
The diuretic phase of acute renal failure develops about 14 days after the initial insult and lasts about 10 days. It is
characterized by an increase in urine output of more than 1000 mL in a 24-hour period
In an alkaline ash diet, all fruits are allowed except cranberries, blueberries, prunes, and plums.
The distal tubule and the collecting duct of the nephron require the presence of ADH for water reabsorption. The
hormone increases the permeability of the membranes to allow water to flow more easily along the concentration
gradient. The glomerulus filters but does not reabsorb. The calices are responsible for collecting the urine. The
proximal tubule and the loop of Henle reabsorb water without the assistance of ADH
The client must produce increased ADH, which will increase reabsorption of water in the renal tubules and
increase circulating volume
Diabetes insipidus results from insufficient ADH production, which causes the kidneys to excrete large volumes of
urine. Water intoxication represents the opposite problem of that experienced with diabetes insipidus.
Clients in renal failure do not manufacture adequate amounts of erythropoietin, which is a glycoprotein needed to
synthesize red blood cells. Renin, angiotensin, and aldosterone are substances that assist in maintaining blood
pressure.
With increased potassium retention, the kidneys excrete more sodium.
Sodium is a cation. With increased retention of sodium, the kidneys also increase reabsorption of chloride and
bicarbonate, which are anions.
The stimuli for ADH release are increased serum osmolality and decreased blood volume. Physiological stress,
alcohol intake, and a cold environment all can cause the release of ADH
Using the process of filtration, creatinine is removed from the body in the glomerulus.
Furosemide works by acting to excrete sodium, potassium, and chloride in the ascending limb of the loop of Henle.
Because of the potentially life-threatening outcomes associated with hyperglycemia, hyperkalemia, and
hypocalcemia, they are the most relevant to nursing management of the client with chronic renal failure
CRF is a condition in which the kidneys have progressive problems in clearing nitrogenous waste products and
controlling fluid and electrolyte balance within the body. The typical signs and symptoms of CRF include
proteinuria or hematuria
Urge incontinence occurs when the client experiences involuntary loss of urine soon after experiencing urgency.
Reflex incontinence occurs when incontinence occurs at rather predictable times that correspond to when a
certain bladder volume is attained. Stress incontinence occurs when the client voids in increments of less than 50
mL under conditions of increased abdominal pressure
Many kidney stones are composed of calcium oxalate. Foods that raise urinary oxalate excretion include spinach,
rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea.
The parietal lobe of the brain is responsible for spatial orientation and awareness of sizes and shapes. The ability to
distinguish an object by touch is called stereognosis, which is a function of the right parietal area. The left parietal
area is responsible for mathematics and right-left orientation
The occipital lobe is responsible for reception of vision and contains visual association areas. This area of the brain
helps the individual to visually recognize and understand the surroundings
Broca’s area in the brain is responsible for the motor aspects of speech, by coordinating the muscular activity of
the tongue, mouth, and larynx. The term assigned to damage in this area is called aphasia.
Carbon dioxide is one of the metabolic end products that can alter the tone of the blood vessels in the brain. High
carbon dioxide levels cause vasodilation, whereas low carbon dioxide levels cause vasoconstriction. As a result, the
client may experience headache and lightheadedness, respectively
The vagus nerve is responsible for sensations in the thoracic and abdominal viscera. It also is responsible for the
decrease in heart rate because approximately 75% of all parasympathetic stimulation is carried by the vagus nerve.
After supratentorial surgery (surgery above the tentorium of the brain), the head of the client’s bed usually is
elevated 30 degrees to promote venous outflow through the jugular veins.
Epidural hematomas frequently are characterized by a “lucid interval” that lasts for minutes, during which the
client is awake and talking. After this lucid interval, signs and symptoms progress rapidly, with potentially
catastophic intracranial pressure increase. Epidural hematomas are medical emergencies.
Brown-Séquard syndrome results from hemisection of the spinal cord, resulting in ipsilateral paralysis and loss of
touch, pressure, vibration, and proprioception. Contralaterally, pain and temperature sensation is lost because
these fibers decussate after entering the cord.
Clients with Guillain-Barré syndrome have dysphagia. Clients with dysphagia are more likely to aspirate clear
liquids than thick or semisolid food
Clients with cholinergic crisis have experienced overdosage of medication. Tensilon will exacerbate symptoms in
cholinergic crisis to the point at which the client may need intubation and mechanical ventilation. Intravenous
atropine sulfate is used to reverse the effects of these anticholinesterase medications
Buck’s extension traction is a type of skin traction often applied after hip fracture before the fracture is reduced in
surgery. Traction reduces muscle spasms and helps immobilize the fracture
Following pin insertion for skeletal traction, a small amount of bleeding is expected. This can be controlled with
small pressure dressings;
A small amount of serous oozing is expected at pin insertion sites. Signs of infection such as inflammation, purulent
drainage, and pain at the pin site are not expected findings and should be reported to the physician.
A casted extremity is elevated continuously for the first 24 to 48 hours to minimize swelling and promote venous
drainage.
The client is taught to hold the cane on the side opposite from the weakness. The reason is that with normal
walking, the opposite arm and leg move together (called reciprocal motion). The cane is placed 4 to 6 inches lateral
to the fifth toe.
1.
Larngotracheobronchitis: inspiratory stridor and restlessness
2. Thorazine: antidote cogentine SE: akathisia(motor restlessness) dystonia(tongue protrusion, abnormal
posture) and diskinesia(stiff neck, difficulty swallowing)
3. Toddlers- parrallel play; infants enjoy company but self play.
4. IV infiltraton D/C IV and apply warm compress.
5. Urticaria= hives.
6. Graves disease: enlarged thyroid, increased metoblism and of course weight loss.
7. The goal for COPD is to improve ventilation.
8. From birth to 18 months Trust vs Mistrust
9 HbA1C- indicates BS for past 6-8 weeks(time varies with source) 2.5-6% normal.
10. myasthemia gravis: autoimmune disease of neuro jnx. destroys Acetylecholine receptors.
11. Meniere's: Inner ear disease: vertigo, tinnitus, sensorineuro hearing loss, N/V
12. Use play therapy for children d/t inability to verbalize emotions.
13. Phenergan: Check vein patency (very important)
14. Visine: contraindicated in glaucoma d/t vasoconstriction
DONNING PPE (Personal Protective Equipment)
GOWN
Fully cover torso from neck to knees, arms to end of wrist, and wrap around the back
Fasten in back at neck and waist
MASK OR RESPIRATOR
Secure ties or elastic band at middle of head and neck
Fit flexible band to nose bridge
Fit snug to face and below chin
Fit-check respirator
GOGGLES/FACE SHIELD
Put on face and adjust to fit
GLOVES
Use non-sterile for isolation
Select according to hand size
Extend to cover wrist of isolation gown
SAFE WORK PRACTICES
Keep hands away from face
Work from clean to dirty
Limit surfaces touched
Change when torn or heavily contaminated
Perform hand hygiene
REMOVING PPE
Remove PPE at doorway before leaving patient room or in anteroom
GLOVES
Outside of gloves are contaminated!
Grasp outside of glove with opposite gloved hand; peel off
Hold removed glove in gloved hand
Slide fingers of ungloved hand under remaining glove at wrist
GOGGLES/FACE SHIELD
Outside of goggles or face shield are contaminated!
To remove, handle by “clean” head band or ear pieces
Place in designated receptacle for reprocessing or in waste container
GOWN
Gown front and sleeves are contaminated!
Unfasten neck, then waist ties
Remove gown using a peeling motion; pull gown from each shoulder toward the same hand
Gown will turn inside out
Hold removed gown away from body, roll into a bundle and discard into waste or linen receptacle
MASK OR RESPIRATOR
Front of mask/respirator is contaminated – DO NOT TOUCH!
Grasp ONLY bottom then top ties/elastics and remove
Discard in waste container
HAND HYGIENE
Perform hand hygiene immediately after removing all PPE!
Chicken pox(13-17 days)--prodromal, child have malaise, fever, anorexia.
Rash is pruritic, and starts out as a macule then papule then a vesicle.
Spread by direct contact, droplet and contaminated object.
ISOLATE till all vesicles are crusted; it can be spread from 2 days before the rash begins.
Avoid use of aspirin due to Reye's syndrome, use tylenol.
Airborne--door can be closed..measles (RUBEOLA), M. tuberculosis, disseminated zoster(shingles),
varicella(chicken pox)--again can cohort and place in same room with the same infective organism.
Droplet--door may be open---Streptococcus pharyngitis, meningitis, pneumonia, adeno virus,
epiglottitis, influenza, mumps, mycoplasma pneumonia, or meningococcal, parvovirus, pertussis,
pneumonia,rubella, scarlet fever, sepsis...private room or pt with same infection--involves contact with
mucous membranes of nose or mouth...happens during talking, coughing, suctioning. MAINTAIN 3FEET
between infected patients and visitors.
Rubella--there's a maculopapular rash on face and all over the body. Prodromal: malaise and fever which
is followed by cough.
Spread by droplets and contaminated objects. placed on contact precautions, isolate child from
pregnant women.
Contact- c-diff, RSV, mrsa, wound infections,skin infections, diarrhea stuff-enteric infections
The earliest symptom of compartment syndrome is paresthesia (numbness and tingling in the fingers).
Other symptoms include pain unrelieved by narcotics, pain that increases with limb elevation, and pallor
and coolness to the distal limb. Cyanosis is a late sign
To achieve proper traction, weights need to be free-hanging, with knots kept away from the pulleys
When going down the stairs with crutches, the client should be instructed to move the crutches and the
affected leg, then move the unaffected leg down.
To go up the stairs, the client should first move up the unaffected leg and then move up the affected leg
and crutches.
In a three-point gait, the client is instructed to simultaneously move both crutches and the affected leg forward
and then to move the unaffected leg forward.
Edema in the extremity indicates impaired venous return.
Signs of impaired arterial circulation in the limb include coolness and pallor of the skin and a diminished arterial
pulse.
A gallium scan is similar to a bone scan, but with injection of gallium isotope instead of technetium Tc 99m.
Gallium is injected 2 to 3 hours before the procedure. The procedure takes 30 to 60 minutes to perform. The client
must lie still during the procedure. There is no special aftercare.
A straight leg cane is useful for the client with slight weakness in one leg. A walker is beneficial to the client with
greater or bilateral weakness, or the client who is at risk for falls. Wooden crutches often are used by clients with a
leg cast. Lofstrand crutches aid clients who need crutches but have limited arm strength.
Clients with low back pain often are more comfortable when placed in William’s position. The bed is placed in
semi-Fowler’s position with the knee gatch raised sufficiently to flex the knees. This relaxes the muscles of the
lower back and relieves pressure on the spinal nerve root.