Nursing Lectures | Free Nursing Lectures | Download Here

Online Nursing Schools A Must tool..

2009-11-25T01:13:00.000-08:00

Online Nursing Schools have been providing a viable and reliable alternative to nursing students who are unable to go to traditional nursing schools. One of the main advantages of these nursing schools is the accessibility and availability of resources.

One of the tools that can greatly increase the learning experience of students is the use of PDAs or Personal Digital Assistant.

These nursing lecture will show you ways to increase your efficiency as a student. Enjoy.

PDAs for Nursing Students: Technology at Your Fingertips

More Information about Online Nursing Schools

Nursing Informatics Innovations

2009-11-25T01:05:00.000-08:00

The Main Objective for this Nursing Informatics course is to increase Information Technology knowledge and literacy among students of offline and online nursing schools.

Connection and Innovation In Nursing Informatics

For more Nursing Informatics Lectures

Nursing Questions

2009-10-19T21:34:00.001-07:00

Here are some sample nursing questions on Cholecystectomy,Appendectomy,Thyroidectomy,CS operation and Gastrectomy. Visit our site often for more Nursing lectures. Subscribe to our RSS feed for instant Email updates.

Nursing Care Plan AP,Chole,Gastrectomy,Thyroidectomy,CS

2009-10-05T09:29:00.000-07:00

Here's a Nursing Care Plan for Appendectomy, Cholecystectomy,Gastrectomy,Thyroidectomy, and Cesarean Operation.

This exclusive report is brought to you by http://1nurses.com/

This nursing lecture cover a detail report on the pathophysiology of each diseases, and it discusses the appropriate medical and nursing interventions for each.

And the end of this report is an exclusive Test Taking Guide for student nurses and for those who will take Nursing exams in the future.

Good luck and Enjoy

Grab this Nursing Lecture and download for Free

Nursing Care Plan for CHF | Nursing Lectures

2009-08-29T07:14:00.000-07:00

This is a new post on a new nursing care plan for chf. Congestive Heart Failure is a serious medical condition. As a Nurse it is important to make sure that an appropriate Nursing Care plan for CHF has been implemented. Download this NCP for CHF for free.

Thyroidectomy Nursing Lectures

2009-08-22T04:47:00.000-07:00

This is a nursing lecture on Thyroidectomyfor nursing students and other health professionals. Enjoy!

ECG Nursing Lecture

2009-08-03T18:30:00.000-07:00

This Nursing Lecture is about ECG or ElectroCardioGraph used in the study and diagnosis of diseases related to the Cardiovascular system.

It depicts and details the different ECG patterns.

Enjoy this nursing lecture.

Nursing Informatics - Innvations LISTEN

2009-07-26T07:55:00.000-07:00

Here's a nursing lecture about the LISTEN (Learning Information Seeking and Technology for Evidence Based Nursing Practice. It covers and indepth analysis for the nursing informatics.

LISTEN Learning Information Seeking and Technology for Evidence-based Nursing practice --a nursing education, research & retention grant founded by Health Resources and Services Administration (HRSA) http://www.listenuphealth.org
Our Solution: Informatics for Healthcare
- Increase information technology (IT)
- and information literacy (IL) attitudes,
- knowledge, and skills of nursing students
Objective Learning Information Seeking and Technology for Evidence-based Nursing practice http://www.listenuphealth.org
Course Description
- Overview of healthcare information technology and computer science systems to prepare students to effectively and efficiently use technology for the identification, collection, processing, and management of data and information.
- Exploration of legal, ethical, cultural, economic, and social factors that affect healthcare information technology.
Learning Information Seeking and Technology for Evidence-based Nursing practice

Maternal Nursing Lecture Presentation

2009-07-16T19:40:00.000-07:00

A new updated Maternal Nursing Lecture Presented by an RN, RN, MAN

Surgical Instrumentation | Nursing Lecture

2009-07-01T09:55:00.001-07:00

Classification of Surgical Instruments
Cutting/Dissecting
Grasping
Retracting
Suturing/Stapling
etc.

Proper Way to Handle Instruments
Care of Instruments
Important Guidelines in Surgical Instrumentation

Fluids and Electrolytes Nursing lecture

2009-06-15T21:17:00.000-07:00

Complete Fluids and Electrolytes Nursing lectures

Contains detailed explanation on the colloid, osmotic pressure, etc.

Hyponatremia, Hypernatremia, Hypokalemia, Hyperkalemia etc.

Principles of Sterile and Aseptic Technique Nursing lecture

2009-06-15T20:46:00.000-07:00

This nursing lecture contains a detailed explanation on the Principles of Sterile and Aseptic technique. Sterile and Asepsis has been differentiated. Famous people and advocates of these principles are also discussed in this nursing lecture

- WHAT IS THE DIFFERENCE BETWEEN ASEPSIS AND STERILE TECHNIQUE??
nursinglectures.blogspot.com
- Ignaz Semmelweis – handwashing
- Louis Pasteur – germ theory
- Robert Koch – use of bichloride of mercury as an antiseptic
- Joseph Lister – Father of modern Surgery
- Gustav Neuber – used mercuric cholride in cleaning his apron
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- Louis Pasteur
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- Ignaz Semmelwies
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- Joseph Lister
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- Gustav Neuber
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- Robert Koch
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- Airborne
- Droplet
- Contact
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- SKIN
- HAIR
- NASOPHARYNX
- HUMAN ERROR
- CROSS-INFECTION
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- FOMITES
- Air
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- Community Acquired Infection
- Communicable Infection
- Spontaneous Infection
- Nosocomial Infection – Exogenous and Endogenous
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- Air-Conditioning System
- Laminar Air System
- Doors
- Traffic and Movement
- Lint
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- Protective barriers and personal protective equipment
- Prevention of puncture injuries
- Management of puncture injuries
- Oral Procedures
- Care of specimens
- Decontamination
- Laundry
- Waste
- Handwashing
- No touching of mucous membranes
- Prophylaxis
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- Know what is sterile
- Know what is unsterile
- Keep the two apart
- Remedy the contamination immediately
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- NO compromise on Sterility
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Sterilization and Disinfection Nursing lecture

2009-06-15T20:44:00.000-07:00

This nursing lecture contains different sterilization and disinfection methods. It also compares the two and cites disadvantages and advantages.

View more OpenOffice presentations from thinkrn.

# Terminologies  Antiseptics  Disinfectants  Disinfection  Microorganism  Pathogenic Microorganisms  Sterilization nursinglectures.blogspot.com
# nursinglectures.blogspot.com
# Methods of Sterilization  A. Physical Sterilization 1. Moist Heat – kills all bacteria by coagulating or denaturing of the protein of the bacteria a. Boiling (non-pressure sterilizer) b. Saturated Steam under pressure (AUTOCLAVE) nursinglectures.blogspot.com

#  2. Dry Heat – recommended for use only where direct contact of material with steam is impractical of not available a. Dry Heat Autoclave (hot air oven) – used for oil, ointment, and powders. nursinglectures.blogspot.com
# nursinglectures.blogspot.com
#  B. Chemical Sterilization  Accomplished by use of ethylene oxide gas  Ethylene oxide is a chemical agent that kills microorganisms, including spores, by interfering with the normal metabolism of protein and reproductive processes, resulting in death of cells nursinglectures.blogspot.com
# nursinglectures.blogspot.com
# Shelf-Life  1. Condition of Storage  Free of dust, dirt and vermin  Paper-wrapped/muslin-wrapped items good for 30 days, open shelving 21 days  Protect from extreme temperature nursinglectures.blogspot.com
#  2. Material used for packaging  Muslin and paper wrapped items may be stored for 24-30 days, afterwhich re- sterilization is required, but if sealed in airtight plastic bag, following cooling or aerating, shelf life can be prolonged from 6-12 months nursinglectures.blogspot.com
#  3. Seal of the package  Tape sealed packages wrapped in non- warm fabrics or plastic film can be stored for 3-4 months  4. Integrity of the package nursinglectures.blogspot.com
# Disinfection  It differs from Sterilization by its lack of sporocidal power  Used in the OR to kill microorganisms on inanimate surfaces and objects that cannot be sterilized nursinglectures.blogspot.com
# Limitations of Chemical Disinfection  Doesn’t KILL SPORES  Real STRENGTH not known  LONG TIMING  DIFFICULT to submerge some articles  NOT SUITABLE for some materials  Can cause IRRITATION to tissue  ABILITY to disinfect is limited to max concentration nursinglectures.blogspot.com
# Uses for chemical disinfection  WOVEN  CATHETER  ENDOSCOPIC Instruments  POLYETHYLENE  EYE Surgery nursinglectures.blogspot.com
# Pointers when Using Chemical Disinfection  Free from blood, secretions  Rinse and dry under sterile conditions  Solutions may be rinsed off if practical nursinglectures.blogspot.com
# DISINFECTANTS  Formaldehyde (Formalin)  Glutaraldehyde (Cidex)  Phenol 100%  Lysol  Zephiran Chloride 17% nursinglectures.blogspot.com
# ANTISEPTICS  Hexacholorophene - neurotoxic  Betadine –watch out iodine sensitivity  Mercurochrome  Aqueous Zephiran  Chorhexidine Gluconate nursinglectures.blogspot.com

Operating Room Team Members Nursing Lecture

2009-06-15T20:42:00.000-07:00

This nursing lecture contains an introduction to the different Operating Room Team members. The .sterile team members work aseptically and the non-sterile team members avoid contaminating the sterile field

Anesthesia Provider
Administers anesthetics
CNRA
Oversees the PACU
CPR
Pain therapy
consultants
Monitors and coordinates activity within the room
Controls physical and emotional atmosphere
Application of nursing process
Creation and maintenance of safe and comfortable environment
Provision of assistance
Identification of any potential danger/stress
Surgeon
First Assistant
Visibility of SS
Close wounds
Apply dressing
Handles tissue
Uses instruments
Scrub Person
Maintains integrity of
Sterile field
May be an RN, LPN/
LVN or an ST

Surgical Positioning Nursing Lecture

2009-06-15T20:39:00.000-07:00

This nursing lecture includes an introduction to studying Surgical Instrumentation. It contains topics on classification of surgical instruments, proper handling and use. Contains images and explanations.

http://nursinglectures.blogspot.com
 1. Optimize Exposure for the SURGEON  2. Minimize the for adverse physiologic effects  3. Facilitate by the ANESTHESIA provider  4. Promote for the patient nursinglectures.blogspot.com 2
 The Anesthesiologist has the on of the patient  The patient is until the anesthesia provider indicates it is safe to do so. nursinglectures.blogspot.com 3
 Patient is  Patient is Assessed for Mobility status  OR bed is securely locked  The anesthesia provider guards the  Body exposure should be minimal  Don’t Cross Ankles(causes DVT) nursinglectures.blogspot.com 4
 Respiratory Considerations  Circulatory Considerations  Peripheral Nerve Considerations  Musculoskeletal Considerations  Soft Tissue Considerations nursinglectures.blogspot.com 5
nursinglectures.blogspot.com 6
 OPERATING BED nursinglectures.blogspot.com 7
 Safety Belt (Thigh Strap)  Lift Sheet (Draw Sheet)  Upper Extremity Table  Shoulder Bridge ( Thyroid Elevator)  Shoulder Braces / Support  Body Rests and Braces  Body (Hip) Restraint Strap  Headrests nursinglectures.blogspot.com 8
 Anesthesia Screen nursinglectures.blogspot.com 9
 Armboard nursinglectures.blogspot.com 10
 Positioning for Anal Procedures with Adhesive Tape nursinglectures.blogspot.com 11
 Stirrups nursinglectures.blogspot.com 12
 Surgical Vacuum Positioning System nursinglectures.blogspot.com 13
 Supine (Dorsal) Position nursinglectures.blogspot.com 14
 Trendelenburg’s nursinglectures.blogspot.com 15
 Reverse Trendelendurg’s nursinglectures.blogspot.com 16
 Fowler’s Position nursinglectures.blogspot.com 17
 Lithotomy Position nursinglectures.blogspot.com 18
 Prone Position nursinglectures.blogspot.com 19
 Kraske (Jackknife) Position nursinglectures.blogspot.com 20
 PILONIDAL SINUS nursinglectures.blogspot.com 21
 Knee-Chest Positions nursinglectures.blogspot.com 22
 Lateral Positions nursinglectures.blogspot.com 23
 Kidney Position nursinglectures.blogspot.com 24
 Beach-Chair Position nursinglectures.blogspot.com 25
 Dorsal Position  Dorsal Recumbent  Fowler’s Position  Sitting Position  Lithotomy  Trendelenburg  Reverse Trendelenburg  Prone  Kraske  Knee-Chest Position  Sim’s  Kidney  Chest Position nursinglectures.blogspot.com 26
Visit: http://nursinglectures.blogspot.com For more Free Nursing lectures on MS, OB, Psych, OR, And more…. nursinglectures.blogspot.com 27

Perioperative Nursing Introduction to Operating Room Nursing lecture

2009-06-15T19:30:00.000-07:00

Introduction to Operating Room Nursing lecture. Contains detailed lecture on the perioperative period, classification and types of surgery, etc.

The branch of medicine that deals with the diagnosis and treatment of surgery, deformity or disease by manual or instrumental means.  3 phases : (Perioperative phase) Pre-Operative Intra-Operative Post-operative nursinglectures.blogspot.com
nursinglectures.blogspot.com
Identification of physiological, psychological, sociological needs of patient and implementation of nursing care Based on the knowledge of the natural and behavioral science In order to restore, or maintain the health and welfare of the patient during and after the surgical intervention nursinglectures.blogspot.com
 Correct deformities or defects nursinglectures.blogspot.com
 Repair Injuries nursinglectures.blogspot.com
 Alter form or structure nursinglectures.blogspot.com
 Diagnose and Cure Disease Process nursinglectures.blogspot.com
 Relieve Suffering nursinglectures.blogspot.com
 Prolong Life nursinglectures.blogspot.com
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 Preserve Life  Maintain Dynamic Body Equilibrium  Undergo Diagnostic Procedures  Prevent Infection and Healing  Obtain Comfort  Ensure ability to earn a living  Restore or reconstruct organ that is malformed  To alter cosmetic appearance nursinglectures.blogspot.com
Congenital Acquired Trauma Anomalies nursinglectures.blogspot.com
 According to Purpose 1. Diagnostic – to establish presence of disease 2. Exploratory – to determine extent of disease 3. Curative – to treat disease condition 4. Ablative – involves removal of an organ 5. Constructive – involves repair of congenitally defective organs 6. Reconstructive – involves repair of damaged organ 7. Palliative – to relieve distressing signs and symptoms, not necessarily to cure nursinglectures.blogspot.com
 MAJOR SURGERY – HIGH RISK 1. Extensive 2. Prolonged 3. Large amount of blood loss 4. Vital organ may be handled or removed 5. Great risk of complication  MINOR SURGERY 1. Generally not prolonged 2. Leads to few serious complications 3. Involves less risk nursinglectures.blogspot.com
 Emergency – to be done immediately to save life or limb  Imperative – to be done within 24 – 48 hours  Planned / Required – necessary for well-being  Elective – not absolutely necessary for survival, delay or omission will not cause adverse effect  Optional – Requested by the client usually for aesthetic purposes  Day (Ambulatory) - done on an outpatient basis nursinglectures.blogspot.com
 Obstructions – impairment to the flow of vital fluids nursinglectures.blogspot.com
 Perforations – rupture of an organ nursinglectures.blogspot.com
 Erosions – wearing off of a surface or membrane nursinglectures.blogspot.com
 Tumors – abnormal cell growth of tissue that serves no physiologic function in the body nursinglectures.blogspot.com
1. Malnutrition 2. Obesity 3. Presence of disease such as : Cardiac problem, URTI, Renal diseases, DM, Liver Diseases 4. Age 5. Concurrent or prior pharmacotherapy 6. Nature of the condition 7. Location of the condition 8. Magnitude and extent of surgical procedure 9. Mental attitude of the person toward surgery 10. Caliber of the professional staff and health care facilities nursinglectures.blogspot.com
 Stress response is elicited  Defense against infection is lowered  Vascular system is disrupted  Organ functions may be disturbed  Lifestyles may change nursinglectures.blogspot.com
 Prefixes – A, Ecto-, Intra-, Inter-, Pan-, Peri-, Poly-, Pseudo-, Retro-  Suffixes – Algia, -centesis, -copy, -ectomy, - itis, -lith, -logy, -lysis, -oma, -ostomy, -pexy, - plasty, -rrhapy  Rootwords – Adeno, Arthro, Auto, Blephar, Cardio, Cephalo, Cerebro, Cheil, Chole, Cholecyst, Choledocho, Chondro, Colpo, Costo, Cranio, Gastro, Hepar, Hyster, Lapar, Nephro, Oculo, Oophoro, Orchi, Osteo, Oto, Phlebo, Pyel, Salphingo nursinglectures.blogspot.com

Free Nursing Lectures | Best Nursing lecture resource on the web!

2009-06-14T18:09:00.000-07:00

Hi, Welcome to Nursing lectures! I am glad to share with you the

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Discover ways to increase your learning fast. Tips to improve your grades and achieve success.

OPERATING Room Nursing Lectures
covers topics in Introduction to Surgery, OR Team Members, Surgical Anesthesia, Sterile Techniques, Surgical Instrumentation, etc.

Medical Surgical Cardiovascular Nursing lecture on Nursing lectures - covers topics in Cardiovascular System. Includes Angina pectoris, Myocardial Infarction, ECG, Diagnostic tests, Lab Values, etc.

Obstetric Nursing on Nursing lectures - includes lecture in the intrapartal period, theories of labor, 4 P's of labor,etc.

Specialty Nursing lecture - covers Nursing informatics, Special senses lectures and new topics and subjects for Nursing

Nursing Informatics

2009-05-23T00:09:00.001-07:00

Nursing informatics is the integration of nursing science, information science and computer science.

One of the early pioneers of Nursing informatics is Dr. Virginia Saba, and she said that nurses should "Think out of the box"

Technology will play an integral part in health delivery and it is imperative that nurses must be able to master and harness them.

- Computers are
- incredibly fast , accurate and stupid . Human beings are incredibly slow , inaccurate and brilliant . Together they are powerful beyond imagination."
- - Albert Einstein
- In the 21 st Century, information is
- doubling every 5yrs , if not tripling in quantity and quality.
- Information is POWER
- Technology also facilitates the creative process in nurses, affording amazing vehicles for
- patient education , teaching and learning , and providing general health promotion and prevention information on a global scale.
- This can only become a common reality if nurses are comfortable working with computers and advanced technology while providing evidence based care for their clients .
- The healthcare of our clients is largely dependent on information.
- Every action taken depends on previous information and knowledge.
- American Nurses Association's Scope and Standards for Nursing Informatics Practice (2008) :
- “ Nursing Informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge and wisdom in nursing practice.”
- Standard areas of nursing :
- COMPUTER Assisted Education
- PDA (Personal Digital Assistants)
- LCD Projectors
- Wireless Routers
- Desktops
- Laptops
- Smartphones
- VIDEOS/ANIMATIONS
- Distance learning
- Testing (NCLEX)
- Student and course record management
- Functions :
- Provides access to standardized forms, policies and procedures
- Access data about client that may be somewhere in the medical record or elsewhere in health care agency.
- records clients assessments, medication administration, progress notes, care plan updating, client acuity and accrued charges
- EMRs/CPRs
- Used extensively in health care to assess and monitor clients conditions
- Data accumulated from various electronic devices are stored for research purposes
- Can monitor client
- Computerized diagnosis
- Telemedicine
- Used to order supplies, tests, meals, and services, from other departments
- Allows nursing service to determine the most costly items used by a particular nursing unit.
- May provide information or decisions to modify budget, provide different staffing, move supplies to different locations, or make other changes for more efficient and higher quality care
- A. Human resources
- B. Medical records management
- C. Facilities management
- 1. problem identification
- 2. literature review
- 3. research design
- 4. Data collection and analysis
- 5. Research dissemination
- Nursing practice will be revolutionized and we will truly be a profession of nurses with our own classification systems, bibliographic systems, and payment systems .
- We need to think outside the box?
- We need to use the Internet to enhance our practice and provide telenursing care . We need to become wireless and conduct our services using all the newer IT tools.
- “ We have a long way to go, but if we utilize information technology effectively, informatics will become an integral part of our profession and the health care industry. I do believe we have the knowledge and perseverance and I am convinced it will come to pass.”-Dr. Virginia Saba
- “ COLLABORATIVE CONNECTIVITY”
- Largest in the Philippines
- Houses 500 patients in 2 towers
- Rooftop (with Helipad)
- Provision for additional 288 beds
- Six-storey podium for special services and diagnostic facilities
- 18 tower Medical arts building housing 280 doctor’s clinics and
- 3 levels of parking for 1000 vehicles
- To implement a reliable and secure networking solution with optimum connectivity capable of carrying information services such as patient records and X-rays as well as sensitive laboratory results and other medical services information
- NORTEL ETHERNET ROUTING SWITCH 8600s
- SHAMAN
- (Strategic Hospital and Medication Automation Network)
- http://nursinglectures.blogspot.com
- http://www.statcom.com – Hospital software
- http://ojni.org – Online Journal for Nursing Informatics
- http://www.telehealth.ph – UP National Telehealth center

Psychiatric Nursing Pharmacology Lecture

2009-05-16T05:12:00.000-07:00

Psychiatric Nursing Pharmacology includes lectures on

ANTIANXIETY/ANXIOLYTICS http://nursinglectures.blogspot.com
Description
- Depress the CNS, thereby increasing the effects of GABA, which produces relaxation and may depress the limbic system
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Side effects
- Daytime sedation
- Ataxia
- Dizziness
- Headaches
- Blurred or double vision
- Hypotension
- Dry mouth
- Nausea
- Tremor
- Amnesia
- Slurred speech
- Urinary incontinence and Urinary retention
- Constipation
- Paradoxical CNS excitement
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Acute Toxicity
- Confusion
- Diminished reflexes and coma
- Flumazenil (Romazicon), a benzodiazepine antagonist, administered IV, will reverse benzodiazepine intoxication in 5 minutes.
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Effect
- Immediate except for Buspar (2 weeks)
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Drug Prototype (-zolam, -zepam)
- Valium (Diazepam)
- Librium (Chlordiazepoxide)
- Ativan (Lorazepam)
- Serax (Oxazepam)
- Tranxene (Chlorazapate)
- Miltown (Meprobamate)
- Equanil (Meprobamate)
- Vistaril (Hydroxyzine Pamoate)
- Atarax (hydroxyzine HCl)
- Inderal( Propanolol)
- Buspar (Buspirone)
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Implementation
- SAFETY
- Avoid sudden changes in position to prevent Orthostatic Hypotension
- Side effects are related to Mental Alertness
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- Given at bedtime
- No alcohol, tranquilizers
- Don’t stop abruptly - withdrawal symptoms (insomnia, anorexia, vomiting)
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ANTIMANIA http://nursinglectures.blogspot.com
Description
- Affect cellular transport mechanisms alter both the pre synaptic and postsynaptic events affecting serotonin, thus enhancing serotonin function.
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- Concurrent use with diuretics, fluoxetine , methyl dopa , or non steroidal anti-inflammatory medications increases lithium reabsorption by the kidney , or inhibits lithium excretion , either of which increases the risk of lithium toxicity.
- Acetazolamide, aminophylline, phenothiazines, or sodium bicarbonate may increase renal excretion of lithium , reducing its effectiveness
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The therapeutic drug serum level of lithium
- 0.6 – 1.2 mEq/L (0.5 – 1.5 mEq/L)
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Side effects
- Polyuria
- Polydipsia
- Anorexia, nausea
- Dry mouth
- Mild thirst
- Weight gain/acne
- Abdominal bloating
- Soft stools or diarrhea
- Fine hand tremors
- Inability to concentrate
- Muscle weakness
- Lethargy
- Fatigue
- Headache
- Hair loss
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Implementation
- Monitor the suicidal client , especially during improved mood and increased energy levels
- Instruct the client to maintain a fluid intake of 6 to 8 glasses of water a day.
- Instruct the client to avoid excessive amounts of coffee, tea, or cola , which have a diuretic effect
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- Instruct the client in the signs and symptoms of lithium toxicity.
- Do not administer diuretics while the client is taking lithium
- Instruct the client to avoid alcohol
- Instruct the client that he or she may take a missed dose within 2 hours of the scheduled time; otherwise the client should take the next dose at the scheduled time
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- Instruct the client not to adjust the dosage without consulting the physician, because lithium should be tapered off and not discontinued abruptly.
- Instruct the client to notify the physician if polyuria, prolonged vomiting, diarrhea, or fever occurs or lack of coordination and confusion
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Effect
- Therapeutic response to the medication is 2 – 4 weeks
- Some textbook says 1-3 weeks
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Drug Prototype
- Lithium carbonate (Eskalith, Lithane, Lithobid)
- Lithium citrate (Cibalith-Si)
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LITHIUM
- L evel 0.6 - 1.2
- I ncrease urination
- T remors, fine hand
- H 2O (water) 3 L/day and 3 gms of salt
- I increase thirst
- U “uu” diarrhea
- M outh dry
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- <>
- 1.5-2 mEq/L (mild to moderate toxic reactions)
- 2-2.5 mEq/L (moderate to severe toxic reactions)
- > 2.5 mEq/L (life-threatening toxicity)
- Reactions unrelated to serum levels
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ANTIPSYCHOTIC http://nursinglectures.blogspot.com
Description
- Sometimes referred to as “neuroleptics”
- Block dopamine receptors in the brain, thereby reducing the psychotic symptoms
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Side Effects
- Akathisia
- Parkinsonian-like symptoms of rigidity and tremor
- Constipation
- Urinary retention
- Photosensitivity
- Drowsiness
- Pruritus
- Dry mouth
- Tardive dyskinesia
- Neuroleptic malignant syndrome
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Extrapyramidal Syndrome
- Parkinsonism
- Dystonia
- Akathisia
- Tardive dyskinesia
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Effect
- 2 – 4 weeks
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Antiparkinsons (CAPABLES)
- Anticholinergic: AABC
- Dopaminergic: PLSE
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- Monitor for extrapyramidal symptoms
- Monitor for symptoms of neuroleptic malignant syndrome
- For oral use, the liquid form might be preferred
- Avoid skin contact with the liquid concentrate to prevent contact dermatitis
- Protect the liquid concentrate from light
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- Inform the client that phenothiazines may cause a harmless pinkish to red-brown urine color
- Instruct the client to use sunscreen, hats, and protective clothing when outdoors (photosensitivity)
- Instruct the client to change positions slowly to avoid orthostatic hypotension
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- Instruct the client to report signs of Agranulocytosis , including sore throat , fever , and malaise
- Instruct the client to report sign of liver dysfunction , including jaundice, malaise, fever, and right upper abdominal pain
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Neuroleptic Malignant Syndrome
- A potentially fatal syndrome that may occur at any time during therapy with neuroleptic medications
- Although its rare, it is more commonly seen at the:
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Assessment
- Dyspnea or tachypnea
- Tachycardia or irregular pulse rate
- Fever
- High or low blood pressure
- Increased sweating
- Loss of bladder control
- Skeletal muscle rigidity
- Pale skin
- Excessive weakness or fatigue
- Altered level of consciousness
- Seizures
- Severe EPS side effects
- Difficulty swallowing
- Excessive salivation
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Implementation
- Monitor vital signs
- Initiate safety and seizure precautions
- Discontinue the neuroleptic medication
- Notify the physician
- Monitor level of consciousness
- Give antipyretic as prescribed
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Drug Prototype
- Stelazine (Triflourperazine)
- Serentil (mesoridazine)
- Thorazine (Chlorpromazine)
- Trilafon (Perphenazine)
- Clozaril (Clozapine)
- Mellaril (Thioridazine HCl)
- Haldol (Haloperidol)
- Prolixin (Fluphenazine)
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“ AZINE (phenothiazines)” “PERIDOL (butyrophenones)” “THIXENE (thioxanthene)” http://nursinglectures.blogspot.com
“ ATYPICAL”
- Clozapine (Clozaril)
- Risperidone (Risperdal)
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- Sertindole (Serlect)
- Ziprasidone (Zeldox)
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ANTIDEPRESSANTS http://nursinglectures.blogspot.com
SELECTIVE SEROTININ REUPTAKE INHIBITORS (SSRIs) http://nursinglectures.blogspot.com
Description 
- Inhibit serotonin uptake
- Enhance the transmission of serotonin in the brain cells
- Produce an antidepressant response
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Side Effects
- Nausea and Diarrhea
- Dry mouth
- CNS stimulation
- Photosensitivity
- Insomnia
- Nervousness
- Headache
- Dizziness
- Weight loss
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Implementation
- Initiate safety precautions , particularly if dizziness occurs
- Instruct the client to take a single dose in the morning to prevent insomnia
- Administer with a snack or with meals to reduce the risk of dizziness and lightheadedness
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- Monitor the suicidal client , especially during improved mood and increased energy levels
- For client on long term therapy, monitor liver and renal function tests
- Monitor WBC and neutrophil counts and discontinue the medication, as prescribed, if levels fall below normal
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Drug Prototype
- Citalopram (Celexa)
- Fluoxetine (Prozac)
- Fluvoxamine (Luvox)
- Paroxetine hydrochloride (Paxil)
- Sertaline hydrochloride (Zoloft)
- Venlafaxine (Effexor)
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Effect
- 2 – 4 weeks
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TRICYCLIC ANTIDEPRESSANTS http://nursinglectures.blogspot.com
Description
- Blocks the reuptake of norepinephrine and serotonin at the presynaptic neuron
- Concurrent use with MAOIs can cause hypertensive crisis
- Use to treat depression
- May reduce seizure threshold
- May reduce effectiveness of antihypertensives
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Side Effects
- Dry mouth
- Decreased GI motility and constipation
- Difficulty voiding
- Dilated pupils and blurred vision
- Photosensitivity
- Cardiovascular disturbances
- Tachycardia, dysrhythmias
- Orthostatic hypotension
- Sedation
- Weight gain
- Anxiety, restlessness and irritability
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Effect
- 2 – 4 weeks
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Drug Prototype
- Amitriptyline hydrochloride (Elavil)
- Amoxapine (Asendin)
- Bupropion (Wellbutrin, Zyban)
- Clomipramine (Anfranil)
- Desipramine hydrochloride (Norpramin)
- Doxepin hydrochloride (Sinequan)
- Imipramine hydrochloride (Tofranil)
- Maprotiline (Ludiomil)
- Mirtazapine (Remeron)
- Nefazodone (Serzone)
- Nortriptyline hydrochloride (Aventyl)
- Protriptyline hydrochloride (Vivactyl)
- Trazodone (Desyrel)
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MONOAMINE OXIDASE INHIBITORS (MAOIs) http://nursinglectures.blogspot.com
Description
- Inhibit MAO enzyme , which is present in the brain, blood platelets, liver, spleen, and kidneys.
- Inhibition of the MAO enzyme metabolizes amines, norepinephrine, and serotonin , and the concentrations of these amines increase
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Description
- Used for depression in the client who has not responded to other anti depressant therapies, including ECT.
- Concurrent use with amphetamines, antidepressants, dopamine, epinephrine, guanetidine, levodopa, methyldopa, nasal decongestants, norepinephrine, reserpine , tyramine containg foods , or vasoconstrictors may cause HYPERTENSIVE CRISIS.
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Side Effects
- Orthostatic hypotension
- Restlessness
- Insomnia
- Dizziness
- Weakness, lethargy
- GI upset
- Dry mouth
- Weight gain
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Hypertensive Crisis
- Hypertension
- Occipital headache radiating frontally
- Neck stiffness and soreness
- Nausea and vomiting
- Sweating
- Fever and chills
- Clammy skin
- Dilated pupils
- Palpitations, tachycardia, or bradycardia
- Constricting chest pain
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Antidote for hypertensive crisis
- 5 to 10 mg PHENTOLAMINE (Regitine) by IV injection
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Implementation
- Monitor blood pressure frequently for hypertension
- Monitor signs for hypertensive crisis
- If palpitations or frequent headaches occur, discontinue the medication and notify the physician
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- Administer with food if GI distress occurs
- Instruct the client to report headache, neck stiffness, or neck soreness immediately
- Instruct the client to change positions slowly to prevent orthostatic hypotension
- Instruct the client to avoid caffeine or over-the-counter preparations such as weight reducing pills or medications for hay fever and colds
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- Monitor the client compliance with medication administration
- Avoid administering the medication in the evening because insomnia may result
- Instruct the client to avoid foods that require bacteria or molds for preparation or those that contain tyramine.
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Effect
- 2 – 4 weeks
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Drug Prototype
- “ PANAMA”
- Tranylcypromine (Parnate)
- Pheneizine sulfate (Nardil)
- Isocaboxazid (Marplan)
- Moclobemide (Manerix)
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TYRAMINE containing foods to AVOID!
- Cheese, especially aged, except cottage cheese
- Sour cream
- Pickled herring
- Avocados
- Bananas
- Papaya
- Broad beans
- Overripe fruit
- Red wine, beer
- Brewer’s yeast
- Meat extracts and tenderizers
- Yogurt Sausage, bologna, pepperoni, salami
- Soy sauce
- Raisins
- Beef, chicken, or liver
- Caffeine as coffee, tea, or chocolate
- Canned goods
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- Children with ADHD may require medication to reduce hyperactive behavior and lengthen attention span
- Medications that are most effective in controlling this disorder are CNS stimulants
- CNS stimulants, which increase agitation and activity in adults , have a calming effect on children with ADHD and increase alertness and sensitivity to stimuli
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Drug Prototype
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Implementation
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Implementation
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Medications to treat ALZHEIMER’S DISEASE
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Donepezil (Aricept)
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Tacrine (Cognex)
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- Aim for success, not perfection. Never give up your right to be wrong, because then you will lose the ability to learn new things and move forward with your life.
- Dr. David M. Burns
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Break
- http://nursinglectures.blogspot.com
- FREE NURSING LECTURES in
- MS,OB,OR,Psych,Funda and a whole lot more!
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ANXIETY DISORDERS http://nursinglectures.blogspot.com
Levels of Anxiety http://nursinglectures.blogspot.com
Mild Anxiety
- Individual is ALERT
- Attention is possible
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Moderate Anxiety
- Decrease perceptual field
- Difficulty concentrating
- acing
- RN meds
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Severe Anxiety
- Has trouble thinking and reasoning.
- Muscle tightens and vital signs increase.
- Learning and Problem solving skills is not Possible.
- Individual needs direction to focus.
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Panic
- uicide
- afety
- tay
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ANXIETY DISORDERS
- Client’s suffering from anxiety disorders can demonstrate unusual behaviors
- Disorder significantly impairs their daily routine, social life and occupational functioning.
- Considered abnormal
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GENERAL ETIOLOGY OF ANXIETY http://nursinglectures.blogspot.com
Psychoanalytical theory
- Psychic conflict
- Overuse of Defense mechanism
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Interpersonal theory
- Values of their parents and family
- Problems in interpersonal relationship = ANXIETY
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Cognitive - Behavioral theory
- Learned through experiences
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Biological theory
- Genetic theory
- Brain abnormality
- Neurochemical Theory
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TREATMENT
- Combination of medication & therapy
- Cognitive behavioral therapy
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ANXIETY DISORDERS
- GAD
- PD
- OCD
- Phobic disorder
- ASD and PTSD
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GENERAL ANXIETY DISORDER
- “ free floating anxiety”
- APPREHENSIVE WORRYING
- UNCONTROLLABLE WORRYING = problems with ADL
- AD
- months
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Primary symptoms
- Nervousness
- Irritability
- Apprehension
- Agitation
- Tension
- Tachycardia
- Diaphoresis
- SOB
- Difficulty falling and staying asleep
- Overlaps those with Panic and depressive
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TNPR
- First , to reduce the level of anxiety
- ULTIMATE GOAL: to assist patient’s with developing adaptive coping responses.
- Initially, patient needs support and reassurance
- TRUST
- EMPATHY
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- S AFETY
- V erbalization of feelings
- C alm Environment and Activities
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PANIC DISORDER
- Greek word “PANIKOS” meaning FEAR.
- Panic attacks that is 15 to 30 minutes (some for an hour) of rapid intense, escalating anxiety
- peak: 10 mins.
- NO precipitating factor
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DSM IV CRITERIA for PANIC DISORDER
- Recurrent, unexpected panic attacks
- Panic Attacks are followed by a month or more of worry about having additional attacks, worry about the results of the attacks, and behavioral changes related to the attacks
- Can be accompanied by agoraphobia
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TNPR
- Key Nursing Intervention:
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OBSESSIVE COMPULSIVE DISORDER
- O - recurrent thoughts, ideas, impulses or images that are experienced as intrusive and senseless.
- C - are repetitive behavior that are performed in a particular manner in response to an obsession
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- Compulsion are performed to prevent discomfort and to bind or neutralize anxiety.
- Central feature: subjective experience of loss of voluntary control.
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- Doubt – the common theme
- DM: Reaction formation, isolation and undoing
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2 Forms:
- Washers
- Checkers
- Others
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TNPR
- Ensure that basic needs of food, rest and grooming are met
- Provide patients with time to perform rituals
- Explain expectataions, routines, and changes
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PHOBIC DISORDER
- Fears are more specific.
- Are intense irrational fear responses to an external object, activity or situation.
- DM: Displacement
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three types
- AGORAPHOBIA
- SOCIAL PHOBIA
- SPECIFIC PHOBIA
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Management
- Assertiveness training
- Social skills groups
- Behavior therapy
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ASD and PTSD
- Develops after exposure to a clearly identifiable traumatic event that threatens the self, others, resources and or a sense of control or hope.
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Traumatic stressors:
- War
- Community violence
- torture
- natural and manmade disasters
- Accidents
- catastrophic illness
- major personal or business losses.
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Duration
- ASD
- PTSD
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PERSONALITY DISORDER
- They suffer lifelong , inflexible and dysfunctional patterns of relating and behaving
- “ Ego Syntonic”
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PERSONALITY DISORDERS CLUSTERS
- CLUSTER A (ODD and ECCENTRIC)
- CLUSTER B (DRAMATIC, EMOTIONAL, ERRATIC)
- CLUSTER C (ANXIOUS, FEARFUL)
- “ PSS BHAN ADO”
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Paranoid personality disorder: SUSPECT
- S : Spouse fidelity, suspected
- U : Unforgiving (bears grudges)
- S : Suspicious of others
- P : Perceives attacks (and reacts quickly)
- E : "Enemy or friend" (suspects associates, friends)
- C : Confiding in others feared
- T : Threats perceived in benign events
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PSYCHOTHERAPEUTIC MANAGEMENT
- Trust
- Formal , business-like manner
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Schizoid personality disorder: DISTANT (4)
- D : Detached (or flattened) affect
- I : Indifferent to criticism and praise
- S : Sexual experiences of little interest
- T : Tasks (activities) done solitarily
- A : Absence of close friends
- N : Neither desires nor enjoys close relations
- T : Takes pleasure in few activities
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Schizotypal personality disorder: ME PECULIAR (5 criteria).
- M : Magical thinking or odd beliefs
- E : Experiences unusual perceptions
- P : Paranoid ideation
- E : Eccentric behavior or appearance
- C : Constricted (or inappropriate) affect
- U : Unusual (odd) thinking and speech
- L : Lacks close friends
- I : Ideas of reference
- A : Anxiety in social situations
- R : Rule out psychotic disorders and pervasive developmental disorder
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PSYCHOTHERAPEUTIC MANAGEMENT
- Focused on improving function in the community
- Assist client to find CASE MANAGER
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CLUSTER B (DRAMATIC, EMOTIONAL, ERRATIC)
- B
- H
- A
- N
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Antisocial personality disorder: CORRUPT (3).
- C : Conformity to law, lacking
- O : Obligations ignored
- R : Reckless disregard for safety of self or others
- R : Remorse lacking
- U : Underhanded (deceitful, lies, cons others)
- P : Planning insufficient (impulsive)
- T : Temper (irritable and aggressive)
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ANTI SOCIAL
- 50% 0f the population in prison have this personality. Peak is 20 years of age.
- Before age 15 this is diagnosed as conduct disorders.
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LIMIT SETTING
- 3 steps in Limit setting
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Example
- “ IT IS NOT ACCEPTABLE FOR YOU TO ASK PERSONAL QUESTIONS, IF YOU CONTINUE I WILL TERMINATE OUR DISCUSSION. WE NEED TO USE THIS TIME TO WORK ON SOLVING YOUR JOB RELATED PROBLEMS.
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Borderline personality disorder: AM SUICIDE (5).
- A : Abandonment
- M : Mood instability (marked reactivity of mood)
- S : Suicidal (or self-mutilating) behavior
- U : Unstable and intense relationships
- I : Impulsivity (in two potentially self-damaging areas)
- C : Control of anger
- I : Identity disturbance
- D : Dissociative (or paranoid) symptoms that are transient and stress-related
- E : Emptiness (chronic feelings of)
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INTERVENTIONS
- Long term psychotherapy to address issues of family dysfunction and abuse
- Short term : self harm and transient psychotic symptoms
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PROMOTING CLIENTS SAFETY
- Safety “ priority ”
- No self harm contract or no suicide contract
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HELPING CLIENT COPE AND TO CONTROL EMOTIONS
- Keeping a journal often helps the client gain awareness of feelings
- Decreasing impulsivity and delay gratification by using distraction techniques
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RESHAPING THINKING PATTERNS
- Cognitive restructuring
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STRUCTURING THE CLIENTS DAILY ACTIVITIES
- Planning activities
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PSYCHOPHARMACOLOGY
- Generally not used
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Histrionic personality disorder: PRAISE ME (5).
- P : Provocative (or sexually seductive) behavior
- R : Relationships (considered more intimate than they are)
- A : Attention (uncomfortable when not the center of attention)
- I : Influenced easily
- S : Style of speech (impressionistic, lacks detail)
- E : Emotions (rapidly shifting and shallow)
- M : Made up (physical appearance used to draw attention to self)
- E : Emotions exaggerated (theatrical)
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Narcissistic personality disorder: SPECIAL (5).
- S : Special (believes he or she is special and unique)
- P : Preoccupied with fantasies (of unlimited success, power, brilliance, beauty, or ideal love)
- E : Entitlement
- C : Conceited (grandiose sense of self-importance)
- I : Interpersonal exploitation
- A : Arrogant (haughty)
- L : Lacks empathy
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PSYCHOTHERAPEUTIC MANAGEMENT
- Decreasing the constant recitation of self importance and grandiosity
- “ Matter of fact”
- Help patient focus on identification and verbalization of feelings
- Supportive Confrontation
- Limit setting
- UNIFIED APPROACH
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CLUSTER C (ANXIOUS, FEARFUL)
- A
- D
- O
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Avoidant personalty disorder: CRINGES (4 criteria).
- C : Certainty (of being liked required before willing to get involved with others)
- R : Rejection (or criticism) preoccupies one's thoughts in social situations
- I : Intimate relationships (restraint in intimate relationships due to fear of being shamed)
- N : New interpersonal relationships (is inhibited in)
- G : Gets around occupational activity (involving significant interpersonal contact)
- E : Embarrassment (potential) prevents new activity or taking personal risks
- S : Self viewed as unappealing, inept, or inferior
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Dependent personality disorder: RELIANCE (5 criteria).
- R : Reassurance required for decisions
- E : Expressing disagreement difficult (due to fear of loss of support or approval)
- L : Life responsibilites (needs to have these assumed by others)
- I : Initiating projects difficult (due to lack of self-confidence)
- A : Alone (feels helpless & discomfort when alone)
- N : Nurturance (goes to excessive lengths to obtain nurturance & support)
- C : Companionship (another relationship) sought urgently when close relationship ends
- E : Exaggerated fears of being left to care for self
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Obsessive-compulsive personality disorder: LAW FIRMS (4).
- L : Loses point of activity (due to preoccupation with detail)
- A : Ability to complete tasks (compromised by perfectionism)
- W : Worthless objects (unable to discard)
- F : Friendships (and leisure activities)
- I : Inflexible, scrupulous
- R : Reluctant to delegate
- M : Miserly (toward self and others).
- S : Stubbornness (and rigidity)
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SCHIZOPHRENIA
- It is characterized by disturbances in THOUGHT, SENSORY PERCEPTION, including the EMOTIONS, MOVEMENTS, BEHAVIOR.
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- AGE OF ONSET:
- GENDER:
- PREVALENCE:
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E. BLEULER
- Coined the term “ schizophrenia”
- ffective disturbance
- utism
- ssociative looseness
- mbivalence
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PARANOID
- one or more delusions or frequent auditory hallucinations
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Intervention
- Serve food sealed
- Don’t laugh or whisper
- Don’t touch, Distance at least 4 ft or Arms length
- Consistency
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DISORGANIZED
- All of the following are prominent
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Intervention
- Less stimulating area
- Provide information boards with schedules and refer to them often
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CATATONIC (2)
- Motor immobility – waxy, stupor
- Excessive motor activity (purposeless)
- Extreme negativism or mutism
- Peculiar movements stereotypy of movements
- Prominent mannerisms and grimacing
- Echolalia and echopraxia
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Intervention
- Immobility
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UNDIFFERENTIATED
- Characteristic symptoms are present
- But criteria for paranoid, catatonic, or disorganized subtypes are not met.
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RESIDUAL
- There is continuing evidence of disturbance such as presence of negative symptoms or criterion A symptoms, in an attenuated form (e.g odd beliefs, unusual perceptual experiences)
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Positive or type I
- Abnormal thought form
- Agitation, tension
- Associational disturbances
- Bizaare behavior
- Conceptual disorganization
- Delusions
- Excitement
- Feeling of persecution
- Grandiosity
- Hallucinations
- Hostility
- Ideas of reference
- Illusions
- Insomnia
- Suspiciousness
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Negative or type II
- Alogia, Anergia,
- Anhedonia
- Asocial behavior
- Attention deficits
- Avolition
- Blunted affect
- Communication difficulties
- Difficulty with abstractions
- Passive social withdrawal
- Poor grooming and hygiene
- Poor rapport
- Poverty of speech
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ETIOLOGY
- BIOLOGICAL
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- PSYCHOLOGICAL (psychodynamic)
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OTHER PSYCHOTIC DISORDERS
- SCHIZOAFFECTIVE DISORDER
- DELUSIONAL DISORDER
- BRIEF PSYCHOTIC DISORDER
- SCHIZOPHRENIFORM
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MAJOR DEPRESSIVE DISORDER
- 2 week period. At least 5 of the following symptoms must be present during the 2 week period one of which must be 1 or 2:
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Intervention
- Safety
- Increase the self esteem
- Punching bags / Foam bats
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MANIC EPISODES
- 1 week
- At least 3 of the following symptoms
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HYPOMANIC
- 4 days
- Not severe enough to result in significant impairment or to require hospitalization
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BIPOLAR DISORDER
- BIPOLAR I
- BIPOLAR II
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CYCLOTHYMIC DISORDER
- For a period of 2 years , the patient has had history of periods of hypomanic and depressed mood.
- The patient is never symptom free for more than 2 months at a time
- The patient has never experienced Major Depression
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Intervention
- SAFETY
- Reduce external stimuli
- Remove hazardous objects from the environment
- Avoid competitive games
- Set realistic limits of behavior
- Give attention to physical needs
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COGNITION
- Is the brain’s ability to process, retain and use information.
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COGNITIVE ABILITIES
- P erception
- O rientation
- R easoning
- M emory
- A ttention
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COGNITIVE DISORDER
- Delirium
- Dementia
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DELIRIUM
- “ acute confusional state”
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DSM CRITERIA for DELIRIUM
- Disturbances of consciousness
- Change in cognition
- Development over a short period of time
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KEY SYMPTOMS OF DELIRIUM
- F EARFULNESS
- D ISORIENTATION
- A GITATION
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ETIOLOGY:
- UNKNOWN
- General Medical condition
- Substance
- Prescription drug intoxication like anticholinergic drugs combination (elavil, antihistamines, antispasmodics, analgesics, steroids, sedatives, cardiovascular drugs (digoxin and diuretics) and cimetidine.)
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MANAGEMENT:
- Treatment of underlying disease and judicious use of medications and manipulation of the environment.
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Psychopharmacology
- Hypoactive delirium – no specific meds
- Hyperactive – sedation
- Restraints
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DEMENTIA
- Is a complex and devastating problem that is a major cause of disability in the older adult population.
- It is not a normal aging process
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DSM CRITERIA for DEMENTIA
- Multiple Cognitive deficits:
- Memory impairment (amnesia)
- At least one of the following cognitive disturbances:
- Significant impairment in social or occupational functioning.
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Amnesia
- Early sign
- Initially RECENT memory and in later stages it affects REMOTE memory
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Aphasia
- Deterioration of language function.
- Can’t say or Can’t express
- Echolalia and Palilalia
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Apraxia
- Impaired ability to execute motor functions despite intact motor abilities.
- Inability to perform routine self care activities
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Agnosia
- Inability to recognize or name objects despite intact sensory abilities.
- Senses
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ONSET & CLINICAL COURSE
- MILD
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- MODERATE
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- SEVERE
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http://nursinglectures.blogspot.com DELIRIUM DEMENTIA Onset Acute, often at night Insidious Course Fluctuating , with lucid intervals, during day: worse at night Stable over course of the day Duration Hours to week Months to years
http://nursinglectures.blogspot.com Awareness Reduced Clear Alertness Abnormally LOW or HIGH Usually Normal Attention Lacks direction and selectivity; distractibility; fluctuates over course of the day Relatively unaffected Orientation Usually impaired for time; tendency to mistake unfamiliar to familiar place and persons Often impaired
http://nursinglectures.blogspot.com Memory Immediate and recent memory impairments Recent and remote memory impairments – the most prominent symptom Thinking Disorganized Impoverished Perception Illusions and Hallucinations (usually visual) Often absent Sometimes: Hallucinations Delusions Illusions
http://nursinglectures.blogspot.com Speech Incoherent, hesitant, slow or rapid Difficulty finding words Sleep wake cycle Always disrupted Fragmented sleep Physical Illness or Drug toxicity Either or both present Often absent, especially in Alzheimer’s type
Reversible Dementia
- SLE (encephalopathy)
- Syphilis
- Hypo and Hyperthyroidism
- B12 and folate deficiency
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Non Reversible Dementia
- Alzheimer’s Disease
- Parkinson’s disease
- Pick’s disease
- Creutzfeldt Jakob Disease
- Vascular or multiinfarct dementia
- Alcoholic Dementia
- TIA
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ALZHEIMER’S DISEASE
- Commonly seen in the elderly ( 65 years old)
- Most prevalent of all non reversible dementia (50 – 75%)
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4A’s
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ETIOLOGY:
- UNKNOWN
- Presence of senile plaques and NFT
- Dystrophic neuritis; thickened swollen neuronal process
- Genetics
- Toxins
- Infection
- Cholinergic deficit
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Impairment In ADL based on stages of AD http://nursinglectures.blogspot.com
Mild
- Difficulty with
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Moderate
- Difficulty with
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Severe
- Needs considerable assistance with
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Profound
- Oblivious to surrounding and totally dependent to the caregiver
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Terminal
- Bed bound, requiring constant care
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TREATMENT
- Donezepil (Aricept)
- Tacrine (Cognex)
- Rivastigmine
- Galantamine
- Ginkgo Biloba
- NSAID’s
- Vitamin E
- Estrogen
- Calcium Channel Blockers prevents influx
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PARKINSON’S DISEASE
- A hypokinetic disorder , is a progressive, chronic, degenerative disease involving an area in the brain called the EPS
- ETIOLOGY: deficiency of the DOPAMINE and a subsequent decrease in the DOPAMINE transmission to the basal ganglia.
- S/Sx: B T R
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DIFFUSE LEWY BODY DISEASE
- Similar to AD but typically occurs in earlier life and is associated more often with Hallucination and Extra Pyramidal Symptoms
- Evolves rapidly
- Pathological feature: Presence of multiple Lewy bodies (eosinophilic cytoplasmic inclusions) in cortical and subcortical neurons.
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HUNTINGTON’S DISEASE (huntington’s Chorea)
- Opposite of PD
- Characterized by uncontrollable quick, jerky and purposeless writhing movements.
- Disturbance in gait and slurred speech are noted in the beginning and progress into neurological and intellectual deterioration.
- Memory loss, paranoia, irritability, impaired impulse control and lack of tongue and breathing control.
- Usually begins between the ages 25 to 45 average duration of 15 to 20 years
- Hereditary
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PICKS’S DISEASE
- Clinical presentation is similar to AD and are usually treated in the same way.
- Associated with aging and is without race and gender basis
- Onset is slow with an average duration of 5 to 7 years.
- Characterized by shrinkage of the frontal lobe.
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CREUTZFELDT – JAKOB DISEASE
- Also known as “Prion disease”
- Is a non inflammatory dementia that accounts for fewer than 1% of all cases of dementia.
- Prion is an infectious particle, smaller than a virus.
- It is rapidly progressive disorder of the CNS involving severe neurological impairment with marked dysfunction.
- Affects the cerebral cortex
- Early symptoms are vision and hearing loss, impaired cognition, myoclonus, ataxia, muscle wasting, tremor, hallucinations and illusions.
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VASCULAR OR MULTI INFARCT DEMENTIA
- Multiple large and small cerebral infarcts.
- CV disease maybe the leading cause of acquired intellectual impairment in the age 85 and older population.
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ALCOHOLIC DEMENTIA
- Typically occurs 15 to 20 years of continues drinking.
- Alcoholic dementia has three primary symptoms:
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TRANSIENT ISCHEMIC ATTACKS
- The chief importance of TIA is a precursor of a major stroke, MI or death.
- The syndrome is caused by microembolism to the brain from atherosclerotic plaques in the aortocranial arteries in about 90% of TIA. 10 % for mural thrombi, valvular disease of the heart, vegetation of the heart valve, polycythemia, or some other blood clotting disorder.
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PSYCHOTHERAPEUTIC MANAGEMENT http://nursinglectures.blogspot.com
TNPR
- Delirium HIGHEST PRIORITY : interventions to maintain life
- Dementia HIGHEST PRIORITY : Providing Nursing Care to maintain optimal level of functioning
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- Must learn the background and lifestyle of the patient.
- One on One basis by using the title and last name.
- Use praise, touch and affection whenever possible.
- Should be dressed in his or her own clothing during the day with his or her hair combed. Make up, shaved.
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3 milieu related issues
- STRESS
- SAFETY
- WANDERING
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CBQ
- Nursing Management
- Never Change the environment
- Don’t educate new skills
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3 stages
- Forgetfulness
- Wandering
- Kleuver Bucy like syndrome
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Substance abuse
- Using a drug in a way that is inconsistent with medical or social norms and despite negative consequences.
- DM: DENIAL
- DETOXIFICATION is the initial priority
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ALCOHOL
- Is a primary drug problem
- Is a central nervous system depressant that is absorbed rapidly into the blood stream.
- Ethanol
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ETIOLOGY
- Psychoanalytical Theories
- Learning theories
- Biological theories
- Socio cultural Theories
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Physiologic effects
- Initially, RELAXATION and DISINHIBITIONS
- Anxiety is relief
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INTOXICATION
- Slurred speech
- Unsteady gait
- Lack of coordination
- Impaired attention, concentration, memory and judgment.
- Some becomes aggressive or display inappropriate sexual behavior
- Intoxication can lead to BLACKOUT
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OVERDOSE OR EXCESSIVE ALCOHOL
- People die of alcohol because it depresses the CNS
- Vital centers becomes anesthesized
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Treatment
- Gastric lavage
- Dialysis
- Supportive care
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CBQ
- KORSAKOFF’S Psychosis
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- WERNICKE’S Encephalopathy
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WITHDRAWAL AND DETOXIFICATION
- Symptoms usually begins 4 – 12 hours
- Peaks on second day and is over by day 5
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PHARMACOLOGIC TREATMENT
- TWO main Purposes
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BENZODIAZEPINES
- To suppress the withdrawal symptoms
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- Vitamin B1 (thiamine)
- Vitamin B12 (cyanocobalamin) and Folic acid
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Disulfiram (ANTABUSE)
- To help deter clients from drinking
- Inhibits breakdown of acetaldehyde by the enzyme aldehyde dehydrogenase
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If taken with alcohol a severe adverse reaction occurs:
- Flushing
- A throbbing headache
- Sweating
- Nausea and vomiting
- Severe hypotension
- Confusion
- Coma
- Death
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AVOID! Products that contain alcohol
- Cough syrup
- Lotions
- Mouthwash
- Perfume
- Aftershaves
- Vinegar
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Odansetron (ZOFRAN)
- Used in young males at high risk for alcohol dependence or early onset alcohol dependence
- Treatment for methampetamine
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Acamprosate (CAMPRAL)
- Modulates transmission of GABA and NMDA,
- Decreases alcohol cravings and to maintain abstinence (UK)
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SEDATIVES, HYPNOTICS, AND ANXIOLYTICS
- Barbiturates
- Non Barbiturates hypnotics
- Anxiolytics (benzodiazepines)
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INTOXICATION
- Slurred speech
- Lack of coordination
- Unsteady gait
- Labile mood
- Impaired attention
- Stupor or coma
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OVERDOSE
- Benzodiazepines (Rarely fatal)
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- Barbiturates (Fatal)
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WITHDRAWAL SYNDROME
- Autonomic hyperactivity
- Hand tremors
- Insomnia
- Anxiety
- Nausea
- Psychomotor agitation
- Seizures and hallucination (severe withdrawal of benzodiazepine)
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DETOXIFICATION
- Tapering the amount of the drug.
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STIMULANTS (Amphetamines, Cocaine, Others)
- Amphetamines
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- Cocaine
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- Methamphetamines
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INTOXICATION (develops rapidly)
- High or euphoric feeling
- Hyperactivity
- Hypervigilance
- Talkativeness
- Anxiety
- Grandiosity
- Hallucinations
- Stereotypic or repetitive behavior
- Anger
- Fighting
- Impaired judgment
- Physiologic effects
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OVERDOSE
- Arrhythmia and Respiratory Collapse
- Seizures
- Coma
- Death (rare)
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MANAGEMENT
- Induction of vomiting
- Forced diuresis
- Chlorpromazine
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- Odansetron (ZOFRAN)
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CANNABIS SATIVA
- Is an Indian hemp plant
- Hashish
- Most often smoked in cigarettes “joints”
- Known to decrease the IOP
- Relieving nausea & vomiting associated with cancer chemotherapy and the anorexia of weight loss of AIDS.
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- Tetrahydrocannabinol
- Acts less than 1 minute after inhalation
- PEAK is 20 – 30 minutes and last at least 2 – 3 hours.
- Ingested – 12 hours
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- Effects similar to your alcohol, lowered inhibition, relaxation, euphoria, increased appetite “munchies”, conjunctival injection ( bloodshot eyes ), dry mouth, hypotension and tachycardia.
- Excessive use: delirium, psychotic disorder (rare)
- 2 cannabinoids
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INTOXICATION
- Impaired motor coordination
- Inappropriate laughter
- Impaired judgment
- Short term memory
- Distortions of time and perception
- Others: anxiety, dysphoria and social withdrawal
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OVERDOSES
- Do not occur
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WITHDRAWAL
- No clinically withdrawal syndrome
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OPIOIDS
- Popular drug abuse because they desensitize the user to both physiologic and psychological pain and induce a sense of euphoria and well being.
- Relieve pain by increasing the pain threshold and by reducing anxiety and fear
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- Morphine
- Meperedine (Demerol)
- Codeine
- hydromorphone
- hydrocodone
- oxycodone
- methadone
- oxymorphone
- hydrocodone
- propoxyphene
- HEROIN
- NORMETHADONE
- Cocaine + heroin = speed balling
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INTOXICATION
- Apathy
- Lethargy
- Listlessness
- Impaired judgment
- Psychomotor agitation or retardation
- Constricted pupils
- Drowsiness
- Slurred speech
- Impaired attention and memory
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OVERDOSE
- Coma
- Respiratory depression – primary effect
- Unconsciousness
- Death
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MANAGEMENT
- Naloxone (NARCAN) – antagonists
- Nalorphine (nalline)
- Clonidine (CATAPRES)
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WITHDRAWAL AND INTOXICATION “painful”
- Early
- Intermediate
- Late
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- METHADONE (Dolophine)
- LEVOMETHADYL
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HALLUCINOGENS “psychosis like reaction”
- “ Psychotomimetics” or “psychedelics”
- Distorts the user’s perception of reality and produces symptoms similar to psychosis including hallucinations (visual and depersonalization)
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- 2 basic groups
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- Increased PR, BP and TEMP, Dilated pupils , Hyperreflexia
- Physiologic symptoms: sweating, tachycardia, palpitations, blurred vision, tremors and lack coordination.
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INTOXICATION
- Anxiety
- Depression
- Paranoid ideation
- Ideas of reference
- Fear of losing one’s mind
- Jumping out of the window
- PCP: belligerence, aggression, impulsivity and unpredictable behavior.
- primarily psychological except PCP
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PCP TOXICITY
- seizures
- hypertension
- hyperthermia
- Respiratory depression
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OVERDOSE
- None
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MANAGEMENT
- psychotic reactions – isolation from external stimuli
- restraints
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WITHDRAWAL AND DETOXIFICATION
- None
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INHALANTS
- CNS depressants
- Most common substances in this category are ALIPATHIC and AROMATIC hydrocarbons
- Can cause significant brain damage , peripheral nervous system damage and liver disease.
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3 Basic forms of Inhalants
- Solvents (gasoline, glues)
- Aerosol propellants (spray cans)
- Anesthetic (chloroform, nitrous oxide)
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INTOXICATION
- Dizziness
- Nystagmus
- Lack of coordination
- Slurred speech
- Unsteady gait
- Tremor
- Muscle weakness
- Blurred vision
- Stupor and coma
- Belligerence
- Aggression
- Apathy
- Impaired judgment
- Inability to function
- Acute toxicity: anoxia, respiratory depression, vagal stimulation, dysrhythmia, death from brochospasm, cardiac arrest, suffocation, aspiration of the compound or vomitus.
- NO MEDS
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WITHDRAWAL AND DETOX
- none
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CBQ
- Short term Goal for Alcoholism
- Long term
- Number 1 sign of Cocaine withdrawal
- Heroine
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- Hallucinogen cardinal sign
- Number sign of Marijuana user
- Signs of withdrawal
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OVERDOSE
- UPPERS
- DOWNERS
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DSM CRITERIA for ANOREXIA
- Refusal to maintain body weight at or above a minimum normal weight for age and height
- Intense fear of gaining weight or becoming fat even through underweight
- Disturbance in the way in which one’s body weight or shape is experienced, overvaluing of shape or weight or denial of seriousness of low weight .
- In females, absence of at least three consecutive menstrual cycle.
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Objective signs
- Deliberate weight loss
- Amenorrhea , low levels of LH and FSH,
- Dry skin , cracking
- Lanugo
- Preoccupied to food and eating which involves all aspects of life.
- Engage in bizarre behavior
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- norexia
- dolescent
- menorrhea
- nderweyt
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DSM CRITERIA for BULIMIA
- Recurrent episodes of binge eating
- A feeling of lack of control over eating behaviors during the eating binges.
- Binge eating and inappropriate compensatory behaviors both occur on average at least twice a week for 3 months .
- Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self induced vomiting, use of laxatives or diuretics, strict dieting or fasting, vigorous exercise, or taking dieter pills.
- Self evaluation is unduly influenced by body shape and weight
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OBJECTIVE SIGNS
- Mechanical irritation and injuries to the GIT
- Fluid and Electrolytes abnormalities
- Esophagitis
- Esophageal stricture
- Aspiration Pneumonia
- Addiction
- Reflex constipation
- Rebound edema
- Enlarged salivary glands (painless)
- Erosion of the dental enamel
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KEY NURSING INTERVENTIONS for EATING DISORDER
- Observe patients for signs of purging
- Monitor activity level
- Weigh daily
- Plan for dietitian
- Regular monitor electrolyte status
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BINGE EATING DISORDER (BED)
- Eating disorder that do not fit clearly into the diagnostic criteria for Anorexia or Bulimia.
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DSM
- Recurrent binge eating at least 2 days per week for 6 months at least 3 of the following:
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Primary Goal Therapy
- Establish a regular, healthful pattern.
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Eating Related Problems http://nursinglectures.blogspot.com
PICA
- Persistent eating of non nutritious food
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Anorexia Athletica
- Obsessed exercised
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Muscle Dysmorphia (bigorexia)
- Worry excessively that they are small even if they have good muscle mass.
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Orthorexia Nervosa
- Pathologic fixation of eating proper, “pure” or “superior” foods
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Night Eating Disorder
- Lack of appetite for breakfast because of preoccupation on the amount of food eaten the night before.
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Nocturnal Sleep related Eating Disorder
- Persons who eats while asleep.
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Rumination Syndrome
- Bizarre eating pattern wherein the person eats, swallows and then regurgitate food back into the mouth again and then swallowed again.
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Gourmand’s Syndrome
- Obsession with fine foods
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Prader Nilli Syndrome
- Incessant eating (congenital problem)
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Chewing and Spitting
- Putting foods in the mouth, tasting, chewing then spitting.
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CBQ
- A menorrhea
- N o organic factor accounts for weight loss
- O bviously thin but feels fat
- R efusal to maintain normal body weight
- E pigastric discomfort
- X symptoms
- I intense fear of gaining weight
- A Always thinking foods
- B inge eating
- U nder strict dieting or vigorous exercise
- I nduced vomiting
- L acks control over eating binges
- M inimum of 2 binge eating episode a week for 3 months
- I ncrease persistent concern of body size/shape
- A buse of diuretics and laxatives
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SEXUAL DYSFUNCTION
- Sexual Response Cycle
- “ EPOR”
- “ DEOR”
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Sexual Desire Disorder
- Individuals with these disorder have little or no sexual desire or have an aversion to sexual contact.
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Sexual Arousal Disorder
- Individuals cannot maintain the physiological requirements for sexual intercourse
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Orgasm Disorder
- Individuals cannot complete the sexual response cycle because of the inability to achieve orgasm.
- In Premature Ejaculation
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Sexual Pain Disorder
- Suffer genital pain “DYSPAREUNIA”, before, during, after sexual intercourse.
- Vaginismus - involuntary spasm of the outer third of the vagina.
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PARAPHILIA
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DSM CRITERIA for PARAPHILIAS http://nursinglectures.blogspot.com
Exhibitionism
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Fetishism
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Frotteurism
- Recurrent, intense sexually arousing fantasies, sexual urges or behaviors involving touching and rubbing against a non consenting person.
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Pedophilia
- Recurrent, intense sexually arousing fantasies, sexual urges or behaviors that involve sexual activity with a child or children generally 13 years of age or younger. The person is at least 16 years of age and at least 5 years older than the child or children involved.
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Sexual masochism
- Recurrent, intense sexually arousing fantasies, sexual urges or behaviors involving the act of being humiliated, beaten, restrained or otherwise made to suffer.
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Sexual sadism
- Recurrent, intense sexually arousing fantasies, sexual urges or behaviors involving acts in which the psychological or physical suffering of the victim is sexually exciting to the person.
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Voyeurism
- Act of observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity
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- The paraphiliac activities last over a period of 6 months and cause distress or impairment in social, occupational, or other important areas of functioning.
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Other types
- Annillingus
- Cunnillingus
- Fellatio
- Partialism
- Urophilia
- Coprophilia
- Telephone scatologia
- Klismaphilia
- Hypoxyphilia
- Buggery
- Sodomy

Nursing Lecture about the Endocrine System: Altered Metabolic Function

2009-03-06T19:44:00.000-08:00

Altered Metabolic Function

- Lack (<) Endocrine Gland Over (>)
- Pineal –behind lateral ventricles
- Diabetes Insipidus Pituitary - SIADH
- Hypothyroidism Thyroid - Hyperthyroidism
- pedia: Cretinism Basedow’s/Parry’s
- adult: Myxedema Coma Grave’s Disease
- Hypoparathyroidism Parathyroid - Hyperparathyroidism
- Thymus
- DM Pancreas
- Addison’s Disease Adrenals - Cushing’s/Conn’s
- Gonads (testes / ovaries)
- Interaction of endocrine system with aging are inconclusive, however, changes in endocrine glands & target organs occur
- Loss of self-regulation (autoimmune or immunodeficiency disorders)
- Target organs lose ability to respond to hormones
- Hypothalamus & pituitary functions may be altered by changes in neurotransmitter levels
- Wear out of body structures in time are no longer able to adapt to stressors (theory of stress adaptation)
- Inspection:
- Palpation:
- Auscultation
- Vital signs & history taking
- “ diabetes” – going through; “mellitus” – honey/sweet
- Metabolic disorder characterized by glucose intolerance resulting from an imbalance between insulin supply & demand
- Involves β -cells if Islet of Langerhans (pancreas) – source of insulin
- Insulin Functions:
- Types:
- Type I
- Juvenile onset
- Abrupt onset
- Little or no insulin produced
- within ideal body weight / thin
- Tx:
- Type II
- Maturity onset
- Insidious onset
- Below normal or normal insulin production (but high demand for it)
- 80% of clients are obese
- Tx:
Genetic predisposition Environmental agents inciting an immune response Autoimmune destruction of β cells Insulin resistance Inability of pancreas to release insulin ↓ glucose utilization Stimulates insulin secretion initially Increased insulin demand Fat & protein mobilization Blood glucose accumulation Uncontrolled increased in blood sugar Diabetes mellitus ↓ insulin response due to exhaustion
- Hyperglycemia – increased blood sugar levels (normal = 80-120mg/dL)
- Glycosuria – (+) glucose in urine
- Polyuria – excessive urination
- Polydypsia – excessive thirst
- Polyphagia – excessive hunger
- Weight loss despite normal or increased appetite (type I)
- Blurring of vision
- Fatigue / weakness
- Skin infections
- Pruritus (candidal infections common among women)
- Blood Tests
- priority = correct deficiency
- D iet: 50-60%CHO, 10-20%CHON, 20-30%fats (unsaturated)
- I nsulin
- A nti-diabetic agents
- B lood sugar monitoring
- E xercise
- T ransplant of pancreas (if indicated)
- I nsure adequate food intake
- S crupulous foot care – cut toenails straight
- - do not use sandpaper or stones
- - socks = cotton
- - shoes = snugly
- - water = tepid
- - foot powder
- - dry between toes (after bath)
- - do not walk on barefoot
- Oral Hypoglycemic agents – for type II only
- Insulin – must be stored in cold (not freezing) temp
- Preparation Onset Duration Peak Route
- Subcutaneous injections are absorbed fastest at the abdomen
- Watch out for signs of hypoglycemia – cold, clammy skin & diaphoresis
- Lipodystrophy – loss of fatty tissues
- Diabetic Ketoacidosis (DKA) – liver ketone production exceeds cellular use & renal excretion
- Function – synthesis of thyroxin (T4) and triiodothyronine (T3)
- Bound to thyroid hormone-binding globulin (TBG) for transport in blood
- T3 = triiodothyronine (active form)
- T4 = thyroxin (needs to be converted to T3 before manifestation of physiologic action)
- Secretion is regulated by hypothalamic-pituitary-thyroid feedback (release of thyroid stimulating hormones –TSH)
- RDA of iodine is 40-50 mcg (infants), 70-120 mcg (children), and 150 mcg (adolescents and adults)
Sleep, cold temp, stress hypothalamus Thyroid-releasing hormone (TRH) Anterior pituitary (TSH) Thyroid gland (T3 & T4) Target organs Inhibition
- Basal Metabolic Rate – measures O 2 consumption of the body at a given time
- Thyroid Function Test – immunoassays measuring T 3 , T 4 , & TSH levels
- Thyroid scan – used to detect nodules & determine functional activity of thyroid glands
- CT Scan & MRI – used to demonstrate tracheal compression on neighboring structures
- too little thyroid hormone produced, when there is decreased conversion from T4 to T3 , or from Tx of hyperthyroidism
- Primary – intrinsic disorder in the thyroid gland
- Secondary – insufficient stimulation of thyroid hormone by TSH from anterior pituitary gland
- Tertiary – hypothalamus fails to produce TRH
- Dx: detailed Hx & physical assessment;
- Tx/Nursing Management: Replacement T3 or T4 therapy – FOR LIFE (caution use with MI, HPN, DM, pregnant & elderly)
- Myxedema Coma – life-threatening end stage expression of the disease
- Excessive delivery of thyroid hormones
- Common cause: Grave’s disease (autoimmune) & goiter
- Grave’s – abnormal stimulation of thyroid gland by thyroid stimulating antibodies
- Dx: increased serum T4
- Tx/ Nursing Management: Anti-thyroids = 2-3wks before effects are seen
- Thyroid storm/crisis – life-threatening
- Hypothyroidism
- Decreased BMR
- Myxedematous features
- Deep voice
- Impaired growth (child)
- ↑ cholesterol levels
- Behavior: mental & physical fatigability; mental retardation (infant)
- Bradycardia
- Decreased appetite
- Weight gain
- Cold intolerance
- Hyperthyroidism
- Increased BMR
- Exophthalmus
- Lid lag
- Fine hand tremors
- Decreased blinking
- ↓ cholesterol levels
- Behavior: restlessness, wakefulness, irritability, anxiety
- Tachycardia & palpitations
- Increased appetite
- Weight loss
- Heat intolerance
- Pre-op: achieve euthyroid state by Lugol’s solution & antithyroid drugs (2-3wks); rest
- Post-op Care:
- also called Radioiodine I-131 therapy
- for hyperthyroidism
- I-131(small dose) is swallowed, it is absorbed into the bloodstream in the GI tract and concentrated from the blood by the thyroid gland, where it begins destroying the gland’s cells
- client simply swallows a single dose (a prepared dose), in capsule or liquid form, and is quickly absorbed
- effect of this treatment on the thyroid gland usually takes between one and three months to develop, with maximum benefit occurring three to six months after treatment
- Nearly all the radioactive iodine leaves the body during the first two days following the treatment, primarily through the urine (Small amounts will also be excreted in saliva, sweat, tears, vaginal secretions, and feces)
- Client will be able to go home after treatment
- Clients who need to travel immediately after treatment are advised to carry a letter of explanation from physician
- Use private toilet facilities, if possible, and flush twice after each use.
- Bathe daily and wash hands frequently.
- Drink a normal amount of fluids.
- Use disposable eating utensils or wash your utensils separately from others.
- Sleep alone and avoid prolonged intimate contact.
- Avoid prolonged contacts esp. with pregnant women, infants, & children
- Launder your linens, towels, and clothes daily at home, separately.
- Do not prepare food for others that requires prolonged handling with bare hands.
- C/I: pregnancy (can damage the baby's thyroid gland)
- Pregnancy should be delayed until at least 6-12months after treatment (treatment exposes the ovaries to radiation)
- Women who have not yet reached menopause should fully discuss the use of I-131 with their physician.
- Inform client that it is highly likely that the entire thyroid gland will be destroyed with this procedure (most clients will need to take thyroid pills for the rest of their life following the procedure.
- There are essentially no other permanent side effects from the procedure
- Parathyroid hormone (PTH) - major regulator of serum calcium & phosphate
- Parathyroid gland –secretes the hormone
↓ serum Ca PTH Kidney- ↓ Ca Elimination & ↑ phosphate elimination ↑ serum Ca Intestine-↑ Ca absorption Bone-release of Ca Activated Vit.D
- Blood tests:
- Urine calcium & phosphate level determination (PO 4 -3 lost in urine is directly related to PO 4 -3 blood concentrations)
- Parathyroid hormone by radioimmunoassay
- Hypoparathyroidism Hyperparathyroidism
- Main Problem: - deficiency of Ca +2 in blood - excess Ca +2 in blood ↓Ca +2 in bones
- S/Sx: - Early = tingling - Recklin-Hensen’s Disease (↑Ca +2 in blood)
- = Chvostek’s sign - bone pain & destruction
- = Trousseau's sign
- Lab: - Ca +2 <>
- Mgt: - priority = Ca +2 - priority = safety
- replacement
- - diet: Broccoli - diet: ↓Ca +2
- Sardines - ↑oral fluids to prevent stone Spinach formation
- Tuna - strain urine
- Meds: - Fosamax - Paracalcitriol – suppress PTH
- Ca +2 gluconate IV (for acute)
- Adrenal glands – found retroperitoneally at the apex of kidneys
- Dx:
- CUSHING’S SYNDROME
- Overproduction of ACTH
- Cortisol
- Aldosterone
- Androgen (hirsutism)
- Mgt: correct electrolyte imbalance = priority
- ADDISON’S DISEASE
- Inadequate production of ACTH
- Cortisol:
- Aldosterone
- Androgen (lesser pubic hair)
- Mgt: correct electrolyte imbalance
- Addisonian Crisis – severe hypotension (coma & shock)

Nursing Care plan about Cholecystitis and Cholelithiasis

2009-03-06T19:10:00.000-08:00

A comprehensive nursing care plan guide for Cholecystitis and Cholelithiasis

CHOLECYSTITIS WITH CHOLELITHIASIS
Cholecystitis is an acute or chronic inflammation of the gallbladder, usually associated with gallstone(s) impacted in the cystic duct, causing distension of the gallbladder.
Stones (calculi) are made up of cholesterol, calcium bilirubinate, or a mixture caused by changes in the bile composition. Gallstones can develop in the common bile duct, the cystic duct, hepatic duct, small bile duct, and pancreatic duct.
Crystals can also form in the submucosa of the gallbladder causing widespread inflammation. Acute cholecystitis with cholelithiasis is usually treated by surgery, although several other treatment methods (fragmentation and dissolution of stones) are now being used.
CARE SETTING Severe acute attacks may require brief hospitalization on a medical unit. This plan of care deals with the acutely ill, hospitalized patient.
RELATED CONCERNS Cholecystectomy Fluid and electrolyte imbalances,Psychosocial aspects of care Total nutritional support: parenteral/enteral feeding Patient Assessment Database
ACTIVITY/REST May report: Fatigue May exhibit: Restlessness
CIRCULATION May exhibit: Tachycardia, diaphoresis, lightheadedness
ELIMINATION May report: Change in color of urine and stools May exhibit: Abdominal distension Palpable mass in right upper quadrant (RUQ) Dark, concentrated urine Clay-colored stool, steatorrhea
FOOD/FLUID May report: Anorexia, nausea/vomiting Intolerance of fatty and “gas-forming” foods; recurrent regurgitation, heartburn, indigestion, flatulence, bloating (dyspepsia) Belching (eructation) May exhibit: Obesity; recent weight loss Normal to hypoactive bowel sounds
PAIN/DISCOMFORT May report: Severe epigastric and right upper abdominal pain, may radiate to mid-back, right shoulder/scapula, or to front of chest Midepigastric colicky pain associated with eating, especially after meals rich in fats Pain severe/ongoing, starting suddenly, sometimes at night, and usually peaking in 30 min, often increases with movement Recurring episodes of similar pain May exhibit: Rebound tenderness, muscle guarding, or abdominal rigidity when RUQ is palpated; positive Murphy’s sign
RESPIRATION
May exhibit: Increased respiratory rate Splinted respiration marked by short, shallow breathing
SAFETY May exhibit: Low-grade fever; high-grade fever and chills (septic complications) Jaundice, with dry, itching skin (pruritus) Bleeding tendencies (vitamin K deficiency) TEACHING/LEARNING May report: Familial tendency for gallstones Recent pregnancy/delivery; history of diabetes mellitus (DM), IBD, blood dyscrasias Discharge plan DRG projected mean length of inpatient stay: 4.3 days considerations: May require support with dietary changes/weight reduction Refer to section at end of plan for postdischarge considerations.
DIAGNOSTIC STUDIES Biliary ultrasound: Reveals calculi, with gallbladder and/or bile duct distension (frequently the initial diagnostic procedure). Oral cholecystography (OCG): Preferred method of visualizing general appearance and function of gallbladder, including presence of filling defects, structural defects, and/or stone in ducts/biliary tree. Can be done IV (IVC) when nausea/vomiting prevent oral intake, when the gallbladder cannot be visualized during OCG, or when symptoms persist following cholecystectomy. IVC may also be done perioperatively to assess structure and function of ducts, detect remaining stones after lithotripsy or cholecystectomy, and/or to detect surgical complications. Dye can also be injected via T-tube drain postoperatively. Endoscopic retrograde cholangiopancreatography (ERCP): Visualizes biliary tree by cannulation of the common bile duct through the duodenum. Percutaneous transhepatic cholangiography (PTC): Fluoroscopic imaging distinguishes between gallbladder disease and cancer of the pancreas (when jaundice is present); supports the diagnosis of obstructive jaundice and reveals calculi in ducts. Cholecystograms (for chronic cholecystitis): Reveals stones in the biliary system. Note: Contraindicated in acute cholecystitis because patient is too ill to take the dye by mouth. Nonnuclear CT scan: May reveal gallbladder cysts, dilation of bile ducts, and distinguish between obstructive/nonobstructive jaundice. Hepatobiliary (HIDA, PIPIDA) scan: May be done to confirm diagnosis of cholecystitis, especially when barium studies are contraindicated. Scan may be combined with cholecystokinin injection to demonstrate abnormal gallbladder ejection. Abdominal x-ray films (multipositional): Radiopaque (calcified) gallstones present in 10%–15% of cases; calcification of the wall or enlargement of the gallbladder. Chest x-ray: Rule out respiratory causes of referred pain. CBC: Moderate leukocytosis (acute). Serum bilirubin and amylase: Elevated. Serum liver enzymes—AST; ALT; ALP; LDH: Slight elevation; alkaline phosphatase and 5-nucleotidase are markedly elevated in biliary obstruction. Prothrombin levels: Reduced when obstruction to the flow of bile into the intestine decreases absorption of vitamin K. NURSING PRIORITIES 1. Relieve pain and promote rest. 2. Maintain fluid and electrolyte balance. 3. Prevent complications. 4. Provide information about disease process, prognosis, and treatment needs. DISCHARGE GOALS 1. Pain relieved. 2. Homeostasis achieved. 3. Complications prevented/minimized. 4. Disease process, prognosis, and therapeutic regimen understood. 5. Plan in place to meet needs after discharge NURSING DIAGNOSIS: Pain, acute May be related to Biological injuring agents: obstruction/ductal spasm, inflammatory process, tissue ischemia/necrosis
ACTIONS/INTERVENTIONS RATIONALE Pain Management (NIC) Collaborative Maintain NPO status, insert/maintain NG suction as Removes gastric secretions that stimulate release of indicated. cholecystokinin and gallbladder contractions. Administer medications as indicated: Anticholinergics, e.g., atropine, propantheline (Pro- Relieves reflex spasm/smooth muscle contraction and Banthı-ne); assists with pain management. Sedatives, e.g., phenobarbital; Promotes rest and relaxes smooth muscle, relieving pain. Narcotics, e.g., meperidine hydrochloride (Demerol), Given to reduce severe pain. Morphine is used with caution morphine sulfate; because it may increase spasms of the sphincter of Oddi, although nitroglycerin may be given to reduce morphine- induced spasms if they occur. Monoctanoin (Moctanin); This medication may be used after a cholecystectomy for retained stones or for newly formed large stones in the bile duct. It is a lengthy treatment (1–3 wk) and is administered via a nasal-biliary tube.
A cholangiogram is done periodically to monitor stone dissolution. Smooth muscle relaxants, e.g., papaverine (Pavabid), Relieves ductal spasm. nitroglycerin, amyl nitrite; Chenodeoxycholic acid (Chenix), ursodeoxycholic
These natural bile acids decrease cholesterol synthesis, acid (Urso, Actigall); dissolving gallstones. Success of this treatment depends on the number and size of gallstones (preferably three or fewer stones smaller than 20 min in diameter) floating in a functioning gallbladder. Antibiotics. To treat infectious process, reducing inflammation.
Prepare for procedures, e.g.: Endoscopic papillotomy (removal of ductal stone); Choice of procedure is dictated by individual situation. Extracorporeal shock wave lithotripsy (ESWL); Shock wave treatment is indicated when patient has mild or moderate symptoms, cholesterol stones in gallbladder are 0.5 mm or larger, and there is no biliary tract obstruction. Depending on the machine being used, the patient may sit in a tank of water or lie prone on a water-filled cushion.
Treatment takes about 1–2 hr and is 75%–95% successful.
Note: This procedure is contraindicated in patients with pacemakers or implantable defibrillators. Procedure done to widen the mouth of the common bile Endoscopic sphincterotomy; duct where it empties into the duodenum. This procedure may also include the manual retrieval of stones from the duct by means of a tiny basket or balloon on the end of the endoscope. Stones must be smaller than 15 mm.
Fluid/Electrolyte Management (NIC) Independent Assess for unusual bleeding, e.g., oozing from injection sites, epistaxis, bleeding gums, ecchymosis, petechiae, hematemesis/melena. Prothrombin is reduced and coagulation time prolonged Collaborative when bile flow is obstructed, increasing risk of bleeding/hemorrhage. Keep patient NPO as necessary. Insert NG tube, connect to suction, and maintain patency as Decreases GI secretions and motility. indicated. Provides rest for GI tract. Administer antiemetics, e.g., prochlorperazine (Compazine). Reduces nausea and prevents vomiting. Review laboratory studies, e.g., Hb/Hct, electrolytes, ABGs (pH), clotting times. Aids in evaluating circulating volume, identifies deficits, and influences choice of intervention for Administer IV fluids, electrolytes, and vitamin K. replacement/correction. Maintains circulating volume and corrects imbalances.
NURSING DIAGNOSIS: Nutrition: imbalanced, risk for less than body requirements Risk factors may include Self-imposed or prescribed dietary restrictions, nausea/vomiting, dyspepsia, pain Loss of nutrients; impaired fat digestion due to obstruction of bile flow Possibly evidenced by [Not applicable; presence of signs and symptoms establishes an actual diagnosis.]
DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Nutritional Status (NOC) Report relief of nausea/vomiting. Demonstrate progression toward desired weight gain or maintain weight as individually appropriate.
ACTIONS/INTERVENTIONS RATIONALE Nutrition Management (NIC) Independent Estimate/calculate caloric intake. Keep comments about Identifies nutritional deficiencies/needs. Focusing on appetite to a minimum. problem creates a negative atmosphere and may interfere with intake.
ACTIONS/INTERVENTIONS RATIONALE Nutrition Management (NIC) Independent Weigh as indicated. Monitors effectiveness of dietary plan. Consult with patient about likes/dislikes, foods that cause Involving patient in planning enables patient to have a distress, and preferred meal schedule. sense of control and encourages eating. Provide a pleasant atmosphere at mealtime; remove Useful in promoting appetite/reducing nausea. noxious stimuli. Provide oral hygiene before meals. A clean mouth enhances appetite. Offer effervescent drinks with meals, if tolerated. May lessen nausea and relieve gas. Note: May be contraindicated if beverage causes gas formation/gastric discomfort. Assess for abdominal distension, frequent belching, Nonverbal signs of discomfort associated with impaired guarding, reluctance to move. digestion, gas pain. Ambulate and increase activity as tolerated. Helpful in expulsion of flatus, reduction of abdominal distension. Contributes to overall recovery and sense of well-being and decreases possibility of secondary problems related to immobility 9e.g., pneumonia, thrombophlebitis).
Collaborative Useful in establishing individual nutritional needs and most Consult with dietitian/nutritional support team as indicated. appropriate route. Begin low-fat liquid diet after NG tube is removed. Limiting fat content reduces stimulation of gallbladder and pain associated with incomplete fat digestion and is helpful in preventing recurrence. Advance diet as tolerated, usually low-fat, high-fiber. Meets nutritional requirements while minimizing Restrict gas-producing foods (e.g., onions, cabbage, stimulation of the gallbladder. popcorn) and foods/fluids high in fats (e.g., butter, fried foods, nuts). Administer bile salts, e.g., Bilron, Zanchol, dehydrocholic Promotes digestion and absorption of fats, fat-soluble acid (Decholin), as indicated. vitamins, cholesterol. Useful in chronic cholecystitis. Monitor laboratory studies, e.g., BUN, prealbumin, Provides information about nutritional albumin, total protein, transferrin levels. deficits/effectiveness of therapy. Provide parenteral/enteral feedings as needed. Alternative feeding may be required depending on degree of disability/gallbladder involvement and need for prolonged gastric rest.
NURSING DIAGNOSIS: Knowledge, deficient [Learning Need] regarding condition, prognosis, treatment, self-care, and discharge needs May be related to Lack of knowledge/recall Information misinterpretation Unfamiliarity with information resources Possibly evidenced by Questions; request for information Statement of misconception Inaccurate follow-through of instruction Development of preventable complications DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Knowledge: Illness Care (NOC) Verbalize understanding of disease process, prognosis, potential complications. Verbalize understanding of therapeutic needs. Initiate necessary lifestyle changes and participate in treatment regimen. ACTIONS/INTERVENTIONS RATIONALE Teaching: Disease Process (NIC) Independent Provide explanations of/reasons for test procedures and Information can decrease anxiety, thereby reducing preparation needed. sympathetic stimulation. Review disease process/prognosis. Discuss hospitalization Provides knowledge base from which patient can make and prospective treatment as indicated. Encourage informed choices. Effective communication and support at questions, expression of concern. this time can diminish anxiety and promote healing. Review drug regimen, possible side effects. Gallstones often recur, necessitating long-term therapy. Development of diarrhea/cramps during chenodiol therapy may be dose-related/correctable. Note: Women of childbearing age should be counseled regarding birth control to prevent pregnancy and risk of fetal hepatic damage. Discuss weight reduction programs if indicated Obesity is a risk factor associated with cholecystitis, and weight loss is beneficial in medical management of chronic condition. Instruct patient to avoid food/fluids high in fats (e.g., Prevents/limits recurrence of gallbladder attacks. whole milk, ice cream, butter, fried foods, nuts, gravies, pork), gas producers (e.g., cabbage, beans, onions, carbonated beverages), or gastric irritants (e.g., spicy foods, caffeine, citrus).
ACTIONS/INTERVENTIONS RATIONALE Teaching: Disease Process (NIC) Independent Review signs/symptoms requiring medical intervention, Indicative of progression of disease process/development e.g., recurrent fever; persistent nausea/vomiting, or pain; of complications requiring further intervention. jaundice of skin or eyes, itching; dark urine; clay-colored stools; blood in urine, stools, vomitus; or bleeding from mucous membranes. Recommend resting in semi-Fowler’s position after meals. Promotes flow of bile and general relaxation during initial digestive process. Suggest patient limit gum chewing, sucking on straw/hard candy, or smoking. Promotes gas formation, which can increase gastric distension/discomfort. Discuss avoidance of aspirin-containing products, forceful Reduces risk of bleeding related to changes in coagulation blowing of nose, straining for bowel movement, contact sports. Recommend use of soft toothbrush, electric razor. time, mucosal irritation, and trauma.
POTENTIAL CONSIDERATIONS following acute hospitalization (dependent on patient’s age, physical condition/presence of complications, personal resources, and life responsibilities) Pain, acute—recurrence of obstruction/ductal spasm; inflammation, tissue ischemia.

Nursing Care plan about Cholecystectomy

2009-03-06T19:09:00.001-08:00

A Comprehensive Nursing care plan guide for Cholecystectomy

Nursing Lecture about Alterations in Fluids and Electrolytes

2009-03-06T18:53:00.000-08:00

Alterations in Fluids and Electrolytes

Fluids and Electrolytes in the Newborn

Nursing Lecture about Altered Nutrition:Gastrointestinal System

2009-03-06T18:26:00.000-08:00

Altered Nutrition: Gastrointestinal System and Biliary Disorders

- Group of ulcerative disorders in the upper GI tract caused by resistance of mucosa to acid-pepsin injury
- Common site: 1 st part of duodenum
- Risk factors:
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- Gastric Ulcer Duodenal Ulcer
- Site - antrum of stomach - duodenum (proximal)
- Problem - weakened mucosa - ↑in HCl
- Pain - gnawing epigastric pain - gnawing epigastric pain
- - occurs 1hr after eating - occurs 2hrs after eating
- - aggravated by eating - relieved by food (closure
- (increase acid secretion) of pyloric sphincter)
- - relieved by vomiting
- (acid is expelled)
- - no pain at hours of sleep - pain at hours of sleep
- ( decreased HCl production) (continuous gastric emptying)
- Bleeding - commonly hematemesis - commonly melena
- (anemia, weight loss)
- Demographics
- - common in older people - middle-age people
- - females with familial history - males with no significant familial history (stress- related)
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- History taking – include use of NSAIDs & ASA
- Lab findings: occult blood
- Barium contrast / Barium Swallow – radiologic visualization of upper GI
- Endoscopy (gastroscopy or duodenoscopy) – direct visualization of the GI system by means of lighted flexible tube
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- Primary objective: provide stomach rest
- Small frequent meals
- Avoid foods that increases acidity (eg. caffeine, alcohol, milk)
- Bland diet
- Lifestyle changes: stop smoking
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- Bismuth subsalicylate (Pepto-Bismol) for H.pylori
- Sucralfate (Caralfate) & prostaglandin analogs; Misoprostol (Cytotec)
- Antacids: - given 1-3hrs after meals & at bedtime (empty stomach; ↓ pain
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- Gastrectomy
- Antrectomy – removal of lower portion of stomach (entire antrum)
- Vagotomy – interruption of vagus nerve to decrease gastric secretion
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- Backward movement of gastric contents into the esophagus (causes heartburn)
- Causes:
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- Heartburn (pyrosis) – occurs 30-60mins after eating; usually at night
- Belching (water brash)
- Pain – epigastric or retrosternal area (pain may be confused with angina)
- Dysphagia – resulting from edema
- wheezing
- Chronic cough
- hoarseness
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- Esopha goscopy – passage of flexible fiber optic endoscope into the esophagus
- 24-hour pH Monitoring – small tube with pH electrode is passed through the nose into the esophagus
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- Instruct client to:
- Have small frequent feedings (4-6x/day) but NPO 3h rs before sleep
- Avoid caffeine, fats, chocolates in the diet (reduces esophageal sphincter tone)
- Avoid alcohol & smoking
- Eat meals sitting up rather (avoid recumbent position for several hours after eating)
- Avoid bending for long periods – increases intra-abdominal pressure
- Sleep with head elevated
- Weight loss for overweight / obese clients
- Meds:
- Antacids
- H 2 blockers: Cimetidine, Ranitidine, Famotidine
- Proton-pump inhibitors: Omeprazole, pantoprazole
- Motility agents: Meteclopramide – increases lower esophageal pressure & enhance esophageal clearance
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- Nissen fundoplication – most frequently used & involves gastric wraparound (fundus around lower esophagus)
- Hill’s operation – narrows the esophageal opening
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- Esophageal diverticulum – out-pouching of the esophageal wall due to weakness of mucularis layer
- Achalasia – failure of lower esophageal sphincter to relax & swallowed food has difficulty passing into the stomach (“something stuck in the throat”)
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- Hiatal hernia – barium swallow (confirmatory)
- Esophageal cancer – more common among 50 years of age
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- Presence of gallstones
- Possible causes: gallbladder stasis, infection, genetics
- Risk factors:
- Manifestations: colicky pain, jaundice, nausea & vomiting
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- inflammation of the gallbladder
- inflammation believed to be caused by chemical irritation from the concentrated bile, mucosal swelling, ischemia from venous congestion & lymphatic stasis, gallstones
- Risk factors: sedentary lifestyle & obesity
- Types:
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- Pain often precipitated by a fatty meal commonly at RUQ
- Tenderness on RUQ
- Vomiting – bilious in character
- Fever
- High WBC count
- Elevated total serum bilirubin, AST / ALT
- Intolerance to fatty food
- belching
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- Ultrasound – can detect wall thickening (inflammation)
- - can detect small (1-2cm) gallstones
- Cholescintigraphy – gallbladder scan
- - relies on the ability of the liver to extract rapidly injected radionuclide (technetium-99) that is excreted into the bile ducts
- - reading every 10-15mins of the hour
- - highly accurate
- Oral cholecystography – radiologic technique that uses oral tablets containing radiopaque contrast medium
- - fat-free diet 1-2days prior
- - dye is taken 10-14hrs prior
- -may produce nausea & vomiting or diarrhea
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- Low-cholesterol diet
- Laparoscopic cholecystectomy – treatment of choice for symptomatic gallbladder disease
- - longer duration of operation shorter hospital stay (1 day after OR)
- - client can resume work 1-2wks after
- ESWL (Extracorporeal Shock-wave Lithotripsy) – uses soundwaves to pulverize gallstones (30-40mins)
- - suitable only for radiolucent stones
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- TPN contents:
- monitoring of the following is vital:
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- Condition characterized by excess body fat (BMI ≥ 30)
- May be seen as a sign of lack of self-control
- Causes:
- Basic energy imbalance – more energy intake (food) than energy expanded for basal metabolic needs & exercise = weight gain
- Genetic & family factor – genetic control regulates differences in body fat & sex differences in weight; family food patterns add to genetic factor = social pressure, habits & attitudes toward food
- Physiological factor – amount of body fat is related to the number & size of fat cells in the body
- Psychosocial factor – eating under emotional stress; using food for comfort
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- Hypertension
- Cardiovascular & pulmonary diseases
- Gallbladder diseases
- Glucose intolerance / insulin resistance
- Stroke
- Arthritis
- Infertility
- Cancer (prostate, colon, breast)
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- Focused on lifestyle modification
- Determine client’s motivation & goal/s to lose weight (organizations: eg. TOPS, Weight Watchers, Overeater anonymous)
- Physical activity – prevention of weight gain
- Dietary therapy – individually prescribed based on client’s weight status & risk profile (usually calorie-restricted)
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- Criteria for Evaluating Weight-reduction Diet
- Realistic goals – promote 1-2lbs/wk weight loss; easily adapted to lifestyle; based on individual’s calorie requirement
- Reduce caloric intake (Food consumption)
- - use food to meet nutritional requirements rather than vitamins & minerals supplement
- - encourage food from major food groups
- - decrease fat consumption
- - increase fruits, vegetables, grains, & fiber
- Behavior Modification – control of eating behaviors & promotes physical activity
- Exercise – encourage exercise plan that is acceptable & enjoyable to the client
- Culturally acceptable – offer a maintenance plan after achievement of weight loss; re-educating of eating habits
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- Sibutramine – inhibits serotonin, dopamine, norepinephrine re-uptake; decreasing appetite
- Orlistat – lipase inhibitor; decreases fat absorption in the intestine
- Surgery: Bariatric Surgery
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- Bariatric Surgery – also known as Gastric banding, O besity surgery (group of various procedures)
- usually for men who are at least 100 pounds overweight and women who are at least 80 pounds overweight
- limits the amount of food you can take in
- reduce the size of the stomach
- stomach is divided into two sections reducing the size of the new pouch from approximately two quarts to two ounces
- drastic reduction in the size limits its capacity to hold food causing client to feel full after eating only a small amount;
- also causes the food to bypass part of the digestive system, reducing the amount of calories the body absorbs
- after surgery, client will find it hard to eat foods high in sugars and fats
- emphasize that procedure is in no way to be considered cosmetic surgery

Biliary Disorders of the GIT system

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Nursing Lecture AIDS nursing care plan

2009-02-28T21:04:00.000-08:00

AIDS Nursing Care plan only here at nursinglectures.blogspot.com

Preparing an individualized Nursing Care plan can be quite confusing. Use this Nursing lecture to help with your preparation.