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 SIADH
Patho Cause
Unnecessary secretion of ADH hormone ¨Tumors ¨Drugs ¨CNS disorders
Excessive fluid retention
¨Encephalitis ¨Meningitis ¨Lung disease

S/S Meds/TX
Dilutional hyponatremia <120, water retention = ¨ Tolvaptanà given only in hospital
­ wt but NO edema, poor appetite, GI upset, ­ ¨ Hypertonic saline (3% NaCl), ­ Na
ICP, lethargy, altered LOC, H/A, seizures, blocks ADH release
bounding pulses, hypothermia ¨ Diuretics

Nursing Interventions
¨Fluid restrictions ¨Sodium replacement ¨Daily wt’s and I&O’s ¨Monitor therapeutic
response to treatment ¨Frequent neuro checks ¨Implement safety precautions for possible
seizure activity due to ¯ Na
 Diabetes Insipidus
Patho Cause
Excessive water loss (not enough ADH) ¨ADH deficiency ¨Kidneys not responding
Dehydration
to ADH ¨Genetics ¨Brain tumor or trauma
¨Damage to pituitary gland or
hypothalamus
S/S Meds/TX
Polyuriaàurine output of 4L or greater per ¨ Desmopressin acetate (DDAVP)
day, dehydration, increased thirst, low sodium ¨ Vasopressin
levels, dry skin, constipation, muscle weakness

Nursing Interventions
¨Increased fluid intake ¨Daily wt’s ¨Urine specific gravity monitoring ¨Neuro assessments
 Hyperthyroidism (Graves’ Disease)
Patho Cause
Excessive thyroid hormone secretion ¨Graves’ disease ¨Goiters & tumors
­ T3 & T4
Autoimmune

S/S Meds/TX
Exophthalmos (bulging eyes), visual changes, ¨ Propylthiouracil (PTU)
heat intolerance, insomnia, increased systolic ¨ Methimazole
BP, tachycardia, low grade fever ¨ Radioactive iodine (RAI)
¨ Surgery

Nursing Interventions
¨Monitor for tetany ¨Reduce stimulation ¨Educate about proper medication use ¨Monitor
for complications
 Hypothyroidism
Patho Cause
¯ thyroid hormone secretion (T3 & T4) ¨Thyroid surgery ¨Radioactive iodine
Decreased metabolism
¨Autoimmune disease ¨Medications

S/S Meds/TX
Expressionless, cold intolerance, weight gain, ¨ Levothyroxine (take at the same
low HR, low RR, low temperature, constipation time every day)

Nursing Interventions
¨Educate on S/S of HYPERthyroidism ¨Educate on proper use of meds ¨Improve gas
exchange ¨Prevent hypotension ¨Monitor cognition
 Thyroid storm
Patho Cause
Uncontrolled hyperthyroidism ¨Triggered by stressors: trauma, infection,
DKA, pregnancy, manipulation of the thyroid
gland

S/S Meds/TX
Fever, tachycardia, systolic hypertension, fever, ¨ Propylthiouracil (PTU)
nervousness/ confusion, N/V/D ¨ Methimazole
¨ Propranolol

Nursing Interventions
¨Immediately report a temp increase of 1 degree ¨Place on cardiac monitoring ¨Be prepared
to call rapid response
 Myxedema Coma
Patho Cause
Rare complication of poorly treated ¨Acute illness ¨Surgery ¨Chemotherapy
hypothyroidism
¨Stopping thyroid replacement therapy

S/S Meds/TX
“Floppy heart” (mitral valve prolapse- valves ¨ Levothyroxine
not closing), decreased cardiac output, ¨ IV glucose
decreased perfusion to the brain ¨ Corticosteroids

Nursing Interventions
¨Assess Q8hr for mental status changes ¨Maintain adequate airway ¨Fluid replacement
¨Keep warm ¨Monitor for BP changes
 Hyperparathyroidism
Patho Cause
Excessive secretion of PTH (calcium) ¨Body not responding to normal feedback
Reduced bone density
of calcium levels ¨Tumor’s

S/S Meds/TX
Weakness, lethargy, depression, anorexia, ¨ Hydration (NS)
constipation, ­ BP & HR, confusion, weight loss, ¨ Furosemide
urinary calculi, ­ calcium and magnesium levels, ¨ Calcitonin
¯ phosphorus levels

Nursing Interventions
¨Monitor cardiac function ¨Q2hr I&O’s ¨Prevent injury/ fall precautions (increased risk of
fractures)
Subtotal or Total Parathyroidectomy, Preop: control HTN, dysrhythmias, tachycardia, deep-breathing, support neck Postop:
monitor complications: hemorrhage, resp distress, parathyroid injury (hypocalcemia or tetany), laryngeal nerve damage; thyroid
storm ¯Ca= tetany
 Hypoparathyroidism
Patho Cause
Rare, decreased parathyroid function leading to ¨Decreased parathyroid hormone secretion
hypocalcemia (calcium level <9)
¨Hypomagnesemia ¨Surgery

S/S Meds/TX
Tingling, numbness, cramps, spasms around the ¨ IV calcium
mouth, hands, and feet, Chvostek’s and ¨ Ergocalciferol
Trousseau’s sign (positive= tetany), ­
phosphorus, ¯ sodium, magnesium, and Vit D *avoid dairy it has too much phosphorus

Nursing Interventions
¨Implement seizure precautions ¨Increase calcium in diet ¨Educate need for lifelong
therapy for hypocalcemia ¨Drug teaching
Subtotal or Total Parathyroidectomy, Preop: control HTN, dysrhythmias, tachycardia, deep-breathing, support neck Postop:
monitor complications: hemorrhage, resp distress, parathyroid injury (hypocalcemia or tetany), laryngeal nerve damage; thyroid
storm ¯Ca= tetany
 Cushing’s Disease
Patho Cause
Excessive secretion of catecholamines ¨Pituitary adenoma ¨Adrenal adenoma
(Fight or Flight)
¨Excessive cortisol

S/S Meds/TX
Hirsutism (excessive body hair), moon face, ¨ Mitotane (monitor urine output and
muscle weakness, bone pain, enlarged trunk for wt loss)
(thin arms & legs), fluid overload, buffalo hump, ¨ Radiation therapy
increased appetite, thin/ fragile skin,
red/purple striae to abdomen/ extremities
Nursing Interventions
¨Safety- monitor/ prevent fluid overload, pulmonary edema, dependent edema ¨Daily wt’s
¨Sodium restriction ¨Prevention of skin breakdown
Hypophysectomy (remove pituitary gland) Preop: do not brush teeth, blow nose, cough, bend forward after surgery can cause ­ ICP, Postop:
monitor neuro status, REPORT postnasal drip or ­swallowing, HOB elevated, assess nasal drainage for presence of glucose, “halo sign” =
cerebrospinal fluid
 Addison’s Disease
Patho Cause
Decreased amounts of cortisol ¨Sudden cessation of long-term
glucocorticoid therapy

S/S Meds/TX
Decreased body hair, hyperpigmentation, ¨ Replacement therapy:
hypoglycemia, hyperkalemia, lethargy, hydrocortisone, prednisone
depression, confusion, psychosis

Nursing Interventions
¨Assess cardiac function ¨Monitor fluid balance ¨VS Q4hr ¨Daily wt’s and I&O’s
¨Teaching on S/S of Cushing’s disease
 Pheochromocytoma
Patho Cause
Catecholamine producing tumors ¨Unknown

S/S Meds/TX
HTN, H/A, agitation, heart palpitations, ¨ Surgery to remove adrenal glands
diaphoresis, feeling of impending doom, ­blood (after VS are controlled)
glucose, emotional instability ¨ Steroids

Nursing Interventions
¨Do not palpate the abdomen can cause severe HTN ¨Avoid tobacco and caffeine ¨Change
positions slowly ¨Increase hydration prior to surgery ¨Monitor BP frequently ¨Will require
lifelong steroids
 Addisonian Crisis
Patho Cause
Severe cortisol and aldosterone deficiency ¨Stressful event (trauma, surgery) when
*life threatening cortisol levels are already low

S/S Meds/TX
Decreased sodium levels, increased potassium ¨ NS/D5-NS
levels, severe hypotension, hypoglycemia ¨ Insulin
¨ Glucose
¨ IV hydrocortisone

Nursing Interventions
¨NS (fluid and electrolyte replacement) ¨IV glucose (monitor glucose level hourly) ¨Replace
steroids ¨Manage hyperkalemia ¨Cardiac monitoring (watch for dysrhythmias) ¨Daily wt’s
¨VS Q4hr
Hyperglycemic-Hyperosmolar State (HHS)
Patho Cause
Uncontrolled hyperglycemia (without ketones) ¨Hyperglycemia ¨Type 2 diabetes mellitus

S/S Meds/TX
Hypotension, extreme thirst, dehydration, ­ BUN ¨ 0.45% NaCl or ½ NS at 1L/hr for first
and creatinine, tachycardia, fever, ¯ sodium and hour then 100-200mL/hr thereafter
potassium levels, blood glucose >600mg/dL, ¨ Regular insulin (lower glucose level 50-
75mg/dL/hr) IV bolus= 0.15 U/kgà IV
serum pH >7.40
drip= 0.1 U/kg/hr until blood glucose
<250
Nursing Interventions
¨Fluids= priority to restore blood volume and tissue perfusion within first 36-72hr due to
extreme diuresis ¨Monitor airway ¨Monitor glucose levels ¨Administer insulin ¨Assess LOC
frequently ¨Monitor VS ¨Strict I&O’s ¨Teach sick day rules
 Diabetic Ketoacidosis (DKA)
Patho Cause
Uncontrolled hyperglycemia (with ketones), ¨Insulin deficiency increase in hormone
metabolic acidosis release that leads to increased liver and
kidney glucose production but decreased
glucose use ¨Sudden infection (most
common cause)
S/S Meds/TX
Polyuria, polydipsia, polyphagia, drowsiness, ¨ 0.9% NaCl (1L in first hr, may need 6-
flushed skin, dry skin and mouth, fruity breath, 10L in 1st 24hr)
glucose level 300-1000mg/dL, pH 6.8-7.3, ¨ 5% dextrose in 45% NS (give when
glucose level reaches 250 or less)
hypotension, high potassium and low sodium
¨ Regular insulin (lower glucose 50-
levels, confusion, coma, kussmal respirations
75mg/dL/hr)
Nursing Interventions
¨Monitor airway ¨Assess LOC ¨Restore fluid volume (15-20mL/kg/hr) ¨Monitor blood
glucose levels ¨Strict I&O’s ¨Teach sick day rules
 Pulmonary Embolism
Patho Cause
Clot that travels and lodges in pulmonary ¨DVT ¨Prolonged immobility ¨Central
vessels
¨Surgery ¨Obesity ¨Age
venous catheter

S/S Meds/TX
Respiratory alkalosis, jugular vein distention, ¨ Heparin
hypotension, chest pain, shortness of breath ¨ Lovonox
*Dyspnea, apprehension, restlessness, cough, ­HR & ¨ TPA
RR, diaphoresis, cyanosis, confusion, labored breathing ¨ Embolectomy
¨ IVC
Nursing Interventions
¨Elevate HOB ¨Place on O2 ¨Frequent respiratory assessments ¨Cardiac assessment
¨Monitor O2 SATs ¨Pulmonary hygiene ¨Pain control ¨Monitor labs (ABGs) ¨Monitor fluid
& electrolytes ¨Teach deep breathing exercises ¨Maintain airway
 Pleural Effusion
Patho Cause
Fluid accumulation in the pleural space ¨Pneumonia ¨TB ¨CHF ¨Chest trauma
¨Renal failure

S/S Meds/TX
Pain on inspiration, friction rub, *NO crackles ¨ Thoracentesis (want clear fluid)
fluid collects outside of lungs
*Dyspnea, apprehension, restlessness, cough, ­HR &
RR, diaphoresis, cyanosis, confusion, labored breathing

Nursing Interventions
¨Elevate HOB ¨Heart monitor ¨Place on O2 ¨Frequent respiratory assessments ¨Cardiac
assessment ¨Monitor O2 SATs ¨Pulmonary hygiene ¨Pain control ¨Monitor labs (ABGs)
¨Monitor fluid & electrolytes ¨Teach deep breathing exercises ¨Maintain airway
 Respiratory Failure
Patho Cause
Inability of lung capillaries to properly ¨Pneumonia ¨CHF ¨Pulmonary embolism
exchange CO2 for oxygen
¨COPD ¨Pneumothorax ¨Opioids ¨Sleep
apnea

S/S Meds/TX
Respiratory acidosis, dyspnea, hypoxemia, PaO2 ¨ Corticosteroids
<60, PaCO2 >45, SaO2 <90 ¨ Proton pump inhibitors
*Dyspnea, apprehension, restlessness, cough, ­HR &
RR, diaphoresis, cyanosis, confusion, labored breathing

Nursing Interventions
¨Elevate HOB ¨Place on O2 ¨Frequent respiratory assessments ¨Cardiac assessment
¨Monitor O2 SATs ¨Pulmonary hygiene ¨Pain control ¨Monitor labs (ABGs) ¨Monitor fluid
& electrolytes ¨Teach deep breathing exercises ¨Maintain airway
 Acute Respiratory Distress Syndrome (ARDS)
Patho Cause
Respiratory failure triggered systemic ¨Shock ¨Trauma ¨Nervous system injury
inflammatory response
¨Pancreatitis ¨Fat emboli ¨Pulmonary
infection ¨Sepsis ¨Smoke ¨Aspiration
¨Drugs ¨Multiple blood transfusions
S/S Meds/TX
Normal lung sounds, Non-heart related ¨ Vent with PEEP
pulmonary edema, hypoxemia even with O2 ¨ O2
*Dyspnea, apprehension, restlessness, cough, ­HR & ¨ Nutrition supplementation
RR, diaphoresis, cyanosis, confusion, labored breathing ¨ Proton pump inhibitors

Nursing Interventions
¨Elevate HOB ¨Place on O2 ¨Frequent respiratory assessments ¨Cardiac assessment
¨Monitor O2 SATs ¨Pulmonary hygiene ¨Pain control ¨Monitor labs (ABGs) ¨Monitor fluid
& electrolytes ¨Teach deep breathing exercises ¨Maintain airway
 Pneumothorax
Patho Cause
Collapse of lung ¨Blunt chest trauma ¨Complication of
medical procedure

S/S Meds/TX
Decreased lung sounds on one side, rice crispy ¨ Chest tube to reinflate lung
sound under skin
*Dyspnea, apprehension, restlessness, cough, ­HR &
RR, diaphoresis, cyanosis, confusion, labored breathing

Nursing Interventions
¨Elevate HOB ¨Place on O2 ¨Frequent respiratory assessments ¨Cardiac assessment
¨Monitor O2 SATs ¨Pulmonary hygiene ¨Pain control ¨Monitor labs (ABGs) ¨Monitor fluid
& electrolytes ¨Teach deep breathing exercises ¨Maintain airway
 Tension Pneumothorax
Patho Cause
Air leaks into chest cavity and can’t escape ¨Blunt chest trauma ¨PEEP

S/S Meds/TX
Juglar vein distention, tracheal deviation toward ¨ Needle thoracotomy then chest
healthy side, complaint of feeling pressure in tube
chest, distended neck veins
*Dyspnea, apprehension, restlessness, cough, ­HR &
RR, diaphoresis, cyanosis, confusion, labored breathing

Nursing Interventions
¨Elevate HOB ¨Place on O2 ¨Frequent respiratory assessments ¨Cardiac assessment
¨Monitor O2 SATs ¨Pulmonary hygiene ¨Pain control ¨Monitor labs (ABGs) ¨Monitor fluid
& electrolytes ¨Teach deep breathing exercises ¨Maintain airway
 Hemothorax
Patho Cause
Blood in the chest cavity causing a collapsed ¨Blunt chest trauma ¨Penetrating injuries
lung

S/S Meds/TX
Dull sound on percussion ¨ Thoracotomy (open thoracotomy if
*Simple hemo= <1000mL blood loss significant blood loss, blood can be
*Massive hemo= >1000mL blood loss reinfused if needed)
*Dyspnea, apprehension, restlessness, cough, ­HR &
RR, diaphoresis, cyanosis, confusion, labored breathing

Nursing Interventions
¨Elevate HOB ¨Place on O2 ¨Frequent respiratory assessments ¨Cardiac assessment
¨Monitor O2 SATs ¨Pulmonary hygiene ¨Pain control ¨Monitor labs (ABGs) ¨Monitor fluid
& electrolytes ¨Teach deep breathing exercises ¨Maintain airway
 Flail Chest
Patho Cause
Fracture of 2 or more ribs causing unstable rib ¨Blunt chest trauma ¨CPR
cage

S/S Meds/TX
Paradoxical chest wall movement, dyspnea, ¨ Vigilant respiratory care
cyanosis, tachycardia, hypotension ¨ Vent if needed with PEEP
*Dyspnea, apprehension, restlessness, cough, ­HR &
RR, diaphoresis, cyanosis, confusion, labored breathing

Nursing Interventions
¨Elevate HOB ¨Place on O2 ¨Frequent respiratory assessments ¨Cardiac assessment
¨Monitor O2 SATs ¨Pulmonary hygiene ¨Pain control ¨Monitor labs (ABGs) ¨Monitor fluid
& electrolytes ¨Teach deep breathing exercises ¨Maintain airway
 Lupus (SLE)
Patho Cause
Chronic progressive inflammatory connective ¨Unknown ¨Genetics and environment play
tissue disorder that can cause major body a role
organ/system failure

S/S Meds/TX
Lupus nephritisàproteinuriaàhematuria- ¨ Immunosuppressant’s/ steroids
leading cause of death. Butterfly rash, discoid ¨ Cortisone
lesions, fever/fatigueàfever=exacerbation, ¨ Tylenol/ NSAIDs
pericarditis, Raynaud’s, CNS lupus, joint pain &
inflammation, weakness, vasculitis * NO CURE
Tachypneaàcoughàpleural inflammation/effusion
Nursing Interventions
¨No live vaccines 30 days prior to tx ¨No prolonged sun/UV/florescent light exposure
¨Protect skin ¨Monitor temperature ¨Pregnancy can cause exacerbationàstill
birthàmiscarriage ¨Use SPF 30 or greater ¨Use mild soaps/ rinse & dry well ¨Inspect skin
daily for new rashes or open areas
 Scleroderma (Systemic Sclerosis)
Patho Cause
Chronic progressive inflammatory connective ¨Overproduction and accumulation of
tissue disorder, hardening of the connective collagen in body tissues
tissue inside and outside the body

S/S Meds/TX
CREST- Calcinosis (calcium deposits), Raynaud’s (1st ¨ Immunosuppressant’s/ steroids
symptom), Esophageal dysmotility, Sclerodactyly ¨ Bosentan (monitor liver enzymes,
(scleroderma of the digits), Telangiectasis (spider-like can cause birth defects)
hemangiomas)
¨ TKI’s (nilotinib/imatinib)
Painless pitting edema to extremities, shiny taunt
skin, ¯ROM, GERD, difficulty swallowing,
¯peristalsis, malodorous diarrhea, tissue necrosis
Nursing Interventions
¨Mild soap/gentle washing & inspect skin for lesions ¨Adjust room temp to ¯chilling ¨HOB
at 60 degrees while eating and 1-2hr after ¨Small meals/semi-soft foods to avoid choking and
no ETOH, caffeine, spicy foods ¨Consult with dietician
 Lyme Disease
Patho Cause
Systemic infectious disease caused by the bite ¨Deer tick bite
of an infected deer tick

S/S Meds/TX
Stage 1- 3-30 days after bite: flu-like symptoms, ¨ Doxycycline/amoxicillin for 2-3
migraines, muscle/joint pain & stiffness, bull’s eye rash weeks if caught in 1st stage
Stage 2- 2-12 weeks after bite: carditis w/dysrhythmias,
dyspnea, dizziness, palpitations, CNS disorders, facial
¨ IV ceftriaxone for 30+ days if
paralysis, peripheral neuritis caught in 2nd stage
Stage 3- chronic complications: arthritis, fatigue,
memory/cognitive issues
Nursing Interventions
¨Teach pt to avoid heavily wooded areas and use insect repellant with DEET ¨Inspect body
for ticks if exposed ¨If bitten clean area with alcohol, remove ticks (don’t squeeze), and
report flu-like symptoms ¨Must wait 4-6 weeks after bite before being tested for Lyme
 Fibromyalgia
Patho Cause
Chronic pain syndrome (not an inflammatory ¨Injury ¨Viral infections ¨Stress
disease)
¨Genetics

S/S Meds/TX
Burning/gnawing pain, pain/stiffness/tenderness ¨ Gabapentin
of the neck/upper chest/trunk/low ¨ Lyrica
back/extremities, mild to severe fatigue, sleep ¨ Tricyclic antidepressants
disturbances, headaches, jaw pain, ¨ Trazodone
constipation/diarrhea, blurred vision/dry eyes ¨ Tramadol
¨ NSAIDs
Nursing Interventions
¨Limit caffeine & alcohol (interferes with deep sleep) ¨No Stimulants ¨Physical therapy and
exercise ¨Encourage adequate sleep/rest ¨Avoid extreme heat or cold
 Sepsis
Patho Cause
Infection increases and causes widespread ¨ Infection somewhere in the body that
inflammation worsens

S/S Meds/TX
In severe sepsisàmicrothrombiàDIC, ¯O2 sat, ¨ IV antibiotics
¯cognition ¨ Vasopressors
1st sign ­HR, confusion, restlessness, tachycardia, ¨ Epinephrine
hypotension, thread pulse, rapid resp, cold/clammy/pale, ¨ IVF
slow cap refill, diaphoresis, ¯urine output, ¯bowel sounds,
hypothermia
Nursing Interventions
¨Monitor urine output ¨Monitor respiratory function ¨Maintain airway ¨Assess for changes
in LOC ¨Assess peripheral circulation ¨Place on O2 and monitor sats
 Septic Shock
Patho Cause
*Everything is dilated* Clotting cascade is ¨Immunocompromise ¨Bacterial infections
initiatedàDIC
¨Indwelling IV/FC

S/S Meds/TX
1st sign ­HR, fever, confusion, restlessness, ¨ IV antibiotics
tachycardia, hypotension, thread pulse, rapid resp, ¨ IVF
cold/clammy/pale, slow cap refill, diaphoresis, ¯urine ¨ Vasopressors
output, ¯bowel sounds, hypothermia
¨ Epinephrine

Nursing Interventions
¨Monitor urine output ¨Monitor respiratory function ¨Maintain airway ¨Assess for changes
in LOC ¨Assess peripheral circulation ¨Place on O2 and monitor sats
 Cardiogenic Shock
Patho Cause
*The pump is broken* inadequate perfusion ¨MI ¨Cardiomyopathy ¨Valvular
dysfunction

S/S Meds/TX
1st sign ­HR, <MAP, confusion, restlessness, ¨ Dobutamine
tachycardia, hypotension, thread pulse, rapid resp, ¨ Digoxin
cold/clammy/pale, slow cap refill, diaphoresis, ¯urine ¨ Lasix
output, ¯bowel sounds, hypothermia
¨ Nitroglycerin

Nursing Interventions
¨Monitor urine output ¨Monitor respiratory function ¨Maintain airway ¨Assess for changes
in LOC ¨Assess peripheral circulation ¨Place on O2 and monitor sats ¨Decrease anxiety
*DO NOT LEAVE PATIENT
 Hypovolemic Shock
Patho Cause
*The tank is empty* Not enough fluids to ¨Blood loss from trauma or GI bleed
perfuse
¨N/V/D ¨Burns

S/S Meds/TX
1st sign ­HR, confusion, restlessness, tachycardia, ¨ IVF (NS/LR)
hypotension, thread pulse, rapid resp, ¨ PRBC
cold/clammy/pale, slow cap refill, diaphoresis, ¯urine ¨ Crystalloid/ colloid solutions
output, ¯bowel sounds, hypothermia
¨ Dopamine, dobutamine,
norepinephrine, nitroprusside
Nursing Interventions
¨Stop bleeding or N/V/D ¨Monitor urine output ¨Monitor respiratory function ¨Maintain
airway ¨Assess for changes in LOC ¨Assess peripheral circulation ¨Place on O2 and monitor
sats
*DO NOT LEAVE PATIENT
 Obstructive Shock
Patho Cause
Blood flow is blocked ¨Pericardial tamponade ¨Tension
pneumothorax ¨Constrictive pericarditis
¨Aortic dissection ¨Pulmonary embolism

S/S Meds/TX
1st sign ­HR, JVD, tracheal deviation, confusion, ¨ Pericardiocentesis
restlessness, tachycardia, hypotension, thread pulse, ¨ Thoracentesis
rapid resp, cold/clammy/pale, slow cap refill, ¨ Surgical repair
diaphoresis, ¯urine output, ¯bowel sounds,
¨ Heparin
hypothermia

Nursing Interventions
¨Monitor urine output ¨Monitor respiratory function ¨Maintain airway ¨Assess for changes
in LOC ¨Assess peripheral circulation ¨Place on O2 and monitor sats
*DO NOT LEAVE PATIENT
 Anaphylactic Shock
Patho Cause
*Everything is dilated* A systemic inflammatory ¨Hypersensitivity reaction
response to an allergen

S/S Meds/TX
1st sign ­HR, skin rash, flushing, airway obstruction, ¨ Intubation
confusion, restlessness, tachycardia, hypotension, ¨ Epinephrine
thread pulse, rapid resp, cold/clammy/pale, slow cap ¨ Bronchodilators
refill, diaphoresis, ¯urine output, ¯bowel sounds,
¨ IVF
hypothermia
¨ Benadryl
¨ Steroids
Nursing Interventions
¨Monitor urine output ¨Monitor respiratory function ¨Maintain airway ¨Assess for changes
in LOC ¨Assess peripheral circulation ¨Place on O2 and monitor sats ¨Wearing off of meds
could cause recurring airway obstruction/compromise
 Neurogenic Shock
Patho Cause
*Everything is dilated* Instability of blood ¨Spinal cord injury ¨Anesthesia ¨Blocked
pressure, heart rate, and temperature vessel tone

S/S Meds/TX
Bradycardia, confusion, restlessness, tachycardia, ¨ Dopamine
hypotension, thread pulse, rapid resp, ¨ IVF
cold/clammy/pale, slow cap refill, diaphoresis, ¯urine
output, ¯bowel sounds, hypothermia

Nursing Interventions
¨Monitor urine output ¨Monitor respiratory function ¨Maintain airway ¨Assess for changes
in LOC ¨Assess peripheral circulation ¨Place on O2 and monitor sats ¨Monitor VS
 Traumatic Brain Injury (TBI)
Patho Cause
Direct- force by a blow to the head ¨Falls ¨MVA ¨Drugs & alcohol ¨Blunt
Indirect- force applied to other parts of the force trauma
body with rebound effect to the brain

S/S Meds/TX
Altered LOC, restlessness, irritability, ¯HR, ­BP, ¨ Mannitol
pinpoint/nonresponsive/asymmetric pupils,
severe HA, N/V, seizures
Cushing’s Triade: severe HTN, widened pulse
pressure, bradycardiaà sign of imminent death
Nursing Interventions
¨1 st
Monitor airway/breathing (vent if needed to keep CO2 down) ¨2nd monitor LOC ¨Keep
HOB at 30-45° ¨Monitor VS Q2hr ¨Keep pt cool ¨Have pt avoid coughing (increases ICP)
give lidocaine to suppress ¨If intubated give 100% O2 before and after suctioning ¨Check
ears and nose for CSF drainage ¨Decrease of 2 points on GCSà call MD
 Intracranial Pressure (ICP)
Patho Cause
Increased pressure in the brain ¨Cerebral edema ¨Increased CSF ¨Ischemia
Normal ICP= 10-15 ¨Hypoxia ¨Hemorrhage ¨Hematoma ¨Tumor
MAP needs to be at least 80 ¨Encephalitis ¨Meningitis ¨Head injury
¨Stroke ¨Fever ¨Cough ¨Suctioning ¨Bearing
down ¨­O2
S/S Meds/TX
Changes in LOC, restlessness, irritability, ¨ Mannitol
confusion, HA, vomiting, behavioral changes, ¨ Sedatives
pupil changes, Cushing’s Triad, ¨ Acetaminophen
decerebrate/decorticate posturing
2mm pupil change in either direction notify MD

Nursing Interventions
¨Avoid cluster care (too much stimuli can worsen ICP) ¨Monitor VS Q1-2hr ¨Frequent neuro
checks ¨HOB <25° improves perfusion ¨HOB >30° improves oxygenation & reduces aspiration
¨Keep head in neutral position ¨Hyperoxygenate if suctioning ¨Decrease stimuli ¨Provide
cooling blankets ¨Avoid vent with PEEP (increases ICP)
 Spinal Cord Injury (SPI)
Patho Cause
Complete- total paralysis below injury Primary- hyperflexion, hyperextension,
Incomplete- some function below level of injury compression injury, excessive rotation of head or
back, penetrating trauma
Secondary- hemorrhage, ischemia, hypovolemia,
neurogenic shock, spinal shock (usually subsides in
7 days)
S/S Meds/TX
*not usual for reflexes/mobility/sensory perception to ¨ Halo device
be absent immediately after injury due to spinal shock ¨ Muscle relaxers
Bradycardia, hypotension (SBP <90 or MAP <65à requires
meds to ­perfusion), hypothermia, breathing problems,
¨ Dextran/dopamine
autonomic dysreflexia, decreased LOC, decreased urine
output

Nursing Interventions
¨#1 Airway then breathing ¨Monitor BP, pulse strength, and peripheral perfusion ¨Monitor
Glasgow coma scale & report decrease of 2pts to MD ¨Preventing secondary SPI ¨Monitor pt
hourly ¨Intervene if O2 sat <95% ¨Assess breath sounds Q2-4hr
 Autonomic Dysreflexia
Patho Cause
Occurs in individuals with a spinal cord injury at ¨ Irritants below the level of injury such
level T6 or above and can happen at any time as: UTI, overfilled bladder,
after spinal shock resolves constipation/impaction, infections,
hemorrhoids

S/S Meds/TX
Sudden significant rise in diastolic BP and ¨ Antihypertensives
bradycardia, excessive sweating/flushing/ ¨ Nitroglycerin
goose bumps above level of injury, ¨ Nifedipine
apprehension/anxiety, blurred vision, nasal ¨ Tizanidine
congestion, sudden severe HA ¨ Baclofen
Nursing Interventions
¨1 sit the pt up then find cause of irritation ¨Check BP frequently (can cause hemorrhagic
st

stroke)
 Encephalitis
Patho Cause
Inflammation/ infection of brain tissue ¨Viruses ¨Bacteria¨ Fungus ¨West Nile
surrounding meninges
Virus ¨Herpes simplex 1

S/S Meds/TX
High fever, N/V, stiff neck, changes in LOC, S/S ¨ Acyclovir
of ICP, joint pain, vertigo, HA, confusion ¨ Anticonvulsants
irritability (especially with herpes)

Nursing Interventions
¨Assess LOC w/ Glasgow coma scale ¨Avoid mosquito infested areas ¨Monitor for S/S of
ICP
 Meningitis
Patho Cause
Inflammation of the meninges of the brain and ¨Viruses (herpes) ¨Bacteria (streptococcus
spinal cord *highly contagious)

S/S Meds/TX
Confusion, altered LOC, increased ICP, mimics ¨ Mannitol for ICP
SIADH, seizures, SIRS, ¯BP, ­HR, clotting ¨ At least 2 weeks of IV antibiotics
disorders, fever/chills, nuchal rigidity
(Kernig’s sign), decreased muscle tone,
rash, HA
Nursing Interventions
¨#1 assess neuro and vascular status Q2-4hr ¨Monitor pupils for nystagmus ¨Observe
extremities color & temp ¨Monitor for DIC/ICP ¨Place patient in isolation
 Myasthenia Gravis
Patho Cause
Acquired autoimmune diseaseà muscle weakness ¨Error in transmission of nerve impulses to
that worsens with exercise and improves with muscle
rest

S/S Meds/TX
Increased weakness that becomes worse with ¨ Pyridostigmine
repetitive muscle use, chewing and swallowing ¨ Corticosteroids
difficulties ¨ IV immunoglobulins
¨ Plasmapheresis

Nursing Interventions
¨#1 maintain adequate respiratory function ¨Keep ambubag at bedside ¨Aspiration
precautions ¨Avoid magnesium (increases weakness) ¨Take meds 45min-1hr before eating to
prevent aspiration ¨Avoid ETOH, heat, laxatives, beta blockers, opioids, antidepressants, and
phenytoin ¨Monitor for myasthenic or cholinergic crisis
 Guillain Barre Syndrome
Patho Cause
Breakdown of the myelin sheath *starts at the ¨Associated with bacterial infections,
feet and works its way up influenza, Epstein Barr, cytomegalovirus, and
zika virus

S/S Meds/TX
Loss of reflexes in arms and legs, low BP with ¨ Plasmapheresis
poor BP control, muscle weakness, paralysis, ¨ IVIG
tachycardia, dysphagia, uncoordinated movement ¨ IV fluids
leading to falls ¨ Beta blockers

Nursing Interventions
¨#1 airway management and adequate gas exchange ¨Prevent respiratory and cardiac
distress/failure ¨Place on heart monitor and watch for dysrhythmias ¨Keep intubation
equipment at bedside
 Amyotrophic Lateral Sclerosis (ALS)
Patho Cause
Progressive muscle weakness and wasting ¨Chronic neurological disease of unknown
leading to paralysis of respiratory muscles cause

S/S Meds/TX
Fatigue, muscle weakness, muscle atrophy ¨ Riluzole
(including tongue), twitching of face and tongue,
poor/slurred speech, dysphagia, stiff/clumsy
gait, abnormal reflexes

Nursing Interventions
¨#1 airway and safety ¨Palliative care to control symptoms and provide respiratory support
*NO CURE
 Trigeminal Neuralgia
Patho Cause
Compression or inflammation of cranial nerve 5 ¨Compression of trigeminal nerve ¨Aging
¨MS

S/S Meds/TX
Severe pain to the sides of the face ¨ Carbamazepine
¨ Gabapentin
¨ Pregabalin
¨ Craniotomy

Nursing Interventions
¨Avoid wind, cold, heat ¨Brushing teeth, smiling, or shaving can cause an attack ¨Assess
pain management, opioids usually not effective
 Bell’s Palsy
Patho Cause
Acute paralysis of cranial nerve 7 ¨ Unknown/ possibly from a virus (herpes)

S/S Meds/TX
Cannot close eyes, wrinkle forehead, smile, ¨ Steroids
whistle, grimace. Tearing may stop or become ¨ Antivirals
excessive, flattening of nasolabial fold, drooping ¨ Surgery if severe
mouth, paralysis to one side of face

Nursing Interventions
¨Have pt chew on unaffected side to avoid aspiration ¨Ensure that paralysis is temporary
*To ensure it is not a stroke have pt raise both arms above head
 Parkinson’s Disease
Patho Cause
Decrease in dopamine production interrupting ¨Loss of nerve cells in the substantia nigra
signals between two regions of the brain that of the brain
coordinate activity

S/S Meds/TX
T-tremor at rest ¨ Carbidopa-levodopa
R-rigidity of the muscles ¨ Ropinirole
A-Akinesia (loss of voluntary movement) ¨ Rasagiline
P-postural instability ¨ Entacapone
-Bradykinesia, speech changes, confusion ¨ Amantadine
¨ Benztropine
Nursing Interventions
¨Assess neurological status ¨Assess ability to chew and swallow ¨Provide high-calorie, high-
¨Increase fluid intake ¨Monitor for constipation ¨Assess safety and
protein, high-fiber foods
ambulation
Chronic Obstructive Pulmonary Disease (COPD)
Patho Cause
A group of lung diseases that block airflow and ¨#1 cigarette smoke ¨Long term exposure
make it difficult to breathe to lung irritants

S/S Meds/TX
SOB, wheezing, chest tightness/ discomfort, ¨ Oxygen (typically low flow)
ongoing dry or productive cough, fatigue, ¨ Albuterol, tiotropium, fluticasone,
cyanosis to lips or fingers, frequent colds, budesonide, ipratropium,
weight loss, lower extremity edema theophylline

Nursing Interventions
¨Monitor respiratory status and effort ¨Administer low flow O2 ¨Increase fluids and provide
high calorie diet ¨Monitor cardiac status/ S/S of right sided heart failure
 Hepatic Cirrhosis
Patho Cause
Necrotic liver cells turning to scar tissue and ¨Excessive alcohol consumption ¨Injury
causing fibrosis.
¨Hepatitis ¨Right sided heart failure
¨Obesity

S/S Meds/TX
N/V/D, indigestion, anemia, altered mental ¨ Lasix, metolazone, spironolactone
status, ascites, hypertension, jaundice, edema to ¨ Lactulose
the extremities, hypoxia ¨ Octreotide
¨ Antibiotics

Nursing Interventions
¨Monitor I&O’s and daily weights ¨Monitor serum electrolyte levels ¨Monitor for mental
status changes and LOC ¨Assess cardiovascular and respiratory status ¨Assess skin for
jaundice, pallor, or dryness ¨Monitor diet
 Osteoporosis
Patho Cause
Reduction of bone mass. Deterioration of bone ¨Genetics ¨Age ¨Nutrition ¨Sedentary
and diminished bone strength
lifestyle ¨Smoking, caffeine, alcohol

S/S Meds/TX
Fractures (specifically compression fractures), ¨ Calcium & Vit D
kyphosis, decreased calcitonin, decreased ¨ Calcitonin
estrogen, increased parathyroid hormone ¨ Alendronate
¨ Raloxifene
¨ Teriparatide
Nursing Interventions
¨Provide pain relief methods ¨Increase fluids and fiber intake ¨Demonstrate good posture
and body mechanics to prevent falls ¨Provide diet rich in calcium and Vit D
 Deep Vein Thrombosis (DVT)
Patho Cause
Platelet aggregation that lodges in one of the ¨Direct trauma ¨Increased blood
many deep veins of the body
coagulability ¨Oral contraceptives
¨Sedentary lifestyle ¨Pregnancy
¨Complications from procedure/ surgery
S/S Meds/TX
Edema, redness/ warmth, phlegmasia cerulea ¨ Enoxaparin
dolens, tenderness, respiratory distress ¨ Warfarin
¨ Aspirin
¨ Alteplase
¨ Clopidogrel
Nursing Interventions
¨Provide comfort (meds, compression, cool packs) ¨Compression therapy (TEDS, tubi-grips,
ACE wraps) ¨Repositioning, exercise, ROM ¨Educate on medication therapy Educate on
underlying cause and prevention
 Rheumatoid Arthritis
Patho Cause
Autoimmune connective tissue disease that ¨Genetics Infectious agents
primarily affects synovial tissue
¨Female hormones
(bacteria/viruses)
¨Environmental factors ¨Occupational
exposures
S/S Meds/TX
Joint pain/ stiffness, swelling, redness/ warmth, ¨ NSAIDs
lack of function due to pain, deformities of the ¨ Antidepressants
fingers, hands, and feet, rheumatoid nodules in ¨ Methotrexate
the subcutaneous tissues ¨ Immunosuppressants
¨ Corticosteroids
¨ Analgesics
Nursing Interventions
¨Refer to physical and occupation therapy Avoid extreme heat/ cold Promote relaxation and
¨Provide pain relief methods ¨Monitor mental health ¨Educate on diet
rest to reduce stress
and lifestyle modifications
 Cholecystitis
Patho Cause
Inflammatory disease of the gallbladder most ¨Gallbladder stones ¨Bacteria
commonly caused by stones
¨Alterations in fluids and electrolytes
¨Bile stasis ¨Blockage or stricture

S/S Meds/TX
Pain to the right upper quadrant of the ¨ Antibiotics
abdomen, leukocytosis, fever, palpable ¨ Promethazine
gallbladder, sepsis, presence of stones on ¨ Analgesics
ultrasound

Nursing Interventions
¨Monitor labs (BUN, pre-albumin, total protein, transferrin) ¨Provide pain relief ¨Promote
bed rest during attacks ¨Provide non-distressing foods/fluids (bland low fat foods and clear
liquids)
 Tuberculosis
Patho Cause
An acute or chronic lung infection caused by ¨Close contact with infected people ¨Low
mycobacterium tuberculosis
immunity ¨Substance abuse ¨Inadequate
*HIGHLY CONTAGIOUS health care ¨Immigration ¨Overcrowding
in infectious regions
S/S Meds/TX
Fatigue & weakness, low grade fever, cough ¨ Isoniazid (INH)
with or without blood sputum, hemoptysis, chest ¨ Rifampin
pain/ discomfort ¨ Pyrazinamide
¨ Ethambutol

Nursing Interventions
¨Promote airway clearance and monitor respiratory status Q2-4hr ¨Place in private negative
pressure isolation room ¨Increase fluids and calorie intake ¨Maintain scheduled medication
therapy ¨Educate on proper disposal of secretions (sputum, tissues, soiled linens)
 Sickle Cell Anemia
Patho Cause
Group of disorders that cause red blood cells to ¨Genetics ¨Cold temperatures ¨Tissue
become misshapen and break down
hypoxia ¨Human parvovirus ¨Splenic
infarction
*Most common in those of African decent

S/S Meds/TX
Anemia, jaundice, dysrhythmias, bone ¨ Hydroxyurea
enlargement, infection, severe pain ¨ Arginine
¨ NSAIDs
¨ Opioid analgesia

Nursing Interventions
¨Pain management is top priority in a sickle cell crisis (very painful) ¨Assess for signs of
dehydration/ inadequate nutrition ¨Monitor for signs of infection ¨Educate on ways to
prevent sickle cell crisis
 Stroke
Patho Cause
Loss of blood flow to a part of the brain Ischemic stroke- clot of plaque breaks off and travels
to the brain
causing brain cells to die Hemorrhagic stroke- blood vessel in the brain leaks or
bursts
TIA- temporary blockage of blood flow
¨HTN ¨Tobacco use ¨Heart disease ¨Diabetes
¨Medications ¨Family hx ¨Gender
S/S Meds/TX
Visual disturbances, dizziness, confusion, slurred ¨ TPA
speech, weakness to extremities (particularly on ¨ Warfarin
one side), facial drooping, lack of pupillary ¨ Aspirin
response or blown pupil ¨ Atorvastatin
¨ Clopidogrel
Nursing Interventions
¨Assess for signs of decreased cerebral perfusion or increased ICP ¨Monitor neurological
status and VS Q2hr ¨Administer supplemental O2 as indicated ¨Treat underlying cause
¨Administer anticoagulation therapy ¨Monitor respiratory status and prevent aspiration
 Multiple Sclerosis
Patho Cause
Inflammatory lesions that cause neuronal ¨Unknown ¨May be an autoimmune
demyelination. Formation of plaques in the grey response
and white matter of the brain and spinal cord

S/S Meds/TX
Numbness or weakness in the limbs usually on one side ¨ Interferon
of the body at a time, shock-like sensations with ¨ Glatiramer acetate
certain neck movements (Lhermitte sign), lack or ¨ Methylprednisolone
coordination/ unsteady gait, fatigue, slow or slurred
¨ ACTH
speech, partial or complete loss of vision in one eye at
a time, problems with bowel, bladder, and sexual
function
Nursing Interventions
¨Monitor urinary frequency, urgency, retention, and incontinence ¨Monitor gait and
implement safety measures to prevent falls ¨Provide high fiber diet ¨Monitor for changes in
neurological function Promote rest
 Epilepsy
Patho Cause
Extreme excitation of susceptible epileptic ¨Genetic syndromes ¨Mitochondrial diseases
cerebral neurons ¨Metabolic disorders ¨Chromosomal 22q
deletion or duplication syndromes ¨Trauma
¨Substance abuse ¨Severe electrolyte
imbalance
S/S Meds/TX
Blank staring, temporary confusion, uncontrolled ¨ Carbamazepine
jerking movements of the extremities and body, ¨ Phenytoin
loss of consciousness/ awareness, cognitive or ¨ Valproic acid
emotional symptoms such as fear, anxiety, or ¨ Lamotrigine
deja vu ¨ Phenobarbital
Nursing Interventions
¨Safety- prevent injury or trauma ¨Promote airway clearance and monitor respiratory
status ¨Avoid triggering activities (flashing lights, over stimulation) ¨Educate on diet and
lifestyle modifications
 Coronary Artery Disease
Patho Cause
Narrowing of the major blood vessels in the ¨Plaque buildup in the walls of the arteries
heart causing ischemia that supply blood to the heart

S/S Meds/TX
Chest pain/ angina, weakness, shortness of ¨ Statin drugs
breath, pain in the arms or shoulders, N/V, ¨ Metoprolol
Indigestion, tachycardia, anxiety ¨ Nitroglycerin
¨ Amlodipine
¨ Diltiazem
Nursing Interventions
¨Monitor VS Q4hr ¨Place pt in a comfortable position ¨Administer O2 as needed ¨Teach
relaxation and anxiety relieving techniques ¨Teach S/S of complications and when to seek
medical attention
 Left Sided Heart Failure
Patho Cause
Weakening of the left ventricle of the heart ¨Coronary artery disease ¨Ischemia
making it unable to pump oxygen-rich blood
from the lungs to the rest of the body
¨Cardiomyopathy Systemic/ pulmonary
hypertension ¨Valvular heart disease

S/S Meds/TX
Dyspnea, dry/ non-productive cough, pulmonary ¨ Lisinopril
crackles, low oxygen saturation levels, fatigue/ ¨ Metoprolol
weakness ¨ Lasix
¨ Digoxin

Nursing Interventions
¨Monitor I&O’s and daily weights ¨Encourage low sodium diet ¨Monitor lung sounds and
respiratory status ¨Teach diet and lifestyle modifications
 Right Sided Heart Failure
Patho Cause
Right sided heart damage due to a failing left ¨Coronary artery disease ¨Ischemia
ventricle causing blood to back up in the body’s
veins
¨Cardiomyopathy Systemic/ pulmonary
hypertension ¨Valvular heart disease

S/S Meds/TX
Enlargement of the liver, accumulation of fluid ¨ Lisinopril
in the peritoneal cavity and extremities, loss of ¨ Metoprolol
appetite, rapid/ irregular heartbeat, fatigue/ ¨ Lasix
weakness ¨ Digoxin

Nursing Interventions
¨Strict I&O’s and daily weights ¨Encourage low sodium diet ¨Monitor VS ¨Monitor
abdominal girth and peripheral edema ¨Encourage diet and lifestyle modifications
 Pneumonia
Patho Cause
Infection of the lungs caused by bacteria, ¨Bacteria, viruses, fungus ¨Prolonged
viruses, or fungi
hospitalization ¨Prolonged immobility
¨Aspiration ¨Impaired immune system

S/S Meds/TX
Fever, productive cough, shortness of breath, ¨ Pneumonia vaccine
low oxygen saturation levels, chest pain/ ¨ Antibiotics (levofloxacin)
heaviness, fatigue, body aches, tachypnea ¨ Corticosteroids (prednisone)
¨ Bronchodilators (albuterol)
¨ Expectorants (guaifenesin)
Nursing Interventions
¨Increase fluid intake ¨Provide humidification ¨Encourage coughing and deep breathing
exercises ¨Chest physiotherapy ¨Monitor VS and fever ¨Monitor lung sounds and respiratory
status
 Asthma
Patho Cause
Chronic inflammation/ constriction of the ¨Airborne allergens: pollen, dust mites,
airway leading to airway obstruction
mold, pet dander¨Respiratory infections
¨Physical activity ¨Cold air

S/S Meds/TX
Coughing, wheezing, shortness of breath, loss of ¨ Bronchodilators (albuterol)
airway, 3 or more ED visits in 1 year ¨ Corticosteroids (budesonide,
fluticasone)

Nursing Interventions
¨Reduce environmental and lifestyle triggers ¨Have emergency intubation equipment at
bedside ¨Assess lung sounds and airway ¨Monitor oxygen saturation
 Diabetes Mellitus II
Patho Cause
Chronic condition affecting how the body ¨Genetics ¨Lifestyle ¨Obesity
processes blood glucose

S/S Meds/TX
Increased thirst, frequent urination, excessive ¨ Metformin
hunger, fatigue, blurred vision, weight gain or ¨ Glipizide
loss ¨ Insulin
¨ Diet

Nursing Interventions
¨Monitor blood glucose levels and for signs of hyper/hypoglycemia ¨Teach diet and lifestyle
changes ¨Monitor skin integrity especially the feet ¨Monitor renal function ¨Educate on
blood glucose monitoring and use of oral meds and insulin
Gastroesophageal Reflux Disease (GERD)
Patho Cause
Relaxation of the lower esophageal sphincter ¨Lower esophageal sphincter not closing
allowing stomach acid up into the esophagus properly

S/S Meds/TX
Belching, heartburn, nausea, regurgitation, a ¨ Antacids (calcium carbonate)
burning sensation of the chest, dry cough, ¨ Proton-pump inhibitors (omeprazole,
abdominal discomfort pantoprazole
¨ Diet and lifestyle modifications

Nursing Interventions
¨Keep HOB supine at least 1hr after meals ¨Encourage small frequent meals ¨Avoid spicy
foods, caffeine, smoking, and alcohol
 Crohn’s Disease
Patho Cause
Chronic inflammatory bowel disease affecting ¨Unknown ¨Possible stress, diet, heredity,
the lining of the digestive tract immunocompromise

*No Cure

S/S Meds/TX
Abdominal pain, diarrhea, weight loss, anemia, ¨ NSAIDs
fatigue, severe cramping ¨ Immunosuppressives (methotrexate,
azathioprine)
¨ Steroids (prednisone)

Nursing Interventions
¨Observe and record stool frequency, characteristics, and amount ¨Restrict food and fluids
that exacerbate condition ¨Monitor for signs of infection ¨Monitor for signs of
malnourishment ¨Monitor for signs of bowel stricture or obstruction
 Irritable Bowel Syndrome (IBS)
Patho Cause
Intestinal disorder causing abdominal pain, gas, ¨Bacteria Viruses ¨Bacterial overgrowth
diarrhea, and constipation
¨Stress ¨Certain foods

S/S Meds/TX
Abdominal pain, change in bowel habits, ¨ Loperamide
constipation, diarrhea, indigestion, nausea, ¨ Dietary supplements
excessive gas, cramping, loss of appetite ¨ Fiber
¨ Gut antispasmodics

Nursing Interventions
¨Assess frequency, characteristics, and amount of stool passed ¨Educate on proper food
choices to prevent bouts of IBS ¨Encourage increased fiber and clear fluid intake ¨Avoid
chocolate, caffeine, smoking
 Ulcerative Colitis
Patho Cause
Chronic inflammatory bowel disease affecting ¨Infection ¨Loss of blood supply ¨Allergic
the lining of the digestive tract
reactions ¨Chronic diseases

S/S Meds/TX
Abdominal pain, joint pain, bloating, bloody ¨ Surgery
stools, constipation, diarrhea, inability to empty ¨ NSAIDs
bowels, urgency, anemia, fatigue, weight loss, ¨ Prednisone
cramping, scarring in the bile ducts ¨ Antibiotics
¨ Azathioprine
Nursing Interventions
¨Observe and record stool frequency, characteristics, and amount ¨Restrict food and fluids
that exacerbate condition ¨Monitor for signs of infection ¨Monitor for signs of
malnourishment ¨Monitor for signs of bowel stricture or obstruction
 Peptic Ulcer Disease (PUD)
Patho Cause
Ulcers that occur on the lining of the stomach, ¨H. pylori infection ¨Long-term NSAID use
esophagus, or small intestine
¨Excess gastric acid ¨Inadequate mucous
protection

S/S Meds/TX
Pain in the chest or upper abdomen, heartburn, ¨ Penicillin
nausea, excessive gas, vomiting, fatigue ¨ Omeprazole, pantoprazole
¨ Calcium carbonate
¨ Imodium

Nursing Interventions
¨Avoid aspirin ¨Avoid acid enhancing foods/ fluids: caffeine, colas, coffee, chocolate, highly
acidic foods ¨Eat small frequent meals and avoid overeating
 Pancreatitis
Patho Cause
Inflammation/ irritation of the pancreas ¨Gallstones ¨Alcoholism ¨Certain
Medications ¨Cystic fibrosis
¨Hypercalcemia ¨Hypertriglyceridemia
¨Infection ¨Obesity ¨Injury ¨Cancer
S/S Meds/TX
Abdominal or back pain, Cullen’s sign (superficial ¨ Low fat diet
edema and bruising at the umbilicus), bloating, ¨ Analgesics
fatty stools, indigestion, N/V, sweating, ¨ Cholecystectomy
tachycardia, weight loss ¨ Antibiotics

Nursing Interventions
¨NPO status until resolved ¨High-carb diet with no fatty acids ¨Pain management ¨IV fluid
replacement ¨Treat infection or underlying cause
 Benign Prostatic Hypertrophy (BPH)
Patho Cause
Age related prostate gland enlargement that ¨Family history ¨Diabetes ¨Heart disease
can cause urination difficulty
¨Age

S/S Meds/TX
Dribbling after urination, excessive urination at ¨ Tamsulosin
night, frequency, inability to empty bladder, ¨ Oxybutynin
weak urinary stream, incontinence, sexual ¨ Surgery (TURP)
dysfunction ¨ Saw palmetto

Nursing Interventions
¨Encourage voiding Q2-4hr ¨Observe urinary stream ¨Percuss and palpate suprapubic area ¨Monitor for
hypotension ¨Bladder scanning to assess volume ¨Encourage 3000cc fluid intake daily

TURP- *Continuous bladder irrigation post procedureà pink output normal, red=bad *Normal for fluid to leak
around catheter *Monitor for no outputà no output= medical emergency *Retention of urine or semen= increase
risk for cystitis
 Chronic Kidney Disease (CKD)
Patho Cause
Chronic disease of the kidneys leading to renal ¨Diabetes ¨Hypertension ¨Polycystic
failure
¨Glomerulonephritis ¨Lupus
kidney disease
¨Repeated urinary infections

S/S Meds/TX
Fatigue, hypertension, fluid/ electrolyte ¨ Dialysis
imbalance, abnormal heart rhythm, fluid in the ¨ Low protein diet
lungs, poor urine output, itching, edema, kidney ¨ Lasix
failure, anemia ¨ Vitamin D
¨ Calcium
Nursing Interventions
¨Hemodialysis or peritoneal dialysis ¨Monitor heart and lung sounds ¨Monitor for
hypertension ¨Place on cardiac monitoring ¨Electrolyte replacement ¨Daily I&O’s and
weights
 Acute Kidney Injury
Patho Cause
Sudden inability of the kidneys to filter waste ¨Contrast dye ¨Medications
from the blood
¨Obstruction/ Stones ¨BPH ¨Tumor
¨Shock/ hypovolemia ¨Abdominal aortic
aneurysm repair graft failure
S/S Meds/TX
Decreased urine output, Elevated BUN/ ¨ Lasix
creatinine, fluid/ electrolyte imbalance, edema, ¨ Dialysis
nausea, fatigue, shortness of breath, low blood ¨ Ureteral stents
pH ¨ Fluid/ electrolyte replacement

Nursing Interventions
¨Monitor daily weights and I&O’s ¨Monitor VS especially BP and HR ¨Cardiac monitoring
¨Monitor electrolyte balance and labs daily ¨Provide low protein diet ¨If caused by stones
have Pt filter urine to monitor for passing of stone
 Pyelonephritis
Patho Cause
Inflammation of the kidney due to infection ¨Bacteria that travel from the bladder up
into the kidney

S/S Meds/TX
Fever, back/flank pain, painful/ cloudy/ foul ¨ Antibiotics (ciprofloxacin,
smelling urination, chills, N/V, confusion ciprofloxacin, Bactrim, etc.)

Nursing Interventions
¨Encourage increased fluids 3-4L/day ¨Encourage voiding Q2-3hr ¨Teach female patients
proper peri-care and wiping front to back
 Polycystic Kidney Disease (PKD)
Patho Cause
Inherited disorder where clusters of cysts ¨Genetics
develop in the kidneys
*Can spread throughout the body

S/S Meds/TX
Pain in the abdomen/ back/ flank areas, ¨ Antihypertensives
fatigue, hypertension, blood in urine ¨ Diet
¨ Dialysis
¨ Kidney transplant

Nursing Interventions
¨Encourage and provide low sodium diet ¨Monitor BUN/ creatinine and electrolytes ¨Monitor
for edema ¨Monitor and treat hypertension ¨Monitor lung sounds
 Hydronephrosis
Patho Cause
Excess fluid in the kidneys due to backed up ¨Kidney stones ¨Congenital defects
urine
¨Blood clot ¨Scarring ¨Enlarged prostate
¨Pregnancy

S/S Meds/TX
Pain in the abdomen/ back/ flank, poor urine ¨ Ureteral stent
production, hematuria, hypertension ¨ Urinary catherization
¨ Stone removal

Nursing Interventions
¨Monitor urine output closely ¨If caused by stones have patient filter urine to ensure
passing of stones ¨Monitor for signs of infection ¨Monitor VS Q4hr
 Iron Deficiency Anemia
Patho Cause
Not enough iron in the body ¨Inadequate iron intake ¨Pregnancy
¨Menstruation ¨Internal bleeding
¨Endometriosis ¨GI disorders

S/S Meds/TX
Fatigue, dizziness, tachycardia, palpitations, ¨ Iron supplements
brittle nails, pallor, shortness of breath ¨ Vitamin C
¨ Diet

Nursing Interventions
¨Encourage patient to take iron supplements with Vit C to increase absorption ¨Do not take
with milk ¨Encourage diet of leafy greens and red meats ¨Monitor labs and S/S of bleeding
 Aplastic Anemia
Patho Cause
Bone marrow damage where the body stops ¨Immune system attacking stem cells in
producing blood cells
bone marrow ¨Chemotherapy/ radiation

S/S Meds/TX
Fatigue, frequent infections, fever, petechiae ¨ Epoetin alfa
like rash, bleeding, bruising, tachycardia, pallor ¨ Blood transfusions
¨ Anti-thymocyte globulin

Nursing Interventions
¨Monitor labs & blood counts and watch for an increase in reticulocyte count ¨Monitor for
renal failure ¨Teach infection prevention due to weakened immune system ¨If receiving blood
monitor for transfusion reactions/ fluid overload
 Thrombocytopenia
Patho Cause
Low platelets ¨Aplastic anemia ¨Vit B12 deficiency
¨Folate deficiency ¨Alcoholism ¨Cirrhosis
¨Leukemia ¨Chemotherapy/ radiation

S/S Meds/TX
Red/ purple/ brown bruising, petechiae like ¨ Blood and platelet transfusion
rash, nosebleeds, bleeding gums, blood in stool ¨ Prednisone
or urine ¨ Plasma exchange
¨ Splenectomy

Nursing Interventions
¨Preventing falls and injury ¨Monitor for new or worsening bleeding/ bruising ¨Monitor VS
¨Monitor platelet count, INR, PT, PTT levels ¨Administer blood/ platelets & monitor for
adverse reaction/ fluid overload ¨Prepare pt for splenectomy as indicated
 Psoriasis
Patho Cause
Buildup of skin cells that form scaly dry ¨Immune response attacking healthy skin
patches on the body cells

S/S Meds/TX
Rashes, dry skin, flaking and peeling, thick ¨ Phototherapy
reddened areas, itching, stiff or sore joints, ¨ Steroids
dents in the finger and toenails ¨ Vitamin A
¨ Adalimumab (Humira)
¨ Topical creams
Nursing Interventions
¨Monitor for skin infection/ cellulitis ¨Teach pt triggers to possible flare ups such stress,
colds, and viruses ¨Teach use of medication and that some meds take weeks to take effect
¨Wear non-irritating clothing and avoid scratching
 Osteoarthritis
Patho Cause
Wearing down of the cartilage at the ends of ¨Heredity ¨Obesity ¨Injury ¨Overuse of
bones (joints)
joints ¨Age ¨Sex (more common in women)
¨Metabolic disease

S/S Meds/TX
Pain in the joints, stiffness, swelling, joint ¨ Weight loss/ exercise
deformity, bony growth around the knuckles ¨ NSAIDs
¨ Narcotics
¨ Joint replacement
¨ Steroids
Nursing Interventions
¨Assess and monitor pain level ¨Encourage lifestyle changes and provide education ¨Apply
heat/ cold packs ¨Encourage adaptive equipment if necessary
 Gout
Patho Cause
Buildup of crystalized uric acid that deposits in ¨ Excess uric acid in the blood from the
the joints breakdown of purine (found in certain foods,
especially meats)

S/S Meds/TX
Pain in the joints/ ankles/ elbows/ feet/ ¨ Allopurinol
knees/ toes, stiffness and swelling, physical ¨ Colchicine
deformity, redness & warmth ¨ Steroids
¨ NSAIDs
¨ Cold packs
Nursing Interventions
¨Encourage a low purine diet ¨Increase fluid intake ¨Avoid alcohol ¨Rest affected area/
joint until gouty flare resolves
 Atrial Fibrillation
Patho Cause
Irregular heart rate that causes poor blood ¨Age ¨Genetics ¨Heart disease ¨Sick
perfusion
sinus syndrome ¨Heart attack
¨Hypertension ¨Lung disease ¨Overactive
thyroid ¨Sleep apnea ¨Viral infections
S/S Meds/TX
Tachycardia, palpitations, dizziness, fatigue, ¨ Cardioversion/ ablation
weakness, chest pain, shortness of breath ¨ Beta-blockers (metoprolol)
¨ Calcium channel blockers (diltiazem)
¨ Antiarrhythmics (amiodarone)
¨ Anticoagulants (warfarin)
Nursing Interventions
¨Monitor anticoagulation therapy (PT/INR/ PTT) ¨Monitor for signs of bleeding ¨Avoid
injury ¨Administer O2 as indicated ¨Educate on signs of MI/ Stroke
 Myocardial Infarction
Patho Cause
Blockage of blood flow to the heart causing ¨Any blockage of blood flow to the heart
ischemia to the cardiac tissue (fatty deposits, blood clots, cholesterol
plaques) ¨Illicit drug use ¨Autoimmune
diseases

S/S Meds/TX
Chest pain that can radiate between the ¨ Coronary artery bypass, stents,
shoulder blades/ arm/ jaw/ upper abdomen, angioplasty
dizziness, fatigue, clammy skin, chest tightness, ¨ Clopidogrel
feeling of impending doom, shortness of breath, ¨ ASA
anxiety ¨ Nitroglycerin
¨ Metoprolol
Nursing Interventions
¨Administer O2 immediately ¨Obtain 12 lead EKG Administer thrombolytic therapy ¨Monitor
VS closely ¨Monitor labs closely (troponins, myoglobin, CK-MB, BNP, IMA) ¨Be prepared to
call code/ defibrillate
 Bronchitis
Patho Cause
Inflammation of the lining of the bronchial ¨Bacteria/ viruses ¨Exposure to chemicals
tubes
or fumes ¨Smoking

S/S Meds/TX
Fever, chills, body aches, wheezing, shortness of ¨ Guaifenesin
breath, cough, chest congestion, cold/ flu-like ¨ NSAIDs
symptoms ¨ Cough suppressants

Nursing Interventions
¨Increase fluid intake to thin mucous and prevent dehydration and tachypnea ¨Teach deep
breathing and coughing exercise to expectorate sputum ¨Educate on lifestyle changes to
prevent recurrence
 Macular Degeneration
Patho Cause
Progressive center field loss of vision loss ¨Genetics ¨Age ¨Smoking ¨Hypertension
¨Obesity ¨High cholesterol

S/S Meds/TX
Blurred vision, darky blurry areas in the center ¨ Surgery
of vision, alterations in color perception, new or ¨ Corrective lenses
abnormal blood vessels in the eye ¨ Vitamins A, C, E
¨ Ranibizumab

Nursing Interventions
¨Provide safe and adequately lit environment to prevent injury ¨Educate on medication and
lifestyle choices ¨Avoid processed foods and those high in saturated fat
 Glaucoma
Patho Cause
Increased ocular pressure causing damage to ¨Blocked blood vessels ¨Severe eye
the nerve connecting the eyes to the brain
infections ¨Blunt or chemical injury
¨Inflammatory conditions

S/S Meds/TX
Blurred/ distorted vision, vision loss, eye ¨ Surgery
pressure/ pain ¨ Travoprost/ latanoprost/
pilocarpine
¨ Beta blockers (metoprolol)

Nursing Interventions
¨Avoid anticholinergics as they dry the eyes and cause an increase in intraocular pressure
¨Monitor VS, keeping BP low decreases intraocular pressure ¨Avoid saturated fats and
caffeine
 Eczema
Patho Cause
Inflammation of the skin that can cause dryness ¨Genetics ¨Allergens ¨Environment
and itching

S/S Meds/TX
Dry skin, itching, reddish patches on the skin, ¨ Topical moisturizers
small raised bumps that can leak fluid and ¨ Ultraviolet light therapy
crust, thick scaly areas on skin ¨ Topical steroids (triamcinolone)
¨ Antihistamines (diphenhydramine)

Nursing Interventions
¨Teach to avoid scratching as this can cause skin infections (cellulitis) ¨Increase fluid intake
and keep skin hydrated/ moisturized ¨Establish triggers and how to avoid them ¨Use gentle
soaps and fragrance free lotions
 Esophageal Varices
Patho Cause
Abnormal veins in the lower part of the ¨Cirrhosis ¨Hepatitis ¨Fatty liver disease
esophagus
¨Alcoholic liver disease

S/S Meds/TX
Bloating, blood in stool, vomiting blood, difficulty ¨ TIPS procedure
swallowing, enlarged veins around belly button, ¨ Ligation/ embolization
flapping hand tremor, swollen blood vessels in ¨ Octreotide
the skin ¨ Propranolol
¨ Norfloxacin
Nursing Interventions
¨Monitor VS and assess for signs of bleeding ¨Monitor abdominal girth ¨Monitor weight daily
¨Monitor I&O’s ¨Avoid alcohol ¨Limit salt and provide soft foods to reduce esophageal
irritation
 Diverticulosis/Diverticulitis
Patho Cause
Small pouches that develop in the digestive ¨Obesity ¨Smoking ¨Eating high fat foods
tract
and not enough fiber ¨Chronic use of
Diverticulitis is the infection of the small
pouches ¨Steroids/ opioids/ NSAID’s

S/S Meds/TX
Abdominal pain, changes in bowel pattern, ¨ Avoiding triggering foods
constipation, fever, N/V ¨ Increasing dietary fiber
¨ Psyllium husk

Nursing Interventions
¨Avoid triggering foods such as nuts, seeds, corn that may get stuck in diverticula and cause
infection ¨Maintain bedrest during infections ¨Ensure adequate fluid intake ¨Monitor for
fever/ chills as may be sign of peritonitis ¨Provide bowel rest
 Glomerulonephritis
Patho Cause
Inflammation of the glomeruli ¨Strep infection ¨Impetigo ¨Viral
infection ¨Mumps ¨Hep B ¨HIV

S/S Meds/TX
Fluid retention, edema, hypertension, hematuria, ¨ Diet (low salt, low potassium, low
proteinuria fluids)
¨ Cyclophosphamide
¨ Rituximab
¨ ACE inhibitors (Enalapril)
Nursing Interventions
¨Provide low sodium, low potassium diet ¨Monitor I&O’s and fluid restrictions ¨Monitor for
hypertension ¨Avoid NSAIDs ¨Monitor renal function closely for failure (BUN/ creatinine)
 Urolithiasis
Patho Cause
Kidney stone ¨Diet ¨Obesity ¨Certain supplements
¨Medications

S/S Meds/TX
Pain in the back/ flank area, painful urination, ¨ Shockwave therapy/ laser
blood in the urine, polyuria, sweating lithotripsy
¨ Narcotics
¨ Steroids

Nursing Interventions
¨Have patient strain urine to check for passing of stones ¨Increase fluid intake and
ambulation ¨Monitor urine output ¨Provide pain relief medication ¨Monitor for signs of UTI
 HIV
Patho Cause
Virus that attacks the body’s immune system ¨Contact with blood/ bodily fluids ¨Sexual
contact ¨Sharing needles ¨Contact with
maternal blood and breast milk

S/S Meds/TX
Fever, night sweats, chills, HA, muscle aches, ¨ Tenofovir
swollen lymph nodes, weight loss ¨ Abacavir
¨ Ritonavir

Nursing Interventions
¨Avoid fatty/ fried foods can cause pancreatitis while on antivirals ¨Instruct strict adherence to
medications as missed doses can cause resistance ¨Monitor temp daily and report to PCP if >100 ¨Inspect
mouth and skin Q8hr ¨Bathe daily with antimicrobial soap and clean toothbrush weekly ¨No gardening or
house plants ¨High calorie & protein diet NO raw fruits/ veggies/ undercooked meat
 AIDS
Patho Cause
Progressive destruction of the cell-mediated ¨HIV infection
immune system

S/S Meds/TX
Fever, night sweats, chills, HA, muscle aches, ¨ Opportunistic infection prevention
swollen lymph nodes, weight loss, frequent ¨ Tenofovir
infections, low CD4+ T-cells ¨ Abacavir
¨ Ritonavir

Nursing Interventions
¨Continually assess for presence of opportunistic infections ¨Place patient on isolation precautions to
prevent infection ¨Avoid fatty/ fried foods can cause pancreatitis while on antivirals ¨Instruct strict
adherence to medications as missed doses can cause resistance ¨Monitor temp daily and report to PCP if
>100 ¨Inspect mouth and skin Q8hr ¨Bathe daily with antimicrobial soap and clean toothbrush weekly ¨No
gardening or house plants ¨High calorie & protein diet NO raw fruits/ veggies/ undercooked meat
 Lung Cancer
Patho Cause
Abnormal overgrowth of cells within the lungs/ ¨Chronic exposure to asbestos, smoke,
lung tissue
¨Second hand
chemicals, gas, tar, radiation
smoke

S/S Meds/TX
Hoarseness, change in respiratory pattern, ¨ Surgery
persistent cough, rust colored sputum, coughing ¨ Lobectomy
up blood, chest pain, changes in endurance ¨ Chemotherapy/ radiation

Nursing Interventions
¨Avoid smoking and other lung irritants ¨Teach that early detection is key ¨Administer O2
as indicated ¨Administering meds such as morphine to decrease respiratory burden/ panic
 Skin Cancer
Patho Cause
Damage to the DNA of the skin ¨Genetics ¨Excessive sun/UV exposure

S/S Meds/TX
New or changing moles, color changes to a ¨ Wear sunscreen
freckle or mole, new change in color/ size/ ¨ Removal of cancerous lesion
shape/ sensation/ or character ¨ Chemotherapy/ radiation

Nursing Interventions
¨Avoid/ reduce skin exposure to sunlight especially between 11am-3pm ¨Avoid tanning beds
¨Inspect skin monthly for any changes/ irregularities (early detection is key) ¨Wear
sunscreen when outside, even on cloudy days
 Prostate Cancer
Patho Cause
Rapid mutation and overgrowth of cells in the ¨Age ¨Diet high in animal fat (red meat)
prostate
¨Race (African Americans, Caucasians, and
Hispanics are at highest risk)

S/S Meds/TX
Difficulty starting urination, frequent bladder ¨ Surgery (TURP)
infections, urinary retention, hematuria, ¨ Chemotherapy/ radiation/
nocturia, painful urination brachytherapy

Nursing Interventions
¨Teach healthy diet choices and foods to avoid (decrease animal fat, increase omega 3, fiber,
fruits/ veggies) ¨Annual PSA screenings starting at age 50 ¨Teach signs to monitor for early
detection
 Breast Cancer
Patho Cause
Single transformed cell that grows and ¨Age ¨Family history ¨Alcohol
multiplies in epithelial cells lining mammary
ducts or lobules
¨Having children at age >30
consumption
¨Obesity ¨Use of oral contraceptives
¨Increased risk in Jewish population
S/S Meds/TX
Breast pain, enlarged lymph nodes around ¨ Surgery
breasts/ armpits, lumps/ bumps/ nodules in and ¨ Mastectomy
around the breasts, redness, discharge from the ¨ Chemotherapy/ radiation
nipples

Nursing Interventions
¨Teach how to perform breast exam and to perform exam 1 week after menstrual cycle
¨Mammography annually starting at age 45, at 55
(monthly for those who do not menstruate)
Q2-3 years until you reach your 70’s ¨Provide supportive care to those with a positive
diagnosis
 Cellulitis
Patho Cause
Bacterial skin infection ¨Bacteria

S/S Meds/TX
Pain, redness, warmth, swelling, fever, chills, ¨ Antibiotics (Bactrim, clindamycin,
pus/ drainage PCN, Keflex, cefazolin)

Nursing Interventions
¨Monitor infected area (draw around reddened area to monitor for spreading) ¨Keep area
clean and dry ¨Administer antibiotics as prescribed and until completed ¨If on extremity,
keep elevated to reduce swelling ¨Monitor for signs of worsening infection/ sepsis
 Cystic Fibrosis
Patho Cause
Inherited disorder that damages the lungs and ¨Genetics
digestive system

S/S Meds/TX
Cough, increased mucous production in the lungs, ¨ Chest oscillation
heartburn, slow growth, fatigue, frequent lung ¨ Medium-chain triglyceride
infections, weight loss, fatty stools, diarrhea ¨ Dornase alfa
¨ Antibiotics
¨ Pancreatic enzymes
Nursing Interventions
¨Educate that CF causes sterility in men and difficult conception in women ¨Provide high
energy/ high fat diet ¨Monitor lung sounds and teach deep breathing/ coughing ¨Monitor for
signs of infection ¨Frequent fatty/ foul smelling stools is common ¨Take pancreatic enzymes
with each meal
 Appendicitis
Patho Cause
Inflammation/ infection of the appendix ¨Viruses ¨Bacteria ¨Parasites ¨Blockage
of stool ¨Tumors

S/S Meds/TX
Lower right quadrant pain, fever, chills, fatigue, ¨ Surgical removal
N/V/D ¨ Antibiotics (Cirpo, cefotetan,
cefazolin, clindamycin)
¨ NPO status

Nursing Interventions
¨Administer IV fluids ¨Monitor VS closely ¨Monitor for signs of peritonitis (increased temp,
HR, resp.) ¨Do not apply heat ¨No enemas or laxatives ¨Position patient to a comfortable
position
*Sudden relief of pain is an EMERGENCY! Appendix has likely ruptured
 Polycystic Ovarian Syndrome (PCOS)
Patho Cause
Hormonal disorder causing enlarged ovaries with ¨Not entirely known, may be from high
development of frequent cysts levels of male hormones

S/S Meds/TX
Menstrual irregularity, excessive hair growth, ¨ Follitropin (for infertility)
obesity, acne, depression, male features, ¨ Gonadotropin-releasing hormone analogue
¨ Estradiol
infertility
¨ Progesterone
¨ Spironolactone

Nursing Interventions
¨Educate on diet and lifestyle changes ¨Monitor hormone use and any adverse effects
¨Evaluate menstrual patterns ¨Supportive care for disturbed body image related to
increased body hair and acne
 Endometriosis
Patho Cause
Condition where tissue that normally lines the ¨Unknown
uterus grows outside of the uterus

S/S Meds/TX
Painful menstruation, menstrual irregularities, ¨ Surgery
feeling of abdominal fullness, infertility, ¨ Cauterization/ ablation
excessive cramping ¨ Progesterone/ Estradiol
¨ Gonadotropin-releasing hormone
analogue
Nursing Interventions
¨Monitor for adverse effects of hormone use ¨Apply heat to abdomen to promote comfort
¨Monitor lab values and for signs of anemia for those with heavy menstruation ¨Increase
fluid intake and monitor for constipation
 Pelvic Inflammatory Disease (PID)
Patho Cause
An infection of the female reproductive organs ¨Bacteria ¨STI’s

S/S Meds/TX
Pain in the pelvis/ abdomen/ lower back/ ¨ Antibiotics (clindamycin,
vagina, fatigue, fever, vaginal discharge or odor, ceftriaxone, azithromycin,
cramping, painful menstruation doxycycline, etc)

Nursing Interventions
¨Teach patient safe sex habits to prevent contraction and spread of infection ¨Abstaining
from sexual intercourse until infection has resolved ¨Monitor for increased temperature
¨Take all medication as prescribed to prevent recurrence
 Erectile Dysfunction
Patho Cause
Inability to achieve or maintain erection for ¨Heart disease ¨Age ¨Diabetes ¨Obesity
sexual activity
¨Metabolic syndrome ¨Parkinson’s disease
¨Atherosclerosis

S/S Meds/TX
Sexual dysfunction, reduced libido, trouble ¨ Sildenafil (Viagra)
getting or maintaining an erection, anxiety ¨ Testosterone
¨ Lifestyle changes

Nursing Interventions
¨Identify factors contributing to sexual dysfunction ¨Educate use of medication (Sildenafil)
and to seek medical attention if maintains an erection >4hr ¨Have patient monitor for signs of
hyper/hypotension
 Lung Transplant
Indication: Irreversible end stage lung disease w/ no comorbiditiesà rare due to cost

FYI: 20% die before organ available, poor short and long term outcome, post-op mortality 24%, 1
year survival 73%, by year 3 only 50% still alive, transplant extends life 1-15 years with 7 year
average.

*Post-transplant will be at continued risk for lethal pulmonary Infectionsà S/S: fever, chills, sore
throat, increased cough/ sputum, abnormal breath sounds, decreased O2 sats, abnormal ABG’s

*rejection manifestations may be subtle: fatigue, fever, sob

Pre-op: donor must be infection & cancer free, have healthy lung tissue, be a close tissue match to
recipient, have same blood type. **priority to teach recipient expected pulmonary hygiene and
strengthening after surgery. Pt won’t want to do anything but must do incentive spirometry
and coughing.

Post-op: intubated for at least 48hr w/chest tubesà anti-rejection drugs start immediately after
surgery which increases risk for infectionà No corticosteroids for 10-14 days.

Green/yellow sputum= infection

 Heart Transplant
FYI: 50% of recipients survive 10 years

Pre-op: must have life expectancy of <1 year, age <65, normal to slightly increased
pulmonary vascular resistance, absence of active infection, stable psychosocial status, no
evidence of current drug/ alcohol use.

Post-op: monitor for S/S of tamponade (hypotension, tachycardia, palpitations, tachypnea,

SOB, edema, wheezing) & bleeding into pericardial sacà complete frequent cardiovascular/
respiratory assessmentsà transplanted heart has no nerves so can’t feel pain/ angina and
has no response to vagal stimulationà atropine, digoxin, and carotid sinus pressure are
not used because they do not have same effects on new heart, use lisopril instead.
Monitor for hypotension due to denervated heart, may require permanent pacemaker,

*Always practice handwashing & aseptic technique

S/S of rejection: SOB, fatigue, wt gain/edema, abdominal bloating, hypotension, a-fib/

flutter, activity intolerance, new bradycardia (WBC’s attack new heart and smother it and
can cause asystole)à late sign= decreased ejection fraction 10-20% (normal 60-65%)
 Liver Transplant
FYI: Cirrhosis is the most common cause for transplant

Common infections post-op: PNA, wound infections, UTIsà opportunistic infectionsà will
be on broad spectrum antibiotics post-op

S/S of rejection: (4-10 days post-op) tachycardia, fever, RUQ/flank pain, dec. bile
pigment/volume, jaundice, increased bilirubin, liver enzymes, PT/INR

Complications: peritonitis (fever abdominal pain, distention/ rigidity), bacteremia,

cirrhosis. Monitor neuro statusà can develop encephalopathy from non-functioning
liver, report S/S of clotting problems (oozing blood from catheter, petechiae,
ecchymosis).

Immunosuppressant drugs side effects: hypertension, nephrotoxicity, GI disturbances

Infection prevention: hand hygiene, early removal of invasive lines, frequent cultures of
tubes/ lines/ drainage, receive applicable vaccinations
 Kidney Transplant
FYI: Transplant is not considered a cureà cancer disqualifies patient for transplant unless
more than 2-5 years since cancer eradicated then may be considered for transplant.

Pre-op: will receive blood transfusion before surgery & dialysis within 24hr of surgeryà monitor
fluids/ electrolytes, remove urinary catheter asap, hourly urine output for 48hrs. (urine will be
pink the first few days), **abrupt decrease in output may indicate rejection, AKI, thrombosis,
or obstruction.

*Monitor for fluid overloadà daily weights & I&O’s, check BP Q2-4hrs.

Post-op: monitor output hourly x48hr, examine urine color, pink colored urine will resolve several
days to weeks after surgery. Oliguria can be caused by ischemia, AKI, or rejection. Fluid
overload can cause HTN, heart failure, pulmonary edema. Diuresisà monitor I&O’s, observe for
disruptions of fluid and electrolytes

Acute rejection: occurs within 1 week of surgeryà oliguria/anuria, temp >100, hypertension,
enlarged/tender kidney, lethargy, elevated BUN/ creatinine/ K+, fluid retention

Chronic rejection: occurs over months to yearsà gradual increase in BUN/creatinine, fluid
retention, changes in electrolyte levels, fatigue, need for dialysis
Alkalotic Sodium Acidic
Nerve Impulses

Hypo Hyper
¨ CNS Symptoms *Think SALT
¨ Headache S- sweaty
¨ Confusion A- agitated
¨ Seizures L- low grade fever
¨ Twitching T- thirsty
Alkalotic Potassium Acidic
Heart

Hypo Hyper
*Think A-SIC-WALT ¨ Severe diarrhea
A- alkalosis ¨ Abdominal cramping
S- shallow respirations ¨ Chronic renal failure
I- irritability ¨ EKG changes
C- confusion ¨ Hypotension
W- weakness
A- arrhythmia
L- lethargy
T- thready pulse
Alkalotic Calcium Acidic
Contractures

Hypo Hyper
¨ Chvostek’s sign (facial *Think BACK-ME
twitching) B- bone pain
¨ Trousseau’s sign (wrist/hand A- arrhythmia
spasm) C- cardiac arrest
¨ Calf pain K- kidney stones
¨ Increased muscle cramping M- muscle weakness
(Charley horses) E- excessive urination
*eliminate calcium & Vit D from dietà no
tumsà start calcitonin
Acidic Magnesium Alkalotic
Heart

Hypo Hyper
*Think 4 M’s ¨ Decreased respiratory rate
M- malnutrition ¨ Bradycardia
M- malabsorption ¨ Hypotension
M- muscle tremor
M- metabolic acidosis *slows everything downà can slow
labor
*alcoholics, loop diuretics
Alkalotic Chloride Acidic
Cellular fluid balance

Hypo Hyper
¨ CNS Symptoms *Think SALT
¨ Fluid loss S- sweaty
¨ Headache A- agitated
¨ Confusion L- low grade fever
¨ Seizures T- thirsty
¨ Twitching *mimics hypernatremia (think of
sodium and chloride as sisters)
*mimics hyponatremia (think of sodium
and chloride as sisters)
Alkalotic Phosphate Acidic
Nerve function

Hypo Hyper
*Think PHATE *Think CRAMPS
P- pulmonary issues (resp. alkalosis) C- confusion
H- hyperglycemia R- reflexes hyperactive
A- alcoholism (unable to absorb phos.) A- anorexia
T- thermal burns (causes hypophos.) M- muscle spasms
E- electrolyte imbalances P- positive Trousseau’s sign
(hypercalcemia, hypokalemia, S- sign of Chvostek
hypomagnesemia)
 Metabolic Acidosis

Causes S/S Tx
¨ DKA ¨ Deep rapid ¨ Treat Cause
¨ Diarrhea Respirations ¨ IV bicarbonate
¨ Dehydration ¨ Dysrhythmia
¨ Renal Failure ¨ Coma
¨ Hypoxia
 Metabolic Alkalosis

Causes S/S Tx
¨ Thiazide ¨ N/V/D ¨ Treat Cause
diuretics ¨ Confusion
¨ Antacids ¨ Tetany
¨ Vomiting
¨ Gastric suction
 Respiratory Acidosis

Causes S/S Tx
¨ Respiratory ¨ Respiratory ¨ Raise HOB
depression distress ¨ Pursed lip
¨ Lung disease ¨ Hypoventilation breathing
¨ Surgery ¨ Shallow ¨ Bronchodilators
¨ Head Injury respiration
 Respiratory Alkalosis

Causes S/S Tx
¨ Hyperventilation ¨ Increased ¨ Breathe into
¨ Fever respiratory paper bag
¨ Anxiety rate ¨ Sedation
 Blood Type Compatibility
Blood Type Gives Receives

A+ A+, AB+ A+, A-, O+, O-

O+ O+, A+, B+, AB+ O+, O-
B+ B+, AB+ B+, B-, O+, O-
AB+ AB+ Everyone
A- A+, A-, AB+, AB- A-, O-
O- Everyone O-

B- B+, B-, AB+, AB- B-, O-

AB- AB+, AB- AB-, A-, B-, O-
 Blood Type Compatibility Table
Donor
Recipient
O- O+ A- A+ B- B+ AB- AB+
O-

O+

A-

A+

B-

B+

AB-

AB+
 Lab Values- NCLEX
Lab Value Lab Value Lab Value
RBC 4-6 CPK 20-198 CrCl 85-140
WBC 5,000-10,000 Albumin 3.5-5 TSH 0.2-5
Platelets 3
150 -400 3
Bilirubin <1.0 T3 75-200
Hgb 12-18 Uric acid 3.5-7.5 T4 5.5-11.5
Hct 37-52% PT 11-12.5 pH 7.35-7.45

Sodium 135-145 PTT 25-35 pCO2 35-45

Potassium 3.5-5 INR 0.8-1.2 HCO3 22-26
Chloride 95-105 aPTT 1.5-2.5 pO2 80-100
Calcium 9-10.5 Bleeding time 1-6 Carbamazepine 4-10
Magnesium 1.5-2.5 LDL <70 Digoxin 0.8-2.0
Phosphorus 2.5-4.5 HDL >40 Lithium 0.8-1.5
Glucose 70-110 Troponin <0.03 Phenobarbital 15-40
BUN 10-20 CK-MB 0-3 Theophylline 10-20
Creatinine 0.5-1.2 C-reactive protein <0.8 Valproic acid 50-100