MS Critical Thinking Skills
MS Critical Thinking Skills
UDAN CONCEPTS
Right- sided CHF “VENOUS BACK- UP”
“SYSTEMIC MANIFESTATIONS” – below the chest
Left- sided CHF “LEFT – LUNGS”
“CELLULAR HYPOXIA”
“RAAS ACTIVATION” (HTN, HypoK+)
• The number one killer of Filipinos is cardiac o When liver and portal vein are congested
disorders (MI, Angina, CHF, HTN). with blood, plasma shift out and the fluid or
• Congestive heart failure happens when the plasma will accumulate in the abd. Cavity
ventricles are unable to eject blood as fast as causing ascites.
blood enters the atria. • LSCHF (Pulmonary): If left ventricle is unable to
• RSCHF (Systemic): When right ventricle is eject blood as fast as the blood enters the left
unable to eject blood as fast as blood enters the atrium, congestion in the left side of the heart will
right atrium, the blood re-entering the right make the lungs unable to return the blood to the
atrium via superior vena cava and inferior vena left atrium. So, when blood accumulates in the
cava will not be able to transport the blood back pulmonary capillaries, plasma or blood will enter
to the right side of the heart. So, there will be the intra- and inter- alveolar spaces called
accumulation of blood in the venous channels pulmonary edema.
called Venous Back-up. o When lungs are affected, very little
o i.e., If venous blood from the upper parts of oxygenated blood goes back to the heart
the body could not re-enter the heart via causing hypoxia.
superior vena cava, there will be jugular o One of the responses of the body to chronic
vein distention or distended neck vein. hypoxia is the activation of RAAS.
o i.e., If the venous blood from the lower parts
of the body could not re-enter the heart via
the inferior vena cava, the venous blood from
the lower half of the body which has to pass
to the liver first, blood accumulates in the
liver causing hepatomegaly.
o If there is hepatomegaly, blood from the
portal vein cannot be transported to the liver,
so there will be accumulation of blood in the
portal vein called portal HTN.
o If there is portal HTN, spleen cannot
transport blood to the portal vein causing
splenomegaly. The primary fxn of the
spleen is to do hemolysis (destruction of old
blood cells), but in this case even the young
blood cells are hemolyzed resulting to
hemolytic anemia.
3. Orthopnea ✔
4. Rales/crackles ✔
5. Ascites ✔
6. Hemolytic anemia ✔
7. Hypertension ✔
8. Serum K+ = 3.0 mEq/L ✔
9. Clubbing of fingers ✔
10. Hepatomegaly ✔
11. Anorexia, weight loss, weakness due to decreased metabolism – d/t hypoxia ✔
12. Polycythemia (↑ prod. of RBC) – response to hypoxia → ↑ release of ✔
erythropoietin stimulating bone marrow to produce RBC
13. Hemoptysis ✔
14. Central Venous Pressure = 15 cm H20 ✔
15. Pulmonary Artery Pressure = 25 mmHg ✔
16. Splenomegaly ✔
17. Oxygen saturation = 90% ✔
18. Icteric sclerae ✔
19. Internal hemorrhoids – d/t venous back-up ✔
20. Syncope ✔
UDAN CONCEPTS
Arterial insufficiency “Low/ No oxygen in the legs” – arteries carry oxygenated blood away from the heart
Venous insufficiency “Blood pooling in the legs” – veins carry unoxygenated blood to the heart
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A. Vesicular E. Crackles
B. Bronchovesicular’ F. Rhonchi
C. Bronchial G. Stridor
D. Wheeze H. Pleural friction rub
UDAN CONCEPTS
SIADH (Syndrome of Inappropriate ADH) “Water Retention”
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Signs/Symptoms SIADH DI
1. Urine output= 4 to 6 L/ day ✔
2. Highly- colored urine ✔
3. Urine specific gravity= 1.050 – H20 retained in blood ✔
4. Weight gain – H20 retention ✔
5. Weight loss – H20 loss ✔
6. Dehydration ✔
7. Serum sodium = 120 mEq/L (N: 135-145 mEq/L) ✔
8. Constipation – d/t H20 loss in the body stools become hard ✔
9. Fluid intake= 4L/day – d/t activation of thirst mech. from H20 ✔
loss
10. Low urine specific gravity ✔
11. Hemoconcentration – d/t H20 loss ✔
12. Low hematocrit - dd/t dilution of blood ✔
13. Polydipsia ✔
14. Hypertension – H20 retention ✔
15. Pulmonary edema – H20 retention ✔
16. Decreased blood osmolarity – blood is diluted d/t retention of ✔
H20
17. Water intoxication ✔
18. Water- like urine ✔
19. Growth retardation – d/t loss of H20 ✔
20. Urine sp gr = 1.004 ✔
UDAN CONCEPTS
Hyperthyroidism “Everything is high, fast, and wet ”
“Hypocalcemia”
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“Eye manifestations”
Hypothyroidism “Everything is low, slow, and dry”
“Hypercalcemia”
Thyroid Gland Hormonal Secretions o Jeffrey’s sign: pt. looks up, forehead
1. T3 (Triiodothyronine): metabolism, growth remains smooth
2. T4 (Thyroxine): catabolism, body heat
production
3. Thyrocalcitonin: regulates serum Ca levels
o Deposits Ca+ into the bones (lowers s. Ca+)
– inversely proportional/ opposite
direction with Ca
↑ hyperthyroidism = ↓ hypoCa+
↓ hypothyroidism = ↑ hyperCa+ o Dalyrimple's sign (thyroid stare):
characterized by bright eyed stare d/t lid
retraction and infrequent blinking
(Stellwag’s sign)
HYPOTHYROIDISM
• ↓ T3 = ↓ metabolism
• ↓ T4 = ↓ body heat prod.
• ↓ Thyrocalcitonin = Hypercalcemia
Nursing Responsibilities
o Exophthalmos: protrusion of the eyeballs • Taken on FULL stomach – to prevent GI irritation
• Start with HIGH dose then gradually taper
THYROID PREPARATIONS
• Synthroid
• Cytomel
Nursing Responsibilities
o Von Graefe’s sign (lid lag): pt. looks down • 1 thyroid prep. at a time, never take them at the
– long and deep palpebral fissure same time → RF thyroid crisis.
• Taken on EMPTY stomach for better absorption.
• Start with LOW dose, then gradually increase to
prevent thyroid crisis
• Check PR and BP before administration – thyroid
prep. can elevate VS
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UDAN CONCEPTS
Hyperparathyroidism “Everything is low and slow Except BP” (BP is high – Ca causes
vasoconstriction)
“Hypercalcemia, Hypophosphatemia”
Hypoparathyroidism “Everything is high and fast Except BP” (BP is low)
“Hypocalcemia, Hyperphosphatemia”
HYPERPARATHYROIDISM
• PISO • Hypersecretion of PTH
o K+ in, Na+ out → muscles RELAX • Hypercalcemia
o Na+ in, K+ out → muscles CONTRACT • Hyperphosphatemia
HYPOPARATHYROIDISM
• Hyposecretion of PTH
• Hypocalcemia
• Hyperphosphatemia
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UDAN CONCEPTS
Hypoglycemia “Decreased glucose supply to the brain” – needs 65%-70% of
glucose in the body
“SNS stimulation” – response to stress
“Feeling hungry”
Hyperglycemia “3 P’s (Polyuria, Polydipsia, Polyphagia)”
“Dehydration” – d/t polyuria
“Ketoacidosis”
UDAN CONCEPTS
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Addison’s Disease “Everything is low (d/t hyposecretion of adrenal cortex hormones) EXCEPT K+ (↓
aldosterone = ↑ K+), Ca+ (slow breakdown of CHON causes ↑ absorption of Ca), Pulse
rate (↓ BP = ↑ PR)”
“Dark skin” – insufficient secretion of hormones from adrenal cortex → Anterior pituitary
gland → ACTH and MSH
Cushing’s Disease “Everything is high EXCEPT K+ (↑ aldosterone = ↓ K+), Ca+ (increased breakdown of
CHON decreases absorption of Ca), Pulse rate (↑ BP = ↓ PR)”
A. Olfactory G. Facial
B. Optic H. Acoustic
C. Oculomotor I. Glossopharyngeal
D. Trochlear J. Vagus nerve
E. Trigeminal K. Spinal accessory
F. Abducens L. Hypoglossal
UDAN CONCEPTS
a. Parkinson’s disease “Tremors, rigidity”
b. Myasthenia gravis (MG) “Muscle weakness”
c. Multiple sclerosis (MS) “Demyelination of CNS”
d. Guillain Barre’ syndrome (GBS) “Demyelination of the peripheral nervous system
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UDAN CONCEPTS
SNS • Origin: Thoraco-lumbar segment of spinal cord
• Hormone released: Norepinephrine
“Everything is high and fast, EXCEPT GI and GU (slow)” – necessary for survival (flight-or-fight)
• Dilate:
o Pupils
o Bronchial tree
o Coronary blood vessels
• Constrict: Peripheral blood vessel – elevates BP
• Pharmacology: Anticholinergic, Beta agonists (Bronchodilators)
o Atropine sulfate (anticholinergic): used as a pre-op med and anti-diarrheal with SNS S/E
PNS • Origin: Sacral segment of the spinal cord
• Hormone released: Acetylcholine
“ Everything is low and slow, Except GI and GU (fast)”
• Dilate:
o Pupils
o Bronchial tree
o Coronary blood vessels
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1. Morphine K. Naloxone
2. Magnesium Sulfate B. Calcium gluconate
3. Hyperkalemia B. Calcium gluconate
4. Beta adrenergic blockers D. Glucagon
5. Calcium channel blockers D. Glucagon
6. Acetaminophen poisoning A. Mucomyst (acetylcystein)
7. Lead Poisoning E. EDTA G. Disulfiram
8. Heparin I. Protamine sulfate
9. Coumadin H. Vitamin K
10. Opiate addiction F. Methadone
11. Digitalis toxicity C. Digibind
12. Alcohol abuse G. Disulfiram
13. Myasthenic crisis J. Cholinergic
14. Cholinergic crisis L. At SO4
15. Diazepam N. Romazicon
16. hemosiderosis M. Desferal
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