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COACHING WITH THE ICONS: DOC UDAN

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.

Signs/Symptoms RSCHF LSCHF

1. Distended neck vein ✔
2. Bipedal edema ✔
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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 ✔

Signs and Symptoms Iron Folate Pernicious Aplastic Thalassemia

Deficiency Deficiency
1. Macrocytic, normochromic anemia ✔ ✔
2. Pancytopenia ✔
3. Microcytic/Hypochromic anemia ✔
4. Cheilosis (cracks at the side of the ✔
lips)
5. Beefy red tongue ✔
6. Koilonychia (spoon-shaped ✔
fingernail)
7. Intrinsic factor deficiency ✔
8. Abnormal Hgb, short lifespan of RBC ✔
9. Cyanocobalamine deficiency (Vit. ✔
B12 Deficiency)
10. Vinson-Plummer’s Syndrome ✔
(stomatitis, dysphagia, esophageal
web)
11. Iron overload ✔

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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Signs/Symptoms Arterial Insufficiency Venous Insufficiency

1. Elevation of legs relieves edema ✔
2. Absence of pulse ✔
3. Thin, shiny, hypopigmented skin in the legs – no O2 ✔
4. Thickened, hyperpigmented skin in the legs - blood ✔
pooling
5. Ulcers in the toes ✔
6. Edema ✔
7. Cold, cyanotic skin in the leg – no O2 ✔
8. Ulcers at the ankle ✔
9. Warm, reddish skin in the leg – blood pooling ✔
10. Leg pain on walking ✔
11. Lowering of legs improves blood flow ✔
12. Gangrene develops – no O2 ✔
13. Leg pain relieved by walking ✔
14. Intermittent claudication (leg pain on walking/exercise) ✔
15. Calf pain (Homan’s sign) ✔
16. Thrombophlebitis ✔
17. Raynaud’s disease ✔
18. Aneurysm ✔

A. Vesicular E. Crackles
B. Bronchovesicular’ F. Rhonchi
C. Bronchial G. Stridor
D. Wheeze H. Pleural friction rub

Description Breath Sounds

1. Rustling like the sound of wind in the trees A. Vesicular
2. Harsh, hollow, tubular C. Bronchial
3. Heard over mainstem bronchi B. Bronchovesicular
4. Burst of popping bubbles E. Crackles
5. High- pitched hissing/ musical sound on expiration D. Wheeze
6. Heard over trachea C. Bronchial
7. Low- pitched musical sound on inspiration F. Rhonchi
8. Musical wheeze over trachea G. Stridor
9. Sounds like 2 pieces of sandpaper rubbing together H. Pleural friction rub
10. Heard at the periphery, apex, and base of the lungs (heard all over lungs) A. Vesicular
11. Inspiration longer than expiration A. Vesicular
12. Inspiration equals expiration B. Bronchovesicular
13. Inspiration shorter than expiration C. Bronchial

UDAN CONCEPTS
SIADH (Syndrome of Inappropriate ADH) “Water Retention”

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“ Low Serum Sodium” or Dilutional hyponatremia– d/t

overwhelming amt. of H20 retention
D.I. (Diabetes Insipidus) “Water Loss”

• ADH (Vasopressin) o Blood : Urine (opposite direction/

o Action: inversely proportional)
 Retains water in the renal tubules  ↓ dilute (blood) : ↑ concentrated (urine)
 Vasoconstriction  ↑ concentrated (blood) : ↓ dilute (urine)
o Hypersecretion: SIADH (Syndrome of • Urine sp. gr (N: 1.010 – 1.025)
Inappropriate ADH) o High sp. gr: urine is CONCENTRATED
o Hyposecretion: DI (Diabetes Insipidus) (1.03 and above)
• Osmolarity: concentration of fluid can be  Parallel to high urine osmolarity
applied in urine and blood o Low sp. gr: urine is DILUTE (1.001 and
o High osmolarity – concentrated (less water) above)
o Low osmolarity – dilute (more water)  Parallel to low urine osmolarity
• Remember: In problems with ADH mindset s/b
“Where is the water? Is it in the urine or in the
blood?”

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

• BMR (Basal Metabolic Rate): lowest O2

HYPERTHYROIDISM consumption at the lowest of activity
• ↑ T3 = ↑ metabolism o Normal (Euthyroid): +20% to -20%
• ↑ T4 = ↑ body heat prod. o Hyperthyroidism: ↑ +20%
• ↑ Thyrocalcitonin = Hypocalcemia o Hypothyroidism: ↓ -20%
• Eye manifestations:
ANTI-THYROID DRUGS
• Tapazole
• PTU (Propylthiouracil)
• Lugol’s Solution

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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Signs/Symptoms Hyperthyroidism Hypothyroidism

1. Anorexia – d/t ↓ metabolism ✔
2. Cold intolerance – ↓ body heat prod. ✔
3. Diarrhea ✔
4. Fatigue ✔
5. Obesity – d/t slow metabolism ✔
6. Exophthalmos ✔
7. Thin – d/t hypermetabolism ✔
8. Restlessness, Nervousness ✔
9. Fine, oily hair ✔
10. Dry, sparse hair ✔
11. Serum Calcium= 12 mg/ dL ✔
12. Serum Calcium= 3.5 mEq/ L ✔
13. Fine tremors ✔
14. Lid lag ✔
15. Pulse rate= 55 to 60 bpm ✔
16. BP= 140/90 to 159/ 94 mmHg ✔
17. Serum cholesterol= 280 mg/dL – d/t slow metabolism ✔
18. Thickened, hyperpigmented skin in the pretibial area ✔
19. Dry, scaly skin ✔
20. Diarrhea ✔
21. Sweaty skin ✔
22. Tachycardia ✔
23. Slow physical and mental reaction ✔
24. Hypercalcemia ✔
25. Elevated body temperature ✔
26. BMR = (-)30 % ✔
27. Treated with Synthroid ✔
28. Treated with Tapazole ✔
29. Treated with PTU ✔
30. Treated with Lugol’s solution ✔
31. Dull look – facial expression ✔
32. Exophthalmos ✔
33. Von Graefe’s sign ✔
34. Jeffrey’s sign ✔
35. Dalyrimple’s sign ✔
36. Treated with Cytomel ✔
37. Requires high calorie diet – pt. lose wt. ✔
38. Requires low fiber diet – d/t diarrhea ✔
39. Requires cool, quiet environment – heat intolerance ✔
40. Requires warm environment during cold climate – cold ✔
intolerance
41. Tendon of Achilles Reflex (+1) – hypoactive ✔

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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”

Parathyroid Gland • Hypocalcemia - ↓ Ca making it easier for Na and

K to pass thru (increased cell membrane
permeability) → increased neuromuscular
irritability/ muscle contraction

• Calcium: regulates cell membrane (located

where the cell and blood vessel connects)
permeability (ability to allow substances to pass • Hypercalcemia - ↑ Ca making it difficult for Na
through) and promotes vasoconstriction and K to pass thru (decreased cell membrane
o 99% are found in bones and teeth while 1% permeability) → decreased neuromuscular
is found in blood and some of that 1% is irritability/ muscle contraction
found in the cell membrane o S/Sx:
 Polyuria since Ca exerts high osmotic
pressure in the renal tubules →
polydipsia
 DHN
 Urinary stones (calcium oxalate)
 Fracture – PTH keeps on drawing Ca
from bones → bones become weak and
brittle esp. long bones

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

• Hypothyroidism and Hypoparathyroidism:

o Dry skin
o Dry hair
o Brittle nails

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Signs/Symptoms Hyperparathyroidism Hypoparathyroidism

1. Hypercalcemia ✔
2. Hypocalcemia ✔
3. Dry, scaly skin ✔
4. Dry, brittle hair and nails ✔
5. Muscle cramps ✔
6. Muscle weakness ✔
7. Hypophosphatemia ✔
8. Low BP ✔
9. Seizures ✔
10. Increased urine output ✔
11. Polydipsia ✔
12. Tingling lips, fingers, toes – Chvostek’s ✔
13. Fracture of long bones ✔
14. + Chvostek’s ✔
15. + Trousseau’s ✔
16. Hypertension ✔
17. Laryngospasm ✔

Signs/Symptoms Type I Type II

1. Non- insulin dependent ✔
2. Associated with obesity ✔
3. Thin ✔
4. Prone to HHNC ✔
5. Onset after age 30 years ✔
6. Lifelong insulin therapy ✔
7. Brittle DM ✔
8. Associated with heredity ✔
9. Treated with Oral Hypoglycemic Agents (OHA) ✔
10. Occurs among children ✔
11. Prone to DKA ✔
12. Pancreas secretes insulin but demands are increased ✔
13. Absence of Islets of Langerhans ✔
14. Ketosis- resistant ✔
15. Onset before age 30 years ✔
16. Associated with autoimmune disorders – triggered by ✔
viral diseases which commonly occurs among children
17. Obese ✔
18. Insulin- dependent DM ✔
19. Best managed with diet, activity, exercise, insulin ✔

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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”

Signs/ Symptoms Hypoglycemia Hyperglycemia

1. Blurred vision ✔
2. Headache, dizziness ✔
3. Pallor, diaphoresis ✔
4. Urine output 300mls/hour ✔
5. Acetone odor of breath ✔
6. Fluid intake 4L/ day ✔
7. Kussmaul’s breathing – blow of CO2 and reduce ✔
acidemia
8. Cold, clammy skin ✔
9. Sunken eyeballs ✔
10. Restlessness ✔
11. Excessive hunger (polyphagia) ✔
12. Weakness, shakiness ✔
13. Faintness ✔
14. Urine (+) for glucose and ketones ✔
15. pH =7.31, HCO3= 18 (metabolic acidosis) ✔
16. Hunger pangs ✔
17. Yawning ✔
18. Blood glucose = 50 mg/ dL (N: 70-110 mg/dL) ✔
19. Warm, flushed, dry skin ✔
20. Inability to concentrate ✔
21. Hypokalemia – d/t polyuria ✔
22. Needs insulin ✔
23. Needs glucose ✔
24. Memory lapses ✔
25. Urine (+) for glucose and ketones ✔
26. Fruity odor of breath ✔
27. Polydipsia ✔
28. Polyphagia ✔

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)”

Adrenal Glands • Na and H20 retention (edema, wt. gain)

• Adrenal cortex: secretes hormones that • Hypokalemia
regulate the 3S • Osteoporosis (Hypercalcemia) – very little Ca
o Sugar – Glucocorticoid: elevate blood can be deposited in the bones
glucose levels • GI irritation (increased HCL secretion) – Mgt:
o Salt – Mineralocorticoid (i.e., Antacid
Aldosterone): retains Na, excretes K • Anti-inflammatory (delayed wound healing)
o Sex – Estrogen, Testosterone • Immunosuppressant (low resistance to infection,
• Adrenal Medulla: secretes catecholamines i.e., fungal infection)
(Epinephrine and Norepinephrine) • Capillary fragility (Easy bruising)
• Abnormal fat distribution:
• Similar Manifestations of HypoK+ and o Moon face
HyperK+ o Truncal obesity with thin arms and legs
o Anorexia o Buffalo hump
o Nausea and vomiting • Sex hormone imbalances
o Muscle weakness o Males: feminization (gynecomastia,
o Fatigue decreased libido, impotence) – d/t increased
o Paralysis estrogen
o Dysrhythmias o Females: masculinization (hirsutism,
o Renal damage thinning of scalp hair, acne, increased
virilism) – d/t increased estrogen and
EFFECTS OF ADRENAL CORTEX HORMONES/ testosterone
SIGNS AND SYMPTOMS OF CHUSHING’S • Purple striae on the abd.
DISEASE/ SIDE EFFECTS OF STEROIDS
• Hyperglycemia – Mgt: Monitor blood glucose Note: “Everything is high EXCEPT K+, Ca+, Pulse
levels and give insulin or OHA if elevated rate”
• HTN

Signs/ Symptoms Addison’s Cushing’s

1. Moon face ✔
2. Hyperglycemia ✔
3. Edema ✔
4. Hypertension ✔
5. Delayed wound healing ✔
6. Hypotension. ✔
7. Hyponatremia ✔
8. Thinning of scalp hair ✔
9. Osteoporosis ✔
10. Bradycardia ✔
11. Eternal tan appearance of the skin ✔
12. Hirsutism ✔
13. Dehydration ✔
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14. Obesed trunk, thin arm and legs ✔

15. Hyperkalemia ✔
16. Purple striae on the abdomen ✔
17. Hypoglycemia ✔
18. Hirsutism in females ✔
19. Loss of appetite to eat ✔ ✔
20. Hypocalcemia ✔
21. Fatigue ✔ ✔
22. Nausea, vomiting ✔ ✔
23. Poor wound healing ✔
24. Gynecomastia in males ✔
25. Depression – d/t lack of hormone ✔
26. Buffalo hump ✔
27. Hypernatremia ✔
28. Hyponatremia ✔
29. Weight loss ✔
30. Muscle weakness ✔ ✔
31. Increased virilism in females ✔

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

Signs/ Symptoms/ Tests Cranial Nerves

1. Blurred vision B. Optic
2. Protrusion of the tongue L. Hypoglossal
3. Tic douloureux E. Trigeminal
4. Vertigo H. Acoustic – Vestibular branch
5. Unequal pupils C. Oculomotor
6. Papilledema B. Optic
7. Rolling of the eyeballs D. Trochlear
8. Loss of sense of taste , anterior 2/3 of the Tongue G. Facial
9. Inability to shrug shoulders K. Spinal accessory
10. Loss of hearing H. Acoustic – Cochlear branch
11. Parasympathetic stimulation J. Vagus nerve
12. Loss of sense of smell A. Olfactory
13. Dysphonia I. Glossopharyngeal
14. Ptosis of the eyelids, diplopia F. Abducens
15. Bell’s palsy G. Facial
16. Inability to smile and show the teeth G. Facial
17. Inability to stick out the tongue L. Hypoglossal
18. Loss of gag reflex J. Vagus nerve, L. Glossopharyngeal
19. Scotoma (Blind spots in the visual field) B. Optic
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20. Slowing and slurring of speech (dysarthria) J. Vagus nerve

Cranial Nerves Functions Abnormal Findings

Olfactory Smell Anosmia (absence of smell)
Optic Vision Papilledema; blurred vision; scotoma;
blindness
Oculomotor Pupil constriction, elevation of the upper Anisocoria; pinpoint pupils; fixed,
lid dilated pupils
Trochlear Eye movement; controls superior oblique Nystagmus
muscle
Trigeminal Controls muscles of mastication; Trigeminal neuralgia (Tic douloureux)
sensations for the entre face and cornea
Abducens Eye movement; control the lateral rectus Diplopia; ptosis of the eyelid
muscles
Facial Controls muscles for facial expression; Bell’s palsy; ageusia (loss of sense of
anterior 2/3 of the tongue taste) on the anterior 2/3 of the tongue
Acoustic Cochlear branch permits hearing; Tinnitus; Vertigo
vestibular branch helps maintain
equilibrium
Glossopharyngeal Controls muscles of the throat; taste of the Loss of gag reflex, drooling of saliva,
posterior 1/3 of the tongue dysphagia, dysphonia, posterior third
ageusia
Vagus nerve Controls muscles of the throat, PNS Loss of gag reflex, drooling of saliva,
stimulation of thoracic and abdominal dysphagia, dysarthria, bradycardia,
organs increased HCl secretion
Spinal Accessory Controls sternocleidomastoid and Inability to rotate the head and move
trapezius muscles the shoulders
Hypoglossal Movement of the tongue Protrusion of the tongue or deviation of
the tongue to one side of the mouth

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

Signs/ Symptoms Disorders

1. Pill rolling tremors a. PD
2. Muscle weakness associated with activity b. MG
3. Ascending paralysis d. GBS
4. Tiptoe walking a. PD
5. Ataxic gait c. MS
6. Shuffling gait a. PD
7. Ptosis, strabismus, diplopia b. MG
8. Treated with Levodopa a. PD
9. Treated with Mestinon b. MG
10. Treated with Cogentin a. PD
11. Bradykinesia a. PD
12. Cogwheel rigidity a. PD
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13. Decreased dopamine production a. PD

14. Decreased acetylcholine receptor sites b. MG
15. Resting tremors a. PD
16. Intention tremors c. MS
17. Sticky skin (oily skin) a. PD
18. Positive Tensilon test b. MG
19. Soft, monotonous voice a. PD
20. Scanning speech – part of Charcot’s Triad (SIN – Scanning speech, c. MS
Intention tremors, Nystagmus)
21. Treated with Baclofen – muscle relaxant c. MS
22. Treated with cholinergic b. MG
23. Treated with anticholinergic a. PD
24. Flattened affect a. PD
25. Stooped posture a. PD
26. Small, shaky handwriting a. PD
27. Associated with swine flu vaccine d. GBS
28. Bladder and bowel dysfunction – d/t spinal cord affectation c. MS
29. Charcot’s triad c. MS
30. Absence of arm swing when walking – rigidity a. PD
31. Lhermitte’s sign or barber chair phenomenon – d/t spinal cord involvement; c. MS
transient sensation of an electric shock that extends down the spine and
extremities upon flexion and/or movement of the neck

Signs/ Symptoms RA OA Gout

1. Degenerative disorder ✔
2. Metabolic disorder ✔
3. Autoimmune disorder ✔
4. Males more commonly affected ✔
5. Females more commonly affected ✔
6. Obese elderly commonly affected ✔
7. Subcutaneous nodules ✔
8. Localized inflammation ✔ ✔
9. Cartilage of joints wear off ✔
10. Synovial membrane affected ✔
11. Joints of fingers commonly affected ✔
12. Weight- bearing joints most commonly affected ✔
13. Big toe commonly affected ✔
14. Tophi ✔
15. Bouchard’s nodes ✔
16. Heberden’s nodes ✔
17. Ulnar drift of the hand ✔
18. Cock- up toe ✔
19. Crepitus ✔
20. Morning stiffness ✔
21. Pain-on-use of joints ✔

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22. Pain-on-nonuse of joints ✔

23. Excessive dryness of eyes, mouth, and vagina (Sjogren’s ✔
syndrome)
24. Leukopenia, splenomegaly (Felty’s syndrome) ✔
25. Hemolytic anemia – d/t splenomegaly ✔
26. Elevated urine and serum uric acid ✔
27. Unilateral affectation of joints ✔ ✔
28. Inflammation affects both side of the body – systemic ✔

COMPARISON OF THE DIFFERENT TYPES OF ARTHTRITIS

Rheumatoid Arthritis Osteoarthritis Gout

Autoimmune disorder Degenerative disorder Metabolic disorder
More common in females Men = Women; obese More common in males
Systemic inflammation Localized inflammation
Symmetrical affectations of joints Unilateral
Synovial membrane affected Cartilage of joints wear off
(crepitus)
Joints of fingers most commonly affected Wt.-bearing joints are most Big toe most commonly
commonly affected affected
Subcutaneous nodules Heberden’s nodes Tophi
Bouchard’s nodes
Pain on non-use of joints Pain on use of joints
Morning stiffness
Sjogren’s syndrome (excessive dryness of ayes,
mouth, vagina)
Felty’s syndrome (leukopenia – decreased
resistance to infection) (splenomegaly – severe
hemoytic anemia)

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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• Dilate: Peripheral blood vessels – decreases BP

• Pharmacology: Cholinergic, Beta blockers (Anti-HTN)
o Metoprolol (Beta Blockers): used to lower BP with PNS S/E
 CI: asthma (causes bronchoconstriction) and DM (cause hypoglycemia)

Signs and Symptoms SNS PNS

1. Restlessness ✔
2. Tachycardia ✔
3. Peripheral vasodilatation – decreases BP ✔
4. Peripheral vasoconstriction – increases BP ✔
5. Hypotension ✔
6. Hypertension ✔
7. Bradycardia ✔
8. Bronchoconstriction ✔
9. Bronchodilatation ✔
10. Dilatation of pupils ✔
11. Constriction of pupils ✔
12. Diarrhea ✔
13. Constipation ✔
14. Urinary retention ✔
15. Urinary frequency ✔
16. Dryness of mouth, thirst ✔
17. Increased salivation ✔
18. Diaphoresis ✔
19. Pallor ✔
20. Cold, clammy skin ✔
21. Hypoglycemia ✔
22. Hyperglycemia ✔
23. Increased gastric acid secretion ✔
24. Decreased peristalsis ✔
25. Wheezing ✔
26. Diminished bowel sounds ✔
27. Increased heart rate ✔
28. Increased respiratory rate ✔
29. Slow respiration ✔
30. Abdominal distention ✔
31. Elevated body temperature ✔
32. Flushed skin – d/t peripheral dilatation ✔
33. Coronary vasodilatation ✔
34. Increased force of myocardial contraction ✔
35. Decreased cardiac output ✔

Drugs/ Conditions Antidotes

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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

Situations/ Conditions Positions

After thoracentesis, left lung Right side- lying
After right modified radical mastectomy Semi- Fowler’s, right arm abducted, elevated
Patient with COPD Upright, leaning forward (orthopneic position)
During liver biopsy Left side- lying
After liver biopsy Right side- lying
Patient with increased ICP Semi- Fowler’s, HOB elevated at 15- 30-degree,
maximum of 45 degree
After kidney biopsy Supine
After tonsillectomy Lateral
After pantopaque (oil-based) myelography Flat/ supine
After metrizamide (water-based) myelography Semi- Fowler’s
After UGI endoscopy Lateral/ side- lying
During colonoscopy Left lateral
After incisional cholecystectomy Semi- Fowler’s
Patient with MI Semi- Fowler’s
Patient with CHF High Fowler’s
Patient who had supratentorial craniotomy Semi- Fowler’s
Patient who had infratentorial craniotomy Flat
During gastrostomy feeding Semi- Fowler’s
During change of IV tubing Trendelenburg
During insertion of TPN catheter into the subclavian Trendelenburg
vein
Patient with arterial insufficiency Legs lower than level of the heart
Patient with leg varicosities Legs higher than the level of the heart
Patient with autonomic hyperreflexia Upright/ Sitting
Patient with spinal cord injury Flat
Patient who had lumbar laminectomy Flat
During enema (adult) Left lateral
Catheterization of female patient Dorsal recumbent
Woman in labor with prolapsed umbilical cord Trendelenburg

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During cystoscopy Lithotomy

Laboratory Tests Normal Values

RBC 4.5 - 5.5 million/cu.mm.
WBC 5,000 – 10,000/cu.mm.
Platelets 150,000 – 450,000/cu.mm
Hgb 12-17 g/dL
Hct 42 – 52%
Blood pH 7.35-7.45
PaO2 80-100 mmHg
PaCO2 35-45 mmHg
HCO3 22-26 mEq/L
O2 Saturation 95-100% (90% and below indicate that hypoxia is
severe)
Prothrombin time (PT) 11-16 sec.
BUN 8-25 mg/dL
BUA 2.5-8 mg/dL
CSF opening pressure 0-15 mmHg or 75-180 mm H20
PTT 60-70 sec.
APTT 30-45 sec.
s. Na+ 135-145 mEq/L
s. K+ 3.5-5.5. mEq/L
s. Ca+ 4.5-5.5 mEq/L or 8.6-10 mg/dL
s. Mg+ 3.5-5.5 mEq/L
PAP 4-12 mmHg
Therapeutic serum level of Digoxin 0.5-2 ng/ml
Therapeutic serum level of Lithium 0.5-1.5 mEq/L
Therapeutic serum level of Dilantin (Phenytoin) 10-20 mcg/dL
Therapeutic serum level of Mg SO4 4-7 mg/dL
Therapeutic serum level of Gentamycin 5-10 mcg/dL
Therapeutic serum level of Theophylline 10-20 mcg/dL
Therapeutic serum level of acetaminophen 10-20 mcg/dL
INR level of pt. on Coumadin 2-3
IOP (tonometry) 11-21 mmHg
Serum ammonia level 40-80 mcg/dL (average: 35-65 mcg/dL)
ALT (SGPT) 7-40 U/mL
CSF glucose level 50-80 mg/dL
CSF protein level 20-50 mg/dL
FBS/ FBG 70-110 mg/dL
HbA1C (glycosylated hemoglobin) 4.4-6.4% (7.5% or less: good diabetic control)
Serum cholesterol 150-200 mg/dL
Serum lipase 0.2-1.5 U/ml or 10-40 U/ml

*** BASAHIN ANG UDAN NANDUN LAHAT!

AMBAG, ALINE O.