Understanding Pathophysiology, 7th Ed., Huether, McCance, Brashers, & Rote | Registered Nurse (RN) School Study Aid
Pain Assessment
- Acute Pain
- Chronic Pain
- Onset
- Provoking or Palliative
- Quality
- Radiation
- Severity
- Timing
- Subjective Findings
- Objective Findings
- Reassessment of Pain
Vital Signs - Adult
- Temperature (96.8-100.4 Degrees F) (36-38 Degrees C)
- Rectal
- Tympanic
- Oral
- Axillary
- Temporal
- Respiration (12-20)
- Oxygen Saturation (94%-100%)
- Pulse (60-100)
- Blood Pressure (<120/80)
- Pain
Fever
- Flushed skin, warm to touch
- Chills
- Sweating
- Change in LOC
- Provide adequate fluids
- Monitor Electrolytes and Fluid
- Monitor vital signs, esp temperature
- Remove excess clothing and blankets
- Sponge bath with tepid water
Stages of Hypothermia
- 32 to 35°C (90 to 95°F)
- Shivering
- 28 to 32°C (82 to 90°F)
- Obvious Motor Impairment
- Slowed Thinking
- < 28°C (< 82°F)
- Shivering Stops
- Paradoxical Undressing
- Arrhythmias
Hypothermia Interventions
- Remove From Environment
- Remove Wet Clothing
- Warm Clothing
- Heated Blankets
- Warm IV Solutions
- Heated Oxygen
- Warm Gastric Lavage
- Warm Trunk BEFORE Extremities
Malignant Hyperthermia vs. Neuroleptic Malignant Syndrome vs. Serotonin Syndrome
- Autonomic Instability
- Muscle Rigidity
- Ryanodine Receptor 1 Mutation
- Inhaled Anesthetics
- Succinylcholine
- Dantrolene
- Antidopaminergic Medications
- Hyporeflexia
- Myoglobinuria
- Dantrolene
- Serotonergic Medications
- Hyperreflexia
- Clonus
- Cyproheptadine
Obstructive Sleep Apnea (OSA)
- Narrowed or Obstructed Air Passage
- Apnea
- Loud Snoring
- Startle Response
- Daytime Drowsiness
- Positional Therapy
- Oral Appliance
- Continuous Positive Airway Pressure (CPAP)
- Surgery
- Weight Loss
Eye
- Sclera
- Cornea
- Iris
- Lens
- Ciliary Muscles
- Optic Nerve
- Rods
- Cones
- Retina
Cataract
- Age-related
- No Pain
- Cloudy Opaque Lens
- Decreased Visual Acuity
- Occurs Gradually
- Surgery
Age-Related Macular Degeneration (AMD)
- Dry (nonexudative)
- Wet (exudative)
- Scotomas
- Blurred, Darkened Vision
- Loss of Central Vision
- Distortion of Vision
- Drug Therapy
- Surgery
- Low-vision Assistive Devices
Meniere's Disease
- Excess Endolymph
- Tinnitus
- One-sided Sensorineural Hearing Loss
- Vertigo
- Nausea and Vomiting
- Meclizine (Antivert)
- Low Salt Diet
- Surgery
Otitis Media Assessment
- Red or Bulging Tympanic Membrane
- Ear Pain
- Pulling at Ear
- Fever
- Upper Respiratory Infection
- More Common in Young Children
- Eustachian Tube Narrower
- Conductive Hearing Loss
- Smoking Increases Risk
Otitis Media Interventions
- Antipyretics
- Analgesics
- Antibiotics
- Irrigation
- Position on Affected Side
- Myringotomy
- Tympanostomy Tube