HYPO PARATHYROIDISM-this hormone is
responsible for the regulation for the regulation of
calcium and phosphorus levels in the blood.
– Calcium and phosphorus levels must maintained
within in the normal limits.
– Bone density is also maintained by the
parathormone.
SIGNS AND SYMPTOMS:
– Decreased blood calcium
– Increased blood phosphorus
– Neuromuscular hyper excitability
– Carpopedal spasms
– Urinary frequency
– Mood changes (depression)
– Dry, scaly skin, and thin hair
– Cataracts
– Changes in teeth cavities
– Seizures
– Changes in EKG prolonged QT intervals and
inverted T waves.
MANAGEMENT:
– Administration of IV calcium gluconate and long
term of calcium salts.
– Vit. D supplements can be given to increase the
absorption of calcium preparation.
HYPERPARATHYROIDISM- overproduction of
parathormone.
SIGNS AND SYMPTOMS:
– Decreased blood phosphorus
– Increased blood calcium
– Muscle weakness
– Osteoporosis
– Bone pain and pathological fracture
– Increased urinary output and renal calculi
– Nausea and vomiting.
– Changes in EKG (shortened QT interval and
signs of the heart block)
MANAGEMENT:
– Removal of parathyroid. Post operative
manangement,
– Assessment of the client for respiratoty distress
– Maintaining suction , oxygen, and tracheostomy
set at the bedside
– Checking for bleeding 1-5 is normal
– Checking the serum calcium level and serum
phosphorus
– Checking Trousseau’s sign, which is carpopedal
spasms, noted when the bp cuff is inflated on
the arm, Chvostek’s sign, facial nerve is tapped
with the nurse’s index finger and twishing of the
facial muscle is observed.
ADRENOCOTICAL INSUFFIENCY (ADDISON’S
DISEASE)
– Result of long term use of steroid or rapid
cessation of corticosteroids. It also caused by
sepsis, surgical stress or hemorrhage of the
adrenal glands (Waterhouse-Friderichsen
Syndrome)
SIGNS AND SYMPTOMS:
– Weakness
– Bronze like pigmentation of the skin
– Decreased level glucose – Osteoporosis
– Decreased BP – Decreased Serum Potassium and Decreased
– Anorexia Serum Chloride
– Sparse axillary hair – Increased 17-hydroxy corticoids
– Urinary frequency – Decreased eosinophils and Decreased
– Depression Lymphocytes
– Addisonian crises are severe hypotension,
cyanosis, and shock MANAGEMENT:
– Removing part of adrenal gland or decreasing
DIAGNOSIS; dosage of steroid medication
– Evaluation of serum sodium and chloride
– Evaluation of ketosteroid and 17-
hydroxycorticoids
– Adrenal function is evaluated by administering
adrenocoticoid stimulating hormone (ACTH) and
checking changes cortisols level. DIABETES MELLITUS
– Chronic disorder of carbohydrate metabolism,
MANAGEMENT; marked by hyperglycemia and hypoglycaemia.
– Use of IV cortisone and plasma expanders to
maintained BP. SIGNS AND SYMPTOMS:
– IM cortisol form of dexamethasone (Decadron) – Wt. Loss
or oral Prednisone. – Ketonuria, fruity breath
– Polyphagia
ADRENOCORTICAL HYPERSECRETION – Polyuria
( CUSHING’S DISEASE) – Polydipsia
– Prolonged administration of cortisone or due to – Delayed wound healing
hypersection of the adrenal cortex. – Elevated blood glucose, normal 70-110 mg/dl

SIGNS AND SYMPTOMS: DIAGNOSIS:

– Pendulous abdomen – Glucose tolerance test
– Buffalo hump – Fasting blood glucose levels
– Moon faces – Two-hour post prandial
– Hirsutism (facial hair) – Dextrostix
– Ruddy complexion (dark red) – Urine check for glucose, if 240 mg/dl ketonuria
– Increased BP occurs.
– Hyperglycemia
ALERT: Regular Insulin peaks in 90-120 minutes
and NPH insulin peaks in 8-12 hours, the nurse
should instructed the client to draw up the regular
insulin (clear) and then draw up the NPH insulin. ROME
HTPERGLYCEMIA S/SX:
Respiratory Opposite
– Headache Metabolic Equal
– Nausea/vomiting
– Coma Respiratory Acidosis- ph , CO2 ,
– Flushed, dry skin
– Glucose and acetone in urine HCO3

TIP: Metabolic Acidosis- ph , CO2 , HCO3

➢ Hot and dry; blood sugar high- this means DM
skins is hot and he is dehydrated, his blood
glucose level is likely high. Respiratory Alkalosis- ph , CO2 ,
➢ Cold and clammy; need some candy- means DM HCO3
skins is cold and clammy, his glucose level is
low and he needs a glucose.
Respiratory Acidosis- ph , CO2 ,
HYPOGLYCEMIA S/SX: HCO3
– Headache ABG VALUES:
– Irritability
– Disoriented
➢ HCO3= 24-26 meq/ml, BICARB
– Nausea and vomiting ➢ CO2= 35-45 meq/ml, CARBON
– Diaphoresis DIOXIDE
– Pallor
– Weakness ➢ PaO2= 80%-100%, PARTIAL
– Convulsion OXYGEN
– Coma
– Death ➢ SaO2= >95%, SATURATION

SODIUM(Na)= 135-145meq/l
POTASSIUM(K+)= 3.5-5.5meq/l
CALCIUM(Ca++)= 4.5-5.5 meq/l or
8.5-10.5 mg/dl
CHLORIDE(Cl)= 95-105 meq/l
PHOSPHORUS(ph+)= 2.5-4.5meg/l
MAGNESIUM(Mg++)= 1.4-2.5 meq/l
Toxic level: 4.8-9-6 meq/l
HEMATOLOGY VALUES
RBC: 4.5-5.0 million
WBC: 5,000-10,000
PLATELET: 200,000-400,000
Hgb: 40%-48% women, 42%-50%
men
CHEMISTRY VALUES
GLUCOSE: 70-110 mg/dl
SPECIFIC GRAVITY: 1.010-1.030
BUN: 7-22 mg/dl
CREATININE: 0.6-1.35 mg/dl
LDH:100-190 U/L
CPK: 21-232 U/L
URIC ACID: 3.5 -7.5 mg/dl
TRIGLYCERIDE: 40-50 mg/dl
TOTAL CHOLESTEROL: 40-50 mg/dl
BILIRUBIN:<1.0 mg/dl
PROTEIN: 6.2-8.1 g/dl
ALBUMIN:3.4-5.0 g/dl
THERAPEUTIC DRUG LEVEL
DIGOXIN: 0.5-2.0 mg/dl
LITHIUM: 0.8-1.5 mg/dl
DILANTIN:10-20 mg/dl
THEOPHYLLINE:10-20 mg/dl
IOP:10-21mmhg
FHR: 120-160 BPM
VARIABILITY: 6-10 BPM
CONTRACTION:
FREQUENCY= 2-5 MINS. APART
DURATION= <90 SEC.
INTENSITY= <100 mm/hg
AMNIOTIC FLUID: 500-1200 ml
Nitrozine urine=litmus paper green
Amniotic Fluid= litmus paper blue
AVA: umbilical
Arteries- 2, carry deoxygenated blood
Vein- 1, carry oxygenated blood
Coumadin (sodium warfarin) PT:10-12 sec
Antidote: Vit.K
Heparin PTT 30-45 sec
Antidote: Protamine Sulfate
RULE OF NINE FOR BURN 5 Ps Fracture and Compartment S.
Head- 9% Pain
Arms- 18% Pallor
Back- 18% Pulselessness
Leg- 36% Paresthesia
Genitalia- 1% Polar(cold)

Diets WASTE MANAGEMENT COLOR CODING

Renal Diets: BLACK- non-infectious, DRY
-high Calorie GREEN- non-infectious, WET
-high Carbo YELLOW- Dry & Wet Chemical & other potentiall
-low Protein infection,pathologic chemical waste
-low Potassium ORANGE- with TREFOIL SIGN, Radioactive sign
-low sodium
-fluid restriction CODING IN DISASTER MANAGEMENT
RED-IMMEDIATE, life threatening but survivable
with minimal intervention
Gout Diets YELLOW-DELAYED,significant injuries but can wait
-low Purine hours without life threat to life
-omit Poultry GREEN-MINIMAL, walking wounded
BLACK-EXPECTANT, extensive injury with unlikely
TX for Spider bites: survival
R-est
I-ce MIDWIFE- 1st level health worker, 1:5000
C-ompression population
E-levate extremity PUBLIC HEALTH NURSE- 2nd level health worker,
1:10,000 population
TX for SCA: PHYSICIAN (MHO)- 3rd level health worker,
H-eat 1:20,000 population
H-ydration
O-xygen Cerebral Edema- mannitol, corticosteroid
P-ain Meds. Increase Intracranial Presure- mannitol
Febrile Seizure- Phenobarbital
Partial Seizure- Carbamazipine
Myoclonic Seizure- Valproic acid
Status Epilepticus- Diazepam(Valium), Phenytoin
Hepatic encephalopathy- Neomycin