1.Te
achi
ng-AGN-dietins
tructi
ons:
a.Ac ut
eGlomerul
on ephr
iti
s:Infl
amma toryi
nju
ryinthe
glomeru
luscausedb yimmu nologic
alreac
ti
on.
b.Ca u
sebys t
rept
oc oc
c a
l i
nfec
tion
c.Comp l
ic
ati
on s
:kidneyfai
lure
, pulmonaryede
ma ,HF
d.As s
essment:per
iorbi
talandfac i
aledema,decr
easeuri
nar
y
ou
tpu
t,h
ema
tur
ia,
hyp
ert
ens
ion
,pr
ote
inu
ria(
exc
ess
ivef
oami
n
u
rin
e),
inc
rea
sedBUNa
ndc
rea
tin
ine
e.Riskforfl
uidv olumeov erl
oad-measuri
ngd ai
l
ywe i
ghtandassessi
ng
forchangesist hemos tuse
fulandeff
ec t
iv
eme asur
efordet
ermini
ng
fl
uidb a
lance
f
.DI ETRE STRICTI ONS:r est
ri
ctsodiu
mi ntakepot
assiu
mma yb e
rest
ri
c t
edd uri
n gp er
iodsofoli
guri
a
g.Diure
ticsareu sua l
l
ya dmini
ster
edwithe dema,a
nti
hyper
tensi
onfor
hypert
en s
iona nda ntib
ioti
csfori
nfect
ion.
2.NP-
Dia
b et
es -
Hyp oglycemics hock:
&a l
ter
edL OC
a.Hypoglycemi csh ocksignsandsymp t
o ms:headac
he,naus
ea,
, s
weati
n g
,tr
emors,l
et
hargy,
hunger
,conf
usion,s
lur
redspee
ch,
ti
ngl
i
ng
a
roundmou t
h,an
xiet
y,ni
ght
ma r
es,al
ter
edL OC
b
.Nu r
singActi
on:l
if
ethre
ateni
ng,
checkgluc
os e
-mays e
izei
f<4
0.Tr
eat
i
mme di
atel
ywit
h
comp lexc arbohy dr
a t
es( CHO) :Tub eofg l
uc ose, Fr
u i
tju i
ce,Cola,Hard
cand y
c.E me rgenc yk i
tofgl ucago nfo rpatient
swi thDMs hou ldbet aught
tous eon lywh enn oti
c es i
gn so fsevereh ypogl ycemi a
d.Ch ec kglu cosel evels
, A1cl eve l
sifnece ssary
e.POL YURIA: THINKSHOCK
f.POL YURIAOl iguriaAn u r
ia(toomu cht oolittl
ec an’tproduc euri
ne)
3.Teac
hing-CVA- Visual perception:
a.Ce reb r
al Va scularAcc i
d ent(CVA) :al
s ok nowna sas t
roke /
Br ai
n
att
ac k.Su ddenl ossofb r
ainfu nct
ionres ul
tingf romad isr
u pti
onin
theb l
oods upplytoap artofth ebrain;clas
s if
ieda st hromb oti
cor
hemor rhagic.
b.CNSi nvolve men trel
atedt oc auseofs troke:
i.He mor rhagic:cau sedb yas l
oworf asth emor rhagei nt
ot hebr
ain
ti
s sue;HTN
ii
.E mb ol
ic:c ausedb yac lotthatha sb roke na wa yfromav esse
l
andh aslod gedinon eoft hea r
te r
iesoft heb rain,bl
oc ki
ngthe
bloods upply.Itisof t
e nr e
latedt oa therosclerosis(ma yo c
cur
aga i
n )
i
ii.TROPONI Ni sthed iagnos ti
ctestt ha
ti smos ts ensi
tivetoMI
c.Ri skfactors :HTN; perviousisc hemica t
tack s;smok in g;di
a betes
;
cardiacd i
s ease
d.F indings:J ugularveind ist
e n
tion ,
Pa l
pab l
ec ervicallymp hn od e
,
Carotidb ruit
,Nu chalrigidi
ty,de cr
easedBP, crack l
esi nlungs
e.E xpre s
sivea p hasia:commu nicatewithp ic
tu reb oards( vi
su al
perce pt
ion )
f.Bec on s
iste ntinu si
ngt hes amewo rdse acht imeaq uest
ioni sasked
4.Le
adership-Rh euma t
oidAr t
h rit
is-paind i
agnos i
s:
,a
.Rh eumatoi
dAr t
hri
ti
s:Chr
onicsyst
emati
cp r
ogressi
ved e
teri
orat
ion
oft
hec onnec
ti
veti
ssue(SYNOVIUM)ofthejoi
nts,char
acte
riz
edb y
i
nfl
amma ti
on
b
.As se
s sment
:fat
igue,
weakness
,we i
ghtl
oss,anore
x i
a,morni
ng
st
if
fness,j
oi
ntpain
c
.Con f
irmedLabresul
ts:c
onfi
rmedb yEl
eva
tedE SR,ASO;posi
ti
ve
r
heu
mat
oidf
act
or,
pre
sen
ceofa
nti
nuc
lea
ran
tib
ody
;ab
nor
mal
s
ynov
ial
flu
id;
C-r
eac
ti
vep
rot
ei
n
d
.Di
agn
osi
s:I
mpa
ire
dpe
rip
her
almo
bil
it
yre
lat
etoj
oi
npa
in
, e
.Pa
inma
nag
eme
nt:
don
ote
xer
ci
sep
ain
ful
swol
l
enj
oi
nts
;don
ot
e
xer
ci
sea
nyj
oi
ntt
oth
epoi
ntofp
ain
,pe
rfor
mex
erc
ise
ssl
owl
yan
d
s
moot
hly
;av
oidj
er
kymov
eme
nts
-th
era
peu
tice
xer
ci
sed
ail
y.
5.Nut
ri
ti
on-Osteoma l
a ciad iet:
a.Osteoma lacia:s often i
n goft heb onesd uetod ef
ici
encyofVI TAMIND
b.Riskforinjury
c.Incr
ea sedie to fhighc alci
u ma ndh ighv i
taminD:
i.F orti
fie dmi l
ka ndc e r
e al
ii
.Hi ghi nv itaminD:oi lyfish(sa l
mo n,ma cker
el,sard
ines)a nd
eggy o lks
6.NP-
Uroli
thi
asis-li
th otrip
s y:( Nep hroli
thiasi
s)
a.Uroli
thiasi
s :re f
e r
st ot hef orma t
ionofu ri
naryc al
cul
i(kidne
ys tones)
formint heu re t
ers
b.Ma yhavep a ina ndN/ Va ndWBCi nu r
ine
c.Anyti
mey ous uspec tak i
dn eys t
oneg etau r
ines pe
cime nASAP&h ave
itcheckforRBC
d.Ifki
dneys ton ea rep res entclientwil
l getpai
nme di
cati
onimme di
atel
y
e.Lit
hotri
p sy:Re mov alofk idne ystones
i
.Ul t
ras on i
cwa vei sa i
me da tthes t
onet obreakintofr
a gments
(
c r
us he s)-ston esa rep assedwi t
h i
nurineinafewd ays
ii
.Cl i
enti st augh ttowa t
c hforsignsofu rin
aryobstruct
ion,
bleeding ,orh ema t
omaf ormation
i
ii
.In st
ru ctc l
ientt oinc re
a seflui
di n
taket ofl
ushou tth
es tone
f
ragme n t
s
i
v.Av oidl on gpe ri
od sofr e ma i
ni
n ginsup i
neposit
ion
v.Se nds tonef ora nalysis
vi
.Re strictp hys i
c alac ti
on
vii
.WATCHF ORHE MATURI A
7.NP-
Thicksecretion s:
a.Nu r
singinterv enti
onf orli
qu efyingorthinni
n gofsecret
ionswou l
dbe
t
oin
cre
asef
lui
din
tak
eto3
L/d
ayi
ftol
era
ted
.Th
epa
tie
ntc
ang
et
s
ecr
eti
onsou
tmor
eea
sil
y.
b
.Te
nac
iou
ssp
utu
mse
cre
ti
ons
-us
ebr
onc
hod
il
ator
s
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