🩺Nursing Insight📚 02

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*Cholera* ⏭️Cholera is an acute diarrheal disease caused by Vibrio cholerae. ⏭️• I.P.- 1-2 days ⏭️First step in epidemic of cholera: Verification of diagnosis 📝 Stool appearance of cholera: “Rice watery stool” 📝Chemoprophylaxis of cholera: Tetracycline 500mg BID for 5 days. *🔖Drug of choice for cholera:* 💿Adults: Doxycycline 300 mg stat. *️⃣ Children: Azithromycin 20 mg/kg, single dose *️⃣Pregnant Female: Azithromycin 1 gm, single dose

Common Nerve Injuries ⌚ *Wrist drop – Radial nerve* 👠 *Foot drop – Either common peroneal nerve or sciatic nerve* ✊🏻 *Claw hand – Ulnar nerve* 🤞 *Paraesthesia of thumb, index and middle finger – Median nerve* 💪 *Numbness on superior aspect of upper arm just below shoulder joint – Axillary nerve* 👢 *Fibular neck fracture – Common peroneal nerve* 🦵 *Femur neck fracture or Acetabular fractures – Sciatic nerve* 🤰 *Fracture of humeral shaft – Likely Radial nerve* 🤰🏾 *Fracture of humeral Neck – Likely Axillary nerve* 🏓 *Monteggia fracture – Radial nerve* 🧤 *Paraesthesia and impaired sensation in both hands (glove distribution) – Peripheral neuropathy*

🔷Antara Programme 🔷 ▪️Injectable contraceptive ▪️MPA (medroxyprogesterone acetate) ▪️Dose - 150mg IM, every 3 months ▪️First dose can be taken : 🔸Anytime after regular menstruation (5th day of Menstrual cycle) 🔸After 6 weeks of delivery 🔸Immediately after abortion 🔷Other Injectible Contraceptive 🔹DMPA ▪️Depot Medroxy Progesterone Acetate ▪️Dose 150 mg (IM) ▪️Site -Gluteus Maximus ▪️Effectiveness -3 Month 🔹 NET-EN ▪️Norehisterone Enantate ▪️200 mg (IM ) ▪️Site - Gluteus Maximus ▪️Effectiveness -3 Month 🔹DMPA SC 104 mg ▪️New lower dose formulations DMPA ( depo subQ provera 104 also called DMPA SC ) Route - SC Site - Upper thigh or Abdomen ▪️Effectiveness -3 month 🔹 Mechanism of Action 🔸Inhibition of ovulation 🔸Cervical mucus thickening 🔸Endometrial atrophy preventing Implantation ▪️Contraindications 🔸Unexplained vaginal bleeding 🔸Stroke or severe diabetes 🔸Breast cancer (past or present) 🔸Active hepatitis or liver tumor 🔸A desire for rapid return of fertility ▪️Disadvantages 🔸Menstrual irregularities (light / heavy bleeding /amenorrhea) 🔸Slight weight gain 🔸No protection against sexually transmitted diseases 🔸A slight loss in bone mineral density during the first two years of use.

Admit card norcet 5.0

🔷Antara Programme 🔷 ▪️Injectable contraceptive ▪️MPA (medroxyprogesterone acetate) ▪️Dose - 150mg IM, every 3 months ▪️First dose can be taken : 🔸Anytime after regular menstruation (5th day of Menstrual cycle) 🔸After 6 weeks of delivery 🔸Immediately after abortion 🔷Other Injectible Contraceptive 🔹DMPA ▪️Depot Medroxy Progesterone Acetate ▪️Dose 150 mg (IM) ▪️Site -Gluteus Maximus ▪️Effectiveness -3 Month 🔹 NET-EN ▪️Norehisterone Enantate ▪️200 mg (IM ) ▪️Site - Gluteus Maximus ▪️Effectiveness -3 Month 🔹DMPA SC 104 mg ▪️New lower dose formulations DMPA ( depo subQ provera 104 also called DMPA SC ) Route - SC Site - Upper thigh or Abdomen ▪️Effectiveness -3 month 🔹 Mechanism of Action 🔸Inhibition of ovulation 🔸Cervical mucus thickening 🔸Endometrial atrophy preventing Implantation ▪️Contraindications 🔸Unexplained vaginal bleeding 🔸Stroke or severe diabetes 🔸Breast cancer (past or present) 🔸Active hepatitis or liver tumor 🔸A desire for rapid return of fertility ▪️Disadvantages 🔸Menstrual irregularities (light / heavy bleeding /amenorrhea) 🔸Slight weight gain 🔸No protection against sexually transmitted diseases 🔸A slight loss in bone mineral density during the first two years of use.

👉 Oligomenorrhea= irregular, infrequent menstrual cycle more than 35 day in duration 👉 Polymenorrhoea = Regular and frequent menstrual cycle less than 21day in duration. 👉 Menorrhagia= Excessive menstrual blood loss more than 80 ml with normal duration of cycle. 👉 Mettorhagea = Excessive irregular menstrual cycle with normal amount of menstrual blood loss. 👉 Meno-mettorhagea = Excessive irregular menstrual cycle with excessive amount of blood loss 👉 Hypomenorrhoea= decrease amount of blood loss Less than 20 ml and less than 2day in duration. 👉 Dysmenorrhea= Excessive painful menstrual bleeding with normal duration of menstrual cycle and normal amount of menstrual blood loss. 👉 Cryptomenorrhoea = present of menstrual like symptoms but absence of menstrual bleeding {Most common course- Imperforate hymen}

*SUMMARY OF CPR :* ∆ PULSE ASSESSMENT:           • ADULT - CAROTID           • CHILDREN (1-8YR) - CAROTID / FEMORAL           • INFANT (UPTO 1 YR) - BRACHIAL *∆ COMPRESSION METHOD:*           • ADULT - TWO HAND           • CHILDREN - TWO HAND / ONE HAND           • INFANT - TWO THUMB / TWO FINGER  *∆ COMPRESSION DEPTH :*            • ADULT - 2 INCH           • CHILDREN - 2 INCH           • INFANT -  1.5 INCH   *∆ COMPRESSION RATIO:*  1 RESCUER :            • ADULT -  30:2           • CHILDREN - 30:2           • INFANT - 30:2  2 RESCUER :            • ADULT - 30:2           • CHILDREN - 15:2            • INFANT - 15:2

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##Important points for NORCET:-) *.Pulmonary Tuberculosis (PTB)* —low-gradeafternoon fever. *. *Pneumonia* —rust-colored sputum. *.Asthma*—wheezing on expiration. *.Emphysema*—barrel chest. *.Kawasaki Syndrome*—strawberry tongue. *.Pernicious Anemia*—red beefy tongue. *.Down syndrome*—protruding tongue. *.Cholera*—rice-watery stool and washer woman’s hands (wrinkled hands from dehydration). *.Malaria*—stepladder like fever with chills. *.Typhoid*—rose spots in the abdomen. *.Dengue*—fever,rash, and headache. Positive Herman’s sign. *.Diphtheria*—pseudomembrane formation. *.Measles*—Koplik’s spots (clustered white lesions on buccal mucosa). *.Systemic Lupus Erythematosus*—butterfly rash. *.Leprosy*—leonine facies (thickened folded facial skin). *.Bulimia*—chipmunk facies (parotid gland swelling). *.Appendicitis*—rebound tenderness at McBurney’s point. Rovsing’s sign (palpation of LLQ elicits pain in RLQ). Psoas sign (pain from flexing the thigh to the hip). *.Meningitis*—Kernig’s sign (stiffness of hamstrings causing inability to straighten the leg when the hip is flexed to 90 degrees), Brudzinski’s sign (forced flexion of the neck elicits a reflex flexion of the hips). *.Tetany*—hypocalcemia, [+] Trousseau’s sign; Chvostek sign. *.Tetanus*— Risus sardonicus or rictus grin. *.Pancreatitis*—Cullen’s sign (ecchymosis of the umbilicus), Grey Turner’s sign (bruising of the flank). *.Pyloric Stenosis*—olive like mass. *.Patent Ductus Arteriosus*—washing machine-like murmur. *.Addison’s disease*—bronzelike skin pigmentation. *.Cushing’s syndrome*—moon face appearance and buffalo hump. *.Grave’s Disease (Hyperthyroidism)*—Exophthalmos(bulging of the eye out of the orbit). *.Intussusception—Sausage*-shaped mass. *.Multiple Sclerosis*—Charcot’s Triad: nystagmus, intention tremor, and dysarthria. *.Myasthenia Gravis*—descending muscle weakness, ptosis (drooping of eyelids). *.Guillain-Barre Syndrome*—ascending muscles weakness. *.Deep vein thrombosis (DVT)*—Homan’s Sign. *.Angina*—crushing, stabbing pain relieved by NTG. *.Myocardial Infarction (MI)*—crushing, stabbing pain radiating to left shoulder, neck, and arms. Unrelieved by NTG. *.Parkinson’s disease*—pill-rolling tremors. *.Cytomegalovirus (CMV) infection*—Owl’seye appearance of cells (huge nucleus in cells). *.Glaucoma*—tunnel vision. *.Retinal Detachment*—flashes of light, shadow with curtain across vision. *.Basilar Skull Fracture*—Raccoon eyes (periorbital ecchymosis) and Battle’s sign (mastoid ecchymosis). *.Buerger’s Disease*—intermittent claudication (pain at buttocks or legs from poor circulation resulting in impaired walking). *.Diabetic Ketoacidosis*—acetone breathe. *.Pregnancy Induced Hypertension (PIH)*—proteinuria, hypertension, edema. *.Diabetes Mellitus*—polydipsia, polyphagia, polyuria. *.Gastroesophageal Reflux Disease (GERD)*—heartburn. *.Hirschsprung’s Disease (Toxic Megacolon)*—ribbon-like stool. *.Sexual Transmitted Infections:* *.Herpes Simplex Type Il*—painful vesicles on genitalia *.Genital Warts*—warts 1-2 mm in diameter. *.Syphilis*—painless chancres. *.Chancroid*—painful chancres. *.Gonorrhea*—green, creamy discharges and painful urination. *.Chlamydia*—milky discharge and painful urination. *.Candidiasis*—white cheesy odorless vaginal discharges. *.Trichomoniasis*—yellow, itchy, frothy, and foul-smelling vaginal discharges.

*Normal value of important subastance in blood.* *Glucose 100~120 mg/dl* *creatinine 0•5~1•5mg/dl* *cholesterol 200mg/dl* *plasma protein 6•4~8•3g/dl* *bilirubin 0•5~1•5mg/dl* *copper 100~200mg/dl* *iron 50~150micro g/dl* *calcium 9~11mg/dl* *sodium 135~145mEq/l* *potassium 3•5~5mEq/l* *magnesium 1•5~2mEq/l* *chloride 100~110mEq/l* *Bicarbonate 22~26mEq/l* *total protein 7•3g/dl* *serum albumin 4•7g/dl* *serum globulin 2•3g/dl* *fibrinogen 0•3g/dl* *A/G ratio 2•1* *IgG 1000mg/dl* *IgA 200mg/dl* *IgM 120mg/dl* *IgD 3mg/dl* *IgE 0•05mg/dl* ANTIDOTE AND DRUG OF CHOICE PROPHYLAXIS(Dx/Px):- 1.Drug for PCM poisoning :- N acetylecystine (mucomyst) 2. DOC for Acute Asthma:- Salbutamol 3.DOC for Chronic Asthma:- Salmetrol 4.Drug of choice for bipolar disorder:- Lithium 5.Drug of choice for mania:- Lithium 6.Drug of choice for acute mania:-Haloperidol 7.Drug of choice for chronic mania:-Lithum 8.Drug of choice for hyperkalamia:- Kayxalate/sodium natropuroside/insuline+dextrose 9.Drug of choice for Ketoacidosis:- Insuline+dextrose 10.Prophylaxis for Asthma:-Montalucast 11.Drug for Digitalis Toxicity:-Digibind 12.Drug of choice for Acute migraine:-Sumatripatan 13 Drug of choice for ADHD:-Methylphenidate(Amphetamine) 14.Drug of choice for Alzeihmers disease:-Tacrine/donepzil/Rivastigmine 15.Drug of choice for Myasthenia gravis:-Neostigmine 16.Drug of choice for Anaphylactic Shock:-Adrenaline 17.Drug of choice for Hyperthyroidism in pregnancy/Lactation:-Propylthiouracil 18.Drug of choice for Atonic Seizures:-Sodium valproate 19.Drug of choice for Febrile Seizures:-Diazepam 20.Antidote for Aspirine poisoning:-Sodium bicarbonate 21.Antidote for organophosphate poisoning:-Atropine 22.Drug of choice for Central Diabetic Insipidus:-Vasoprassin/desmopressin 23.DOC for Chemotherapy induced vomiting:-Ondasteron 24.DOC for chloroquine resistant malaria:-Quinine 25.DOC for cholera:Tetracycline 26.Antidote for Benzodiazapine poisoning:-Flumazenil 27.Antidote for Barbiturate poisoning:-Sodium bicarbonate 28.Antidote for Atropine poisoning:-Physostigmine 29.DOC for Chese reaction:-Phentolamine 30.DOC for Acute Gout:-Indomethacin 31.DOC for Chronic Gout:-Allopurinol 32.DOC for complicated Malaria:-Artesunate 33.Antidote for Cyanide poisoning:-Amyl nitrate 34.DOC for Depression:-Any of SSRI                 drug(Citalopram,Escitalopram,Fluoetine,Paroxetine,Sertraline,Vilazodone) 35.DOC for disease modifying anti Rheumatic drug(DMARD):-Methotrexate 36.DOC for drug induced parkinson disease:-Benzhexol 37.Choice of Muscle relaxant for Endotracheal intubation:-Succinylcholine 38.Choice for Relaxant for ECT:-succinylcholine 39.Treatment of choice for severe Depression:-ECT 40.DOC for Enteric Fever:-Ceftrixone 41.DOC for Epilepsy in pregnancy:-Lamotrigine 42.Antidote for Fibrinolytics:-Aminocaproic acid 43.DOC for BPH(Benign prostate hypertrophy):-Prozosin 44.Antidote for Heparine Toxicity:-Protamine sulphate 45.prophylaxis for herpes:-Acyclovir 46.prophylaxis for rheumatic fever:-Benzathaine penicilline 47.prophylaxis for MI:-Asprine 48.DOC for Malaria:-Chloroquine 49.DOC for hypertensive emergency:-Sodium nitroprusside 50.DOC for hypertension in pregnancy:-Lobetalol 51.DOC for Eclampsia:-Mgso4 52.DOC for Hypothyroidism:-Levothyroxin 53.DOC for hypovolemic Shock:-IV fluids 54.Antidote for Iron toxicity :-Desferoxamine 55.DOC for Methanol poisoning:-Fomepizole 56.DOC FOR Methicillin resistant staphylococcus aureus :- Vencomycin 57.Mydriatic of choice in Adults:-Tropicamide 58.Mydriatic of choice in children:-Atropine 59.DOC for syphillis:-Benzathine penicilline 60.DOC for noctural enuresis :- Desmopressin/imipramine 61.DOC for obsessive compulsive disorders:-SSRI drug(Citalopram,Escitalopram,Fluoetine,Paroxetine,Sertraline,Vilazodone) 62.Antidote for Opiod poisoning:-Nalaxone 63. DOC for oral hypoglycemic drug in obese :- metformine 64.DOC for oral hypoglycemic drug in thin:-Sulfonylureas 65.DOC for cardiogenic Shock:-Dobutamine