NCLEX® - RN & VN review NCLEX® - RN & VN...

George Mata Montaus RN, MSN/Ed &

Walter Urdas Donato BSN, RN

Visit us @ www.nclexmadeeasy.com or www.nclexmadeeasy.org

Telephone # 714-679-9320 Fax# 909-247-2721

NCLEX® - RN & VN review

NCLEX® - RN & VN review

http://www.nclexmadeeasy.com/

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Commonly Asked Medications for NCLEX-‐RN & NCLEX-‐VN/PN

MEDICATION CLASIFICATION SIDE-‐EFFECTS NURSING INTERVENTIONS ACE INHIBITORS

1. Benazepril (Lotensin) 2. Captopril (Capoten) 3. Enalapril (Vasotec) 4. Fosinopril (Monopril) 5. Lisinopril (Zestril,

Prinivil) 6. Moexpril (Univasc) 7. Perindopril (Aceon) 8. Quinapril (Accupril) 9. Ramipril (Altace) 10. Trandolapril (Mavik)

1. Hyperkalemia 2. Elevated BUN, Creatinine 3. Dry Cough 4. Neutropenia 5. Hypotension/Orthostatic

ü Question MD order if patient have renal failure related diagnosis. Monitor for URTI and assist patient during positioning from lying, sitting and standing.

Angiotensin II Receptor Antagonist SIDE-‐EFFECTS NURSING INTERVENTION

1. Candesartan (Atacand)

2. Eprosartan (Teveten) 3. Irbesartan (Avapro) 4. Losartan (Cozaar) 5. Olmesartan (Benicar) 6. Telmisartan

(Micardis) 7. Valsartan (Diovan)

1. Hyperkalemia 2. Elevated BUN, Creatinine 3. Dry Cough 4. Neutropenia 5. Hypotension/Orthostatic

ü Question MD order if patient have renal failure related diagnosis. Monitor for URTI and assist patient during positioning from lying, sitting and standing.

Antiarrythmics SIDE-‐EFFECTS NURSING INTERVENTION 1. Digoxin (Lanoxin) 2. Disopyramide

(Norpace) 3. Proafenone

(Rythmol)

1. Bradycardia 2. Aggranulocytosis 3. Thrombocytopenia 4. Taste Changes

ü Monitor patient for presence of arrhythmias, decrease in WBC, platelets and bitter taste or metal taste.

Anticonvulsants SIDE-‐EFFECTS NURSING INTERVENTION 1. Carbamazepine

(Tegretol) 2. Ethosuximide

(Zarontin)

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3. Felbamate (Felbatol) 4. Gabapentine

(Neurontin) 5. Lamotrigine

(Lamictal) 6. Levetiracetam

(Keppra) 7. Methsuximide

(Celontin) 8. Phenobarbital

(Luminal) 9. Phenytoin (Dilantin) 10. Pregabalin (Lyrica) 11. Primidone (Mysoline) 12. Tiagabine (Gabatril) 13. Topiramate

(Topamax) 14. Valproate (Depakote) 15. Zonisamide

(Zonegran) Antidepressants SIDE-‐EFFECTS NURSING INTERVENTION

1. Amitriptyline (Elavil) 2. Amoxapine 3. Bupropion

(Wellbutrin) 4. Citalopram (Celexa) 5. Clomipramine

(Anafranil) 6. Desipramine

(Norpramin) 7. Doxepin 8. Duloxetine

(Cymbalta) 9. Escitalopram

(Lexapro) 10. Fluoxetine (Prozac) 11. Fluvoxamine (Luvox) 12. Imipramine

(Tofranil) 13. Isocarboxazid

(Marplan) 14. Mirtazapine

(Remeron) 15. Paroxetine (Paxil) 16. Phenelzine (Nardil) 17. Protriptyline

(Vivactil) 18. Sertraline (Zoloft) 19. Tranycypromine

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(Parnate) 20. Trimipramine

(Sumontil) 21. Venlafaxine (Effexor)

Antihistamines SIDE-‐EFFECTS NURSING INTERVENTION 1. Dimenhydrinate

(Dramamine) 2. Diphenhydramine

(Benadryl) 3. Hydroxyzine

(Vistaril) 4. Meclizine (Antivert) 5. Metoclopramide

(Reglan) 6. Prochlorperazine

(Compazine) 7. Promethazine

(Phenergan) 8. Scopolamine Patch

(Transderm Scop)

Antiparkinsons SIDE-‐EFFECTS NURSING INTERVENTION 1. Amantadine

(Symmetrel) 2. Bromocriptine

(Parlodel) 3. Entacapone (Comtan) 4. Levodopa/carbidopa

(Sinemet) 5. Pramipexole

(Mirapex) 6. Selegiline (Eldepryl)

Antipsychotics SIDE-‐EFFECTS NURSING INTERVENTION 1. Aripiprazole (Abilify) 2. Clozapine (Clorazil) 3. Olanzapine (Zyprexa) 4. Paliperidone (Invega) 5. Quetiapine (Seroquel) 6. Risperidone

(Risperdal) 7. Ziprasidone (Geodon) 8. Chlorpromazine

(Thorazine) 9. Fluphenazine

(Prolixin) 10. Haloperidol (Haldol) 11. Loxapine (Loxitane) 12. Molindone (Moban) 13. Perphenazine

(Trilafon)

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14. Pimozide (Orap) 15. Thioridazine

(Mellaril) 16. Thiotixine (Navane) 17. Trifluoperazine

(Stelazine) Anxiolytics SIDE-‐EFFECTS NURSING INTERVENTION

1. Buspirone (Buspar) 2. Meprobamate

Benzodiazepines SIDE-‐EFFECTS NURSING INTERVENTION 1. Chlordiazepoxide

(Librium) 2. Clonazepam

(Klonopin) 3. Clorazepate

Tranxene) 4. Diazepam (Valium) 5. Flurazepam

(Dalmane) 6. Quazepam (Doral) 7. Alprazolam (Xanax) 8. Estazolam (Prosom) 9. Lorazepam (Ativan) 10. Oxazepam (Serax) 11. Temazepam

(Restoril) 12. Triazolam (Halcion)

Beta Blockers SIDE-‐EFFECTS NURSING INTERVENTION 1. Acebutolo (Sectral) 2. Atenolol (Tenormin) 3. Bisprolol (Zebeta) 4. Carvedilol (Coreg) 5. Labetalol (Trandate) 6. Metoprolol

(Lopressor) 7. Propranolol (Inderal) 8. Timolol

Calcium Channel Blockers SIDE-‐EFFECTS NURSING INTERVENTION

1. Amlodipine (Norvasc) 2. Diltiazem (Cartia) 3. Felodipine (Plendil) 4. Isradipine (DynaCirc) 5. Nicardipine

(Cardene) 6. Nifedipine

(Procardia) 7. Nisoldipine (Sular) 8. Verapamil (Calan)

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Diuretics SIDE-‐EFFECTS NURSING INTERVENTION 1. Amiloride/HCTZ 2. Bumetanide (Bumex) 3. Furosemide (Lasix) 4. Hydrochlorothiazide

(Microzide) 5. Triamterene/HCTZ

(Dyazide, Maxzide)

Opioid Analgesics SIDE-‐EFFECTS NURSING INTERVENTION 1. Dilaudid 2. Morphine 3. Demerol

Vasodilators SIDE-‐EFFECTS NURSING INTERVENTION 1. Doxazosin (Cardura) 2. Hydralazine

(Apresoline) 3. Isosorbide (Imdur,

Isordil) 4. Nitroglycerine

(Nitrostat) 5. Prazosin (Minipress) 6. Terazosin (Hytrin)

Muscle Relaxants SIDE-‐EFFECTS NURSING INTERVENTION 1. Soma 2. Flexiril 3. Baclofen 4. Amrix 5. Robaxin

Antiemetic’s SIDE-‐EFFECTS NURSING INTERVENTION 1. Zofran 2. Aloxi 3. Anzemet 4. Kytril 5. Phenergan 6. Vistaril 7. Reglan 8. Compazine 9. Tigan

Medication Antidotes

1. Acetaminophen Actylcysteine (Mucomyst) 2. Anticholinergic Agents Physostigmine (Antilirium) 3. Antihistamine Physostigmine (Antilirium) 4. Atropine Dimercaprol (BAL) 5. Arsenic Trioxide Flumazenil (Romazicon) 6. Benzodiazepines Flumazenil (Romazicon) 7. Beta Blockers Glucagon 8. Calcium Channel Blockers Calcium Chloride 9. Cholinergic Agonist Activated Charcoal 10. Digoxin Digoxin Immune FAB (Digibind, Digifab) 11. Ethyl Glycol Fomepizole (Antizol) 12. Heparin Protamine Sulfate 13. High Potassium Regular Insulin & Dextrose 50%, Kayexalate 14. Hypercalcemic Emergency Edetate Disodium (Endrate) 15. Iron Deferoxamine (Desferal) 16. Insulin Dextrose 50%, Glucagon 17. Opiods Naloxone (Narcan) 18. Organo Phosphate Insecticides

Pralidoxine (Protapan)

19. Thrombolytics Aminocaproic Acid (Amicar) 20. Warfarin (Coumadin) Phytonadione (Vitamin K)

TYPES OF INSULINS Generic Brand Onset Peak Duration

Rapid Acting Insulin

Insulin Lispro Humalog 15 minutes 30 – 90 mins 3 – 6 hrs. Insulin Aspart Novolog 15 minutes 1 – 3 hrs. 3 – 5 hrs.

Insulin Glulisine Apidra 15 minutes 30 – 90 mins 6 hrs

Short Acting Insulin

Regular Insulin Regular 30 minutes 2 – 4 hrs. 6 – 8 hrs.

Intermediate Acting Insulin

NPH Insulin NPH 1 ½ hrs. 6 – 12 hrs. 16 – 24 hrs. Zinc Insulin Lente 1 – 3 hrs. 6 – 12 hrs. 16 – 24 hrs.

Long Acting Insulin

Zinc Insulin Extended

Ultralente 4 – 6 hrs. 8 – 20 hrs. 24 – 30 hrs.

Insulin Glargine Lantus 1 hr. None 24 hrs. Insulin Detemir Levemir 1 hr. None 24 hrs.

Mixed Insulin

NPH / Regular Insulin

Humulin 70/30,

Humulin 50/50

30 minutes 2 – 12 hrs. 24 hrs.

NPL / Lispro 75/25 & 50/50

Humalog Mix

15 minutes 1 – 6 hrs. 24 hrs.

*NPL = Neutral Protamine Lispro *NPH = Neutral Protamine Hagedorn

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Anti-Allergy Medication Allergic Reaction results from antigen-antibody reaction causing multiple signs and symptoms such as:

1. Generalized vasodilation, hypotension and flushing. 2. Edema 3. Bronchospasm 4. Abdominal cramps 5. Increased mucus, salivary, tears and gastric secretions Beclomethasone (Beclovent, Vanceril) Betamethasone (Celestone) Brompheniramine (Dimetane) Budesonide (Pulmicort, Rhinicort) Cetirizine (Zyrtec) Chlorphrniramine (Chlor-Trimeton) Clemastine (Tavist) Cyproheptadine (Periactin) Desloratadibe (Clarinex) Dexamethasone (Decardron) Dimenhydrinate (Dramamine) Diphenhydramine (Benadryl)

Epinephrine (Adrenalin) Fexofenadine (Allegra) Flunisolide (AeroBid, Nasalide) Fluticasone (Flovent) Hydrocotisone (Solu-Cortef) Levocetirizine (Xyzal) Loratadine (Claritin) Prednisolone (Prelone) Prednisone (Deltasone) Promethazine (Phenergan) Triamcinolone (Kenalog)

Alzheimer’s Disease The most common form of dementia is characterized by progressive impairment of memory, cognitive function, language, judgment and ADL.

Donepezil (Aricept) Galantamine (Razadyne, Razadyne ER) Memantine (Namenda)

Rivastigmine (Excelon) Tacrine (Cognex)

Angina Angina pectoris is the medical term for chest pain or discomfort due to coronary heart disease. Angina is a symptom of a condition called myocardial ischemia. It occurs when the heart muscle doesn't get as much blood as it needs. This usually happens because one or more of the heart's arteries is narrowed or blocked. Insufficient blood supply is called ischemia.

Amlodipine (Norvasc) Atenolol (Tenormin) Diltiazem (Cardizem, Dilacor) Isoosorbide (Imdur, Isordil) Metoprolol (Lopressor) Nadolol (Corgard)

Nicardipine (Cardene) Nifedipine (Adalat, Procardia) Nitroglycerin (Nitrostat) Propranolol (Inderal) Verapamil (Calan, isoptin)

Anxiety

Anxiety is a normal human emotion that everyone experiences at times. Many people feel anxious, or nervous, when faced with a problem at work, before taking a test, or making an important decision.

Alprazolam (Xanax) Buspirone (BuSpar) Diazepam (Valium) Hydroxyzine (Atarax, Vistaril)

Lorazepam (Ativan) Oxazepam (Serax) Venlafaxine (Effexor) Propranolol (Inderal)

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Arrhythmias

Cardiac arrhythmia (also dysrhythmia) is a term for any of a large and heterogeneous group of conditions in which there is abnormal electrical activity in the heart. The heart beat may be too fast or too slow, and may be regular or irregular. Some arrhythmias are life-threatening medical emergencies that can result in cardiac arrest and sudden death. Others cause symptoms such as an abnormal awareness of heart beat (palpitations), and may be merely annoying.

Acebutolol (Sectral) Adenosine (Adenocard) Amiodarone (Cardorone, Pacerone) Digoxin (Lanoxin) Diltiazem (Cardizem, Dilacor) Disopyramide (Norpace) Dofetilide (Tikosyn) Esmolol (Brevibloc) Ibutilide (Corvert)

Lidocaine Mexiletine (Mexitil) Procainamide (Procan, Pronestyl) Propafenone (Rythmol) Propranolol (Inderal) Quinidine Sotalol (Tonocard) Verapamil (Calan, Isoptin)

Arthritis, Rheumatoid (RA) Rheumatoid arthritis is an inflammatory form of arthritis that causes joint pain and damage. Rheumatoid arthritis attacks the lining of your joints (synovium) causing swelling that can result in aching and throbbing and eventually deformity. Rheumatoid arthritis is two to three times more common in women than in men and generally occurs between the ages of 40 and 60. But rheumatoid arthritis can also affect young children and older adults. Signs and symptoms of rheumatoid arthritis may includes joint pain and swelling, red and puffy hands, firm bumps of tissue under the skin on your arms (rheumatoid nodules), fatigue, morning stiffness that lasts at least 30 minutes, fever and weight loss.

Abatacept (Orencia) Adalimumab (Humira) Anakinra (Kineret) Aspirin Auronofin (Ridaura) Aurothioglucose (Solganal) Azathioprine (Imuran) Betamethasone (Celestone) Capsaicin (Zostrix) Celecoxib (Celebrex) Cyclosporine (Sandimmune)

Diclofenac (Cataflam, Voltaren) Diflunisal (Dolobid) Etanercept (Enbrel) Hydoxychloroquine (Plaquenil) Infliximab (Remicade) Leflunomide (Arava) Methotrexate Penicillamine (Cuprimine) Prednisone (Deltasone) Rituximab (Rituxan)

Asthma Asthma occurs when the airways in your lungs (bronchial tubes) become inflamed and constricted. The muscles of

the bronchial walls tighten, and your airways produce extra mucus that blocks your airways. Signs and symptoms of

asthma range from minor wheezing to life-threatening asthma attacks. Asthma signs and symptoms includes

shortness of breath, chest tightness or pain, trouble sleeping caused by shortness of breath, coughing or wheezing,

an audible whistling or wheezing sound when exhaling, bouts of coughing or wheezing that are worsened by a

respiratory virus such as a cold or the flu, an increase in the severity and frequency of asthma signs and symptoms,

a fall in peak flow rates as measured by a peak flow meter, an increased need to use bronchodilators.

Albuterol (Priventil, Ventolin) Amniophylline (Theophylline) Arformoterol (Brovana)

Metaproterenol (Alupent) Methylprednisolone (Solu-Medrol) Monetasone (Asmanex)

http://en.wikipedia.org/wiki/Electrical_conduction_system_of_the_heart

http://en.wikipedia.org/wiki/Heart

http://en.wikipedia.org/wiki/Medical_emergencies

http://en.wikipedia.org/wiki/Cardiac_arrest

http://en.wikipedia.org/wiki/Palpitations

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Beclomethasone (Beclovent, Vanceril) Budesonide (Pulmicort) Ciclesonide (Omnaris) Cromolyn (Crolom, Intal) Epinephrine (Adrenalin) Flunisolide (AeroBid) Fluticasone (Flovent) Formoterol (Foradil) Hydrocortisone (Solu-Cortef) Ipratropium (Atrovent) Levalbuterol (Xopenex)

Montelukast (Singulair) Nedocromil (Tilade) Prednisolone (Prelone) Prednisone (Deltasone) Salmeterol (Serevent) Terbutaline (Brethine) Theophylline (SloBid) Zafirlukast (Accolate) Zileuton (Zyflo, Zyflo, CR)

Attention Deficit Hyperactivity Disorder (ADHD) Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition that affects millions of children and often persists

into adulthood. Problems associated with ADHD include inattention and hyperactive, impulsive behavior. Children

with ADHD may struggle with low self-esteem, troubled relationships and poor performance in school.

Atomoxetine (Strattera) Bupropion (Wellbutrin) Desipramine (Norpramin) Dexmethylphenidate (Focalin, Focalin XR) Dextroamphetamine (Dexedrine, Dextrostat) Imipramine (Tofranil)

Lisdexamphetamine (Vyvanse) Methylphenidate (Methylin, Ritalin) Mixed amphetamine (Adderall) Modafinil (Provigil)

Benign Prostatic Hypertrophy (BPH)

Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate that occurs in almost all men as they age. As the prostate enlarges, it may cause difficulty urinating, a need to get up many times during the night to urinate, a frequent urge to urinate, or a sense that the bladder is not completely empty after urination.

Alfuzosin (UroXatral) Doxazosin (Cardura) Dutasteride (Avodart) Finasteride (Avodart)

Finasteride (Proscar) Tamsulosi (Flomax) Terazosin (Hytrin)

Bladder Hyperactivity

Hyperactive bladder a dysfunction characterized by urinary frequency and/or urge incontinence

Darifenacin (Enablex) Solifenacin (VESIcare) Tolterodine (Detrol)

Trospium (Sanctura)

Bronchospasm

Bronchospasm is an abnormal contraction of the smooth muscle of the bronchi, resulting in an acute narrowing and obstruction of the respiratory airway. A cough with generalized wheezing usually indicates this condition.

Albuterol (Proventil, Ventolin) Bitolterol (Tornalate) Levalbuterol (Xopenex) Metaproterenol (Alupent)

Salmeterol (Serevent) Terbutaline (Brethine)

http://www.drugs.com/dict/hyperactive-bladder.html

http://www.healthscout.com/ency/68/591/main.html

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Cancer Cancer (medical term: malignant neoplasm) is a class of diseases in which a group of cells display uncontrolled growth (division beyond the normal limits), invasion (intrusion on and destruction of adjacent tissues), and sometimes metastasis (spread to other locations in the body via lymph or blood). These three malignant properties of cancers differentiate them from benign tumors, which are self-limited, and do not invade or metastasize. There are many different kinds of cancers. Cancer can develop in almost any organ or tissue, such as the lung, colon, breast, skin, bones, or nerve tissue. There are many causes of cancers, including:

1. Benzene and other chemicals 2. Certain poisonous mushrooms and a type of poison that can grow on peanut plants (aflatoxins) 3. Certain viruses 4. Radiation 5. Sunlight 6. Tobacco

Symptoms of cancer depend on the type and location of the tumor. For example, lung cancer can cause coughing, shortness of breath, or chest pain. Colon cancer often causes diarrhea, constipation, and blood in the stool. Some cancers may not have any symptoms at all. In certain cancers, such as gallbladder cancer, symptoms often do not start until the disease has reached an advanced stage. The following symptoms can occur with most cancers:

1. Chills 2. Fatigue 3. Fever 4. Loss of appetite 5. Malaise 6. Night sweats 7. Weight loss

Common tests include the following:

1. Biopsy of the tumor 2. Blood chemistry 3. Bone marrow biopsy (for lymphoma or leukemia) 4. Chest x-ray 5. Complete blood count (CBC) 6. CT scan

Most cancers are diagnosed by biopsy. Depending on the location of the tumor, the biopsy may be a simple procedure or a serious operation. Most patients with cancer have CT scans to determine the exact location and size of the tumor or tumors.

Abarelix (Plenaxis) Aldesleukin (Proleukin) Alemtuzumab (Campath) Alitretinoin (Panretin) Altretamine (Hexalen) Anastrozole (Arimidex) Arsenic trioxide (Trisenox) Asparaginase (Elspar)

Ifosfamide (Ifex) Imatinib (Gleevec) Interferon alfa-2a (Roferon A) Interferon alfa-2b (Intron A) Irinotecan (Camtosar) Ixabepilone (Ixempra) Lapatinib (Tykerb) Letrozole (Femara)

http://en.wikipedia.org/wiki/Malignant

http://en.wikipedia.org/wiki/Neoplasm

http://en.wikipedia.org/wiki/Disease

http://en.wikipedia.org/wiki/Cell_(biology)

http://en.wikipedia.org/wiki/Cell_division

http://en.wikipedia.org/wiki/Metastasis

http://en.wikipedia.org/wiki/Benign_tumor

http://health.nytimes.com/health/guides/symptoms/cough/overview.html

http://health.nytimes.com/health/guides/symptoms/breathing-difficulty/overview.html

http://health.nytimes.com/health/guides/symptoms/chest-pain/overview.html

http://health.nytimes.com/health/guides/symptoms/diarrhea/overview.html

http://health.nytimes.com/health/guides/symptoms/constipation/overview.html

http://health.nytimes.com/health/guides/symptoms/bloody-or-tarry-stools/overview.html

http://health.nytimes.com/health/guides/symptoms/chills/overview.html

http://health.nytimes.com/health/guides/symptoms/fatigue/overview.html

http://health.nytimes.com/health/guides/symptoms/fever/overview.html

http://health.nytimes.com/health/guides/symptoms/appetite-decreased/overview.html

http://health.nytimes.com/health/guides/symptoms/malaise/overview.html

http://health.nytimes.com/health/guides/symptoms/weight-loss-unintentional/overview.html

http://health.nytimes.com/health/guides/test/biopsy/overview.html

http://health.nytimes.com/health/guides/test/bone-marrow-biopsy/overview.html

http://health.nytimes.com/health/guides/test/chest-x-ray/overview.html

http://health.nytimes.com/health/guides/test/cbc/overview.html

http://health.nytimes.com/health/guides/test/ct-scan/overview.html

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Azacitadine (Vidaza) BCG (TheraCys, Tice BCG) Bevacizumab (Avastin) Bexarotene (Targretin) Bicalutamide (Casodex) Bleomycin (Blenoxane) Bortezomib (Velcade) Buslfan (Myleran) Capecitabine (Xeloda) Carboplatin (Paraplatin) Carmustine (BiCNU) Cetuximab (Erbitux) Chlorambucil (Leukeran) Cisplatin (Platinol) Cladribinr (Leustatin) Clofarabine (Clolar) Cyclophosphamide (Cytoxan) Cytarabine (Ara-C, Cytosar) Dacarbazine (DTIC) Dactinomycin (Cosmegen) Dasatinib (Sprycel) Daunorobicin (Cerubidine, DaunoXome) Denileukin (Ontak) Docetaxel (Taxotere) Doxorubicin (Adriamycin, Doxil) Epirubicin (Ellence) Erlotinib (Tarceva) Estramustine (Emcyt) Etoposide (VePesid) Fludarabine (Fludara) Fluorouracil Flutamide (Eulexin) Fulvestrant (Faslodex) Feftnib (Iressa) Gemctabine (Gemzar) Gemtuzumab (Mylotarg) Goserelin (Zoladex) Hydroxyurea (Hydrea) Ibritumomab (Zevalin) Idarubicin (Idamycin)

Leuprolide (Lupron) Lomustine (CeeNU) Mechlorethamine (Mustargen) Megestrol (Megace) Mephalan (Alkeran) Mercaptopurine (Purinethol) Methotrexate Mitomycin (Mutamycin) Mitotane (Lysodren) Miltoxantrone (Novantrone) Nelarabine (Arranon) Nilotinib (Tasigna) Nil;utamide (Nilandron) Oxaliplatin (Eloxatin) Paclitaxel (Taxol) Panitummumab (Vectibix) Pemetrexed (Alimta) Pentostatin (Nipent) Plicamycin (Mithracin) Procarbazine (Mutulane) Rituximab (Rituxan) Sorafenib (Nexavar) Streptozocin (Zanosar) Sunitinib (Sutent) Tamoxifen (Novadex) Temozolomode (Temodar) Temsirolimus (Torisel) Teniposide (Vumon) Thioguanine Thiotepa (Thioplex) Tipifarnib (Zarnestra) Topotecan (Hycamtim) Toremifene (Fareston) Tositumomab (Ber) Trastuzumab (Herceptin) Tretinoin (Vesanoid, ATRA) Valrubicin (Valstar) Vinblastine (Oncovin) Vinorelbine (Navelbine) Vorinostat (Zolinza)

Cerebrovascular Accident (CVA) Cerebrovascular accident (CVA) is a sudden onset of neurologic deficit due to disruption of vascular function. This may be caused by partial or total blockage of blood vessels to the brain by a hemorrhage, or blood clot, of the brain.

Aspirin Clopidogrel (Plavix) Heparin Nimodipine (Nimotop)

Ticlopidine (Ticlid) Warfarin (Coumadin)

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Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) refers to a group of lung diseases that block airflow and make it

increasingly difficult for you to breathe. Emphysema and chronic bronchitis are the two main conditions that make up

COPD, but COPD can also refer to damage caused by chronic asthmatic bronchitis.

Albuterol (Proventil HFA, Ventolin HFA) Aminophylline (Theophylline) Arformoterol (Brovana) Budesonide (Pulicort) Formoterol (Foradil) Ipratopium (Atrovent HFA)

Levalbuterol (Xopenex) pributerol (Maxair) Salmeterol (Serevent) Theophylline (Theo ZY, Theochron)

Congestive Heart Failure (CHF) Heart failure, also known as congestive heart failure (CHF), means your heart can't pump enough blood to meet your body's needs. Over time, conditions such as coronary artery disease or high blood pressure gradually leave your heart too weak or stiff to fill and pump efficiently.

Left-sided heart failure manifest the following symptoms due to lack of oxygen:

1. Shortness of breath, 2. Coughing (sometimes coughing up frothy pink-tinged sputum), 3. Difficulty breathing when lying down.

Right-sided heart failure can cause the following symptoms due to fluid retention:

1. Swollen legs and feet 2. Upset stomach 3. Loss of appetite 4. Nausea and vomiting 5. Low blood pressure Bisoprolol (Zebeta) Bumetanide (Bumex) Candesartan (Atacand) Captopril (Capoten) Carvedilol (Coreg) Digoxin (Lanoxin) Dobutamine (Dobutrex) Dopamine (Intopin) Inalapril (Vasotec) Eplerenone (Inspra) Fosinopril (Monopril) Furosemide (Lasix)

Hydralazine (Apresoline) Isoorbide (Isordil) Lisinopril (Prinivil, Zestril) Losartan (Cozaar) Metoprolol (Primacor) Nitrogycerin Quinapril (Accupril) Ramipril (Altace) Spironolactone (Aldactone) Torsemide (Demandex) Valsartan (Diovan)

Constipation Constipation occurs when bowel movements become difficult or less frequent. You are considered constipated if you have two or more of the following for at least 3 months:

1. Straining during a bowel movement 2. Incomplete evacuation more than 25% of the time.

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3. Two or fewer bowel movements in a week.

Bisacodyl (Dulcolax) Docusate (Colace) Lactulose (Kristalose) Lubriprostone (Amitiza) Methylcellulose (Citrucel) Milk of magnesia (MOM)

Polyethylene glycol (Miralax) Psyllium (Metamucil) Senna (Senokot) Tegaserod (Zelnorm)

Crohn’s Disease Crohn's disease, a type of inflammatory bowel disease (IBD), a condition in which the lining of your small intestine becomes inflamed, causing mild diarrhea and abdominal pain and mild bleeding.

Hydrocortisone (Cortenema) Infliximab (Remicade) Mesalamine (Asacol, Pentasa)

Natalizumab (Tysabri) Sulfasalazine (Azulfidine) Adalimumab (Humira)

Deep Vein Thrombosis (DVT)

Deep vein thrombosis is a condition in which a blood clot (thrombus) forms in one or more of the deep veins in your body, usually in your legs. Deep vein thrombosis is a serious condition because a blood clot that has formed in your vein can break loose and travel to your lungs.

Daterparin (Fragmin) Enoxaparin (Lovenox) Heparin

Tinzaparin (Inohep) Warfarin (Coumadin), Dabigatran (Pradaxa) Fondaparinux (Arixtra)

Depression Depression is a serious medical illness that involves the brain. It's more than just a feeling of being "down in the dumps" or "blue" for a few days. Depression can run in families, and usually starts between the ages of 15 and 30. It is much more common in women. Women can also get postpartum depression after the birth of a baby. Symptoms can includes:

Sadness Loss of interest or pleasure in activities you used to enjoy Change in weight Difficulty sleeping or oversleeping Energy loss Feelings of worthlessness Thoughts of death or suicide

Amitriptyline (Elavil, Endep) Bupropion (Wellbutrin) Citalopram (Celexa) Clomipramine (Norpramin) Doxepin (Sinequan) Escitalopram (lexapro) Fluoxetine (Prozac) Imipramine (Tofranil) Moprotiline (Ludiomil)

Mirtazapine (Remeron) Notriptyline (Ludiomil) Paroxetine (Paxil) Phenelzine (Nardil) Sertraline (Zoloft) Tranyclcypromine (Parnate) Trazodone (Desyrel) Venlafaxine (Effexor)

http://www.nlm.nih.gov/medlineplus/postpartumdepression.html

http://www.nlm.nih.gov/medlineplus/suicide.html

8

Diabetes Mellitus

Diabetes mellitus is a disorder in which blood sugar (glucose) levels are abnormally high because the body

does not produce enough insulin to meet its needs.

Urination and thirst are increased, and people lose weight when they are not trying to.

Diabetes damages the nerves and causes problems with sensation.

Diabetes damages blood vessels and increases the risk of heart attack, stroke, and kidney failure.

Doctors diagnose diabetes by measuring blood sugar levels.

People with diabetes need to follow a low-sugar, low-fat diet, exercise, and usually take drugs.

The variation in blood sugar levels is usually within a narrow range, about 70 to 110 milligrams per deciliter (mg/dL) of blood.

Acarbose (Precose) Exenatide (Byetta) Glimeperide (Amaryl) Glipizide (Glucotrol) Glyburide (Miconase) Insulin preparations (Rapid, Short, Intermediate, Long, mixed)

Metformin (Glucophage) Miglitol (Glycet)

Nateglinide (Starlix) Pioglitazone (Actos) Pramlintide (Symlin) Repaglinide (Prandin) Rosiglitazone (Avandia) Sitaglipin (Januvia) Sitagliptin/Metformin (Janumet)

Diabetic Peripheral Neuropathy

Diabetic neuropathy is nerve damage caused by diabetes. When it affects the arms, hands, legs and feet it is known as diabetic peripheral neuropathy. Diabetic peripheral neuropathy is different from peripheral arterial disease (poor circulation), which affects the blood vessels rather than the nerves. Three different groups of nerves can be affected by diabetic neuropathy:

Sensory nerves, which enable people to feel pain, temperature, and other sensations Motor nerves, which control the muscles and give them their strength and tone Autonomic nerves, which allow the body to perform certain involuntary functions, such as sweating.

Amitiptyline (Elavil) Bupropion (Wellbutrin) Carbamazepine (Tegretol) Cita;opram (Celexa) Duloxetine (Cymbalta) gabapentin (Neurontin) Lamotrigine (Lamictal) Lidocaine patch (Lidoderm)

Nortriptyline (Pamelor) Oxcarbazepine (Trileptal) Paroxetine (Paxil) Pregabalin (Lyrica) Tramadol (Ultram) Venlafaxine (Effexor)

Diarrhea

Diarrhea is an increase in the volume, wateriness, or frequency of bowel movements. Diarrhea can lead to

dehydration and a loss of electrolytes, such as sodium, potassium, magnesium, chloride, and bicarbonate,

from the blood. Bismuth subsalicylate (Pepto-Bismol) Diphenoxylate and atropine (Lomotil) Kaolin-pectin (Kaopectate) loperamide (Imodium)

Octreotide (Sandostatin) Rifaximin (Xifaxan)

9

Duodenal, Gastric Ulcer Duodenal and gastric are called peptic ulcers that causes open sores that develop on the inside lining of your stomach, upper small intestine or esophagus. The most common symptom of a peptic ulcer is burning abdominal pain. The pain is caused by the ulcer and is aggravated by stomach acid coming in contact with the ulcerated area.

Cimetidine (Tagamet) Esomeprazole (Nexium) Famotidine (Pepcid) Lansoprazole (Prevacid) Misoprostol (Cytotec) Nizatidine (Axid)

omeprazole (Prolosec) Pantoprazole (Protonix) Rabeprazole (Aciphex) Ranitidine (Zantac) Sucralfate (Carafate)

Edema Edema is swelling caused by excess fluid trapped in your body's tissues. Although edema can affect any part of your

body, its most commonly noticed in your hands, arms, feet, ankles and legs. Edema can be the result of underlying

medical conditions, certain medications or pregnancy.

Amiloride (Midamor) Bumetanide (Bumex) Chlorthalidone (Hygroton) Ethacrynic acid (Edecrin) Furosemide (Lasix) Hydrochlorothiazide (HydoDIURIL)

Indapamide (Lozol) Metolazone (Zaroxolyn) Spironolactone (Aldactone) Torsemide (Demadex) Triamterene (Dyrenium)

Epilepsy

Epilepsy is a brain disorder that causes people to have recurring seizures. The seizures happen when clusters of nerve cells, or neurons, in the brain send out the wrong signals. People may have strange sensations and emotions or behave strangely. They may have violent muscle spasms or lose consciousness.

Epilepsy has many possible causes, including illness, brain injury and abnormal brain development. In many cases, the cause is unknown.

Acetazolamide (Diamox) Carbamazepine (Tegretol) Clonazepam (Klonopin) Clorazepate (Tranxene) Diazepam (Valium) Fosphenytoin (Cerebyx) Gadapentin (Neurontin) Lamotrigine (Lamictal) Levetiracetam (Keppra) Lorazepam (Ativan)

Oxcarbazepine (Trileptal) Phenobarbital Phenytoin (Dilantin) Primidone (Mysoline) Tiagabine (Gabitril) Topiramate (Topamax) Valproic acid (Depakene, Depakote) Zonisamide (Zonegran)

Fever A fever is usually a sign that something out of the ordinary is going on in your body. For an adult, a fever

may be uncomfortable, but usually isn't dangerous unless it reaches 103 F (39.4 C) or higher. For young

children and infants, a slightly elevated temperature may indicate a serious infection.

Acetaminophen (Tylenol) Aspirin

Naproxen (Aleve, Anaprox, Naprosyn) Ibuprofen (Advil, Motrin)

http://www.nlm.nih.gov/medlineplus/seizures.html

10

Fibromyalgia Fibromyalgia is a chronic condition characterized by widespread pain in your muscles, ligaments and tendons, as well as fatigue and multiple tender points — places on your body where slight pressure causes pain.

Acetaminophen (Tylenol) Amitriptyline (Elavil) Carisoprodol (Soma) Citalopram (Celexa) Cyclobenzapine (Flexeril)

Duloxetine (Prozac) Pregabalin (Lyrica) Tramadol (Ultram) Venlafaxine (Effexor)

Gastritis Gastritis is a term used to describe a group of conditions with one thing in common: inflammation of the

lining of your stomach. The inflammation of gastritis is often the result of infection with the same bacterium

that causes most stomach ulcers. However, other factors — such as traumatic injury, regular use of certain

pain relievers or drinking too much alcohol — also can contribute to gastritis.

Cimetidine (Tagamet) Famotidine (Pepcid) Nizatidine (Axid)

Ranitidine (Zantac)

Gastroesphageal Reflux Disease (GERD)

Gastroesophageal reflux disease (GERD) is a chronic digestive disease that occurs when stomach acid or, occasionally, bile flows back (refluxes) into your food pipe (esophagus). The backwash of acid irritates the lining of your esophagus and causes GERD signs and symptoms.

Cimetidine (Tagamet) Esomeprazole (Nexium) Famotidine (Pepcid) Lansoprazole (Prevacid) Metoclopramide (reglan) Nizatidine (Axid)

Omeprazole (Prilosec) Pantoprazole (Protonix) Rabeprazole (Aciphex) Ranitidine (Zantac)

Glaucoma

Glaucoma is an eye condition that develops when too much fluid pressure builds up inside of the eye. It tends to be inherited and may not show up until later in life.

The increased pressure, called intraocular pressure, can damage the optic nerve, which transmits images to the brain. If damage to the optic nerve from high eye pressure continues, glaucoma will cause loss of vision. Without treatment, glaucoma can cause total permanent blindness within a few years.

Acetazolamide (Diamox) Apraclonidine (Lopidine) Betaxolol (Betoptic) Bimatoprost (Lumigan) Brimonidine (Alphagan) Brinzolamide (Azopt) Carbochol Carteolol (Ocupress) Dipivefrin (Propine) Dorzolamide (Trusopt)

Echothiophate iodine (Phospholine) Latanoprost (Xalatan) Levobunolol (Betagan) Metipranolol (OptiPranolol) Pilocarpine (Isopto Carpine) Timolol (Timoptic) Travoprost (Travatan) Unoprostone (Rescula)

11

Gout Gout is a disease that results from an overload of uric acid in the body. This overload of uric acid leads to the formation of tiny crystals of urate that deposit in tissues of the body, especially the joints.

Allopurinol (Zyloprim) Colchicine Indomethacin (Indocin)

Probenecid (Benemid) Sulindac (Clinoril) Febuxostat (Uloric)

Human Immunodeficiency Virus (HIV)

AIDS is a chronic, life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging your immune system, HIV interferes with your body's ability to fight off viruses, bacteria and fungi that cause disease. HIV makes you more susceptible to certain types of cancers and to infections your body would normally resist, such as pneumonia and meningitis. The virus and the infection itself are known as HIV. "Acquired immunodeficiency syndrome (AIDS)" is the name given to the later stages of an HIV infection.

Albacavir (Ziagen) Amprenavir (Agenerase) Atazanavir (Reyataz) Darunavir (Prezista) Delavirdine (rescriptor) Didanosine (Videx) Efavirenz (Sustiva) Emtricitabine (Emtriva) Enfuvirtide (Fuzeon) Etravrine (Intelence) Indinavir (Crixivan) Lamivudie (Epivir)

Lopinavir/ritonavir (Kaletra) Maraviroc (Selzentry) Nelfinavir (Viracept) Nevirapine (Viramune) Rahegravir (Norvir) Saquilnavir (Forlovase, Invirase) Stavudine (Zerit) Tenofovir (Viread) Tipranavir (Aptivus) Zidovudine (AZT, Retrovir)

Hypercholesterolemia Hypercholesterolemia is a condition characterized by very high levels of cholesterol in the blood. Cholesterol is a waxy, fat-like substance that is produced in the body and obtained from foods that come from animals (particularly egg yolks, meat, poultry, fish, and dairy products). The body needs this substance to build cell membranes, make certain hormones, and produce compounds that aid in fat digestion. Too much cholesterol, however, increases a person's risk of developing heart disease.

Atorvastalin (Lipitor) Cholestyramine (Questran) Colesevelam (Welchol) Colestipol (Colestid) Ezetimibe (Zetia) Fenofibrate (Antara, Lofibra, tricor)

Fluvastatin (Altroprev, Mevacor) Niacin (Niaspan, Slo-Niacin) Pravastatin (Crestor) Simvastatin (Zocor)

Hyperphosphatemia

Hyperphosphatemia may be described as high levels of inorganic phosphate in the blood. The kidneys excrete phosphate. The most common cause of increased phosphate levels is the kidney's inability to get rid of phosphate.

Aluminum salts Calcium salts

Sevelamer (Renagel) Lanthanum (Fosrenol) Calcium Acetate (Phoslo)

12

Hypertension Hypertension is a repeated elevation of blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above 140 with a diastolic pressure above 90. Chronic hypertension is a "silent" condition. Stealthy as a cat, it can cause blood vessel changes in the back of the eye (retina), abnormal thickening of the heart muscle, kidney failure, and brain damage. There are several categories of blood pressure, including:

1. Normal: Less than 120/80 2. Prehypertension: 120-139/80-89 3. Stage 1 high blood pressure: 140-159/90-99 4. Stage 2 high blood pressure: 160 and above/100 and above

Factors and conditions may play a role in its development, including:

1. Smoking 2. Being overweight or obese 3. Lack of physical activity 4. Too much salt in the diet 5. Too much alcohol consumption (more than 1 to 2 drinks per day) 6. Stress 7. Older age 8. Genetics 9. Family history of high blood pressure 10. Chronic kidney disease 11. Adrenal and thyroid disorders

Aliskiren (Tekturna) Amlodipine (Niovasc) Atenolol (Tenormin) Benazepril (Lotensin) Bisoprolol (Zebeta) Candesartan (Atacand) Captopril (Capoten) Clonidine (Catapres) Diltiazem (Cardiazem, Dilacor) Doxazosin (Cardura) Enalapril (Vasotec) Eplerenone (Inspra) Eprosartan (Teveten) Felodipine (Plendil) Fosinopril (Monopril) Hydralazine (Apresolline) Hydrochlorothiazide (HydroDIURIL) Indapamide (Lozol) Irbeasartan (Avapro) Isradipine (DynaCirc) Labetalol (Normodyne, Trandate) Lisonopril (Prinvil, Zestril) Losartan (Cozaar) Methyldopa (Aldomet)

Metoloazone (Diulo, Zaroxolyn) Metoprolol (Lopressor) Minoxidil (Loniten) Moexipril (Univasc) Nadolol (Cogard) Nebivolol (Bystolic) Nicardipine (Adalat, Procardia) Nitrogycerin Nitroprusside (Nipride) Olmesartan (Benicar) Perindopril (Aceon) Pindolol (Visken) Prazosin (Minipres) Propranolol (Inderal) Quinapril (Accupril) Ramipril (Altace) Spironolactone (Aldactone) Telmisartan (Micardis) Terazosin (Hytrin) Trimolol (Blocardren) Trandolapril (Mavik) Valsartan (Dovan) Verapamil (Calan, Isoptin)

http://www.medterms.com/script/main/art.asp?articlekey=10419

13

Hypertriglyceridemia

12. Hypertriglyceridemia may be described as an excess of triglycerides in the blood. Triglycerides are fatty substances in your blood and body that get their name from their chemical structure.

Atorvastatin (Lipitor) Fenofibrate (Triclor) Fluvastatin (Lescol) Gemfibrozil (Lopid) Lovastatin (Mevacor) Niacin (Niasepan)

Omega-3 acid ethyl esters (Lovaza) Pravastatin (Provachol) Rosuvastatin (Crestor) Simvastatin (Zocor)

Hyperuricemia The condition of hyperuricemia is indicative of a high level of uric acid in the blood (>7 for men, >6 for women). Human beings have higher levels of uric acid (hyperuricemia) because of a deficiency of the hepatic enzyme, uricase, and a lower fractional excretion of uric acid. Approximately two thirds of total body urate is produced endogenously, while the remaining one third is accounted for by dietary purines. Approximately 70% of the urate produced daily is excreted by the kidneys, while the rest is eliminated by the intestines.

Allopurinol (Zyloprim) Probenecid (Benemid)

Febuxostat (Uloric) Colchicine

Hypotension Low blood pressure, also called hypotension, would seem to be something to strive for. However, for many people,

low blood pressure can cause symptoms of dizziness and fainting or mean that they have serious heart, endocrine or

neurological disorders. Severely low blood pressure can deprive the brain and other vital organs of oxygen and

nutrients, leading to a life-threatening condition called shock.

Dobutamine (Dobutrex) Dopamine (Intropin) Ephedrine

Norepinephrine (Levophed) Phenylephrine (Neo-Synephrine) Epinephrine

Hypothyroidism

Hypothyroidism (underactive thyroid) is a condition in which your thyroid gland doesn't produce enough of certain

important hormones. Women, especially those older than age 50, are more likely to have hypothyroidism.

Hypothyroidism upsets the normal balance of chemical reactions in your body. It seldom causes symptoms in the

early stages, but, over time, untreated hypothyroidism can cause a number of health problems, such as obesity, joint

pain, infertility and heart disease.

Levothyroxine (Levoxyl, Synthroid) Liothyronine (Cytomel)

Thyroid

Idiopathic Thrombocytopenic Purpura (ITP) Idiopathic thrombocytopenic purpura (ITP), also called immune thrombocytopenic purpura, is a blood-clotting

disorder that can lead to easy or excessive bruising and bleeding. ITP results from unusually low levels of platelets —

the cells that help your blood clot. Idiopathic thrombocytopenic purpura affects both children and adults. Children

often develop idiopathic thrombocytopenic purpura after a viral infection and usually recover fully without treatment.

In adults, however, the disorder is often chronic.

Cyclophosphamide (Cytoxan) Dexamethasone (Decadron) Hydrocortisone (SoluCortef) Immune globulin intravenous

Prednisone Rho (D) immune globulin (RhoGam) Rituximab (Rituxan) Methylprednisolone (SoluMedrol)

14

Insomnia

Insomnia includes having trouble falling or staying asleep. It's one of the most common medical complaints. With

insomnia, you usually awaken feeling unrefreshed, which takes a toll on your ability to function during the day.

Insomnia can sap not only your energy level and mood, but also your health, work performance and quality of life.

How much sleep is enough varies from person to person. Most adults need seven to eight hours a night. More than

one-third of adults have insomnia at some time, while 10 to 15 percent report long-term (chronic) insomnia.

Diphenhydramine (Benadryl) Estazolam (ProSom) Eszopiclone (Lunesta) Flurazepam (Restoril)

Zalepton (Sonata) Zolpidem (Ambien)

Migraine Headaches Migraines are chronic headaches that can cause significant pain for hours or even days. Symptoms can be so severe

that all you can think about is finding a dark, quiet place to lie down. Some migraines are preceded or accompanied

by sensory warning symptoms or signs (auras), such as flashes of light, blind spots or tingling in your arm or leg. A

migraine is often accompanied by nausea, vomiting, and extreme sensitivity to light and sound.

Almmotriptan (Axert) Amitriptyline (Elavil), Endep) Dilhydroergotamine Electriptan (Relpax) Ergotamine (Ergomar) Frovatriptan (Frovan)

Nartriptan (Amerge) Propranolol (Inderal) Rizatriptan (Maxalt) Sumatriptan (Imitrex) Zolmitriptan (Zomig)

Multiple Sclerosis (MS)

Multiple sclerosis (MS) is a potentially debilitating disease in which your body's immune system eats away at the

protective sheath that covers your nerves. This interferes with the communication between your brain and the rest of

your body. Ultimately, this may result in deterioration of the nerves themselves, a process that's not reversible.

Symptoms vary widely, depending on the amount of damage and which particular nerves are affected. People with

severe cases of multiple sclerosis may lose the ability to walk or speak. Multiple sclerosis can be difficult to diagnose

early in the course of the disease, because symptoms often come and go — sometimes disappearing for months.

Glatiramer (Copaxone) Interferon beta-Ia (Avones, Rebif) Interferon beta-1b (Betaseron)

Mitoxantrone (Novantrone) Natalizumav (Tysabri)

Myelodysplastic syndrome Myelodysplastic syndromes are a group of disorders caused by poorly formed or dysfunctional blood cells.

Myelodysplastic syndromes occur when something goes wrong in your bone marrow — the spongy material inside

your bones where blood cells are made. There is no cure for myelodysplastic syndromes. Treatment for

myelodysplastic syndromes usually focuses on reducing or preventing complications of the disease and of

treatments. In certain cases, myelodysplastic syndromes are treated with a bone marrow transplant, which may help

prolong life.

Azacitidine (Vidaza) Decitabine (Decagen)

Lenalinomide (Revlimid)

15

Myocardial Infarction (MI)

A heart attack usually occurs when a blood clot blocks the flow of blood through a coronary artery — a blood vessel

that feeds blood to a part of the heart muscle. Interrupted blood flow to your heart can damage or destroy a part of

the heart muscle. A heart attack, also called a myocardial infarction, was often fatal. Thanks to better awareness of

heart attack signs and symptoms and improved treatments, most people who have a heart attack now survive.

Alteplase (Activase) Aspirin Atenolol (Tenormin) Captopril (Capoten) Clopidogrel (Plavix) Dalteparin (Framin) Diltiazem (Cardizem, Dilacor) Enalapril (Vasotec) Enoxaparin (Lovenox) Heparin Lidocaine

Lisinopril (Prinivil, Zestril) Metoprolol (Lopressor) Morphine Nitroglycerin Propranolol (Inderal) Quinapril (Accupril) Ramipril (Altace) Reteplase (Retavase) Streptokinase Timolol (Blocarden) Warfarin (Coumadin)

Nausea Nausea is the sensation that there is a need to vomit. Nausea can be acute and short-lived, or it can be prolonged. When prolonged, it is a debilitating symptom. Nausea (and vomiting) can be psychological or physical in origin. It can originate from problems in the brain or organs of the upper gastrointestinal tract (esophagus, stomach, small intestine, liver, pancreas, and gallbladder). It also may be caused by pain, motion, medications and diseases of many non-gastrointestinal organs of the body.

Aprepitant (Emend) Chlorpromazine (Thorazine) Dexamethasone (Decardon) Dimenhydrinate (Dramamine) Dolasetron (Anzemet) Dronabinol (Marinol) Droperidol (Inapsine) granisetron (Kytril) Hydroxyzine (Vistaril) Lorazepam (Ativan)

Meclixine (Antivert) Metoclopramide (Reglan) Nabilone (Cesamet) Ondansetron (Zofran) Palonosetron (Aloxi) Prochlorperazine (Compazine) Promethazine (Phenergan) Trimethobenzamide (Tigan)

Obesity

Obesity is defined as having an excessive amount of body fat. Obesity is more than just a cosmetic concern, though.

It increases your risk of diseases and health problems such as diabetes and high blood pressure. Doctors often use a

formula based on your height and weight — called the body mass index (BMI) — to determine if you are obese.

Adults with a BMI of 30 or higher are considered obese. Extreme obesity, also called severe obesity or morbid

obesity, occurs when you have a BMI of 40 or more. With morbid obesity, you are especially likely to have serious

health problems.

BMI Weight status

Below 18.5 Underweight

18.5 — 24.9 Normal

25.0 — 29.9 Overweight

16

30.0 and higher Obese

benzphetamine (Didrex) Diethylpropion (Tenuate) Mazindol (Sanorex) Orlistat (Xenical)

Phendimetrazine (Bontril) Phentermine (Ionamin) Sibutramine (Meridia)

Obsessive-Compulsive Disorder (OCD) Obsessive-compulsive disorder symptoms include both obsessions and compulsions. OCD obsessions are repeated,

persistent and unwanted ideas, thoughts, images or impulses that you have involuntarily and that seem to make no

sense. These obsessions typically intrude when you're trying to think of or do other things. OCD symptoms involving

obsessions may include:

1. Fear of being contaminated by shaking hands or by touching objects others have touched 2. Doubts that you've locked the door or turned off the stove 3. Thoughts that you've hurt someone in a traffic accident 4. Intense distress when objects aren't orderly or facing the right way 5. Images of hurting your child 6. Impulses to shout obscenities in inappropriate situations 7. Avoidance of situations that can trigger obsessions, such as shaking hands 8. Replaying pornographic images in your mind 9. Dermatitis because of frequent hand washing 10. Skin lesions because of picking at your skin 11. Hair loss or bald spots because of hair pulling

OCD symptoms involving compulsions may include:

1. Hand washing until your skin becomes raw

2. Checking doors repeatedly to make sure they're locked

3. Checking the stove repeatedly to make sure it's off

4. Counting in certain patterns

5. Making sure all your canned goods face the same way

Citalopram (Celexa) Clomipramine (Anafranil) Fluoxetine (Prozac) Fluvoxamine (Luvox)

Paroxetine (Paxil) Sertraline (Zoloft)

Osteoarthritis Osteoarthritis, sometimes called degenerative joint disease or osteoarthrosis, is the most common form of arthritis.

Osteoarthritis occurs when cartilage in your joints wears down over time.

While osteoarthritis can affect any joint in your body, the disorder most commonly affects joints in your:

1. Hands

2. Hips

3. Knees

4. Neck

5. Lower back

Osteoarthritis gradually worsens with time, and no cure exists. But osteoarthritis treatments can relieve pain and help

you remain active. Taking steps to actively manage your osteoarthritis may help you gain control over your

17

symptoms.

Acetaminophen (Tylenol) Celecoxib (Celebrex) Diclofenac (Cataflam, Voltaren) Etodolac (Iodine) Flurbiprofen (Ansaid) Ibuprofen (Motrin) Ketoprofen (Orudis) meloxicam (Mobic)

Nabumetone (Relafen) Naproxen (Naprosyn) Oxaprozin (Daypro) Piroxicam (Feldene) Salicylates (Aspirin) Sulindac (Clinoril) Tramadol (Ultram)

Osteoporosis Osteoporosis, which means "porous bones," causes bones to become weak and brittle — so brittle that a fall or even

mild stresses like bending over or coughing can cause a fracture. In many cases, bones weaken when you have low

levels of calcium and other minerals in your bones. A common result of osteoporosis is fractures — most of them

occur in the spine, hip or wrist. Although it's often thought of as a women's disease, osteoporosis affects men too.

And aside from people who have osteoporosis, many others have low bone density, putting them at risk of

developing osteoporosis.

Alendronate (Fosamax) Calcitonin (Miacalcin) Calcium salts Conjugated estrogens (Prentarin) Estradiol (Estrace) Ibandronate (Boniva)

Raloxifene (Evista) Risedronate (Actonel) Teriparatide (Forteo) Vitamin D Zoledronic acid (Reciast) Denosumab (Prolia)

Paget’s Disease

Paget's disease of bone is a condition that affects the way your bone breaks down and rebuilds (metabolizes).

Healthy bone metabolism allows for old bone to be recycled into new bone throughout the course of your life. In

Paget's disease of bone, the rate at which old bone is broken down and new bone is formed becomes distorted. Over

time, the affected bones may become fragile and misshapen.

Alendronate (Fosamax) Calcitonin (Miacalcin) Etidronate (Didronel) Pamidronate (Aredia)

Risedronate (Actonel) Tiludronate (Skelid) Zoledronic acid (Reclast)

Pain, Mild to Moderate Acetaminophen (Tylenol) Aspirin Celecoxib (Celebrex) Codeine Diclofenac (Cataflam, Voltaren) Diflunisal (Dolobid) Etodolac (Lodine)

Flurbiprofen (Advil, Motrin) Ketorolac (Toradol) Naproxen (Anaprox, Naprosyn) Propoxyphene (Darvon) Salsalate (Disalcid) Tramadol (Ultram)

Pain, Moderate to Severe Butorphanol (Stadol) Fentanyl (Sublimaze) Hydromorphone (Dilaudid) Meperidine (Demerol)

Morphine (Nubain) Oxycodone (OxyFast, Roxicodone) Oxymorphone (Oprana) Ziconotide (Prialt)

18

Methadone (Dolophine)

Panic Attack Disorder

A panic attack is a sudden episode of intense fear that develops for no apparent reason and that triggers severe

physical reactions. Panic attacks can be very frightening. When panic attacks occur, you might think you're losing

control, having a heart attack or even dying. You may have only one or two panic attacks in your lifetime. But if you

have had several panic attacks and have spent long periods in constant fear of another attack, you may have a

chronic condition called panic disorder.

Alprazolam (Xanax) Clonazepam (Klonopin) Paroxetine (Paxil)

Sertraline (Zoloft) Venlafaxine (Effexor)

Parkinsonism

The symptoms of Parkinson's disease can vary from person to person. Early signs may be subtle and can go

unnoticed. Symptoms typically begin on one side of the body and usually remain worse on that side even after

symptoms begin to affect both sides. Parkinson's signs and symptoms may include:

1. Tremor. The characteristic shaking associated with Parkinson's disease often begins in a hand. A

back-and-forth rubbing of your thumb and forefinger, known as pill-rolling, is common, and may

occur when your hand is at rest. However, not everyone experiences tremors.

2. Slowed motion (bradykinesia). Over time, Parkinson's disease may reduce your ability to initiate

voluntary movement. This may make even the simplest tasks difficult and time-consuming. When

you walk, your steps may become short and shuffling. Or your feet may freeze to the floor, making

it hard to take the first step.

3. Rigid muscles. Muscle stiffness can occur in any part of your body. Sometimes the stiffness can be

so severe that it limits the range of your movements and causes pain. People may first notice this

sign when you no longer swing your arms when you're walking.

4. Impaired posture and balance. Your posture may become stooped as a result of Parkinson's

disease. Balance problems also may occur, although this is usually in the later stages of the

disease.

5. Loss of automatic movements. Blinking, smiling and swinging your arms when you walk are all

unconscious acts that are a normal part of being human. In Parkinson's disease, these acts tend to

be diminished and even lost. Some people may develop a fixed staring expression and unblinking

eyes. Others may no longer gesture or seem animated when they speak.

6. Speech changes. Many people with Parkinson's disease have problems with speech. You may

speak more softly, rapidly or in a monotone, sometimes slurring or repeating words, or hesitating

before speaking.

Amatdine (Symmetrel) Apomorphine (Apokyn) Bromocriptine (Parlodel) Carbidopa/Levodapa (Sinemet, Sinemet CR) Diphenhydramine (Benadryl) Entacapone (Comtan)

Rasagiline (Azilect) Ropinirole (Requip) Rotigotine (Neupro) Selgiline (Eldepryl, Zelapar) Tolcapone (Tasmar)

19

Pramipexole (Mirapex)

Peptic Ulcer Disease Peptic ulcers are open sores that develop on the inside lining of your stomach, upper small intestine or esophagus.

The most common symptom of a peptic ulcer is abdominal pain.

Cimetidine (Tagamet) Esomeprazole (Nexium) Famotidine (Pepcid?) Lansoprazole (Prevacid) Misoprostol (Cytotec) Nizatidine (Axid)

Omeprazole (Prilosec) Pantoprazole (Protonix) Rabeprazole (Aciphex) Ranitidine (Zantac) Sucralfate (Carafate)

Pneumonia

Pneumonia is an inflammation of your lungs, usually caused by infection. Bacteria, viruses, fungi or parasites can cause pneumonia. Pneumonia is a particular concern if you're older than 65 or have a chronic illness or impaired immune system. Pneumonia is classified according to the cause of pneumonia:

1. Community-acquired pneumonia. This refers to pneumonia you acquire in the course of your daily life — at

school, work or the gym, for instance. The most common cause is the bacterium Streptococcus

pneumoniae. Another, less common cause is Mycoplasma pneumoniae, a tiny organism that typically

produces milder signs and symptoms than other types of pneumonia. Walking pneumonia, a term used to

describe pneumonia that isn't severe enough to require bed rest, may result from Mycoplasma pneumoniae.

2. Hospital-acquired (nosocomial) pneumonia. If you're hospitalized, you're at a higher risk of pneumonia,

especially if you're breathing with the help of a mechanical ventilator, in an intensive care unit or have a

weakened immune system. This type of pneumonia can be extremely serious, especially for older adults,

young children and people with chronic obstructive pulmonary diseases (COPD) or HIV/AIDS.

3. Hospital-acquired pneumonia develops at least 48 hours after you're admitted to the hospital. This

category includes post-operative pneumonia — most common in people older than age 70 who

have abdominal or chest surgery — and health-care associated pneumonia — acquired in chronic

care facilities, centers where drugs are given by intravenous drip (infusion) and kidney dialysis

centers.

4. Aspiration pneumonia. This type of pneumonia occurs when you aspirate foreign matter into your lungs —

most often when the contents of your stomach enter your lungs after you vomit. This commonly happens

when a brain injury or other condition affects your normal gag reflex. Difficulty swallowing, which occurs with

diseases such as amyotrophic lateral sclerosis (ALS), Parkinson's disease and strokes, may also lead to

aspiration pneumonia.

5. Pneumonia caused by opportunistic organisms. This type of pneumonia strikes people with weakened

immune systems. Organisms that aren't harmful for healthy people can be dangerous for people with AIDS

and other conditions that impair the immune system, as well as people who have had an organ transplant.

Medications that suppress your immune system, such as corticosteroids or chemotherapy, also can put you

at risk of opportunistic pneumonia.

Amoxicillin (Amoxil) Amoxicillin (Polycillin) Azithromycin (Zithromax)

Erythromycin Gentamicin (Garmycin) Levofloxacin (Levaquin)

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Cefaclor (Ceclor) Cefpodoxime (Vantin) Cefriaxone (Rocephin) Cefuroxime (Kefurox, Zinacef) Clarithromycin (Blaxin) Co-trimoxazole (Bactrim, Septra)

Moxifloxacin (Levaquin) Linezolid (Zyvox) Moxiflixacin (Avelox) Piperacillin/Tazobactam (Zosyn) Tobramycin (Nebcin) Vancomycin (Vancocin)

Posttraumatic Stress Disorder Post-traumatic stress disorder (PTSD) is a type of anxiety disorder that's triggered by a traumatic event. You can develop post-traumatic stress disorder when you experience or witness an event that causes intense fear, helplessness or horror. Post-traumatic stress disorder is probably caused by a complex mix of:

1. Inherited predisposition to psychiatric illness, especially anxiety and depression

2. Your life experiences, including the amount and severity of trauma you've been exposed to since early

childhood

3. The inherited aspects of your personality — often called your temperament

4. The way your brain regulates the chemicals and hormones your body releases in response to stress

Amitriptyliine (Elavil) Aripiprazole (Abilify) Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Zyprexa) Paroxetine (Paxil)

Propranolol (Inderal) Quetiapine (Risperdal) Sertraline (Zoloft) Venlafaxine (Effexor) Ziprasidone (Geodon)

Pruritus Anyone can get pruritus but certain groups of people are more susceptible to the condition, including:

1. People with seasonal allergies, hay fever, asthma, and eczema 2. People with diabetes 3. People with HIV/AIDS and various types of cancer 4. Pregnant women 5. The elderly

Amcinonide (Cyclocort) Brompheniramine (Dimetane) Cetirizine (Zyrtec) Chlorpheniramine (Dimetane) Clemastine (Tavist) Clobetasol (Temovate) Cypropheptadine (Periactin) Desloraradine (Clarinex) Desonide (Tridesilon) Desoximetasone (Topicort)

Diphenhydramine (Benadryl) Flucinolone (Synalar) Fluocinonide (Lidex) Halobetasol (Ultravate) Hydrocortisone (Cort-Dome, Hytone) Hydroxyzine (Atarax, Vistaril) Prednisolone (Prelone) Prednisone (Deltasone) Proethazine (Phenergan)

Psychosis

People experiencing psychosis may report hallucinations or delusional beliefs, and may exhibit personality changes and thought disorder. Depending on its severity, this may be accompanied by unusual or bizarre behavior, as well as difficulty with social interaction and impairment in carrying out the daily life activities.

Aripiprazole (Abilify) Chlorpromazine (Thorazine) Clozapine (Clozaril) Fluphenazine (Prolixin)

Perphenazine (Trilafon) Quetiapine (Seroquel, Seroquel XR) Reisperidone (Risperdal) Thiorisdazine (Mellaril)

http://en.wikipedia.org/wiki/Hallucination

http://en.wikipedia.org/wiki/Delusion

http://en.wikipedia.org/wiki/Thought_disorder

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Haloperidol (Haldol) Olanzapine (Zyrexa)

Thiothixene (Navame) Ziprasidone (Geodon)

Pulmonary Arterial Hypertension

Bosentan (Tracleer) Epoprostenol (Flolan) Iloprost (Ventavis)

Sildenafil (Revatio) Treprostinil (Remodulin)

Respiratory Arterial Hypertension

Beractant (Survanta) Calfactant (Infasurf)

Poractant alfa (Curosurf)

Schizophrenia

Schizophrenia is a group of severe brain disorders in which people interpret reality abnormally. Schizophrenia may

result in some combination of hallucinations, delusions and disordered thinking and behavior. The ability of people

with schizophrenia to function normally and to care for themselves tends to deteriorate over time.

Aripiprazole (Abilify) Chlorpromazine (Thorazine) Clozapine (Clozaril) Fluphenazine (Prolixin) Haloperidol (Haldol) Olanzapine (Zyprexa) Perphenazine (Trlafon)

Quetlapine (Seroquel, Seroquel XR) Risperidone (Risperdal) Thioridazine (Mellaril) Thiothixene (Navane) Ziprasidone (Geodon)

Smoking cessation Bupropion (Zyban) Clonidine (Catpres) Nicotine (Nicoderm, Nicotrol)

Nortriptyline (Pamelor) Varenicline (Chantix)

Thrombosis Dalteparin (Fragmin) Enoxaparin (Lovenox) Heparin

Tinzaparin (Innohep) Warfarin (Coumadin)

Thyroid disorders Levothyroxine (Levoxyl, Synthroid) Liothyronine (Cytomel)

Thyroid

Transient ischemic attack (TIA) Aspirin Clopidogrel (Plavix) Triclopidine (Ticlid)

Warfarin (Coumadin)

Tremors Atenolol (Tenormin) Chlordiazepoxide (Librium) Diazepam (Valium) Lorazepam (Ativan)

Metoprolol (Lopressor) Nadolol (Corgard) Propranolol (Inderal)

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Tuberculosis (TB) Tuberculosis (TB) is a potentially serious infectious disease that primarily affects your lungs. Tuberculosis is spread

from person to person through tiny droplets released into the air. Most people who become infected with the bacteria

that cause tuberculosis don't develop symptoms of the disease. Tuberculosis is caused by an organism called

Mycobacterium tuberculosis. The bacteria spread from person to person through microscopic droplets released into

the air. This can happen when someone with the untreated, active form of tuberculosis coughs, speaks, sneezes,

spits, laughs or sings.

Ethambutiol (Myambutol) Isoniazid (INH) Pyrazinamide Rifabutin (Mycobutin)

Rifampin (Rifadin) Rifapentine (Priftin)

Urticaria

Cetririzine (Zyrtec) Cimetidine (Tagamet) Clemastine (Tavist) Cyproheptadine (Periactin) Diphenhydramine (Benadryl)

Hydroxyzine (Atarax, Vistaril) Loratadine (Claritin) Promethazine (Phenergan) Ranitidine (Zantac)

Vertigo Dimenhydrinate (Dramamine) Diphenhydramine (Benadryl) Meclizine (Antivert)

Scopolamine (Trans-Derm Scop)

Vomiting Aprepitant (Emend) Chlorpromazine (Thorazine) Dexamethasone (Decadron) Dimenhydrinate (Dramamine) Dolasetron (Marinol) Droperidol (Inapsine) Granisetron (Kytril) Hydroxyzine (Vistaril) Lorazepam (Ativan)

Meclizine (Antiert) Metoclopramide (Reglan) Nabilone (Cesamet) Ondansetron (Aloxi) Prochlorperazine (Compazine) Promethazine (Phenergan) Scopolamine (Trans-Derm Scop) Trimethobenzamide (Tigan)

Zollinger-Ellison syndrome Zollinger-Ellison syndrome is a complex condition in which one or more tumors form in your pancreas or in the upper part of your small intestine (duodenum). These tumors secrete large amounts of a hormone that causes excessive production of acid by your stomach. The excess acid, in turn, leads to peptic ulcers.

Aluminum salts Cimetidine (Tagamet) Esomeprazole (Nexim) Famotidine (Pepcid) Lansoprazole (Prevacid) Omeprazole (Prilosec)

Pantropazole (Nexium) Famotidine (Pepcid) Lansoprazole (Prilosec) Pantoprazole (Protonix) Rabeprazole (Aciphex) Ranitidine (Zantac)

HERBALS MEDICATIONS AND DRUG INTERACTIONS Name of Herb Some Common Uses Possible Side Effects or Drug Interactions

Cayenne

External: used for muscle spasm and soreness Internal: GI tract disorders

External: potential for skin ulceration and blistering with greater than 2 days of use. Internal: overuse may cause severe hypothermia.

Echinacea

Echinacea boosts the immune system and helps fight colds and flu. Aids wound healing.

Echinacea may cause inflammation of the liver if used with certain other medications, such as anabolic steroids, methotrexate or others.

Ephedra

Ephedra is also called Ma-Huang. It is used in many over-the-counter diet aids as an appetite suppressant. It is also used for asthma or bronchitis.

Ephedra may interact with certain antidepressant medications or certain high blood pressure medications to cause dangerous elevation in blood pressure or heart rate. It could cause death in certain individuals.

Feverfew

Feverfew is used to ward offf migraine headaches and for arthritis, rheumatic disease and allergies.

Feverfew may increase bleeding, especially in patients already taking certain anti-clotting medications.

Garlic

Garlic is used for lowering blood cholesterol, triglyceride levels and blood pressure.

Garlic may increase bleeding, especially in patients already taking certain anti-clotting medications.

Ginger

Ginger is used for reducing nausea, vomiting and vertigo

Ginger may increase bleeding, especially in patients already taking certain anti-clotting medications.

Ginkgo

Ginkgo, also called ginkgo biloba, is used for increasing blood circulation and oxygenation and for improving memory and mental alertness.

Ginkgo may increase bleeding, especially in patients already taking certain anti-clotting medications.

Ginseng

Ginseng increases physical stamina and mental concentration.

Ginseng may cause decreased effectiveness of certain anti-clotting medications. Persons using ginseng see increased heart rate or high blood pressure. It may cause bleeding in women after menopause.

Goldenseal

Goldenseal is used aas a mild laxative and also reduces inflammation.

Goldenseal may worsen swelling and/or high blood pressure.

Licorice

Licorice is used for treating stomach ulcers.

Certain licorice compounds may cause high blood pressure, swelling or electrolyte imbalances.

Saw Palmetto

Saw Palmetto is used for enlarged prostate and urinary inflammations.

People using saw palmetto may see effects with other hormone therapies.

St. John's

Wort

St. John's Wort is used for mild to moderate depression or anxiety and sleep disorders.

St. John's Wort may prolong the effect of certain anesthetic agents.

Kava-kava

Kava-kava is used for nervousness, anxiety or restlessness; it is also a muscle relaxant.

Kava-kava may increase the effects of certain anti-seizure medications and/or prolong the effects of certain anesthetics. it can enhance the effects of alcohol. It may increase the risk of suicide for people with certain types of depression.

Valerian

Valerian is used as a mild sedative or sleep-aid. It is also a muscle relaxant.

Valerian may increase the effects of certain anti-seizure medications or prolong the effects of certain anesthetic agents.

Anise

Anise is used for relief of dry cough, Asthma and Flatulence.

May Increase Iron absorption and may cause toxicity.

Black Cohosh

Black Cohosh is used for treatment of PMS and Rheumatoid Arthritis.

Do not use with hormonal contraceptives, may cause hypotension.

Bilberry

Bilberry is used for treatment of diabetes, cardiovascular problems, lowers cholesterol, cataracts and night blindness.

Increased risk of bleeding with anticoagulants, avoid alcohol (disulfiram-like reaction)

Pysillium

Pysillium is used as treatment for constipation and lowers cholesterol.

Can cause severe gas and stomach pain; inhibit effects of warfarin, digoxin, and lithium. Do not combine with other laxatives.

TABLE 1

FOODS WITH ANTIGENS RELATED TO LATEX

Non-Food Allergens

Fruits and Vegetables

Legumes and

Grains

Nuts and Seeds

Other Plants that may

Contain Similar Antigens

Latex

Avocado Apricot Banana Celery Cherry Citrus fruits (orange, grapefruit, lemon, lime) Fig (Weeping fig) Grapes Kiwi fruit Mango Melon Papaya (pawpaw) Passion fruit Peach Peppers (sweet, paprika) Pineapple Potato Tomato

Peanut Soya bean Buckwheat

Chestnut Walnut �“Nuts�” (various species, unspecified)

Mugwort Ragweed Rye grass Timothy grass

Note The table lists the foods and plants that have been shown in research studies to contain antigens that are similar to those in latex. This does not mean that a person with latex allergy will react to all of the foods on the list. Latex-allergic individuals need avoid only those foods to which they have experienced an allergic reaction. The list may serve to indicate to the latex-allergic person those foods that could trigger a reaction in the future.

1

!  Complete blood count (cbc) rbc (erythrocytes) = 4.5- 5. 5 million /cu.mm. wbc (leukocytes) = 5,000-10,000 /cu.mm. platelets (thrombocytes) = 150,000- 450,000 /cu.mm.

!  Hemoglobin (hgb) = 12- 18 G/ dL

!  Hematocrit (hct) = 37% - 52 % Note: H and H means hemoglobin and hematocrit

Normal Laboratory Values

1

!  Differential Count (Leukocytes) Neutrophils = 60 - 70% Eosinophils = 1% - 4% Basophils = 0.5% - 1.0% Lymphocytes = 20% - 40% Monocytes = 2 % - 6%

!  Erythrocyte Sedimentation Rate (ESR) Males = 0 - 15 mm/ hr. Females = 0 - 20 mm/ hr.

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2

!  Blood Coagulation Studies Prothrombin Time (Protime, PT) = 11 - 16 seconds Partial Thromboplastin Time(PTT) = 60 - 70 seconds Activated Partial Thromboplastin Time (APTT) = 30 - 45 seconds

Bleeding Time = 1 - 9 minutes Clotting Time = 3 - 9 minutes

3

!  Serum Iron •  Males = 65 -175 mcg/ dL •  Females = 50 -170 mcg/ dL •  Ferritin Level = 12 -300 ng/ml

!  Blood Lipids •  Serum Cholesterol = 150 - 200 mg/ dL •  Serum Triglycerides = 140 - 200 mg/ dL •  Low Density Lipoprotein (LDL)

= less than 130 mg/ dL •  High Density Lipoprotein (HDL)

= 30 - 70 mg/ dL

4

3

!  Serum Enzymes Studies Aspartate AminoTransferase (ALT/SGOT)= 7 - 40 U/ml Alanine Aminotransferase (ALT/SGPT) = 10 -40 U/ml Creatine Phosphokinase (CK-MB)

Males = 50-325 mU/ml Females = 50-250 mU/ml

Lactic Dehydrogenase =100-225 mU/ml or 140- 280 U/L Serum Lipase= 0.2-1.5 U/ml or 10- 40 U/L Serum Amylase = 60 – 160 Somogyi U/dL or 53-123U/L Serum Alkaline Phosphatase = 30-150 mU/ml

5

!  Troponin Troponin I = less than 0.6 ng./ml. (greater than 1.5 ng./ml. indicates

myocardial infarction (MI) Troponin T= 0 to less than 0.1 ng./ml.

(greater than 0.1- 0.2 ng./ml. indicate MI)

!  Blood Uric Acid (BUA) = 2.5- 8 mg./dl. !  Blood Urea Nitrogen (BUN) = 7 -20 mg./ dL.

6

4

!  Serum Electrolytes

potassium (K+) = 3.5-5.5 mEq/L sodium (Na+) = 135-145 mEq/L calcium (Ca+) = 4.5- 5.5 mEq/L 9-11 mg/dl magnesium (Mg+) = 1.5-2.5 mEq/L 1.8-3.0 mg/dl chloride (Cl-) = 95-105 mEq/L phosphate (PO4) = 1.5- 2.6 mEq/L 2.4- 4.7 mg/dl

7

!  Central Venous Pressure (CVP) = 5-12 cm. H2O (average: 4- 10 cm. H2O)

!  Pulmonary Artery Pressures Pulmonary Artery Pressure (PAP) = 4-12mmHg Pulmonary Capillary Wedge Pressure (PCWP) = 4-12 mmHg

!  Serum Protein Levels Total Serum Protein = 6 - 8 g/dL

Albumin = 4 - 6 g/dL Globulin = 1.5 - 3 g/dL Albumin : Globulin (A:G) ratio = 2 : 1

!  Serum Ammonia = 10 – 80 mcg /dL (average: 10-65 mcg/dl)

8

5

!  Lead Serum Levels =less than10 mcg/dL {45 mcg/dL: oral chelating agent is required} {70mcg/dL : IV chelating agent is required}

!  Bilirubin Levels Total Serum Bilirubin = 0.3-1.2 mg/dL Conjugated (Direct) Bilirubin = 0.1- 0.2 mg/dL (! biliary obstruction) Unconjugated (Indirect) Bilirubin= 0.2- 0.8 mg/dL (! hemolysis of rbc, hepatocellular damage)

9

!  Blood Glucose Levels Fasting Blood Glucose (FBG) = 70-110 mg/dL Glycosylated Hemoglobin (HbAIc )= 4.4 -6.4%

(7.5% or less: good diabetic control) !  Thyroid Hormone Levels

Triiodothyronine (T3)= 75 - 200 ng/dL Thyroxine (T4) = 4.5-11.5 mcg/dL

!  Vanillylmandelic Acid= 0.7-6.8 mg/24 hrs. !  Urine Catecholamines = 14 mcg/ 100mls of

urine

10

6

!  Serum Osmolality = 285- 310 mOsm/ kg. !  Creatinine Clearance =100 - 120 ml/ min. !  Serum Creatinine = 0.7- 1.4 mg/ dL

!  Cerebrospinal Fluid (CSF) Studies Opening Pressure = 0-15mmHg or 75-180

mm H20 Glucose = 50 - 80 mg/dL Protein = 20 - 50 mg/dL

11

!  Arterial Blood Gas (ABG) Analysis Blood pH = 7.35-7.45 paO2 = 80-100 mmHg paCO2 = 35-45 mmHg HCO3 = 22-26 mEq/L O2 Saturation = 95-100%

(88% and below indicate that hypoxia is severe)

12

7

!  Therapeutic Serum Medication Levels Acetaminophen Phenytoin (Dilantin) 10-20 mcg/dL Theophylline Carbamazepine (Tegretol) = 5-12 mcg/dL Gentamycin Sulfate = 5-10 mcg/dL Magnesium Sulfate = 4- 7 mg/dL Digoxin = 0.5- 2 ng/ml Lithium = 0.5-1.5 mEq/L Coumadin = INR: 2- 3

13

Peak & Trough Medication Levels Drugs Therapeutic range

Amikacin Peak: 25-35 mcg/ml Trough: 4-8 mcg/ml

Gentamicin Peak: 4-10 mcg/ml. Trough: 0.5 to 2 mcg/ml

Tobramycin Peak: 4-10 mcg/ml. Trough: 0.5 to 2 mcg/ml

Vancomycin Peak: 20-40 mcg/ml Trough: 5-15 mcg/ml

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8

Diagnostic Tests Concepts

1. Prepare the client physically and psychosocially to allay anxiety.

2. Provide privacy to prevent feelings of embarrassment.

3. Provide adequate information about the procedure: purpose of the procedure, what to expect during the procedure, and what is expected of the client, to gain his cooperation.

15

4. NPO (nothing per orem) is required for procedures that involve examination of the following: a. upper gastrointestinal tract, e.g., upper G.I.

series, upper G.I. endoscopy. b. lower gastrointestinal tract, e.g., barium

enema, lower G.I. endoscopy. c. body cavities that involve insertion of

instruments through the nose or mouth, e.g., bronchoscopy, bronchography, upper G.I. endoscopy, ERCP.

16

9

5. Written consent is required for procedures that involve the following: a. Invasion of body cavities, e.g.,endoscopic

examinations : G.I. endoscopy, cystoscopy, bronchoscopy.

b. Tissue injury,e.g., biopsy, lumbar puncture, thoracentesis, paracentesis.

c. Use of anesthesia. d. Use of contrast medium, either radiopaque

dye or radioisotope, e.g., radiographic examinations.

17

6. Assess for allergy to seafoods and iodine for procedures that involve use of iodinated contrast medium. E.g., bronchography, cardiac catheterization, angiography, intravenous pyelography (IVP). Iodinated contrast medium normally causes warm or flushing sensation.

7. Assess for history of claustrophobia if the procedure involves placing the client in a tunnel- like device. E.g., CAT Scan, MRI, PET Scan.

8. Increase fluid intake after procedures that involve use of contrast medium. This is to promote excretion of the dye. E.g., IVP, myelography, angiography.

18

10

9. The sequence of methods for examination of the abdomen is as follows: Inspection, Auscultation, Percussion, and Palpation.

10. No abdominal palpation among clients with tumor of the liver and tumor of the kidneys.

11. During examination of the abdomen, it is important to flex the knees to relax the abdominal muscles and facilitate the examination of abdominal organs.

12.The sequence of examining the quadrants of the abdomen is as follows:right lower quadrant, right upper quadrant, left upper quadrant, left lower quadrant (RLQ,RUQ,LUQ, LLQ).

19

13. The best position when examining the chest is sitting/ upright position. This permits examination of both the anterior and the posterior chest.

14. To palpate the neck for lymphadenopathy and enlargement of the thyroid gland, the nurse should stand behind the client.

15. If opthalmoscopy is done, darken the room for better illumination.

16. For culture and sensitivity test of various specimen (urine, stool, sputum, blood, body secretions), obtain specimen before the first dose of antimicrobials and use strictly sterile specimen container.

20

11

17. If a female client is to be examined by a male physician, a female nurse must be in attendance. This ensures that the procedure is done in an ethical manner.

*Critical Concepts to Remember in Diagnostic Tests A.  Respiratory System 1. Mantoux Test (Skin Test)

- PPD (purified protein derivative) is used. - Administered by intradermal injection. - Interpretation of result is 48- 72 hours after

injection.

21

- (+) Mantoux Test is induration of 10mm or

more. - For HIV (+) clients, induration of 5 mm is

considered positive. - (+) Mantoux test signifies exposure to

Mycobacterium tubercle bacilli. - Clients who have received BCG

immunization will have (+) Mantoux test.

22

12

2. Chest X-Ray - Instruct client to remove metals from the

chest, e.g., necklace. Metals are radiopaque. 3. Chest Fluoroscopy - Studies the lungs and the chest in motion. 4. Bronchoscopy and bronchography - Both procedures require insertion of

bronchoscope. - Bronchography involves introduction of

iodinated contrast medium into the bronchial tree followed by radiographic examination.

23

- In both procedures, premedication's are administered as follows: a. anticholinergic to reduce secretions and prevent aspiration, e.g., Rubinol, Atropine SO4. b. anxiolytic to allay anxiety and relax the client,

e.g. Valium (diazepam). c. topical anesthetic spray, followed by injection of

anesthetic into the larynx to depress the gag reflex.

- After bronchoscopy and bronchography, the client will be on NPO until gag reflex returns; and placed in side- lying position to promote drainage from the mouth and prevent aspiration.

24

13

5. Lung Scan - Involves injection of radioisotope per IV, e.g.,

gallium. - The client is instructed to remain still during the

procedure. 6. Sputum Examination

- The best time to collect sputum specimen is in the morning upon awakening.

- Instruct the client to rinse mouth with plain water before collection of sputum specimen.

- AFB- staining requires collection of sputum specimen for 3 consecutive mornings.

25

7. Lung Biopsy - After percutaneous needle lung biopsy, the

client is turned toward affected side. This is to apply pressure and prevent bleeding.

8. Pulmonary Function Studies - Measures lung volumes and lung capacities - In COPD, there is retention of carbon dioxide.

Therefore, the results of pulmonary function studies are as follows: decreased Vital Capacity, Inspiratory Reserve Volume, Expiratory Reserve Volume; Increased Residual Volume and Total Lung Capacity.

26

14

9. Arterial Blood Gas Analysis - Assesses ventilation and acid- base

balance. - Blood specimen is commonly withdrawn from

the radial artery. - Allen’s test is done if ABG monitoring will be

done. To ascertain that there is adequate collateral circulation of the hand.

- The syringe to be used for withdrawal of blood specimen should be heparinized to prevent clotting of specimen.

- The specimen should be placed in a container with ice to prevent hemolysis.

27

10. Thoracentesis - Inform client that pressure sensation is

experienced as the aspiration needle is introduced.

- For pneumothorax, the needle is inserted in the second and third intercostal space (ICS); for pleural effusion, the needle is inserted in the seventh or eighth ICS.

- After the procedure, monitor client for bleeding and hypovolemic shock.

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15

Nervous System 1. Skull film - remove metallic items from hair. 2. Spine film - avoid flexion and rotation of spine when

fracture is suspected. 3. CAT Scan - assess for allergy to seafoods and iodine (if

done with contrast medium). - assess for claustrophobia. - remove metallic items from hair.

29

4. Electroencephalography (EEG) - provide hair shampoo before the procedure. - avoid caffeine, anticonvulsants, and stimulants for at least 24 hours before the procedure.

5. Electromyography (EMG) and Nerve Conduction Velocity (NCV) - done to diagnose neuromuscular disorders. - explain to the client that electrode needles will be inserted into the muscles; and that there will be mild discomfort.

6. Cerebral Angiography - contrast material is injected into the carotid, brachial, or carotid artery.

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16

- check allergy to iodine and seafoods. - observe arterial puncture site for bleeding or hematoma; apply pressure dressing or ice pack to the area. - observe for the following after the procedure: a. signs and symptoms of impaired circulation

distal to the puncture site ( skin color, skin temperature, sensation, pulse).

b. if carotid artery is involved, observe for signs and symptoms of vagal irritation (bradycardia and hypotension).

31

c. any change in neurologic status; there is risk of stroke or ischemia after the procedure due to thrombus, embolus, or vasospasm.

- if femoral artery was involved, promote bedrest for 12- 24 hours. To prevent bleeding and to prevent dislodgment of blood clot.

7. Lumbar Puncture - client should be placed in lateral, knee- chest position during the procedure. - label specimen to ensure significance of results. - after the procedure, place the client in flat position for 6 to 8 hours to prevent spinal headache. Spinal headache is due to leakage of CSF through the dural hole.

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17

8. Myelography - detects vertebral disk diseases and spinal cord tumors. - contrast medium is administered through lumbar puncture.

9.Magnetic Resonance Imaging (MRI) - obtain history of metal implants and artificial cardiac pacemaker; these make the client ineligible for the procedure. - assess for claustrophobia. -inform client that the machine makes drum- like or knocking sound.

33

Cranial Nerves Nerve Location

Functions Signs &Symptoms of damage

Olfactory (CNI) Olfactory tract Smell Anosmia

Optic (CNII) Thalamus Vision Blindness

Oculomotor (CNIII) Midbrain Midbrain

Eye movement (elevation, adduction)

Eye deviates down & out Loss of pupillary/accommodation reflexes

Trochlear (CNIV) Midbrain Eye movement (depression of adducted eye)

Diplopia, lateral deviation of eye

Trigeminal (CNV) Pons Medulla Pons/midbrain Pons

Facial sensation Mastication

Facial anesthesia Loss of pain sensation Weakness/loss of mastication

Abducent (CNVI) Pons Eye movement (Abduction) Medial eye deviation

Facial (CNVII) Pons Pons Pons

Facial expresssion Taste Salivation, lacrimation

Paralysis of facial nerve muscles Loss of taste (anterior 2/3rds of tongue) Dry mouth, loss of lacrimation

Acoustic(CN VIII) or Vestibulocochlear

Medulla Medulla

Balance Hearing

Vertigo, disequilibrium, nystagmus Hearing

Glossopharyngeal (CN IX) Medulla Medulla Medulla

Taste Salivation Innervation of pharynx

Loss of taste (posterior 1/3rd of tongue) Loss of gag reflex

Vagus (X) Medulla Medulla Medulla

Swallowing & talking Cardiac, GI tract, respiration Taste

Dysphagia & hoarseness of voice Bradycardia, Hyperactive Loss of cough reflex (larynx/pharynx), loss of taste (hard palate)

Spinal accessory Cranial (XI)

Medulla Cervical cord

Pharynx/larynx muscles Neck & shoulder movement

Head turning/shoulder shrugging weakness

Hypoglossal (XII) Medulla Tongue movement Atrophy of tongue muscles, deviation on protrusion, fasciculation's

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Cardiovascular and Hematologic System 1. Complete Blood Count and Erythrocyte Indices

- Erythrocyte indices (MCV, MCH, MCHC) are the best indicators of anemia.

- MCV and MCH are increased in macrocytic anemia: decreased in microcytic anemia.

- MCHC is decreased in severe hypochromic anemia. - RBC, hemoglobin and hematocrit are low in

anemia. - Polycythemia (increased rbc and hemoglobin)

indicates hypoxia. - Elevated wbc indicates presence of infection.

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- Neutropenia/ agranulocytosis (low neutrophil count) indicates low resistance to infection.

- Eosinophilia (elevated eosinophil count) indicates allergy or parasitism.

2. Erythrocyte Sedimentation Rate (ESR) - It is elevated in inflammatory conditions, e.g.,

MI. 3. Blood Coagulation Studies

- High Level of PT, INR, PTT, APTT indicate bleeding tendencies. - PT is valuable in evaluating effectiveness of

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coumadin. Therapeutic range is: PT x 1.5- 2.5 - INR is used to monitor the effectiveness of coumadin is 2-3 seconds. - PTT and APTT are used to evaluate

effectiveness of heparin. APTT is most specific test for effectiveness of heparin. Therapeutic range is : PTT/ APTT x 1.5-2.5.

4. BUN, BUA - The values are elevated when there is low

renal tissue perfusion due to decreased cardiac output.

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5. Blood Lipids (serum cholesterol and serum lipids)

- Require NPO for 10- 12 hours before withdrawal of blood specimen.

- Elevated levels of blood lipids increase risk of atherosclerosis.

6. Enzyme Studies - AST (SGOT), CK- MB, LDH, HBD are elevated in MI. - The most cardiac- specific enzyme is CK- MB.

7. Troponin - Elevated Troponin I and T are the best indicators of MI.

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8.Electrocardiography (ECG, EKG) - The ECG changes in MI are as follows:

elevated ST segment, inverted T wave, pathologic/ enlarged Q wave.

- The ECG changes in hypokalemia are as follows: U- wave, depressed ST segment, short T wave.

- The ECG changes in hyperkalemia are as follows: prolonged QRS complex, elevated ST segment, peaked T wave.

9. Holter Monitoring - This is continuous ECG monitoring, over a

24- hour period. 39

- Instruct client or significant others to record activities, and any unusual sensations experienced during the test.

- The client may remove the device only during bathing.

- Monitoring should be continued even during sleep.

10. Central Venous Pressure (CVP) Monitoring - Place 0 level/ base of the water manometer at the

right mid- axillary, 4th ICS . This is the approximate level of the right atrium when the client is in supine position.

- Elevated CVP readings indicate hypervolemia or right- sided congestive heart failure.

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11. Pulmonary Artery Pressure (PAP) and Pulmonary Capillary Wedge Pressure PCWP)

- Pulmonary artery pressures are measured by Swan- Ganz catheter.

- Inflate the balloon of Swan- Ganz catheter only during PCWP reading, deflate between readings.

- PAP and PCWP are elevated in left- sided congestive heart failure.

12. Echocardiography - Uses ultrasound to assess cardiac structures and

mobility. 41

13. Stress Testing/ Exercise Testing - Exercise is done on a treadmill or bicycle- like

device. - The client should wear loose, comfortable

clothings and low- heeled, rubber- soled pair of shoes during the test.

- Advise client to avoid tea, coffee, and alcohol on the day of the test.

- Advise client to avoid smoking and taking nitroglycerine 2 hours before the test. To prevent orthostatic hypotension.

- Allow the client to rest after the procedure.

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14. Cardiac Catheterization - For right- sided cardiac catheterization, the catheter is

inserted via a vein. - For left- sided cardiac catheterization, the catheter is

inserted via an artery. - Assess for allergy to seafoods and iodine. - The procedure is done under local anesthesia, in the

cardiac catheterization laboratory. - Cardiac monitoring is done before, during, and after the procedure to detect dysrhythmias. - Promote bed rest until VS are stable if a blood vessel in

the upper extremity is involved. - Promote bed rest for 24 hours if a blood vessel in the

lower extremity is involved to prevent bleeding and dislodgement of blood clot.

- Apply pressure dressing and small sandbag or ice pack over puncture site to prevent bleeding.

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- Immobilize affected extremity in extension to prevent bleeding and to promote circulation.

- Monitor the extremity involved for skin color, skin temperature, sensation and pulse for signs and symptoms of impaired circulation.

15. Doppler Ultrasonography - Permits assessment of arterial and venous

flow in the lower extremities with the use of a probe moved over a skin surface.

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16. Ultrasonic Duplex Scanning - Localizes site of vascular obstruction,

evaluates degree of narrowing and the amount of vascular reflux.

- Detects deep vein thrombosis. 17. Plethysmography

- Evaluates venous insufficiency. 18. Arteriography and venography

- Assess for allergy to seafoods and iodine before the procedure.

19. Trendelenburg Test - Done to detect leg varicosities.

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Gastrointestinal System 1.  Carcinoembryonic Antigen (CEA)

- Indicates presence of colorectal cancer. 2. D- xylose Absorption Test

- Indicates presence of malabsorption disorders.

3. Fecal Analysis -Guaiac stool examination (occult blood examination): a. No red meats, poultry for 3 days before

collection of stool specimen.

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b. Withold iron, steroids, NSAID’s for 48 hours before collection of stool specimen. Iron causes dark discoloration of stool; steroids and NSAID’s may cause G.I. irritation.

- If the purpose of fecal analysis is for detection of ova and parasites, send fresh, warm stool specimen to the laboratory.

4. Gastric Analysis - Gastric aspirate is collected every 15 minutes

to 1 hour.

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- Hypersecretion of hydrochloric acid (HCl) indicates duodenal ulcer or Zollinger- Ellison syndrome.

- Achlorhydria/ decreased HCl indicates gastric cancer or pernicious anemia.

5. Scout Film of the Abdomen - Involves plain X-Ray of the abdomen.

6. Upper G.I. Series/ Barium Swallow - NPO for 6 to 8 hours. - Barium Sulfate is administered per orem.

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- X- rays are taken in standing and supine position.

- Laxatives and fluids are given after the procedure because Barium SO4 causes constipation.

7. Lower G.I. Series/ Barium Enema - Preparation for the test includes the following: a. NPO for 6 to 8 hours. b. Laxative the night before the procedure.

c. Cleansing enema in the morning of the test.

- Care after the procedure is same as after Upper G.I. Series.

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8. Upper G.I. Endoscopy - NPO for 6 to 8 hours. - Remove dentures. - Gag reflex is depressed with local anesthetic. - After the procedure, place client in side- lying

position and maintain NPO until gag reflex returns. To prevent aspiration.

9. Lower G.I. Endoscopy a. Proctosigmoidoscopy - NPO for 6- 8 hours. - Laxative the night before the test.

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- Cleansing enema in the morning of the test.

- Client is placed in knee- chest/ lateral position during the procedure.

- After the procedure, prevent postural hypotension, assess for signs and symptoms of perforation and of vagal stimulation (hypotension and bradycardia).

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b. Colonoscopy - Preparation is same as

proctosigmoidoscopy. - Place the client in side- lying

position with knees flexed, during procedure.

- Care of the client after the procedure is same as proctosigmoidoscopy.

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10. Ultrasound of the Abdomen, Liver, Gall bladder, pancreas

- NPO for 8- 12 hours. - Laxative the night before the test to

remove bowel gas.

Hepato- Biliary and Pancreatic System 1.  Metabolic Function Tests

- Hepatocellular damage is manifested by the following laboratory findings:

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a. decreased total serum cholesterol and serum phospholipids – because the liver is unable to metabolize fats.

b. decreased total serum protein, BUN – because the liver is unable to metabolize protein. Low serum protein causes decreased colloidal osmotic pressure, that leads to edema including ascites.

c. prolonged PT, PTT, APTT - because the liver is unable to metabolize protein that is required to synthesize clotting factors. This increases risk for bleeding.

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d. elevated serum ammonia – because the liver is unable to convert ammonia into urea. This causes hepatic encephalopathy. Ammonia is not water – soluble, therefore it can not be excreted from the body unless it is converted into urea. Urea is water- soluble and can readily be excreted from the body.

e. elevated total serum bilirubin – because the liver is unable to metabolize bilirubin. This causes jaundice.

f. elevated unconjugated/ indirect bilirubin – because the liver is unable to conjugate bilirubin. This causes further jaundice.

g. elevated urine urobilinogen – because of increased levels in the blood, the kidneys filter the urobilinogen.

h. elevated urine bilirubin – because levels of bilirubin in the blood is high, the kidneys filter bilirubin from the blood.

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- Biliary obstruction is validated by the following laboratory findings:

a. elevated serum cholesterol and serum phospholipids.

b. elevated conjugated/ direct bilirubin. c. elavated urine bilirubin. d. decreased urine urobilinogen. e. absence of fecal urobilinogen/ stercobilin –

this results to acholic stool.

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2. Serum Enzyme Studies - Hepatocellular damage is characterized by

elevated AST (SGOT), ALT (SGPT), LDH, serum alkaline phosphatase. - Gamma glutamyl transpeptidase (GGT) is elevated if liver cirrhosis is caused by alcoholism.

3. Acute pancreatitis is characterized by elevated serum lipase and serum amylase.

4.Biopsy of the Liver - Vitamin K injection before the procedure if PT is prolonged. This is to prevent bleeding.

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- position of the client during the procedure: left lateral position, because the liver is found in the right side of the abdomen. - instruct client to exhale deeply, hold breath for 5 to 10 seconds during needle insertion to prevent trauma to the diaphragm. - position of the client after the procedure: right side for 4 hours to apply pressure and prevent bleeding.

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5. Paracentesis - check initial VS. - ask client to empty the bladder before the procedure to prevent puncture of the bladder. - place the client in upright or sitting position. - after the procedure, monitor the client for hypovolemic shock and peritonitis. - hypotension is the most characteristic manifestation of hypovolemic shock. - fever, pain and rigidity of the abdomen

indicate peritonitis.

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6. Endoscopic Retrograde Cholangiopancreatography (ERCP) - involves upper G.I. endoscopy for introduction of contrast medium. - assess for allergy to seafoods and iodine. - after the procedure, keep the client on NPO until gag reflex returns; turn client to sides to prevent aspiration.

7. Ultrasound of the gall bladder - the most definitive test to detect gallstones.

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Endocrine System 1. Pancreas: Diabetes Mellitus (DM) - FBS, 2- hour PPBS, OGTT/ GTT levels are

elevated in DM. - Glycosylated hemoglobin is the most accurate

indicator of DM; it reflects serum glucose levels for the past 3- 4 months.

2. Thyroid Gland - T3, T4, RAIU are increased in hyperthyroidism;

decreased in hypothyroidism. - Thyroid scan helps determine whether the tumor is

benign or malignant. - Fine needle biopsy is done to confirm malignancy.

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- Basal Metabolic Rate requires NPO for 10- 12 hours; night sleep of 8- 10 hours; client is instructed not to get up from the bed the following morning until the test is done.

- Reflex testing (kinemometry) a. in hyperthyroidism, tendon of Achilles

reflex is hyperactive due to hypocalcemia. b. in hypothyroidism, tendon of Achilles

reflex is hypoactive due to hypercalcemia.

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3. Adrenal glands a. adrenal cortex - plasma cortisol is elevated in Cushing’s

Syndrome; low values in Addison’s disease.

- 24- hour urinary free cortisol test helps establish diagnosis of hypercortisolism.

b. adrenal medulla - Vanillylmandelic Acid (VMA) test is

done to detect pheochromocytoma. VMA is the metabolite of epinephrine.

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- 24- hour urine specimen is collected for VMA test.

- instruct client to avoid the following during 24- hour urine collection: coffee, tea, chocolate, banana, vanilla, aspirin because these may alter test result.

- elevated VMA test indicates pheochromocytoma, a tumor in the adrenal medulla.

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F. Genito- Urinary System 1. Routine Urinalysis - the best time to collect urine specimen is in

the morning upon awakening. - instruct client to cleanse external genitals

with soap and water to reduce microorganisms in the area. This prevents contamination of the specimen.

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- instruct the client to discard the first flow of urine, collect the midstream, then discard the last flow. The last flow of urine in males may be contaminated with semen.

- label properly and send the urine specimen immediately to the laboratory. This prevents contamination of the specimen and the environment.

2. Creatinine Clearance - the best indicator of glomerular function. - requires 24- hour urine specimen. - values are low in renal function impairment.

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- to collect 24- hour urine specimen, discard the first voided urine specimen. This urine was formed before the time of collection. Then collect all specimen thereafter. Include the last voided specimen. E.g., Wednesday 10 AM to Thursday 10 AM. Discard the urine specimen voided on Wednesday 10 AM, collect the specimen voided on Thursday 10 AM. If a specimen was discarded, restart collection the following day.

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3. Cystoscopy - done under local or general anesthesia. - force fluids before the procedure if done under local anesthesia. To prevent ascending UTI. - maintain NPO, if done under general anesthesia. - the client is placed in lithotomy position during the procedure. - after the procedure, pink- tinged urine is normal for 24- 48 hours. - urinary retention, signs of infection, and excessive hematuria should be reported to the physician.

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4. KUB - plain X- Ray of the kidneys, ureters, and bladder. - laxative is administered the night before the test to remove gas and feces from the colon before the test.

5. Intravenous Pyelogram (IVP)/ Excretory Urogram - contrast medium (hypaque) is administered per IV. - assess allergy to seafoods and iodine. - administer laxative to cleanse the colon. - the most dangerous potential complication is anaphylactic shock; have epinephrine readily available.

6. Retrograde Pyelogram - contrast medium is administered through cystoscope; outlines renal pelvis and ureters.

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7. Ultrasound of the kidneys, ureters, bladder - distend the bladder by giving 2 glasses of water to the client. - instruct client to withold voiding; distended bladder permits better imaging.

8. Renal Biopsy - check coagulation studies; bleeding is the most common complication of the procedure. - during the procedure, the client is placed in prone position. - after the procedure, the client is placed in supine position with small pillow or rolled towel placed under the posterior lumbar area. To apply pressure and prevent bleeding. - monitor for signs and symptoms of internal bleeding.

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Musculoskeletal System 1. Blood Tests for Rheumatoid Arthritis

a. (+) Rheumatoid factors b. Elevated ESR c. (+) Antinuclear Antibodies (ANA) d. (+) C- Reactive Protein e. (+) Complement Fixation Test

2. Blood tests for Systemic Lupus Erythematosus (SLE) a. (+) LE (lupus erythematosus) cells b. (+) anti- DNA Test (most definitive for SLE) c. (+) ANA d. Elevated ESR e. Pancytopenia

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3. Blood Tests for Bone Cancer a. Elevated serum Calcium b. Elevated serum alkaline phosphatase c. Elevated phosphorous

4. Blood and Urine Tests for Gout a. Elevated urine and serum uric acid

5. Muscle Enzymes - Elevated in skeletal muscle injury: Aldolase, AST, CK- MM, LDH.

5. Bone X- Ray - To detect bone fracture.

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6. Bone Scan - Instruct client to void immediately before the procedure to prevent irritation of the bladder by the radioisotope.

7. Arthroscopy - Performed in O.R. - Apply pressure dressing over the puncture site for 24 hours to prevent bleeding. - Suture is removed after 7 days. - Limit activity for few days.

8. Arthrocentesis - Apply pressure dressing over puncture site for 24 hours to prevent bleeding.

9. Arthrography - assess for history of allergy to iodine or seafood.

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Eye and Ear A.  Diagnostic Assessment of the Eyes

1. Snellen’s Test - tests visual acuity. - normal result is 20/ 20. - the numerator indicates the distance of the client from the chart.

- the denominator indicates the distance at which the normal eye can read the letters.

- result of 20/ 200 indicates legal blindness.

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- Snellen’s test result s of 20/ 30 or greater indicates myopia/ nearsightedness; results of

20/ 15 or less indicates hyperopia/ farsightedness.

2. Tonometery - indirectly measures intraocular pressure (IOP) - IOP of 25 mmHg and above indicate glaucoma. 3. Perimetry - normal peripheral visual field is 90 degree angle. - loss of peripheral visual field indicates glaucoma. 4. Bjerrum Tangent Screen - measures central vision. Macular damage causes

loss of central vision.

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5. Ophthalmoscopy - examines the fundus, interior of the eyes. - may diagnose retinal detachment and papilledema/ choked disk.

B. Diagnostic Assessment of the Ears 1.  Tuning Fork Tests

a. Rinne’s Test - compares air conduction from bone conduction; the vibrating tuning fork is placed against the mastoid process (behind the ear), then 2 inches from the opening of the ear canal.

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- normal result: air conduction is better than bone conduction.

- conductive hearing loss: bone conduction is better than air conduction.

- sensorineural hearing loss: result is same as normal result.

- the test is valuable in the diagnosis of otosclerosis, which is characterized by conductive hearing loss.

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b. Weber Test - the rounded tip of the handle of vibrating tuning fork is placed in the center of the client’s head. - interpretation of results:

a. Normal: tone is perceived in the center of the client’s head or equally in both ears.

b. Conductive hearing loss: tone is heard better in the poor ear.

c. Sensorineural hearing loss: tone is heard better in the good ear.

- this test is valuable in the diagnosis of Meniere’s Disease, which is characterized by sensorineural hearing loss.

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2. Whisper Voice Test - the client covers one ear with the palm of the hand, then the examiner whispers softly from a distance of 1 t0 2 feet from the uncovered ear. - the person with normal hearing acuity can correctly repeat what was whispered.

3. Audiometry - this is the single most important diagnostic test in detecting hearing loss. - may be pure tone or speech audiometry. - the critical level of loudness is 30 decibels.

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4. Oculovestibular Test/ Caloric Test - the ear is irrigated with cold water, then warm

water. - Normal: lateral conjugate nystagmus of the eyes towards area of stimulation if warm water is used to irrigate the ear; nystagmus of the eyes is away from the area of stimulation if cold water is used. - Abnormal: dysconjugate nystagmus of the eyes when ear is irrigated with warm and cold water. This indicates impairment of function of the vestibular branch of the acoustic nerve.

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Positioning of Patients

Care of clients with Respiratory Disorders •  After lung biopsy, turn the client toward

affected side. To apply pressure in the area and prevent bleeding.

•  During thoracentesis, place the client in upright or sitting position at the edge of the bed, arms on an overbed table, leaning forward, feet supported on a foot stool. This position permits easy access to the site of insertion of aspiration needle. In addition, this will promote comfort of the client.

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•  After thoracentesis, position the client toward unaffected side for at least an hour, to prevent leakage of fluid into the thoracic cavity.

•  The client on oxygen therapy is best placed in semi- Fowler’s position. To enhance lung expansion and ventilation.

•  During tracheostomy or endotracheal tube suctioning, the client is preferably placed in semi- Fowler’s position. To facilitate insertion of suction catheter and enhance removal of mucous secretions.

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•  During postural drainage, position the client so that the area of accumulation of mucous secretions is in vertical position with the bronchus. To facilitate drainage of secretions by gravity, e.g., if the affected area is a lower lobe, the head part should be lower than the body (Trendelenburg position).

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•  After bronchography and bronchoscopy, the client should be placed in side- lying/ lateral position or semi- Fowler’s position. This is to promote drainage of secretions from the mouth and prevent aspiration.

•  The client with COPD/ CAL ( chronic obstructive pulmonary disease / chronic airflow limitation) is best placed in sitting upright, leaning forward position, with arms on overbed table at shoulder level (orthopneic position). Upright position moves the diaphragm down, by gravity. This allows adequate lung expansion. Leaning forward position allows adequate exhalation of retained carbon dioxide. Elevation of the arms at shoulder level allows adequate movement of respiratory muscles.

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•  The client with epistaxis (nosebleeding) is best placed in sitting/ upright position, leaning forward with head tipped. This position prevents aspiration of blood.

•  After tonsillectomy, the client is placed either in side- lying/ lateral position or in prone position with pillow under the chest. This is to promote drainage of secretions from the mouth and therefore, prevent aspiration. Once the client is awake, he may be placed in semi- Fowler’s position.

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•  The client with pulmonary edema is best placed in high- Fowler’s position, with legs slightly dependent (lowered). High- Fowler’s position is effective in relieving dyspnea. Lowering the client’s legs will reduce venous return to the heart (preload), thereby reducing cardiac workload.

•  The client who had undergone pneumonectomy should be turned slightly towards affected side (one-quarter of a full turn), with head elevated or be placed in semi- Fowler’s position. Turning the client towards affected side prevents flooding of the remaining lung with blood from the operated side. Slight turning,( not full side- lying position) towards affected side is done to prevent mediastinal shift. Semi- Fowler’s position permits maximum lung expansion.

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•  After lobectomy, segmentectomy, wedge resection, decortication, thoracoplasty, place the client in semi- Fowler’s position or turn to the unaffected side with head elevated. Semi- Fowler’s position permits maximum lung expansion. Turning the client to the unoperated side allows adequate ventilation of the involved lung.

•  The client with flail chest is best placed in semi- Fowler’s position, turned towards the affected side or the affected side be supported. This is to control paradoxical breathing thereby, prevent hypercapnea (retention of carbon dioxide).

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•  The child with epiglottitis, laryngotracheobronchitis, bronchiolitis, usually assumes the tripod position (sitting upright, leaning forward with hands on the bed/ floor). This position facilitates breathing.

•  To prevent SIDS (Sudden Infant Death Syndrome), place the infant during sleep in supine or side- lying position in a firm bed. Refrain from placing the infant in prone position during sleep. This position had been associated with SIDS. In addition, do not place the infant in soft bed or over a pillow or over a comforter. Sleeping on soft surface had also been associated with SIDS.

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Care of Clients with Cardiovascular and Hematologic Disorders

•  The most comfortable position for the client

with myocardial infarction (MI) is semi- Fowler’s. This position promotes maximum lung expansion and improves myocardial oxygenation.

•  The client with congestive heart failure (CHF) is best placed in high- Fowler’s position. This position relieves dyspnea and reduces cardiac workload.

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•  During central venous pressure (CVP) monitoring, the client is best placed in supine position. However if the client is dyspneic and is unable to tolerate supine position, the CVP reading is taken with head of bed (HOB) elevated. Record the degree of elevation of HOB during the initial reading, and place the client in the same position during the subsequent readings. This is to ensure accuracy of CVP readings.

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•  If the client had undergone cardiac catheterization that involves the femoral artery, the client should be on bedrest for 24 hours, with the lower extremities in extension. The HOB may be elevated at a maximum of 30- degree angle for the first 24 hours. Acute flexion of the area may cause circulatory impairment.

•  When taking nitroglycerine, assume sitting or supine position for several minutes. To prevent orthostatic hypotension.

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•  During cardioversion,defibrillation, cardiopulmonary resuscitation (CPR), the client is best placed in supine position on a flat, firm surface.

•  The client with arterial insufficiency (e.g. arteriosclerosis obliterans, Raynaud’s disease, Buerger’s disease), should be positioned with the lower extremities slightly lower than the level of the heart (dependent position). This position promotes arterial flow.

•  The client with venous insufficiency (e.g., varicose veins in the legs, thrombophlebitis) should be positioned with the lower extremities elevated. This position promotes venous return and relieves edema of the legs.

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•  The child with Tetralogy of Fallot in “tet spell” (hypoxic episode) should be placed in knee-to-chest position (squatting position is usually assumed by older children). This position improves venous return to the heart, increases cardiac output, and improves tissue oxygenation.

•  If the client receiving IV fluid infusion experiences signs and symptoms of air embolism, he should be placed on the left side- lying, Trendelenburg position (left side- lying position with HOB lower than the foot part). This position allows the air to be absorbed in the right side of the heart and prevents pulmonary embolism.

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Care of the Clients with Gastrointestinal, Hepato-Biliary and Pancreatic Disorders

•  During examination of the abdomen, the client

is placed in dorsal recumbent position (supine with knees flexed). This is to relax the abdominal muscles and facilitate examination of abdominal organs.

•  During rectal examination, the client is placed in lateral/ side-lying position. To facilitate examination of the area.

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•  After upper gastrointestinal endoscopy (esophagoscopy, gastroscopy, doudenoscopy), the client should be placed in lateral/ side- lying position. This promotes drainage from the mouth and prevents aspiration. (The gag reflex was depressed by anesthetic spray into the throat during the procedure to facilitate insertion of endoscope).

•  After endoscopic retrograde cholangiopancreatography (ERCP), the client is placed in side- lying position. (This procedure involves upper G.I. endoscopy).

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•  During nasogastric tube (NGT) insertion, the client should be placed in high- Fowler’s position, with the neck hyperextended, initially. Once the tube reaches the oropharynx, the neck is slightly flexed. The tube is advanced as the client swallows sips of water, if permissible. These actions facilitate insertion of the NGT.

•  During and after NGT feeding (gastric gavage) and gastrostomy feeding, the client is best placed in semi- Fowler’s position. This position prevents reflux and aspiration of feeding.

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•  After insertion of intestinal/ nasoenteric tube (e.g., Cantor tube, Miller- Abbot tube), the client should be placed in right side- lying position, to help advance the tube into the duodenum.

•  During insertion of total parenteral nutrition (TPN) catheter, through the subclavian vein, the client should be placed in Trendelenburg position. This is to engorge the vein and facilitate insertion of the catheter. This will also prevent air embolism.

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•  During enema administration, the adult client should be placed in left lateral position. This is to facilitate the flow of solution by gravity.

•  During enema administration in an infant or small child, the child should be placed in dorsal recumbent position.

•  The client with hiatal hernia should assume upright / sitting position during and after eating. This is to prevent gastroesophageal reflux.

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•  After gastric and biliary surgery (during immediate postoperative period), the client should be placed in semi- Fowler’s position. This is to promote lung expansion and ventilation, and to prevent atelectasis. (Gastric and biliary surgery involve high abdominal incision / near the diaphragm. Therefore, there is high risk for respiratory complications to occur).

•  To prevent dumping syndrome after gastric surgery, the client should lie down in left side- lying position. This is to slow down emptying of gastric content into the duodenum.

•  If the client has peritonitis, he is preferably placed in semi- Fowler’s position. This is to localize the inflammatory process in the pelvic area.

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•  Colostomy irrigation is done with the client in semi- Fowler’s position, then sitting on a toilet bowl once he/ she is ambulatory.

•  After hemorrhoidectomy, the client should be placed in side- lying position. To prevent pressure in the operated area and to promote comfort.

•  After feeding an infant, place him/ her in right side- lying position. To prevent gastroesophageal reflux and aspiration.

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•  After cleft lip repair, the client is placed in side- lying position. This is to promote drainage from the mouth and to prevent aspiration. Do not place the client in prone position to prevent tension on the suture line. Elbow restraints should also be applied to prevent trauma to the suture line.

•  After cleft palate repair, the client may be placed in side- lying and prone positions. These positions promote drainage from the mouth and prevent aspiration.

•  After repair of imperforate anus, the child is placed in side- lying position or supine with the legs suspended at right angle. This is to prevent pressure in the operated area thereby, minimize discomfort.

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•  During liver biopsy, the client is placed on the left side. To facilitate approach to the liver which is located in the right side of the abdomen (right upper quadrant).

•  After liver biopsy, the client is turned to the right side, with rolled towel under the puncture site. This is to apply pressure at the puncture site and prevent bleeding.

•  During paracentesis, the client is placed in sitting/ upright position. To facilitate aspiration of abdominal (peritoneal) fluid.

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Care of Clients with Endocrine Disorders •  After transphenoidal hypophysectomy, the

client is placed in semi- Fowler’s position (HOB elevated for 2 weeks). To promote venous drainage and drainage of fluids from the surgical site.

•  After thyroidectomy, the client should be placed in semi- Fowler’s position with the head, neck, and shoulders erect. Avoid hyperextension and flexion of the neck to prevent tension on the suture line. Tension on the suture line may cause bleeding.

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•  During episode of hypertension in a client with pheochromocytoma, the client should be positioned with HOB elevated (Fowler’s position) to provide orthostatic decrease in blood pressure.

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Care of Clients with Fluid- Electrolyte, Acid- Base Imbalances, Genito-

Urinary Disorders, Shock, Burns •  During insertion of urinary catheter,

position the client as follows: Male: supine with legs extended and

abducted. Female: dorsal recumbent (supine with

knees flexed). •  During cystoscopy, the client is placed in

lithotomy position. This position promotes easy insertion of cystoscope.

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•  During renal biopsy, the client should be placed in prone position, because the kidneys are located retroperitoneally.

•  After renal biopsy, the client should be placed in supine position with small pillow or rolled towel under the posterior lumbar area to apply pressure and prevent bleeding.

•  During insertion of peritoneal catheter for peritoneal dialysis, the client should be placed in dorsal recumbent position or semi- Fowler’s position with the knees flexed. This is to relax abdominal muscles and facilitate insertion of the peritoneal catheter.

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•  During vaginal examination, the client should be placed in dorsal recumbent position, if she is in bed. If the procedure is done on an examination table, the client is placed in lithotomy position. This is to facilitate visualization and examination of the area.

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•  The client in shock should be placed in modified Trendelenburg position (supine with small head pillow to prevent cerebral venous congestion ; legs elevated at 20- 30 degree angle; hips higher than the trunk, to promote venous return). Increased venous return causes increased force of cardiac contractility and therefore, increased cardiac output and tissue perfusion).

•  The client with burns (especially on the face, neck, chest, arms, and body) should be positioned supine to promote position of extension. This is to prevent contractures.

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Care of Clients with Neurologic Disorders •  During lumbar puncture, the client should be

placed in lateral, knee- chest position (fetal position/ flexed position/ C- position/ shrimp position) to widen intervertebral spaces and facilitate insertion of spinal needle.

•  After lumbar puncture, the client should lie flat for 6 to 8 hours to prevent headache due to leakage of CSF (cerebrospinal fluid) from the puncture hole. The client is allowed to turn to sides.

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•  After cerebral angiography that involves femoral puncture, keep the affected leg extended and immobile for few hours. This is to promote circulation and prevent dislodgement of blood clot. The client should be on bed rest for 24 hours.

•  After pantopaque (oil- based dye) myelogram, the client should lie flat for 6 to 24 hours to prevent spinal headache. (All of the oil- based dye can be removed after the procedure because it does not mix with CSF).

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•  After metrizamide (water- based dye) myelogram, HOB is elevated at 30- degree angle (semi- Fowler’s) for at least 8 hours to prevent meningeal irritation. ( The water- based dye combines well with CSF. Therefore, not all of it is removed after the procedure).

•  The client with increased intracranial pressure should be placed in lateral, semi- Fowler’s position (HOB elevated at 15 to 30- degree angle up to 45- degree angle). This is to drain CSF from the subarachnoid space of the brain to the subarachnoid space of the spinal cord. This will reduce the intracranial pressure (ICP). This position will also promote adequate lung expansion and improve cerebral tissue oxygenation. The head of the client should be in neutral position. Flexion of the neck will result to cerebral venous congestion causing further increase in ICP. Elevation of HOB more than 45- degree angle may cause brain herniation.

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•  The client with spinal cord injury should be placed in flat/ supine position on a firm surface (spinal board). This is to maintain alignment of the spine.

•  The client on aspiration precaution (e.g.,neuromuscular disorders) should be placed in an upright position during feeding or drinking.

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Care of Clients with Musculoskeletal Disorders •  The client in Bryant’s traction should be

placed in supine position with both legs suspended at 90- degree angle. Both legs are elevated even if only one hip is affected because the weight of the child is not adequate to provide countertraction. The knees should be slightly flexed to prevent hyperextension deformity of the knees. Hyperextension deformity of the knees will cause inability of the child to flex the knees.

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The buttocks should be off from the mattress by one inch. This is to improve the efficiency of the weight of the body as countertraction.

•  The client in Buck’s traction should be placed in supine position, with the foot- part of the bed elevated. This is to improve the efficiency of the weight of the body as countertraction. Elevate the affected leg with a pillow to prevent pressure sore at the heel of the foot.

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•  The client in Russell traction should be placed in supine position with knees flexed at 20 to 30 degree angle, supported with sling. Check the back of the knee for pressure sore.

•  In 90- 90 traction, the client’s thigh is positioned at 90- degree angle (perpendicular) with the body and his leg is at 90- degree angle with the thigh.

•  The client in balanced suspension traction is placed in supine position, with the affected leg supported with Thomas splint and the knee flexed at 20- 30 degree angle. If the client is in Thomas splint, check the groin for pressure sore. The foot should be supported with footplate to prevent footdrop.

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•  The client using crutches should assume tripod position (place crutches forward and to the side) for balance and stability.

•  After lumbar laminectomy, the client should be placed in flat position and turned as a unit (logrolling technique). This is to maintain alignment of the operated area.

•  After cervical laminectomy, the client should be placed in semi- Fowler’s position to facilitate breathing and relieve pressure from the operated area.

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•  The client on crutchfield traction tongs should be placed flat on bed, and turned as a unit. Massage back of the head to prevent pressure

sore. •  After total hip replacement (hip arthroplasty)

the client is placed in supine position, with the affected extremity extended and abducted with abductor pillow. This is to keep the prosthesis in place. The HOB may be elevated at a maximum of 30- degree angle during eating. Once the client is allowed to sit up, hip flexion should be up to 90- degree angle only. Acute hip flexion may cause dislodgment of the prosthesis.

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•  After amputation of lower extremity, the stump should be positioned in adduction with the unaffected extremity. This is to prevent contracture deformity of the hip.

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Care of the Client with Eye and Ear Disorders

•  After eye surgery (e.g., cataract extraction), the client should be placed in supine position and he may be turned to the unoperated side. This is to prevent trauma to the operated eye. Once the client is fully awake, he may be placed in semi- Fowler’s position.

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•  The client with retinal detachment should be positioned as follows:

a.  Preoperatively, the area of detachment should be on dependent position (lower), to allow the vitreous humor to apply pressure in the area . This will prevent further detachment of the retina.

b.  Postoperatively, the area affected should be in upper position. This is to lower the sclera and choroid by gravity and allow attachment of the area of detachment.

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•  After ear surgery, the client should be turned to the unoperated side to prevent trauma to the operated ear.

Care of Clients After Breast Surgery •  After mastectomy, the client should be placed

in semi- Fowler’s position with the arm on the affected side abducted and elevated with pillow. This is to promote venous return and to prevent lymphedema.

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Dietary Guidelines

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Protein Food Sources

Meats Dairy Products Cereal Products Dried Beans

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Protein & Fat in Common Food Sources

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Food Sources of Vitamins

1.  Water – soluble Vitamins

a.  Vitamin C (Ascorbic Acid) Citrus fruits Tomatoes “greens” Guava Broccoli Potatoes Strawberries Cabbage

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b.  Vitamin B1 (Thiamine) Pork liver Nuts Eggs Whole and enriched grains Organ meats Legumes Milk Potatoes

c.  Vitamin B2 (Riboflavin)

Milk Organ meats Enriched grains Dairy products Lean meats Green leafy Vegetables Fish Eggs

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d.  Vitamin B3 (Niacin) Kidney, liver Fish Whole grain Poultry Peanut butter Nuts Lean meat Dried peas and greens

e.  Vitamin B6 (Pyridoxine)

Meats Yeast Bananas Poultry Oats Egg yolk Fish Corn Whole grain cereals Organ meats Peanuts Wheat germ Potatoes

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f.  Vitamin B9 (Folacin/Folic Acid) Green,leafy vegetables Legumes Asparagus Eggs Organ meats Yeast Beef Wheat germ Fish Grapefruit and orange

g.  Vitamin B12 (Cobalamin/Cyanocobalamin) Liver Oyster Eggs Kidney Meat Cheese Shrimp Milk

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2.  Fat-soluble Vitamins

a.  Vitamin A (Retinol) Liver Dark green and yellow/ Fish liver oil orange vegetables Milk and dairy products (sweet potatoes, squash Margarine carrots, broccoli, spinach,

Breakfast cereals “greens”) Cantaloupe

b.  Vitamin D (Ergocalciferol) Fortified Milk Liver Margarine Salmon Butter Sardines Breakfast cereals Tuna Egg yolk Fish oils

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c.  Vitamin E (Tocopherol) Vegetable oils Peanut Green, leafy vegetables Margarine Wheat germ/ cereals Apples Corn Peaches

d.  Vitamin K (Menadione)

Green, leafy vegetables Cheese Cauliflower Egg yolk Cabbage Liver Bacon Yogurt

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Food Sources of Minerals a.  Calcium

Yogurt, low fat Broccoli Milk and dairy products Carrots Green, leafy vegetables Seafoods Rhubarb Tofu Nuts, legumes Whole grains

b.  Potassium Bananas Mushrooms Raisins (and other dried fruits) Avocado Lima Beans Carrots Fish Cantaloupe Pork Sunflower seeds Tomatoes Oranges Grape fruit Potatoes Beef, veal Strawberries Nuts Spinach Sanka Coffee

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c.  Iron Liver Egg yolk Meats Breads, cereals Dark-green vegetables Clams Green and red beans Seaweeds (Dried beans)

d.  Iodine Iodized salt Milk Bread Sea foods Eggs

e.  Sodium Table salt Milk Canned food Soy sauce Butter Processed foods Cured pork Ketchup White and whole wheat bread Cheese Mustard Snack foods

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f. Magnesium Pork, beef, chicken Raisins Green leafy vegetables Peanut butter Avocado Cauliflower Canned tuna fish Low-fat yogurt Cooked rolled oats Milk Peas Potatoes

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Therapeutic Diets

a.  Clear liquid diet. Includes only liquids that lack residue.

Water Carbonated Beverages Bouillon Lemonades Clear broth Hard candy Gelatin Coffee, tea (without dairy products) Popsicles

b.  Full Liquid diet. Includes all fluids and foods that become liquid at room temperature.

Plain ice cream Strained soups Sherbet Strained vegetable juices Milk Pudding /custard

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c.  Soft diet. Includes soft food, chopped or pureed foods.

d.  Bland diet. Includes foods that are not gas-forming. Foods that stimulate gastric acid secretions and that are irritating to the gastric mucosa are eliminated . Foods to be avoided include: Alcohol Caffeine Caffeine – containing beverages (cola,

cocoa, coffee, tea) Fried foods Pepper and spicy foods

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e.  Low Residue/ low fiber diet. Includes foods that are least likely to form an obstruction when the intestinal tract is narrowed by inflammation or scarring or when GI motility is slowed.

Foods high in carbohydrates are usually low in residue, e.g., white bread, cereal, pasta.

Foods to be avoided are raw fruits (bananas are allowed), vegetables, seeds, plant fibers, whole grains. Dairy products are limited to two servings a day.

f.  High Fiber Diet. Includes fruits and vegetables.

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g.  Sodium – Restriction diet. A no-added – salt diet includes no salt at the table (e.g., salt shakers) and lightly salting foods during cooking. Foods to be avoided are as follows: P- rocessed foods M- oo foods (milk, dairy, products) S- alty foods Note: carrots and celery are vegetables with high

sodium content. (sodium- free spices and flavorings: allspice,

almond extract, bay leaves, caraway seeds, cinnamon, curry powder, garlic powder, garlic, ginger, lemon extract, maple extract, marjoram, mustard powder, and nutmeg).

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h.  Low-purine diet. Eliminate foods that contain purine, a precursor for uric acid. Foods to be avoided are as follows: organ meats (e.g. liver, gizzard) gravies meat extracts wild game goose sweetbreads fishes (e.g. anchovies, herring, mackerel,

sardines,scallops) shellfish mushroom beer, wine

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i.  Diets for Renal Calculi 1. Alkaline – ash diet. Includes foods that

increase pH. Foods allowed are as follows: Milk Fruits (except cranberries, blueberries,

plums, prunes) Rhubarb Small amounts of beef, halibut, veal,

trout, and salami.

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2.  Acid – ash diet. Includes foods that decrease pH. Foods allowed are as follows: Egg, Cheese Red Meat, Grains Cranberries, blueberries, plums,

prunes Fish Poultry Oysters

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j. Tyramine Rich Foods (avoid with antidepressants especially MAOI’s and stimulant medications)

Processed Foods Aged Foods Fermented Foods

Examples: Avocado Banana Mango Red/White Wine Aged Cheese Beer Pepperoni Pickled Fish Ripe & Dried Fruits Salami Yeast Yogurt Caffeinated Beverages Chocolates

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Note: The following are Gas – forming foods: Apples Cabbage Melons Artichokes Celery Milk Barley Cherries Molasses Beans Coconuts Nuts Bran Eggplant Onions Broccoli Figs Radishes Brussel Sprouts Honey Wheat & yeast

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