NCLEX RN Test Study Guide | studyguidezone.com
I n t r odu ct ion t o t h is Gu ide
Your NCLEX score is one of t he m ost crit ical elem ent s t o your qualificat ion t o becom e a nurse, so it is nat urally m uch t oo im port ant for you t o t ake t his t est unprepared. The higher your NCLEX score, t he bet t er your chances of passing t he boards.
Careful preparat ion, as described in t his expert guide, along w it h hard w ork, w ill dram at ically enhance your probabilit y of success. I n fact , it is w ise t o apply t his philosophy not only t o your board’s exam , but t o ot her elem ent s of your life as w ell, t o raise you above t he com pet it ion. Your NCLEX score is one of t he areas in t he licensure process over w hich you have a subst ant ial am ount of cont rol; t his opport unit y should not be t aken light ly. Hence, a rat ional, prepared approach t o your NCLEX t est as well as t he rest of t he licensure process w ill cont ribut e considerably t o t he likelihood of success.
Keep in m ind, t hat alt hough it is possible t o t ake t he NCLEX m ore t han once, you should never t ake t he t est as an “ experim ent ” j ust t o see how well you do. I t is of ext rem e im port ance t hat you always be prepared t o do your best w hen t aking t he NCLEX. For one t hing, it is ext rem ely challenging t o surm ount a poor perform ance. I f you ar e looking t o t ake a “ pract ice” run, look int o review course, professionally developed m ock NCLEX exam inat ions, and, of course, t his guide.
This guide provides you w it h t he professional inst ruct ion you require for underst anding t he t radit ional NCLEX t est . Covered ar e all aspect s of t he t est and preparat ion procedures t hat you w ill require t hroughout t he process. Upon com plet ion of t his guide, you’ll have t he confidence This guide provides you w it h t he professional inst ruct ion you require for underst anding t he t radit ional NCLEX t est . Covered ar e all aspect s of t he t est and preparat ion procedures t hat you w ill require t hroughout t he process. Upon com plet ion of t his guide, you’ll have t he confidence
Te st in g a n d An a lysis
I t w on’t t ake you long t o discover t hat t he NCLEX is unlike any t est you’ve t aken before, and it is probably unlike any t est you w ill ever t ake again in your academ ic career. The t ypical high school or college t est is a know ledge- based t est . The NCLEX, how ever, is applicat ion- based.
What does t his m ean t o you? I t m eans t hat you’ll have t o prepare yourself in a com plet ely different w ay! You w on’t sim ply be recit ing m em orized fact s as t hey w ere phrased in som e t ext book, and you w on’t be applying any learned form ulas t o specific problem s t hat w ill
be laid out .
The NCLEX requires you t o t hink in a t horough, quick and st rat egic m anner…and st ill be accurat e, logical and w ise. This t est is designed t o j udge your abilit ies in t he w ays t hat t he licensure boards feel is vit al t o t he success of first year nursing graduat e.
To som e ext ent , you have already gradually obt ained t hese abilit ies over t he lengt h of your academ ic career. However, what you probably have not yet becom e fam iliar w it h is t he capabilit y t o use t hese abilit ies for t he purpose of m axim izing perform ance w it hin t he com plex and profound environm ent of a st andardized, skills- based exam inat ion.
There are different st rat egies, m indset s and perspect ives t hat you w ill
be required t o apply t hroughout t he NCLEX. You’ll need t o be prepared t o use your w hole brain as far as t hinking and assessm ent is concerned, and you’ll need t o do t his in a t im ely m anner. This is not be required t o apply t hroughout t he NCLEX. You’ll need t o be prepared t o use your w hole brain as far as t hinking and assessm ent is concerned, and you’ll need t o do t his in a t im ely m anner. This is not
The follow ing chapt ers in t his guidebook w ill lay out t he form at and st yle of t he NCLEX as well as give you sam ple quest ions and exam ples of t he fram e of m ind you’ll be expect ed t o t ake. I f t here is one skill t hat you t ake w it h you from your preparat ion for t he NCLEX, t his should be it .
I n t r odu ct ion t o t h e N CLEX
The purpose of t he NCLEX is t o est ablish a st andard m et hod of m easurem ent for t he skills t hat have been acquired by nursing school graduat es. These skills are considered crit ical t o t he healt hcare profession. The principle behind t he NCLEX is sim ilar t o t he SAT’s t hat are required for applicat ion t o Am erican colleges. Alt hough t hese t est s are sim ilar experiences in som e respect s, t he NCLEX is a m uch m ore challenging and com plex.
Fort unat ely, t he NCLEX does not change very dram at ically from year t o year. What t his m eans t o you, is t hat it has becom e possible for qualit y pract ice t est s t o be produced, and if you should t ake enough of t hese t est s, in addit ion t o learning t he correct st rat egies, you w ill be able t o prepare for t he t est in an effect ive m anner.
The NCLEX is not j ust a m ult iple- choice t est . Fill in t he blank quest ions and m ult iple right answ er quest ions have been added t o t he t est . Alt hough t hese t ypes of quest ions are not t he m aj orit y of quest ions asked on t he NCLEX. The m ain point is t hat t he cont ent has st ayed t he sam e. The nursing principles t est ed prior t o t hese changes are st ill t he sam e. The cont ent has rem ained relat ively t he sam e. I f you underst and t he cont ent m at erial of t he exam , t he t ype of t est ing quest ion w on’t m at t er.
Th e N CLEX Scor in g Sca le
The m inim um num ber of quest ions asked on t he NCLEX- RN exam is
75. The m axim um num ber of quest ions is 265. The exam is offered in CAT form at w hich m eans t he difficult ly of t he quest ions varies significant ly. I f you m iss a quest ion, t he com put er w ill give you an easier quest ion. I f you get it right , t hen you w ill get harder quest ions.
Many NCLEX t est t akers freak out if com put er shut s off aft er 75 quest ions, or if t hey have t o t ake t he m axim um num ber of quest ions. The m ain point is t o be prepared t o go t he dist ance. Don’t be sprint er and concent rat e for 100 quest ions and t hen let your concent rat ion begin t o fade. Likew ise, don’t st ress on how m any quest ions you have t o t ake. You w on’t know t he out com e unt il you get your scores, so don’t st ress out .
Take som e t im e for yourself and do som et hing fun follow ing t he exam .
N CLEX Tips
1. Arrive early t o t he t est ing cent er.
2. Bring m ult iple form s of idea.
3. Wear layered clot hing.
4. Get a good night ’s sleep before t he t est . ( Don’t cram )
5. Use a st udy part ner w hen preparing for t he exam .
6. Be fam iliar w it h t he form at of t he exam .
7. Know your m edical t erm inology.
8. Lim it your dist ract ions preparing for t he exam .
9. Take t im e t o unw ind and reduce st ress as you prepare.
10. Rem em ber if you don’t pass, you can ret ake t he exam .
Ge n e r a l St r a t e gie s
St r a t e gy 1 : Un de r st a n din g t h e I n t im ida t ion
The t est w rit ers w ill generally choose som e m at erial on t he exam t hat w ill be com plet ely foreign t o m ost t est t akers. You can’t expect all of t he m edical t opics t o be a t opic w it h w hich you have a fair am ount of fam iliarit y. I f you do happen t o com e across a high num ber of t opics/ cases t hat you are ext rem ely fam iliar w it h, consider yourself lucky, but don’t plan on t hat happening.
Each case and scenario w ill be slight ly different . Try and underst and all of t he m at erial, w hile w eeding out t he dist ract er inform at ion. The cases w ill also frequent ly be draw n from real w orld experiences. Therefore, t he passage t hat you w ill face on t he t est m ay alm ost seem out of cont ext and as t hough it begins in t he m iddle of a m edical process. You w on’t have a nice t it le overhead explaining t he general t opic being covered but w ill im m ediat ely be t hrow n int o t he m iddle of a st range form at t hat you don’t recognize.
Get t ing hit by st range sounding m edical t opics t hat you don’t recognize, of w hich you m ay only have a sm all exposure, is j ust norm al on t he NCLEX. Just rem em ber t hat t he quest ions t hem selves w ill cont ain all t he inform at ion necessary t o choose a correct answ er.
St r a t e gy 2 : Fin din g you r Opt im a l Pa ce
Everyone reads and t est s at a different rat e. I t w ill t ake pract ice t o det erm ine w hat is t he opt im al rat e at w hich you can read fast and yet absorb and com prehend t he inform at ion. This is t rue for bot h t he flyover t hat you should init ially conduct and t hen t he subsequent reading you w ill have t o do as you go t hrough and begin focusing on a specific quest ion. How ever, on t he flyover, you are looking for only a surface level know ledge and are not t rying t o com prehend t he m inut ia of det ails t hat w ill be cont ained in t he quest ion. Basically, skim t he quest ion and t hen read t he quest ion slow ly.
Wit h pract ice, you w ill find t he pace t hat you should m aint ain on t he t est w hile answ ering t he quest ions. I t should be a com fort able rat e. This is not a speed- reading t est . I f you have a good pace, and don’t spend t oo m uch t im e on any quest ion, you should have a sufficient am ount of t im e t o read t he quest ions at a com fort able rat e. The t w o ext rem es you w ant t o avoid are t he dum bfounded m ode, in w hich you are lip reading every w ord individually and m out hing each w ord as t hough in a st upor, and t he overw helm ed m ode, w here you are panicked and are buzzing back and fort h t hrough t he quest ion in a frenzy and not com prehending anyt hing.
You m ust find your ow n pace t hat is relaxed and focused, allow ing you t o have t im e for every quest ion and give you opt im al com prehension. Not e t hat you are looking for opt im al com prehension, not m axim um com prehension. I f you spent hours on each w ord and m em orized t he quest ion, you w ould have m axim um com prehension. That isn’t t he goal t hough, you want t o opt im ize how m uch you com prehend w it h You m ust find your ow n pace t hat is relaxed and focused, allow ing you t o have t im e for every quest ion and give you opt im al com prehension. Not e t hat you are looking for opt im al com prehension, not m axim um com prehension. I f you spent hours on each w ord and m em orized t he quest ion, you w ould have m axim um com prehension. That isn’t t he goal t hough, you want t o opt im ize how m uch you com prehend w it h
St r a t e gy 3 : D on ’t be a Pe r fe ct ion ist
I f you’re a perfect ionist , t his m ay be one of t he hardest st rat egies, and yet one of t he m ost im port ant . The t est you are t aking is t im ed, and you cannot afford t o spend t oo m uch t im e on any one quest ion.
I f you are w orking on a quest ion and you’ve got your answ er split bet ween t wo possible answer choices, and you’re going back t hrough t he quest ion and reading it over and over again in order t o decide bet ween t he t wo answer choices, you can be in one of t he m ost frust rat ing sit uat ions possible. You feel t hat if you j ust spent one m ore m inut e on t he problem , t hat you w ould be able t o figure t he right answ er out and decide bet w een t he t w o. Wat ch out ! You can easily get so absorbed in t hat problem t hat you loose t rack of t im e, get off t rack and end up spending t he rest of t he t est playing cat ch up because of all t he w ast ed t im e, w hich m ay leave you rat t led and cause you t o m iss even m ore quest ions t hat you w ould have ot herw ise.
Therefore, unless you w ill only be sat isfied w it h a perfect score and your abilit ies are in t he t op .1% st rat a of t est t akers, you should not go int o t he t est w it h t he m indset t hat you’ve got t o get every quest ion right . I t is far bet t er t o accept t hat you will have t o guess on som e quest ions and possibly get t hem w rong and st ill have t im e for every quest ion, t han t o analyze every quest ion unt il you’re absolut ely confident in your answ er and t hen run out of t im e on t he t est .
St r a t e gy 4 : Fa ct u a lly Cor r e ct , bu t Act u a lly W r on g
A favorit e ploy of quest ion writ ers is t o writ e answer choices t hat are fact ually correct on t heir own, but fail t o answ er t he quest ion, and so are act ually wrong.
When you are going t hrough t he answer choices and one j um ps out for being fact ually correct , w at ch out . Before you m ark it as your answ er choice, first m ake sure t hat you go back t o t he quest ion and confirm t hat t he answ er choice answ ers t he quest ion being asked.
St r a t e gy 5 : Ex t r a n e ou s I n for m a t ion
Som e answ er choices w ill seem t o fit in and answ er t he quest ion being asked. They m ight even be fact ually correct . Everyt hing seem s t o check out , so w hat could possibly be w rong?
Does t he answer choice act ually m at ch t he quest ion, or is it based on ext raneous inform at ion cont ained in t he quest ion. Just because an answer choice seem s right , don’t assum e t hat you overlooked inform at ion w hile reading t he quest ion. Your m ind can easily play t ricks on you and m ake you t hink t hat you read som et hing or t hat you overlooked a phrase.
Unless you are behind on t im e, alw ays go back t o t he quest ion and m ake sure t hat t he answ er choice “ checks out .”
St r a t e gy 6 : Avoidin g D e fin it e s
Answ er choices t hat m ake definit e st at em ent s w it h no “ w iggle room ” are oft en w rong. Try t o choose answ er choices t hat m ake less definit e and m ore general st at em ent s t hat w ould likely be correct in a w ider range of sit uat ions and aren’t exclusive. Exam ple:
A. The nurse should follow universal cont act precaut ions at all t im es in every case.
B. The nursing assist ant com plet ely dem onst rat ed poor aw areness of t ransfer safet y.
C. Never allow new m edicat ions t o be accessible on t he unit .
D. Som et im es, t he act ion t aken by t he aide w as not w ell planned.
Wit hout know ing anyt hing about t he quest ion, answ er choice D uses t he t erm “ som et im es,” w hich has w iggle room , m eaning t here could have been a few st rong point s and w eak point s about t he aide’s perform ance. All of t he ot her answer choices have a m ore definit e sense about t hem , im plying a m ore precise answ er choice w it hout w iggle room t hat is oft en w r ong.
St r a t e gy 7 : Usin g Com m on Se n se
The quest ions on t he t est are not int ended t o be t rick quest ions. Therefore, m ost of t he answer choices w ill have a sense of norm alcy about t hem t hat m ay be fairly obvious and could be answered sim ply by using com m on sense.
While m any of t he t opics w ill be ones t hat you are som ew hat unfam iliar w it h, t here w ill likely be num erous t opics t hat you have som e prior indirect knowledge about t hat w ill help you answ er t he quest ions.
St r a t e gy 8 : I n st in ct s a r e Righ t
When in doubt , go w it h your first inst inct . This is an old t est - t aking t rick t hat st ill w orks t oday. Oft ent im es if som et hing feels right inst inct ively, it is right . Unfort unat ely, over analyt ical t est t akers w ill oft en convince t hem selves ot herw ise. Don’t fall for t hat t rap and t ry not t o get t oo nit picky about an answ er choice. You shouldn’t have t o t w ist t he fact s and creat e hypot het ical scenarios for an answ er choice t o be correct .
St r a t e gy 9 : N o Fe a r
The dept h and breadt h of t he NCLEX t est can be a bit int im idat ing t o a lot of people as it can deal w it h t opics t hat have never been encount ered before and are highly t echnical. Don’t get bogged dow n by t he inform at ion present ed. Don’t t ry t o underst and every facet of t he nursing m anagem ent process. You w on’t have t o w rit e an essay about t he t opics aft erw ards, so don’t m em orize all of t he m inut e det ails. Don’t get overw helm ed.
St r a t e gy 1 0 : D on ’t Ge t Th r ow n Off by N e w
I n for m a t ion
Som et im es t est w rit ers w ill include com plet ely new inform at ion in answer choices t hat are wrong. Test t akers will get t hrown off by t he new inform at ion and if it seem s like it m ight be relat ed, t hey could choose t hat answer choice incorrect ly. Make sure t hat you don’t get dist ract ed by answ er choices cont aining new inform at ion t hat doesn’t answ er t he quest ion.
Exam ple: Which conclusion is best support ed?
A: Hyponat rem ia can cause t he anxiet y present ed in t his case.
Was anxiet y even discussed in t he quest ion? I f t he answ er is NO – t hen don’t consider t his answ er choice, it is w rong.
St r a t e gy 1 1 : N a r r ow in g t h e Se a r ch
Whenever t w o answ er choices are direct opposit es, t he correct answ er choice is usually one of t he t wo. I t is hard for t est writ ers t o resist m aking one of t he w rong answ er choices w it h t he sam e w ording, but changing one word t o m ake it t he direct opposit e in m eaning. This can usually cue a t est t aker in t hat one of t he t wo choices is correct .
Exam ple:
A. Calcium is t he prim ary m ineral linked t o ost eoporosis t reat m ent .
B. Pot assium is t he prim ary m ineral linked t o ost eoporosis t reat m ent .
These answer choices are direct opposit es, m eaning one of t hem is likely correct . You can t ypically rule out t he ot her t wo answ er choices.
St r a t e gy 1 2 : You ’r e n ot Ex pe ct e d t o be Ein st e in
The quest ions w ill cont ain t he inform at ion t hat you need t o know in order t o answ er t hem . You aren’t expect ed t o be Einst ein or t o know all relat ed know ledge t o t he t opic being discussed. Rem em ber, t hese quest ions m ay be about obscure t opics t hat you’ve never heard of. I f you w ould need t o know a lot of out side know ledge about a t opic in order t o choose a cert ain answ er choice – it ’s usually w rong.
Re spir a t or y Con dit ion s
Pulm onary Valve St enosis
Causes: Congenit al
Test s:
Endocardit is Cardiac cat het erizat ion Rheum at ic Fever
ECG Chest - Xray
Sym pt om s:
Echocardiogram
Faint ing SOB
Treat m ent :
Palpit at ions
Prost aglandins
Cyanosis
Dieuret ics
Poor w eight gain Ant i- arrhyt hm ics
Blood t hinners
Valvuloplast y
ARDS- low oxygen levels caused by a build up of fluid in t he lungs and inflam m at ion of lung t issue.
Causes: Traum a
Sym pt om s:
Chem ical inhalat ion
Low BP
Pneum onia Rapid breat hing Sept ic shock
SOB
Test s:
Cyanosis
ABG
Chest X- ray
CBC Cult ures Treat m ent :
Mechanical Vent ilat ion Echocardiogram
Treat t he underlying condit ion Auscult at ion Monit or t he Pat ient for: Pulm onary fibrosis Mult iple syst em organ failure Vent ilat or associat ed pneum onia Acidosis Respirat ory failure
Respirat ory Acidosis- Build- up of Carbon Dioxide in t he lungs t hat causes acid- base im balances and t he body becom es acidic.
Causes: Confusion COPD
Fat igue
Airw ay obst ruct ion Hypovent ilat ion syndrom e
Test s:
Severe scoliosis CAT Scan Severe ast hm a
ABG Pulm onary Funct ion Test .
Sym pt om s: Treat m ent : Chronic cough
Mechanical vent ilat ion Wheezing
Bronchodilat ors SOB
Respirat ory Alkalosis: CO2 levels are reduced and pH is high.
Causes:
Test s:
Anxiet y
ABG
Fever
Chest X- ray
Hypervent ilat ion Pulm onary funct ion t est s
Sym t pom s:
Treat m ent :
Dizziness Paper bag t echnique Num bness
I ncrease carbon dioxide levels
RSV ( Respirat ory synct ial virus) - spread by cont act , virus can survive for various t im e periods on different surfaces.
Sym pt om s: Fever
Treat m ent :
SOB
Ribvirin
Cyanosis Vent ilat or in severe cases Wheezing
I V fluids
Nasal congest ion
Bronchodilat ors
Croupy cough Monit or t he pat ient for: Test s:
Pneum onia
ABG Respirat ory failure Chest X- ray
Ot it is Media
Hypervent ilat ion Causes:
Ket oacidosis
COPD Aspirin overdose Panic At t acks
Anxiet y
St ress
Apnea: no spont aneous breat hing.
Causes:
Drug overdose
Obst ruct ive sleep apnea
Prem at urit y
Seizures
Bronchospasm
Cardiac Arrhyt hm ias
Encephalit is
Brain inj ury
Choking
Nervous syst em dysfunct ion
Lung surgery
Causes:
Em physem a
Cancer
Pneum ot horax
Lung abscesses
Tum ors
At elect asis
Bronchiect asis
Pneum onia: viruses t he prim ary cause in young children, bact eria t he prim ary cause in adult s. Bact eria: St rept ococcus pneum oniae, Mycoplasm a pneum oniae pneum oniae ( pneum ococcus) .
Types of pneum onia:
Chest pain
Viral pneum onia
Test s:
Walking pneum onia
Chest X- ray
Legionella pneum onia Pulm onary perfusion scan CMV pneum onia
CBC
Aspirat ion pneum onia Cult ures of sput um At ypical pneum onia
Presence of crackles Legionella pneum onia
Treat m ent :
Sym pt om s: Ant ibiot ics if caused by a Fever
bact erial infect ion Headache
Respirat ory t reat m ent s Ribvirin
St eroids
SOB
I V fluids
Cough Vaccine t reat m ent s
Pulm onary act inom ycosis –bact eria infect ion of t he lungs caused by ( propionibact eria or act inom yces)
Causes:
Fever
Microorganism s
Test s:
Sym pt om s:
CBC
Pleural effusions
Lung biopsy
Facial lesions Thoracent esis Chest pain
CT scan
Cough Bronchoscopy Weight loss
Monit or pat ient for:
Meningit is
Em physem a Ost eom yelit is
Alveolar prot einosis: A build- up of a phospholipid in t he lungs w ere carbon dioxide and oxygen are t ransferred.
Causes:
Test s:
May be associat ed w it h infect ion
Chest X- ray
Genet ic disorder 30- 50 yrs. Old Presence of crackles CT scan
Sym pt om s: Bronchoscopy Weight loss
ABG- low O2 levels Fat igue
Pulm onary Funct ion t est s Cough Fever
Treat m ent :
SOB Lung t ransplant at ion Special lavage of t he lungs
Pulm onary hypert ension: elevat ed BP in t he lung art eries
Causes:
Fat igue
May be genet ically linked
Chest Pain
More predom inant in wom en SOB w it h act ivit y LE edem a
Sym pt om s:
Weakness
Faint ing
Test s: Pulm onary art eriogram
Treat m ent :
Chest X- ray Manage sym pt om s ECG
Diuret ics
Pulm onary funct ion t est s Calcium channel blockers CT scan
Heart / Lung Transplant if Cardiac cat het erizat ion
necessary
Pulm onary art eriovenous fist ulas: a congenit al defect w ere lung art eries and veins form im properly, and a fist ula is form ed creat ing poor oxygenat ion of blood.
Sym pt om s:
CT Scan
SOB w it h act ivit y Pulm onary art eriogram Presence of a m urm ur
Low O2 Sat urat ion levels Cyanosis
Elevat ed RBC’s Clubbing Paradoxical em bolism
Treat m ent : Surgery
Test s:
Em bolizat ion
Pulm onary aspergillom a: fungal infect ion of t he lung cavit ies causing abscesses.
Cause:
SOB
Fungus Aspergillus
Chest pain Fever
Sym pt om s:
Cough
Wheezing
Test s:
Bronchoscopy
CT scan Sput um cult ure
Treat m ent :
Serum precipit ans
Surgery
Chest X- ray Ant ifungal m edicat ions
Pulm onary edem a: m ost com m only caused by Heart Failure, but m ay
be due t o lung disorders.
Sym pt om s:
Test s:
Rest less behavior Murm urs m ay be present Anxiet y
Echocardiogram Wheezing
Presence of crackles Poor speech
Low O2 Sat urat ion levels SOB Sweat ing
Treat m ent :
Pale skin
Diuret ics
Drow ning sensat ion
Oxygen Treat t he underlying cause
I diopat hic pulm onary fibrosis: Thickening of lung t issue in t he lower aspect s of t he lungs.
Causes: Response t o an inflam m at ory agent
Test s:
Found in people ages 50- 70. Pulm onary funct ion t est s Linked t o sm oking
Lung biopsy Rule out ot her connect ive t issue
CT scan
SOB
Chest X- ray
Chest pain Cyanosis
Treat m ent :
Clubbing Lung t ransplant at ion Cyanosis
Cort icost eroids Ant i- inflam m at ory drugs
Monit or t he pat ient for: Polycyt hem ia Pulm onary Ht n. Respirat ory failure Cor pulm onarle
Pulm onary em boli: Blood clot of t he pulm onary vessels or blockage due t o fat droplet s, t um ors or parasit es.
Causes:
Chest pain
DVT- m ost com m on
Decreased BP Skin color changes
Sym pt om s: LE and pelvic pain SOB ( rapid onset )
Sweat ing
Dizziness Pulm onary perfusion t est Anxiet y
Plet hysm ography Tachycardia
ABG
Labored breat hing Check O2 sat urat ion Cough
Treat m ent : Placem ent of an I VC filt er
Test s: Adm inist er Oxygen Doppler US
Surgery
Chest X- ray Throm bolyt ic Therapy if clot Pulm onary angiogram
det ect ed
Monit or t he pat ient for: Shock Pulm onary hypert ension Hem orrhage Palpit at ions Heart failure
Tuberculosis- infect ion caused by Mycobat erium t uberculosis.
Causes:
Fat igue
Due t o airborne exposure
Wheezing Phlegm product ion
Sym pt om s: Fever
Test s:
Chest pain Thoracent esis SOB
Sput um cult ures Weight Loss
Presence of crackles
TB skin t est Generally about 6 m ont hs Chest X- ray
Rifam pin
Bronchoscopy
Pyrazinam ide
I soniazid
Treat m ent :
Cyt om egalovirus – can cause lung infect ions and is a herpes- t ype virus.
Causes: More com m on in im m unocom prom ised pat ient s Oft en associat ed w it h organ t ransplant at ion
Sym pt om s:
Bronchoscopy
Fever SOB
Treat m ent :
Fat igue Ant iviral m edicat ions Loss of appet it e
Oxygen t herapy Cough Joint pain
Monit or t he pat ient for: Kidney dysfunct ion
Test s:
I nfect ion
CMV serology t est s Decreased WBC levels ABG
Relapses
Blood cult ures Viral pneum onia – inflam m at ion of t he lungs caused by viral infect ion.
Causes: Herpes sim plex virus Rhinovirus
I nfluenza
Adenovirus
Test s:
Hant avirus Bronchoscopy CMV
Open Lung biopsy RSV
Sput um cult ures Viral blood t est s
Sym pt om s: Fat igue
Treat m ent : Sore Throat s
Ant iviral m edicat ions Nausea
I V fluids Joint pain Headaches
Monit or t he pat ient for: Muscular pain
Liver failure Cough
Heart failure SOB
Respirat ory failure
Pneum ot horax: a build- up of a gas in t he pleural cavit ies.
Types: Traum at ic pneum ot horax
Sym pt om s: Tension pneum ot horax
SOB
Spont aneous pneum ot horax Tachycardia Secondary spont aneous
Hypot ension pneum ot horax
Anxiet y
Cyanosis Chest X- ray Chest pain- sharp
Poor breat h sounds Fat igue Treat m ent : Test s:
Chest t ube insert ion ABG
Adm inist rat ion of oxygen
Cir cu la t or y Syst e m
Fu n ct ion s
The circulat ory syst em serves:
( 1) t o conduct nut rient s and oxygen t o t he t issues; ( 2)
t o rem ove w ast e m at erials by t ransport ing nit rogenous com pounds t o t he kidneys and carbon dioxide t o t he lungs;
( 3) t o t ransport chem ical m essengers ( horm ones) t o t arget organs and m odulat e and int egrat e t he int ernal m ilieu of t he body;
( 4) t o t ransport agent s w hich serve t he body in allergic, im m une, and infect ious responses; ( 5)
t o init iat e clot t ing and t hereby prevent blood loss; ( 6)
t o m aint ain body t em perat ure;
t o produce, carry and cont ain blood;
( 8) t o t ransfer body reserves, specifically m ineral salt s, t o areas of need.
Ge n e r a l Com pon e n t s a n d St r u ct u r e
The circulat ory syst em consist s of t he heart , blood vessels, blood and lym phat ics. I t is a net w ork of t ubular st ruct ures t hrough w hich blood t ravels t o and from all t he part s of t he body. I n vert ebrat es t his is a com plet ely closed circuit syst em , as William Harvey ( 1628) once dem onst rat ed. The heart is a m odified, specialized, pow erful pum ping blood vessel. Art eries, event ually becom ing art erioles, conduct blood The circulat ory syst em consist s of t he heart , blood vessels, blood and lym phat ics. I t is a net w ork of t ubular st ruct ures t hrough w hich blood t ravels t o and from all t he part s of t he body. I n vert ebrat es t his is a com plet ely closed circuit syst em , as William Harvey ( 1628) once dem onst rat ed. The heart is a m odified, specialized, pow erful pum ping blood vessel. Art eries, event ually becom ing art erioles, conduct blood
Cou r se of Cir cu la t ion
Syst e m ic Rou t e :
a. Art erial syst em . Blood is delivered by t he pulm onary veins ( t w o from each lung) t o t he left at rium , passes t hrough t he bicuspid ( m it ral) valve int o t he left vent ricle and t hen is pum ped int o t he ascending aort a; backflow here is prevent ed by t he aort ic sem ilunar valves. The aort ic arch t ow ard t he right side gives rise t o t he brachiocephalic ( innom inat e) art ery w hich divides int o t he right subclavian and right com m on carot id art eries. Next , arising from t he arch is t he com m on carot id art ery, t hen t he left subclavian art ery.
The subclavians supply t he upper lim bs. As t he subclavian art eries leave t he axilla ( arm pit ) and ent er t he arm ( brachium ) , t hey are called brachial art eries. Below t he elbow t hese m ain t runk lines divide int o ulnar and radial art eries, w hich supply t he forearm and event ually form a set of art erial arches in t he hand w hich give rise t o com m on and proper digit al art eries. The descending ( dorsal) aort a cont inues along t he post erior aspect of t he t horax giving rise t o t he segm ent al int ercost als art eries. Aft er passage “ t hrough” ( behind) t he diaphragm it is called t he abdom inal aort a.
At t he pelvic rim t he abdom inal aort a divides int o t he right and left com m on iliac art eries. These divide int o t he int ernal iliacs, w hich At t he pelvic rim t he abdom inal aort a divides int o t he right and left com m on iliac art eries. These divide int o t he int ernal iliacs, w hich
b. Venous syst em . Veins are frequent ly m ult iple and variat ions are com m on. They ret urn blood originat ing in t he capillaries of peripheral and dist al body part s t o t he heart .
H e pa t ic Por t a l Sy st e m : Blood draining t he alim ent ary t ract ( int est ines) , pancreas, spleen and gall bladder does not ret urn direct ly t o t he syst em ic circulat ion, but is relayed by t he hepat ic port al syst em of veins t o and t hrough t he liver. I n t he liver, absorbed foodst uffs and wast es are processed. Aft er processing, t he liver ret urns t he blood via hepat ic veins t o t he inferior vena cava and from t here t o t he heart .
Pu lm on a r y Cir cu it : Blood is oxygenat ed and deplet ed of m et abolic product s such as carbon dioxide in t he lungs.
Lym ph a t ic D r a in a ge : A net w ork of lym phat ic capillaries perm eat es t he body t issues. Lym ph is a fluid sim ilar in com posit ion t o blood plasm a, and t issue fluids not reabsorbed int o blood capillaries are t ransport ed via t he lym phat ic syst em event ually t o j oin t he venous syst em at t he j unct ion of t he left int ernal j ugular and subclavian veins.
Th e H e a r t
The heart is a highly specialized blood vessel w hich pum ps 72 t im es per m inut e and propels about 4,000 gallons ( about 15,000 lit ers) of blood daily t o t he t issues. I t is com posed of:
Endocardium ( lining coat ; epit helium )
Myocardium ( m iddle coat ; cardiac m uscle) Epicardium ( ext ernal coat or visceral layer of pericardium ; epit helium and m ost ly connect ive t issue)
I m pulse conduct ing syst em
Ca r dia c N e r ve s: Modificat ion of t he int rinsic rhyt hm icit y of t he heart m uscle is produced by cardiac nerves of t he sym pat het ic and parasym pat het ic nervous syst em . St im ulat ion of t he sym pat het ic syst em increases t he rat e and force of t he heart beat and dilat es t he coronary art eries. St im ulat ion of t he parasym pat het ic ( vagus nerve) reduces t he rat e and force of t he heart beat and const rict s t he coronary circulat ion. Visceral afferent ( sensory) fibers from t he heart end alm ost w holly in t he first four segm ent s of t he t horacic spinal cord.
Ca r dia c Cycle : Alt ernat ing cont ract ion and relaxat ion is repeat ed about 75 t im es per m inut e; t he durat ion of one cycle is about 0.8 second. Three phases succeed one anot her during t he cycle:
a) at rial syst ole: 0.1 second,
b) vent ricular syst ole: 0.3 second,
c) diast ole: 0.4 second
The act ual period of rest for each cham ber is 0.7 second for t he at ria and 0.5 second for t he vent ricles, so in spit e of it s act ivit y, t he heart is at rest longer t han at work.
Blood
Blood is com posed of cells ( corpuscles) and a liquid int ercellular ground subst ance called plasm a. The average blood volum e is 5 or 6 Blood is com posed of cells ( corpuscles) and a liquid int ercellular ground subst ance called plasm a. The average blood volum e is 5 or 6
Pla sm a : Over 90% of plasm a is wat er; t he balance is m ade up of plasm a prot eins and dissolved elect rolyt es, horm ones, ant ibodies, nut rient s, and w ast e product s. Plasm a is isot onic ( 0.85% sodium chloride) . Plasm a plays a vit al role in respirat ion, circulat ion, coagulat ion, t em perat ure regulat ion, buffer act ivit ies and overall fluid balance.
Ca r diova scu la r Con dit ion s
Cardiogenic Shock: heart is unable t o m eet t he dem ands of t he body. This can be caused by conduct ion syst em failure or heart m uscle dysfunct ion.
Sym pt om s of Shock: Rapid breat hing
ABG
Rapid pulse
Chem - 7
Anxiet y
Chem - 20
Nervousness
Elect rolyt es
Thready pulse Cardiac Enzym es Mot t led skin color Profuse sw eat ing
Treat m ent :
Poor capilary refill
Am rinone Norepinephrine
Test s:
Dobut am ine
Nuclear Scans
I V fluids
Elect rocar diogram
PTCA
Echocardiogram Ext rem e cases- pacem aker, I ABP Elect rocar diogram
Aort ic insufficiency: Heart valve disease t hat prevent s t he aort ic valve from closing com plet ely. Backflow of blood int o t he left vent ricle.
Causes:
Endocardit is
Rheum at ic fever Marfan’s syndrom e Congenit al abnorm alit ies
Ankylosing spondylit is
Reit er’s syndrom e
Auscult at ion Left heart cat heret erizat ion
Sym pt om s: Aort ica angiography Faint ing
Dopper US
Weakness
Echocardiogram
Bounding pulse
Treat m ent :
Chest pain on occasion
Digoxin
SOB
Dieuret ics
Fat igue Surgical aort a valve repair
Test s: Monit or pat ient for: Palpat ion
PE
I ncreased pulse pressure and Left - sided heart failure diast olic pressure
Endocardit is
Pulm onary edem a present
Aort ic aneurysm : Expansion of t he blood vessel w all oft en ident ified in t he t horacic region.
Causes: Possible back pain m ay be t he Ht n
only indicat or
Marfan’s syndrom e Syphilis
Test s:
At herosclerosis ( m ost com m on)
Aort ogram
Traum a
Chest CT
X- ray
Sym pt om s:
Treat m ent :
Varies depending on locat ion
Bleeding
St ent
St roke
Circulat ory arrest Graft infect ion Surgery
I rregular Heart beat s Heart At t ack Monit or pat ient for:
Hypovolem ic shock: Poor blood volum e prevent s t he heart fr om pum ping enough blood t o t he body.
Causes: Traum a Diarrhea Burns GI Bleeding
Cardiogenic shock: Enough blood is available, however t he heart is unable t o m ove t he blood in an effect ive m anner.
Sym pt om s: Echocardiogram Anxiet y
CT scan
Weakness Endoscopy w it h GI bleeding Sweat ing
Sw an- Ganz cat het erizat ion Rapid pulse
Treat m ent :
Confusion
I ncrease fluids via I V Clam m y skin
Avoid Hypot herm ia Epinephrine
Test s: Norepinephrine CBC
Dobut am ine
Dopam ine
Myocardit is: inflam m at ion of t he heart m uscle.
Causes:
Test s:
Bact erial or Viral I nfect ions
Chest X- ray
Polio, adenovirus, coxsackie Echocardiogram virus
ECG WBC and RBC count
Sym pt om s: Blood cult ures Leg edem a SOB
Treat m ent :
Viral sym pt om s
Diuret ics
Joint Pain
Pacem aker
Syncope
Ant ibiot ics
Heart at t ack ( Pain)
St eroids
Fever Unable t o lie flat
Monit or t he pat ient for:
I rregular heart beat s
Pericardit is Cardiom yopat hy
Heart valve infect ion: endocardit is ( inflam m at ion) , probable valvular heart disease. Can be caused by fungi or bact eria.
Sym pt om s: Janeway lesions Weakness
Joint pain
Fever Murm ur
Test s:
SOB
CBC
Night sw eat s
ESR
ECG Surgery m ay be indicat ed Blood cult ures Enlarged speen
Monit or t he pat ient for: Presence of splint er
Jaundice
hem orrhages Arrhyt hm ias CHF
Treat m ent : Glom erulonephrit is
I V ant ibiot ics
Em boli
Pericardit is: I nflam m at ion of t he pericardium .
Causes: Viral- coxsackie, adenovirus, influenza, rubella viruses Bact erial ( various m icroorganism s) Fungi Oft en associat ed w it h TB, Kidney failure, AI DS, and aut oim m une disorders. Surgery
Sym pt om s: Unable t o lie down flat Dry cough Pleurit is
Test s:
Fever Auscult at ion Anxiet y
MRI scan
Crackles
CT scan
Pleural effusion Echocardiogram ( key t est ) LE sw elling
ESR
Chest pain Chest x- ray
Blood cult ures Pericardiect om y CBC Monit or t he pat ient for: Treat m ent :
Const rict ive pericardit is NSAI DS
A fib.
Pericardiocent esis Supravent ricular t achycardia Analgesics
( SVT)
Arrhyt hm ias: I rregular heart beat s and rhyt hm s disorder
Types:
I rregular pulse Bradycardia Tachycardia
Test s:
Vent ricular fibrillat ion Coronary angiography Ect opic heart beat
ECG
Vent ricular t achycardia Echocardiogram Wolff- Parkinson- w hit e syndrom e
Holt er m onit or At rial fib. Sick sinus syndrom e
Treat m ent :
Sinus Tachycardia Defibrillat ion Sinus Bradycardia
Pacem aker Medicat ions
Sym pt om s: SOB
Monit or t he pat ient for: Faint ing
Heart failure Palpit at ions
St roke
Dizziness Heart at t ack Chest pain
I schem ia
Art eriosclerosis: hardening of t he art eries.
Causes:
I VSU
Sm oking
MRI t est
Ht n Poor ABI ( Ankle brachial index) Kidney disease
reading
CAD St roke
Treat m ent : Analgesics
Sym pt om s: Vasodilat ion m edicat ions Claudicat ion pain
Surgery if severe Cold feet
Ballon surgery Muscle acheness and pain in t he
St ent placem ent legs Hair loss on t he legs
Monit or t he pat ient for: Num bness in t he ext rem it ies
Art erial em boli Weak dist al pulse
Ulcers
I m pot ence
Test s: Gas gangreene Doppler US
I nfect ion of t he low er Angiography
ext rem it ies
Cardiom yopat hy- poor hear pum ping and w eakness of t he m yocardium .
Causes: Ht n Heart at t acks Viral infect ions
Types: Alcoholic cardiom yopat hy- due t o alcohol consum pt ion Dilat ed cardiom yopat hy- left vent ricle enlargem ent Hypert rophic cardiom yopat hy- abnorm al grow t h left vent ricle
I schem ic cardiom yopat hy- w eakness of t he m yocardium due t o heart at t acks. Peripart um cardiom yopat hy- found in lat e pregnancy Rest rict ive cardiom yopat hy- lim it ed filling of t he heart due t o inabilit y t o relax heart t issue.
Sym pt om s:
I soenzym e t est s Chest pain
Coronary Angigraphy SOB
Chest X- ray
Fat igue
MRI
Ascit es
Auscult at ion
LE sw elling Faint ing
Treat m ent :
Poor Appet it e
Ace inhibit ors
Ht n
Dieuret ics
Palpit at ions Blood t hinners LVAD – Left Vent ricular Assist
Test s:
Vasodilat ors
Congest ive Heart Failure:
Class I describes a pat ient who is not lim it ed w it h norm al physical act ivit y by sym pt om s. Class I I occurs w hen ordinary physical act ivit y result s in fat igue, dyspnea, or ot her sym pt om s. Class I I I is charact erized by a m arked lim it at ion in norm al physical act ivit y. Class I V is defined by sym pt om s at rest or w it h any physical act ivit y.
Causes:
Sym pt om s:
CAD Skin cold or cyanot ic Valvular heart disease
Wheezing
Cardiom yopat hies Mit ral valvular deficit s Endocardit is
Low er ext rem it y edem a Ext racardiac infect ion
Pulsus alt ernans Pulm onary em bolus
Hypert ension Tachypnea
Heart Sounds: S1- t ricuspid and m it ral valve close S2- pulm onary and aort ic valve close S3- vent ricular filling com plet e S4- elevat ed at rial pressure ( at rial kick)
Wave Review
ST segm ent :
vent ricles depolarized
P w ave:
at rial depolarizat ion
PR segm ent :
AV node conduct ion
QRS com plex:
vent ricular depolarizat ion
U wave:
hypokalem ia creat es a U wave
T wave:
vent ricular repolarizat ion
Wave Review I ndept h:
1. P WAVE - sm all upw ard w ave; indicat es at rial depolarizat ion
2. QRS COMPLEX - init ial dow nw ard deflect ion follow ed by large upright wave followed by sm all downward wave; represent s vent ricular depolarizat ion; m asks at rial repolarizat ion; enlarged R port ion - enlarged vent ricles; enlarged Q port ion - probable heart at t ack.
3. T WAVE - dom e shaped w ave; indicat es vent ricular repolarizat ion; flat w hen insufficient oxygen; elevat ed w it h increased K levels
4. P - R I NTERVAL - int erval from beginning of P w ave t o R w ave; represent s conduct ion t im e from init ial at rial excit at ion t o init ial vent ricular excit at ion; good diagnost ic t ool; norm ally < 0.2sec.
5. S- T SEGMENT - t im e from end of S t o beginning t o T w ave; represent s t im e bet ween end of spreading im pulse t hrough vent ricles and vent ricular repolarizat ion; elevat ed w it h heart at t ack; depressed w hen insufficient oxygen.
6. Q- T I NTERVAL - t im e for singular depolarizat ion and repolarizat ion of t he vent ricles. Conduct ion problem s, m yocardial dam age or congenit al heart defect s can prolong t his.
Ar r h yt h m ia s Re vie w
Supravent ricular Tachyarrhyt hm ias
At rial fibrillat ion – Abnorm al QRS rhyt hm and poor P w ave appearance. ( > 300bpm .)
Sinus Tachycardia- Elevat ed vent ricular rhyt hum / rat e.
Paroxysm al at rial t achycardia- Abnorm al P w ave, Norm al QRS com plex
At rial flut t er- I rregular P Wave developm ent . ( 250- 350 bpm .)
Paroxysm al supravent ricular t achycardia- Elevat ed bpm ( 160- 250)
Mult ifocal at rial t achycardia- bpm ( > 105) . Various P w ave appearances.
Vent ricular Tachyarrhyt hm ias
Vent ricular Tachycardia- Presence of 3 or great er PVC’s ( 150- 200bpm ) , possible abrupt onset . Possibly due t o an ischem ic vent ricle. No P waves present .
( PVC) - Prem at ure Vent ricular Cont ract ion- I n m any cases no P w ave follow ed by a large QRS com plex t hat is prem at ure, follow ed by a com pensat ory pause.
Vent ricular fibrillat ion- Com plet ely abnorm al vent ricular rat e and rhyt hum requiring em ergency innervent ion. No effect ive cardiac out put .
Bradyarrhyt hm ias
AV block ( prim ary, secondary ( I ,I I ) Tert iary Prim ary- > .02 PR int erval Secondary ( Mobit z I ) – PR int erval I ncrease Secondary ( Mobit z I I ) – PR int erval ( no change) Tert iary- m ost severe, No signal bet w een vent ricles and at ria not ed on ECG. Probable use of At rophine indicat ed. Pacem aker required.
Right Bundle Branch Block ( RBBB) / Left Bundle Branch Block ( LBBB)
Sinus Bradycardia- < 60 bpm , w it h presence of a st andard P w ave.
Ca r dia c Fa ilu r e Re vie w
Right Sided Heart Failure
A. Right Upper Quadrant Pain Left Sided Heart Failure
B. Right Vent ricular heave
A. Left Vent ricular Heave
C. Tricuspid Murm ur
B. Confusion
D. Weight gain
C. Paroxysm al not urnal dyspnea
E. Nausea
D. DOE
F. Elevat ed Right At rial
E. Fat igue
pressure
3 F. S gallop
G. Elevat ed Cent ral Venous
G. Crackles
pressure
H. Tachycardia
H. Peripheral edem a
I . Cough
I . Ascit es J. Mit ral Murm ur J. Anorexia
K. Diaphoresis
K. Hepat om egaly
L. Ort hopnea
ECG Changes w it h MI
T Wave inversion ST Segm ent Elevat ion Abnorm al Q waves
ECG Changes w it h Digit alis
I nvert s T wave QT segm ent short er
Depresses ST segm ent
ECG Changes w it h Quinidine
I nvert s T wave QT segm ent longer QRS segm ent longer
ECG Changes w it h Pot assium
Hyperkalem ia- Low ers P w ave, I ncreases w idt h of QRS com plex Hypokalem ia- Low ers T w ave, causes a U w ave
ECG Changes w it h Calcium Hypercalcem ia- Makes a longer QRS segm ent Hypocalcem ia- I ncreases t im e of QT int erval
En docr in e Re vie w
Hypot hyroidism : Poor product ion of t hyroid hor m one: Prim ary- Thyroid cannot m eet t he dem ands of t he pit uit ary gland. Secondary- No st im ulat ion of t he t hyroid by t he pit uit ary gland.
Causes: Decreased BP and HR Surgical t hyroid rem oval
Chest X- ray
I rradiat ion Elevat ed liver enzym es, Congenit al defect s
prolact in, and cholest erol Hashim ot o’s t hyroidit is ( key)
Decreased T4 levels and serum sodium levels
Sym pt om s: Presence of anem ia Const ipat ion
Low t em perat ure Weight gain
Poor r eflexes
Weakness Fat igue
Treat m ent :
Poor t ast e
I ncrease t hyroid horm one levels Hoarse vocal sounds
Levot hyroxine
Joint pain Muscle weakness
Monit or t he pat ient for: Poor speech
Hypert hyroidism sym pt om s Color changes
following t reat m ent Depression
Heart disease Miscarriage
Test s: Myxedem a com a if unt reat ed
Hypert hyroidism : excessive product ion of t hyroid horm one.
Causes:
Hair loss
I odine overdose
Elevat ed BP
Thyroid horm one overdose
Fat igue
Graves’ disease ( key)
Sweat ing
Tum ors affect ing t he reproduct ive syst em
Test s: Elevat ed Syst olic pressure not ed
Sym pt om s: T3/ T4 ( free) levels increased Skin color changes
TSH levels reduced Weight loss Anxiet y
Treat m ent :
Possible goit er Radioact ive iodine Nausea
Surgery
Exopht halm os
Bet a- blockers
Diarrhea Ant it hyroid drugs
Congenit al adrenal hyperplasia: Excessive product ion of androgen and low levels of aldost erone and cort isol. ( Genet icially inherit ed disorder) . Different form s of t his disorder t hat affect m ales and fem ales different ly.
Causes: Adrenal gland enzym e deficit causes cort isol and aldost erone t o not be produced. Causing m ale sex charact erist ics t o be expressed prem at urely in boys and found in girls.
Sym pt om s:
Salt levels
Boys: Low levels of cot isol Sm all t est es developm ent
Low levels of aldost erone Enlarged penis developm ent
I ncreased 17- OH progest erone St rong m usculat ure appearance
I ncreased 17- ket ost eroids in Girls:
urine
Abnorm al hair grow t h Low t oned voice
Treat m ent :
Abnorm al genit alia Reconst ruct ive surgery Lack of m enst ruat ion
Hydrocorist one Dexam et hasone
Test s:
Prim ary/ Secondary Hyperaldost eronism Prim ary Hyperaldost eronism : problem w it hin t he adrenal gland causing excessive product ion of aldost erone. Secondary Hyperaldost eronism : problem found elsew here causing excessive product ion of aldost erone.
Causes: Prim ary:
Sym pt om s:
Tum or affect ing t he adrenal
Paralysis
gland
Fat igue
Possibly due t o HBP Num bness sensat ions Secondary:
Ht n
Nephrot ic syndrom e
Weakness
Heart failure Cirrhosis
Test s:
Ht n
I ncreased urinary aldost erone
Abnorm al ECG readings
Treat m ent :
Decreased pot assium levels Prim ary: Surgery Decreased renin levels
Secondary: Diet / Drugs
Cushing’s syndrom e: Abnorm al product ion of ACTH w hich in t urn causes elevat ed cort isol levels.
Causes: Cort icost eroids prolonged use
Test s:
Tum ors Dexam et hasone suppression t est
Sym pt om s: Cort isol level check Muscle weakness
MRI - check for t um ors Cent ral obesit y dist ribut ion Back pain
Treat m ent :
Thirst Surgery t o rem ove t um or Skin color changes
Monit or cort icost eroid levels Bone and j oint pain Ht n
Monit or t he pat ient for: Headaches
Kidney st ones Frequent urinat ion
Ht n
Moon face Bone fract ures Weight gain
DM
Acne
I nfect ions
Diabet ic ket oacidosis: increased levels of ket ones due t o a lack of glucose.
Causes: I nsufficient insulin causing ket one product ion w hich end up in t he urine. More com m on in t ype I vs. t ype 2 DM.
Sym pt om s:
I ncreased am ylase and Low BP
pot assium levels Abdom inal pain
Ket ones in urine Headaches
Check BP
Rapid breat hing Loss of appet it e
Treat m ent :
Nausea
I nsulin
Fruit breat h sm ell
I V fluids
Ment al deficit s Monit or t he pat ient for: Test s:
Renal failure
Elevat ed glucose levels
MI Com a
T3/ T4 Review Bot h are st im ulat ed by TSH release from t he Pit uit ary gland T4 cont rol basal m et abolic rat e T4 becom es T3 wit hin cells. ( T3) Act ive form . T3 radioim m unoassay- Check T3 levels Hypert hyroidism - T3 increased, T4 norm al- ( in m any cases)
Medicat ions t hat increase levels of T4: Met hadone Oral cont racept ives Est rogen
Cloffibrat e
Medicat ions t hat decrease levels of T4: Lit hium Propranolol
I nt erferon alpha Anabolic st eroids Met hiam azole
Lym phocyt ic t hyroidit is: Hypert hyroidism leading t o hypot hyroidism and t hen norm al levels. Causes: Lym phocyt es perm eat e t he t hyroid gland causing hypert hyroidism init ially.
Sym pt om s: Lym phocyt e concent rat ion not ed Fat igue
w it h biopsy
Menst rual changes Weight loss
Treat m ent :
Poor t em perat ure t olerance Varies depending on sym pt om s. Muscle weakness
( Bet a blockers m ay be used.) Hypert hyroidism sym pt om s Monit or t he pat ient for: Test s:
Aut oim m une t hyrodit is T3/ T4 increased
Hashim ot o’s t hyroidit is
I ncreased HR
Goit er St um a lym phom at osom a