Drug or chemical damage to the inner ear

-having a deleterious effect upon the 8th nerve or on the organs of hearing and balance

Proper Administration of Medications

Intradermal

-Use TB syringe (max 1ml)

-25gauge, 3/8-5/8inch needle

-Insert needle with bevel up directly under skin. Advance needle through epidermis to approx 1/8inch (3mm) below skin surface. You need to be able to see tip of needle through skin.

-If test is for sensitivity 2 injections are made, one NACL or bacteriostatic saline, other test substance. If sensitivity test, 2nd injection: make small bubblelike wheal with test solution. Insert needle at approx 15 degree angle.

-Do not masage site

-Draw a circle around test site; label area with time, date, and name of test.

Proper Administration of Medications

Intramuscular

-Clean skin w/ alcohol, spread skin tight with thumb and index finger; let dry.

-Ask pt to take a deep breath and exhale slowly to relax muscle as needle in inserted.

-Insert needle at a 90-degree angle quickly in a dart like motion.

-Maintain needle's position; gently aspirate(5-10 seconds)

-Slowly inject medication to lessen discomfort.

-Withdraw needle quickly without bending or twisting it.

Proper Administration of Medication

Subcutaneous

usual needle length: 1/2-5/8in; 25gauge

-Method A (thin pt or child): spread skin on selected site taut and hold firmly; insert needle at 45 degree angle and aspirate. Inject medication slowly. (do not aspirate if giving heparin, lovenox, fragmin)

-Method B (average-obese): grasp and press together skin of selected site to that it forms roll between fingers. Insert needle at 90 degree angle and aspirate (dont if giving lovenox, heparin, fragmin). Inject medication slowly.

withdraw needle quickly

Proper Administration of Medication

Eye drops

-Position back of pts head on pillow; direct pts face upward toward ceiling; determine which eye; don gloves.

-Remove exudate; clean prn using sterile saline; use cotton balls to wipe away exudate; one cotton ball per stroke, wiping from inner canthus outward.

-Expose lower sac while having patient look upward while gentle traction is applied to lower eyelid.

-Put perscribed # into conjunctival sac, not onto eyeball.

*Conjunctival sac normally holds one to two drops.

-Using a cotton ball or tissue, apply gentle pressure above bone at inner corner of eyelid for 1-2 minutes; apply sterile dressing if ordered.

 CBC

 a. 4300-10800

b. Male: 4.6-6.2; Female: 4.2-5.9

c. Male: 13-18; Female: 12-16

d. Male: 45-52%; Female: 37-48%

e. MCV

f. MCH

g. MCHC

h.150,000-350,000

A common blood test done in most labs that reports the total number of WBC as well as what % of the total # of WBC are neutrophils, monocytes, eosinophils, basophils, and lymphocytes. Both the total # of WBC in the body, and the differention, or % of each specific types of WBC in the body, are evaluated.

 Normal Values?

a. WBC

b. RBC (M-F)

c. HGB(M-F)

d. HCT(M-F)

e.measure average size of RBC

f. calculation of the average amount of oxygen-carrying hemoglobin inside a red blood cell.

g. calculation of the average concentration of hemoglobin inside a red cell.

h. PLT

Prothrombin Time

(PT)

Lab Values and what do they show us

evaluates the ability of blood to clot properly, it can be used to help diagnose bleeding.

Results measured in seconds and compared to the average value in healthy people

Normal Value: 10-12 seconds

International Normalized Ratio

(INR)

Lab values and what they show us

used to monitor the effectiveness of blood thinning drugs such as warfarin(Coumadin)

carefully monitored to maintain a balance between preventing clots and causing excessive bleeding.

Normal Values:  2.0 to 3.0 for basic "blood-thinning" needs. For some patients who have a high risk of clot formation, the this needs to be higher - about 2.5 to 3.5. Your doctor will use the this to adjust your drug to get the PT into the range that is right for you.

Sodium

Electrolytes

The most abundant electrolyte in the body and the primary electrolyte in the extracellular fluid.

Plays a major role in the regulation on body fluid volumes, muscular activity, nerve impulse conduction, and acid-base balance.

 Normal Value: 135-145

Potassium

Electrolytes

 Found mainly in the intracellular fluid and is the major intracellular cation. Because its so abundant in the cell, it plays an important role in maintaining fluid osmolarity and volume within the cell.

Essential for normal membrance excitability- a critical factor in the transmission of nerve impulses.

Also needed for protein synthesis, for the synthesis and breakdown on glycogen, and to maintain plasma acid-base balance.

Normal Value:3.5-5.0 mEq/L

Chloride

Electrolytes

Extracellular anion that is usually bound with other ions, especially sodium or potassium.

Its major functions are to regulate osmotic pressure between fluid compartments and to assist in regulating acid-base balance.

Normal Value: 100-106 mEq/L

Calcium

Electrolytes

 --In addition to maintaining strong teeth and bones, this promotes normal transmission of nerve impulses and helps regulate normal muscle contraction and relaxation.

 --Constant regulation takes place in the body. If serum ___ levels fall, additional ___ is absorbed in the intestine, reabsorbed through the kidneys, or taken from the bones. If more ___ is needed from the bones, it is taken from the bloodstream and also reabsorbed through the kidneys.

 --Normal Level: 8.5-10.5 mg/ 100ml

Magnesium

Electrolytes

After potassium, this is the most abundant cation in intracellular fluid, so its vital to cellular function.

It plays a role in the metabolism of carbohydrates and proteins, the storage and use of intracellular energy, and neural transmission.

___is important in the function of the heart, nerves, and muscles.

Normal Values: 1.5-2.0 mEg/L

Creatinine

used along with a BUN (blood urea nitrogen) test to assess kidney function.

A combination of blood and urine ____ levels may be used to calculate a ____ clearance. This test measures how effectively your kidneys are filtering small molecules out of your blood.

Normal Levels: 15-25mg/kg of body weight/day

BUN

(Blood Urea Nitrogen)

To evaluate kidney function or monitor the effectiveness of dialysis and other treatments related to kidney disease or damage.

Normal Values: 6-23mg/dl

Partial Prothrombin Time

(PTT)

End Stage Renal Failure

(ESRF)

"Uremia"

The term used when chronic kidney disease  advances to the point that the kidney's are unable to to maintain fluid and electrolyte or acid-base balance.

Causes:

chronic renal infections may predispose the patient to progressive renal failure; most common causes: HTN, DM, and atherosclerosis.

Electrolyte Imbalances

1. Hyperkalemia

2.Hypocalcemia

End Stage Renal Failure

1. The primary means of potassium excretion is through the kidneys. As kidney function fails, potassium is retained, which results in _______, the most threatening effect of renal failure.

2. Diseased kidney tissue lacks the enzyme that activates vitamin D. Without active vitamin D, ___ absorption from the bowel decreases.

S/S of Hyperkalemia

Elevated serum potassium levels intereferes with normal cardiac function, causing cardiac dysrhythmias which are potentially fatal. The patient becomes:

-apathetic and confused

-may have nausea and abdominal cramps

-muscle weakness

numbness of the extremities

 ---If serum potassium levels are not reduced bradycardia(pulse <50) or asystole(no heartbeat) may occur.

S/S of Hypocalcemia

Patients with abnormally low serum calcium experience:

-tingling sensations

-muscle twitches

-irritability

-tetany: sustained painful muscle contraction

1. hypervolemia

2. Congestive Heart Failure

3. Sodium Wasters

ESRF

Most patients with chronic kidney disease retain sodium and water, causing hypernatremia and hypervolemia

1. Elevated BP and edema are signs of _____.

2. ____ __ ___ may develop in the hypervolemic patient because the patients heart cannot handle the high fluid volume.

**Some patients are ___ ___: These patients lose excess sodium and water in the urine and become hyponatremic and hypovolemic.

intake and output

fluid volume excess

During Hospitalization for chronic renal failure, accurate ___ and ___ records must be kept.

Be alert for S/S of ___ ___ ___, which can lead to cardiac failure. Warning signs include:

-increasing edema, dyspnea, tachycardia, bounding pulse, and rising blood pressure.

Cystitis

Inflammation of the urinary bladder

Most common cause: bacterial contamination

Bladder Cancer

Causes:

Over the years, chemical agents have been suspected as carcinogens. The tars found in smoking tobacco, aniline dyes found in industrial compounds, and tryptophan all have been implicated in the development of ____ ____.

1. Cytoscopic Resection

2. Fulgulration

Surgical Removal of Bladder Cancer

Superficial lesions with low recurrence rates may be treated with ___1 ____, which is the removal of tissue through a cytoscope with a special cutting instrument, and can also be treated with __2___, which is the use of electric current to burn and destroy tissue.

Proper Administration of Medications

Eye Ointment

Expose lower conjunctival sac by having pt look upward while gentle traction is applied to lower eyelid.

-Squeeze ointment into lower conjunctival sac.

-Ask patient to close eye and move it around in circular motion.

-Apply sterile dressing if ordered.

3. Segmental Bladder Resection

4. Radical Cystectomy

Surgical Removal of Bladder Cancer

--3. done for a single, primary tumor too large to be removed another way. It involves removal of the tumor and adjacent bladder muscle, a procedure that decreases size of the bladder.

 --4. removal of the entire bladder and adjacent structures with diversion of the ureters. This is reserved for malignancies that are untreatable with less conservative measures. This is very extensive, and an optimal state of health before surgery is desirable.

Urolithiasis

The formation of calculi (stones) in the urinary tract.

Causes: Concentrated urine; excessive intake of calcium, vit D, protein, oxalates, calcium based antacids; Familial tendency; Hyperparathyroidism; Immobility, urinary stasis; Sedentary lifestyle; Altered Urine pH; Lack of kidney substance that inhibits calculi formation.

So urine may be examined for calculi

Why would a nurse strain a patients urine?

     1. fluid intake

     2. dietary restrictions

     4. urine pH

Patient Teaching for Urolithiasis

to prevent recurrence

     1. high ___ ___ to keep urine dilute.

     2. ____ ____ for specific elements (ex: calcium, prurines).

     3. regular exercise.

     4. Occasional medications to alter the ___ __

KUP

IVP

retrograde pyelogram

or

ultrasound

The presence and location of calculi in the urinary tract may be confirmed by:

___

___

________ ________

or

_______

a. drainage

b. UTI

c. pulmonary and circulatory

Nursing considerations to be knowlegable prior to procedure for Urolithiasis

Before surgery

explain the expected procedure to the patient and answer any questions.

---Goals of postoperative care are:---

a. Maintenence of urine ______

b. prevention of ___

c. and prevention of _______ and _______ complications

Pain Relief

calculi in the urinary tract can cause excruciating pain (renal colic)

Major nursing concern for calculi in the urinary tract (urolithiasis)?

Pleurisy

R                                          

Inflammation of the pleura; Fluid accumulates in the pleural space( pleural effusion); Infected fluid

Drugs used to treat:

Analgesics, Anti-Inflammatory drugs, Antitussives, Antimicromials

Pneumothorax

Accumulation of air in the pleural cavity that results in complete or partial collapase of lung.

1. Tension Pneumothroax

2. Open pneumothroax

____ and ____ Pneumothorax

1. air enters pleural space with inspiration; pressure increases; air isnt able to escape from wound; accumulates pressure; affected lung collapses

2. chest wound allowing air to move in and out freely with inspiration and expiration; lung on affected side collapses causing heart, trachea, esophagus, and great blood vessels to shift back and forth (medicinal flutter and potentially fatal)

Chest Tubes

_____ _____ are inserted to drain air or fluid from the pleural space of the lungs. This permits reexpansion of a collapsed lung in the patient with a hemothorax, pneumothroax, or pleural effusion. Inserted into the 2nd to 4th intercostal space to remove air. Placed in the 8th or 9th intercostal space for fluid removal.

Chest fluid and air drain into the collection chamber. Air is diverted to the water seal chamber, where it can be seen bubbling up through the control chamber. The tubing in the suction chamber is partially submerged in water; the depth of the tube in the water regulates the amount of suction.

The chambers for bubbling.

Continuous bubbling in water seal chamber suggests an air leak.

Cerebral Vascular Accident

An interruption of blood flow to part of the brain

 Two main classifications: hemmorrhagic and ischemic

Signs of a stroke

Sudden numbness or weakness of the face, arm, or leg, especially one one side of the body.

Sudden confusion, trouble speaking or understanding.

Sudden trouble seeing in one or both eyes.

Sudden trouble walking, dizziness, loss of balance or coordination.

Sudden severe headach with no known cause.

Complications that can arise from a stroke

Abrupt impairment of brain functioning due to impaird blood flow to the brain, resulting in a set of neurologic signs and symptoms.

A ____ ____ results in damage to:

Motor, sensory, and cognitive

Hemorrhagic Stroke

Accounts for 20% of all strokes

A blood vessel in the brain ruptures and bleeding into the brain occurs.

As a result, intracranial pressure may increase, disrupting normal cerebral function.

Ischemic Stroke

An ______ stoke is caused by the obstruction of a blood vessel by an atheroschlerotic plaque, a blood clot, or a combination of the two by other debris released into the vessel that impedes blood flow to an area of the brain. Brain cells deprived of blood flow become ____ and die.

Account for 80% of all strokes.

Protamine Sulfate

Heparin Antidote

1. Aphasia

2. receptive aphasia

3. Expressive aphasia

4. nonfluent aphasia

5. global aphasia

6. dysarthria

7. dysphagia

8. dyspraxia

S/S of a Stroke

1. A defect in the use of language: speech, reading, writing, or word comprehension.

2. difficulty understanding spoken or written words

3.difficulty speaking or writing

4.difficulty initiating speech

5.used when speech is impaired to the point that the person has almost no ability to communicate.

6.Inability to speak clearly

7.swallowing difficulty

8.partial inability to initiate coordinated voluntary motor acts

Transient Ischemic Attack

A temporary neurologic deficit caused by impairment of cerebral  blood flow.

Blood vessels may be occluded by spasms, fragments of plaque, or blood clots.

S/S of a TIA

neurologic s/s last from a few minuted to a 24 hours, often with no permanent damage. Some commom s/s are: dizziness, momentary confusion, loss of speech, loss of balance, tinnitis, visual disturbances, ptosis, dysarthria, dysphagia, drooping mouth, weakness, and tingling or numbness on one side of the body.

The nature and severity of the symptoms depend on the area of the brain involved and the extent of tissue debrived oxygen.

Tissue Plasminogen Activtor

tPA, Altepase, Activase

The only FDA approved medication that can reverse the effects of a stroke.

Must be taken within 3 hours of the onset of a stroke

Multiple Sclerosis

A chronic, progressive, degenerative disease that attacks the protective myelin sheath around axons and disrupts the conduction of impulses through the CNS.

As damage to the myelin sheath occurs, sclerotic tissue develops.

Remission occurs as the scar tissue forms.

As nerve fibers degenerate, permanent damage results.

4 patterns of MS

4 patters of ________ ________

1. Chronic (progressive)

2.Exacerbating - remitting

3. Relapsing- progressive

4. Stable

S/S of Multiple Sclerosis

The most common signs and symptoms are:

fatigue, weakness and tingling in one or more extremities, visual disturbaces, problems with coordination, bowel and bladder dysfunction, spasticity, depression.

Weakness and/or spasticity

The patient with MS may experience impaired physical mobility related to:

2

bone marrow suppression

When immunosuppressive agents are used, nurses must carefully monitor the patient for....

Multiple Sclerosis

Myasthenia Gravis

A chronic, progressive disease in which there is a defect at the neuromuscular junction, where electrical impulses are transmitted to muscle tissue.

In ____ __, there are insufficient receptor sites at the junction of the motor nerve with the muscle. With repeated stimulation, the muscle becomes exhausted and is eventually unable to contract at all.

S/S of Myasthenia Gravis

weakness of voluntary muscles, particularly those of chewing, swallowing, and speaking.

The onset of symptoms is gradual, and early weakness may go unnoticed. Muscles responsible for fine movements, such as eye, facial, or hand muscles are often affected early in the disease process.

Ptosis and diploplia are commonly seen.

Parkinson's

A progressive degenerative disorder of the basal ganglia that results in an eventual loss of coordination and control over involuntary motor movement.

Men are affected more than women.

Have no known cause but is R/T decreased levels of dopamine in the basal ganglia.

S/S of Parkinsons

Major Triad Symptoms: tremor, rigidity, bradykinesia-typically disappear during sleep.

A movement associated with the tremor is pin rolling, in which the tremor repetitively moved the individuals thumb against fingertips, as if rolling a small object.

Other S/S: loss of dexterity and power in affected limbs, aching,monotone voice, handwriting changes,drooling, lack of facial expressions, rhythimic head nodding, reduced blinking, and slumped posture.

Complications that can arise from parkinsons

jerky movements with passive muscle jerking

gait disturbances

may appear to freeze and may have difficulty initiating the action of walking

depression

dementia

Most common med for parkinsons

1. carbidopa

2 carbidopa/levadopa(Sinemet)

L-Dopa is the most prevalent, it crosses the blood brain barrier and is converted to dopamine inthe basal ganglia, thereby supplementing levels of the neurotransmitter and reducing the symptoms of the Parkinsons.

The conversion of L-Dopa to dopamine must occur in the basal ganglia and not in the peripheral tissue. to ensure this, inhibitors are administered to prevent breakdown of L-Dopa by decarboxylase enzymes. The most commonly used is ____1___. It is frequently given in combination as ____2__/____(_____). When combined therapeutic levels may be achieved with lower dosages.

Nursing management for the patient with Parkinson's syndrome is primarily related to maintain _____ and preventing _____.

The health history of a patient with ____ should specifically include assessment for weakness, farigue, muscle cramps, sweating, dysphagia, constipation, difficulty voiding, and unusual movements.

During physical exam, be alert for lack of facial expression, eyes fixed in one direction, drooling, slurred speech, tearing, tremors, muscle stiffness, and poor balance and coordination.

Scalp Injuries

Head Injury

may include lacerations, contusions, abraisions, and hematomas; may bleed profusely; may or may not be associated with skull or brain injuries

Concussion

Head Injury

head trauma in which there is no visible injury to the skull or brain; loss of consciousness for less than 5 minutes; may have a headache, amnesia about the event, nausea, and vomiting.

Contusion

Head injury

actual bruising and bleeding in the brain tissue; can be very serious, especially in the brainstem is affected

Hematoma

HEAD INJURY

a collection of blood, usually clotted; may be classified as subdural or epidural.

Intracerebral Hemorrhage

Head Injury

result from lesions within the tissue of the brain itself; injuries may be small or large and may be accompanied by massive neurologic deficits.

Penetrating Injuries

Head Injury

result from sharp objects that penetrate the skull and brain tissue; scalp laceration along with the skull fracture; require prompt surgical intervention and pose an extremely high risk of infection for the patient because of the wound contamination that occurs

1.hematomas

2. debriding

Surgial Intervention for each type of head injury is directed at evacuating _____1____ and ______2___ damaged tissue.

Psoriasis

Skin Conditions

Bright red lesions or patches that may be covered with silvery scales.

no cure; treated topically or systematically; encourage patient to manage perscribed regimen of care

corticosteroids, tazarotene, estar, vit D

keratolytics, vit A derivative, antipsoriatic, retinoid antipsoriatic, photosensitity drug, biologic agents

Intertrigo

skin conditions

Inflammation of the skin where two skin surfaces touch: axillae, abdominal skinfolds, and the area under the breasts; usually red and "weeping" with clear margins; may be surrounded by vesicles and pustules.

Use a topical corticosteroid or antifungal agent(nystatin, ketoconazole,clotrimazole, terbinafine; Vytone 1% is a combo: antibacterial, antifungal, corticosteroid; keep area dry and clean

Atopic Dermatitis

(Eczema)

Acute Stage: red, oozing, crusty rash, intense pruritis

Subacute: red, excoriations and scaling plaques or pustules

Chronic: skin: dry, thick, scaly, brownish-gray in color

Topical corticosteroids-best control of inflammation; teach to decrease itching; moisturize skin; avoid irritants, mild soap; instruct on meds.

fluid shift

______________________________________

Local edema and decrease in cardiac output

greatest threat to life in the first 24 hours after a burn

___________________________

what nurse looks for in first 24 hours after burn

1. Emergent

2. Acute

3. Rehabilitation

Care of burn patient-3 stages

1.___ phase: stop the burning process; maintain airway and control bleeding

2.___ phase: fluid shifts back to the intravascular spaces 48-72 hours after; phase may last 10 days to months.

3. _____phase: begins at admission; focused on returning patient to a productive life.

Loop Diuretic

Diuretic

Act in the ascending loop of henle; Inhibit tubular reabsorption or sodium and chloride; Most potent diuretic; Leading to electrolyte depletion; Side effects: Orthostatic hypotension, hypokalemia, hyponatremia; Monitor patients with DM for hyperglycemia, Encourage potassium rich foods, Teach patients to cope with Orthostatic Hypotension

Osmotic Diuretics

Act at the proximal convoluted tubule; Increases the plasma osmotic pressure; causes redistribution of fluid toward the circulatory system; Side Effects: dehydration, electrolyte imbalances; Monitor infusion site for extravasations, Administer only freshly prepared solutions.

Common Meds: mannitol, urea

Carbonic anhydrase diuretics

Interferes with bonding of water and carbonic dioxide by the enzyme ____ ____ at the proximal convoluted tubule; Affects promotion of diuresis and urinary alkalinization.

Diamox

Potassium-sparing diuretics

Acts on distal convoluted tubule; Inihits sodium reabsorption and potassium secretion; Decreases the sodium and potassium exchange; Side Effects: Hyperkalemia, drowsiness, Gynecomastia in men on LT therapy; Teach safety measures; Assess for hyperkalemia: diarrhea, muscle twitching, dysrhythmias

spironolactone (Aldactonel)

Nalidixic Acid (NegGram)

Nitrofurantoin (Furadantin, Macrodantin)

Used to treat chronic and acute UTI’s; Side Effects: Dyspnea, N/V, numbness and tingling of legs; Administer with food or milk to reduce gastric distress.

Radiotherapy

The use of Ionizing radiation in the treatment of disease.

Used to treat cancer because malignant cells are more sensitive than normal cells to _______.

Has immediate and delayed effects.

Immediate: cell death due to damage to the cell membrane.

Delayed: alteration of DNA, which impairs cells ability to reproduce.

May be given internally or externally

Unit of measure is called Gray(formerly rad) 1gy=100rads

Chemotherapy

The use of chemical agents in the treatment of disease.

Chemical agents used to treat cancer: antineoplastics.

Act by destroying rapidly dividing cells and may be used alone or in combination with other forms of treatment.

Sometimes it can be curative, sometimes it may reduce the # of cancer cells, causing symptoms to decrease and often prolonging life.

Biotherapy

(Immunotherapy)

Agents that help boost the bodys natural immune system.

-Colony stimulating factors (CSF)

-Hematopoietic growth factors

-Biologic Response Modifiers (BRM)

 Causes of

Throat Cancer

(Laryngeal Cancer)

Factors believed to predispose to _____ cancer: exposure to smoke and other noxious fumes, alcohol consumption, vocal strain, chronic laryngitis; people who smoke and drink are at a particularly high risk.

S/S of Throat(laryngeal) Cancer

Common Treatment for

Throat (laryngeal) cancer

surgery, radiotherapy, chemotherapy, or some combination of these.

Diagnostic tests aid in selecting treatment.

Important consideration: Patients overall health state and ability to cope with the effects of specifit treatments

1. vocal cords

2. lung

3.men

4. women

Prognosis of Throat Cancer

The cure rate in highest for patients with tumors that are confined to the 1._____ _____.

The most common site of metastisis is the 2.____.

The death rate among men as 3. ____ slightly, but it has 4. _______ dramatically for women

TNM Staging of Cancer

1. T0

2. Tis

3. T1

4. T2, T3

5. T4

T=Primary Tumor

1. T_: no sign on tumor after tx

2. T__: malignancy in epithelial tissue but not basement membrane.

3. T_: Minimal size and extension

4. T_, T_: progressively increasing in size and extension.

5. T_: large size and extension

TNM Staging of Cancer

1. N0

2. N1

3. N2

4. N3

N= Regional Lymph Nodes

1. N_: no regional lymph nodes involved.

2. N_: minimal regional lymph node involvement

3. N_: increased involvement of regional lymph nodes

4. N_: extensive involvement of regional lymph nodes

TNM Staging of Cancer

1. M0

2. M1

M= Distant Metastasis

1. M_: no distant metastasis

2. M_: distant metastasis present

Antitussives

Codeine, Hydrocodone Bitatrate, Dextromethorphan

Supress cough reflex; control nonproductive cough or couch that intereferes with rest or wound healing; cause sedation; encourage fluids unless CI to facilitate expectoration of secretions

Antihistamines

Benadryl

Block allergic response; dry respiratory secretions; antiemetic and sedative effects; cause drowsiness, dry mouth, blurred vision, photophobia, thich secretions, decreased sweating, constipation, urinary retention, increased HR; monitor resp status; encourage fluids; monitor elimination; oral hygiene; CI asthma

Expectorant

Guaifenesin (robitussin)

thin resp secretions for easier expectoration; causes N/V with large doses; assess cough productivity; do not crush SR capsules

Initial Phase

Guillain Barre Syndrom Phases

Begins with onset of symptoms; Ends with disease ceases to progress; duration: usually 1-3 wks

Plateau Phase

Guillain Barre Syndrome Phases

No furthur changes; duration: several days to 2 wks

Recovery Phase

Guillain Barre Syndrome Phases

Gradual improvement; duration: as long as 2 years; some residual effects may be permanent.

Medical tx

Guillain-Barre Syndrome

Management during the acute phase is directed at preserving vital function, especially respiration. Respitation status is closely monitored and mechanical ventilation initiated if the vital capacity falls to 15ml/kg of body weight.

Massive doses of corticosterids may be perscribed to suppress the inflammatory process.