Rule of NIne

To approximate the percentage of burned surface area, the body has been divided into eleven
sections:
• Head
• Right arm
• Left arm
• Chest
• Abdomen
• Upper back
• Lower back
• Right thigh
• Left thigh
• Right leg (below the knee)
• Left leg (below the knee)
Each of these sections takes about nine percent of the body's skin to cover it. Added all together,
these sections account for 99 percent. The genitals make up the last one percent. To apply the
rule of nines, add up all the areas of the body that are burned deep enough to cause blisters or
worse (2nd or 3rd degree burns).

Kindle Wireless Reading Device, Wi-Fi, 6" Display - with New E Ink (Pearl) Technology

Excess Fluid Volume Hypervolemia; Fluid Overload

Nursing Diagnosis: Excess Fluid Volume
Hypervolemia; Fluid Overload
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels

* Fluid Balance

NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels

* Fluid Monitoring
* Fluid Management

NANDA Definition: Increased isotonic fluid retention

Fluid volume excess, or hypervolemia, occurs from an increase in total body sodium content and an increase in total body water. This fluid excess usually results from compromised regulatory mechanisms for sodium and water as seen in congestive heart failure (CHF), kidney failure, and liver failure. It may also be caused by excessive intake of sodium from foods, intravenous (IV) solutions, medications, or diagnostic contrast dyes. Hypervolemia may be an acute or chronic condition managed in the hospital, outpatient center, or home setting. The therapeutic goal is to treat the underlying disorder and return the extracellular fluid compartment to normal. Treatment consists of fluid and sodium restriction, and the use of diuretics. For acute cases dialysis may be required.

* Defining Characteristics: Weight gain
* Edema
* Bounding pulses
* Shortness of breath; orthopnea
* Pulmonary congestion on x-ray
* Abnormal breath sounds: crackles (rales)
* Change in respiratory pattern
* Third heart sound (S3)
* Intake greater than output
* Decreased hemoglobin or hematocrit
* Increased blood pressure
* Increased central venous pressure (CVP)
* Increased pulmonary artery pressure (PAP)
* Jugular vein distension
* Change in mental status (lethargy or confusion)
* Oliguria
* Specific gravity changes
* Azotemia
* Change in electrolytes
* Restlessness and anxiety

* Related Factors: Excessive fluid intake
* Excessive sodium intake
* Renal insufficiency or failure
* Steroid therapy
* Low protein intake or malnutrition
* Decreased cardiac output; chronic or acute heart disease
* Head injury
* Liver disease
* Severe stress
* Hormonal disturbances

* Expected Outcomes Patient maintains adequate fluid volume and electrolyte balance as evidenced by vital signs within normal limits, clear lung sounds, pulmonary congestion absent on x-ray, and resolution of edema.

Ongoing Assessment

* Obtain patient history to ascertain the probable cause of the fluid disturbance. This can help to guide interventions. May include increased fluids or sodium intake, or compromised regulatory mechanisms.
* Assess or instruct patient to monitor weight daily and consistently, with same scale and preferably at the same time of day. Instruction facilitates accurate measurement and helps to follow trends.
* Monitor for a significant weight change (2 pounds) in 1 day.
* Evaluate weight in relation to nutritional status. In some heart failure patients, weight may be a poor indicator of fluid volume status. Poor nutrition and decreased appetite over time result in a decrease in weight, which may be accompanied by fluid retention even though the net weight remains unchanged.
* If patient is on fluid restriction, review daily log or chart for recorded intake. Patients should be reminded to include items that are liquid at room temperature such as Jell-O, sherbet, and Popsicles.
* Monitor and document vital signs. Sinus tachycardia and increased blood pressure are seen in early stages. Elderly patients have reduced response to catecholamines, thus their response to fluid overload may be blunted, with less rise in heart rate.
* Monitor for distended neck veins and ascites. Monitor abdominal girth to follow any ascites accurately.
* Auscultate for a third sound, and assess for bounding peripheral pulses. These are signs of fluid overload.
* Assess for crackles in lungs, changes in respiratory pattern, shortness of breath, and orthopnea. These are early signs of pulmonary congestion.
* Assess for presence of edema by palpating over tibia, ankles, feet, and sacrum. Pitting edema is manifested by a depression that remains after one’s finger is pressed over an edematous area and then removed. Grade edema from trace (indicating barely perceptible) to 4 (severe edema). Measurement of an extremity with a measuring tape is another method of following edema.
* Monitor chest x-ray reports. As interstitial edema accumulates, the x-rays show cloudy white lung fields.
* Monitor input and output closely. Although overall fluid intake may be adequate, shifting of fluid out of the intravascular to the extravascular spaces may result in dehydration. The risk of this occurring increases when diuretics are given. Patients may use diaries for home assessment.
* Evaluate urine output in response to diuretic therapy. Focus is on monitoring the response to the diuretics, rather than the actual amount voided. At home, it is unrealistic to expect patients to measure each void. Therefore recording two voids versus six voids after a diuretic medication may provide more useful information. NOTE: Fluid volume excess in the abdomen may interfere with absorption of oral diuretic medications. Medications may need to be given intravenously by a nurse in the home or outpatient setting.
* Monitor for excessive response to diuretics: 2-pound loss in 1 day, hypotension, weakness, blood urea nitrogen (BUN) elevated out of proportion to serum creatinine level.
* Monitor serum electrolytes, urine osmolality, and urine-specific gravity.
* Assess the need for an indwelling urinary catheter. Treatment focuses on diuresis of excess fluid.
* During therapy, monitor for signs of hypovolemia. Monitoring prevents complications associated with therapy.
* If hospitalized, monitor hemodynamic status including CVP, PAP, and PCWP, if available. This direct measurement serves as optimal guide for therapy.

Therapeutic Interventions

* Institute/instruct patient regarding fluid restrictions as appropriate. This helps reduce extracellular volume. For some patients, fluids may need to be restricted to 1000 ml/day.
* Provide innovative techniques for monitoring fluid allotment at home. For example, suggest that patients measure out and pour into a large pitcher the prescribed daily fluid allowance (e.g., 1000 ml); then every time patient drinks some fluid, he or she is to remove that amount from the pitcher. This provides a visual guide for how much fluid is still allowed throughout the day.
* Restrict sodium intake as prescribed. Sodium diets of 2 to 3 g are usually prescribed.
* Administer or instruct patient to take diuretics as prescribed. Diuretic therapy may include several different types of agents for optimal therapy, depending on the acuteness or chronicity of the problem. For chronic patients, compliance is often difficult for patients trying to maintain a normal lifestyle.
* Instruct patient to avoid medications that may cause fluid retention, such as over-the-counter nonsteroidal antiinflammatory agents, certain vasodilators, and steroids.
* Elevate edematous extremities. This increases venous return and, in turn, decreases edema.
* Reduce constriction of vessels (e.g., use appropriate garments, avoid crossing of legs or ankles). This prevents venous pooling.
* Instruct in need for antiembolic stockings or bandages as ordered. These help promote venous return and minimize fluid accumulation in the extremities.
* Provide interventions related to specific etiological factors (e.g., inotropic medications for heart failure, paracentesis for liver disease).

* For acute patients: Consider admission to acute care setting for hemofiltration or ultrafiltration. This is a very effective method to draw off excess fluid.
* Collaborate with the pharmacist to maximally concentrate IVs and medications. This decreases unnecessary fluids.
* Apply saline lock on IV line. This maintains patency but decreases fluid delivered to patient in a 24-hour period.
* Administer IV fluids through infusion pump, if possible. This ensures accurate delivery of IV fluids.
* Assist with repositioning every 2 hours if patient is not mobile. This prevents fluid accumulation in dependent areas.

Education/Continuity of Care

* Teach causes of fluid volume excess and/or excess intake to patient or caregiver.
* Provide information as needed regarding the individual’s medical diagnosis (e.g., congestive heart failure [CHF], renal failure).
* Explain or reinforce rationale and intended effect of treatment program.
* Identify signs and symptoms of fluid volume excess.
* Explain importance of maintaining proper nutrition and hydration, and diet modifications.
* Identify symptoms to be reported.

Imbalanced Nutrition: Less than Body Requirements

Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements
Starvation; Weight Loss; Anorexia
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels

* Nutritional Status: Food and Fluid Intake
* Nutritional Status: Nutrient Intake

NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels

* Nutrition Monitoring
* Nutrition Therapy
* Nutrition Management

NANDA Definition: Intake of nutrients insufficient to meet metabolic needs

Adequate nutrition is necessary to meet the body’s demands. Nutritional status can be affected by disease or injury states (e.g., gastrointestinal [GI] malabsorption, cancer, burns); physical factors (e.g., muscle weakness, poor dentition, activity intolerance, pain, substance abuse); social factors (e.g., lack of financial resources to obtain nutritious foods); or psychological factors (e.g., depression, boredom). During times of illness (e.g., trauma, surgery, sepsis, burns), adequate nutrition plays an important role in healing and recovery. Cultural and religious factors strongly affect the food habits of patients. Women exhibit a higher incidence of voluntary restriction of food intake secondary to anorexia, bulimia, and self-constructed fad dieting. Patients who are elderly likewise experience problems in nutrition related to lack of financial resources, cognitive impairments causing them to forget to eat, physical limitations that interfere with preparing food, deterioration of their sense of taste and smell, reduction of gastric secretion that accompanies aging and interferes with digestion, and social isolation and boredom that cause a lack of interest in eating. This care plan addresses general concerns related to nutritional deficits for the hospital or home setting.

* Defining Characteristics: Loss of weight with or without adequate caloric intake
* 10% to 20% below ideal body weight
* Documented inadequate caloric intake

* Related Factors: Inability to ingest foods
* Inability to digest foods
* Inability to absorb or metabolize foods
* Inability to procure adequate amounts of food
* Knowledge deficit
* Unwillingness to eat
* Increased metabolic needs caused by disease process or therapy

* Expected Outcomes Patient or caregiver verbalizes and demonstrates selection of foods or meals that will achieve a cessation of weight loss.
* Patient weighs within 10% of ideal body weight.

Ongoing Assessment

* Document actual weight; do not estimate. Patients may be unaware of their actual weight or weight loss due to estimating weight.
* intervObtain nutritional history; include family, significant others, or caregiver in assessment. Patient’s perception of actual intake may differ.
* Determine etiological factors for reduced nutritional intake. Proper assessment guides intervention. For example, patients with dentition problems require referral to a dentist, whereas patients with memory losses may require services such as Meals-on-Wheels.
* Monitor or explore attitudes toward eating and food. Many psychological, psychosocial, and cultural factors determine the type, amount, and appropriateness of food consumed.
* Monitor environment in which eating occurs. Fewer families today have a general meal together. Many adults find themselves "eating on the run" (e.g., at their desk, in the car) or relying heavily on fast foods with reduced nutritional components.
* Encourage patient participation in recording food intake using a daily log. Determination of type, amount, and pattern of food or fluid intake is facilitated by accurate documentation by patient or caregiver as the intake occurs; memory is insufficient.
* Monitor laboratory values that indicate nutritional well-being/deterioration:
o Serum albumin This indicates degree of protein depletion (2.5 g/dl indicates severe depletion; 3.8 to 4.5 g/dl is normal).
o Transferrin This is important for iron transfer and typically decreases as serum protein decreases.
o RBC and WBC counts These are usually decreased in malnutrition, indicating anemia and decreased resistance to infection.
o Serum electrolyte values Potassium is typically increased and sodium is typically decreased in malnutrition.
* Weigh patient weekly. During aggressive nutritional support, patient can gain up to 0.5 pound/day.

Therapeutic Interventions

* Consult dietitian for further assessment and recommendations regarding food preferences and nutritional support. Dietitians have a greater understanding of the nutritional value of foods and may be helpful in assessing specific ethnic or cultural foods (e.g., "soul foods," Hispanic dishes, kosher foods).
* Establish appropriate short- and long-range goals. Depending on the etiological factors of the problem, improvement in nutritional status may take a long time. Without realistic short-term goals to provide tangible rewards, patients may lose interest in addressing this problem.
* Suggest ways to assist patient with meals as needed. Ensure a pleasant environment, facilitate proper position, and provide good oral hygiene and dentition. Elevating the head of bed 30 degrees aids in swallowing and reduces risk of aspiration.
* Provide companionship during mealtime. Attention to the social aspects of eating is important in both the hospital and home settings.
* For patients with changes in sense of taste, encourage use of seasoning.
* For patients with physical impairments, refer to occupational therapist for adaptive devices.
* For hospitalized patients, encourage family to bring food from home as appropriate. Patients with specific ethnic, religious preferences, or restrictions may not be able to eat hospital foods.
* Suggest liquid drinks for supplemental nutrition.
* Discourage beverages that are caffeinated or carbonated. These may decrease appetite and lead to early satiety.
* Discuss possible need for enteral or parenteral nutritional support with patient, family, and caregiver as appropriate. Enteral tube feedings are preferred for patients with a functioning GI tract. Feedings may be continuous or intermittent (bolus). Parenteral nutrition may be indicated for patients who cannot tolerate enteral feedings. Either solution can be modified to provide required glucose, protein, electrolytes, vitamins, minerals, and trace elements. Fat and fat-soluble vitamins can also be administered two or three times per week. These feedings may be used with in-hospital, long-term care, and subacute care settings, as well as in the home.
* Encourage exercise. Metabolism and utilization of nutrients are enhanced by activity.

Education/Continuity of Care

* Review and reinforce the following to patient or caregivers:
o The basic four food groups, as well as the need for specific minerals or vitamins Patients may not understand what is involved in a balanced diet.
o Importance of maintaining adequate caloric intake; an average adult (70 kg) needs 1800 to 2200 kcal/ day; patients with burns, severe infections, or draining wounds may require 3000 to 4000 kcal/day
o Foods high in calories and protein that will promote weight gain and nitrogen balance (e.g., small frequent meals of foods high in calories and protein)
* Provide referral to community nutritional resources such as Meals-on-Wheels or hot lunch programs for seniors as indicated.

Top 10 Detox Foods, lowering your weight and your real age

Green leafy vegetables.
Eat them raw, throw them into a broth, add them to juices. Their chlorophyll helps swab out environmental toxins (heavy metals, pesticides) and is an all-round liver protector.

Lemons. You need to keep the fluids flowing to wash out the body and fresh lemonade is ideal. Its vitamin C - considered the detox vitamin - helps convert toxins into a water - soluble form that?s easily flushed away.

Watercress. Put a handful into salads, soups, and sandwiches. The peppery little green leaves have a diuretic effect that helps move things through your system. And cress is rich in minerals too.

Garlic. Add it to everything - salads, sauces, spreads. In addition to the bulb's cardio benefits, it activates liver enzymes that help filter out junk.
Green tea. This antioxidant-rich brew is one of the healthiest ways to get more fluids into your system. Bonus: It contains catechins, which speed up liver activity.

Broccoli sprouts. Get 'em at your health-food store. They pack 20 to 50 times more cancer-fighting, enzyme-stimulating activity into each bite than the grown-up vegetable.

Sesame seeds. They're credited with protecting liver cells from the damaging effects of alcohol and other chemicals. For a concentrated form, try tahini, the yummy sesame seed paste that?s a staple of Asian cooking.

Cabbage. There are two main types of detoxifying enzymes in the liver; this potent veggie helps activate both of them. Coleslaw, anyone?

Psyllium. A plant that?s rich in soluble fiber, like oat bran, but more versatile. It mops up toxins (cholesterol too) and helps clear them out. Stir powdered psyllium into juice to help cleanse your colon, or have psyllium-fortified Bran Buds for breakfast.

Fruits, fruits, fruits. They're full of almost all the good things above - vitamin C, fiber, nutritious fluids, and all kinds of antioxidants. Besides, nothing tastes better than a ripe mango, fresh berries, or a perfect pear. Kung ano nalang makikita dito sa pinas basta fruit.

High Blood Pressure: Anyone?

High blood pressure has been known to affect alot of individuals throughout the world. It is known as the "silent killer". Its still considered as one of the causes of morbidity and mortality in the world. Here are some ways of reducing or preventing high blood pressure:
1. Garlic is a proven remedy for those exhibiting symptoms of high blood pressure but as garlic thins the blood consultation with your physician is recommended before treatment begins.

2. Fish oil has also been used effectively in high blood pressure treatment. Studies have shown that it is the docohexaenoic acid, or DHA, which is the active ingredient in the treatment of high blood pressure.
3. A potassium-rich diet Very often, blood pressure levels depend on the sodium/potassium ratio in the blood. If there is enough potassium in the blood, then it acts as a buffer and mitigates the effects of high sodium levels, known to increase blood pressure. Potassium rich food includes bananas, oranges and potatoes can therefore be a natural treatment for high blood pressure. Both children and adults should eat 4500 mg of potassium a day. A significant reduction in the symptoms of high blood pressure are seen when supplements like folic acid are added to the diet. Studies have showed positive results in smokers who were given a folic acid treatment for high blood pressure.

4. Exercise High blood pressure can be lowered by regular exercise, which in turn will help keep weight down. Research has shown that there can be a fall of 1 mm Hg in blood pressure for every 2lbs lost. Keep food intake at a reasonable level and ensure that through diet, exercise and supplementation, the medical treatment of high blood pressure may never become necessary.

Psychiatry Assessment

❍ What are the three types of clinical psychiatric evaluations according to the American Psychiatric
Association (APA)?
The general psychiatric evaluation, the emergency psychiatric evaluation, and the clinical psychiatric consultation.

❍ What are the goals of a general psychiatric evaluation according to the APA?
To establish a diagnosis, generate a case formulation, develop a treatment plan, and ascertain if any symptoms (such
as suicidal ideation) need emergency treatment. Development of an empathic rapport is also essential to initiating
and maintaining treatment compliance.

❍ How do the goals of an emergency psychiatric evaluation differ from the goals of a general psychiatric
evaluation?
Not much, in reality. However, out of necessity, there is a greater emphasis on safety and willingness to participate
in treatment during the emergency psychiatric evaluation. In the event that a person is unable to maintain his or
her own safety (and/or others), and unwilling to participate in an appropriate level of care, involuntary
commitment processes are indicated.

❍ What is the essential component of the clinical psychiatric consultation?
The reason for the evaluation. If you do not answer the question the consulting physician, court, therapist, or
caseworker is asking, you will not be consulted again. When the reason for the psychiatric consultation is vague,
it is best to ascertain (from the person/institution requesting the evaluation) the exact reason for the evaluation
(i.e., psych 2C = call 2U).

❍ True/False: The patient is not to be informed of who requested a psychiatric consultation or the reason for
the evaluation.
False. The person/institution requesting the psychiatric evaluation should ideally ask the patient to participate in a
psychiatric evaluation and the reason why, while the consultant should clearly state who is requesting the evaluation
and the reason thereof. When psychiatric consultations are requested for nonclinical reasons, the limits of
confidentiality should be reviewed and agreed to by the patient and/or their guardian before the evaluation
begins.

❍ What are the components of a clinical psychiatric examination?
The components of a clinical psychiatric examination are the reason for evaluation, history of present illness; past
psychiatric history; review of collateral sources of information including previous psychiatric records, psychological
testing, and rating scales; past medical history; review of pertinent laboratory and radiology studies; review of
systems; developmental history; family history; social history; mental status examination; physical examination; risk
assessment; multiaxial diagnoses; and treatment recommendations.

❍ What sources of information are utilized during a clinical psychiatric examination?
The first and foremost source of information for a psychiatric evaluation is the clinical interview with the patient.
Additional information can be obtained from structured interview, various questionnaires, and results of
psychological testing. With written permission from the patient or their guardian, review of previous records and
interviews with appropriate persons involved the patient’s life can yield valuable perspectives as to the patient’s level
of functioning and risk for adverse events.

❍ What factors should be considered when determining the reason for a psychiatric evaluation?
Who, why, and what services the psychiatrist is expected to render. All these factors will influence the nature and
the course of the psychiatric evaluation.
It is important to determine who requested the evaluation, especially if not requested by the patient. Reliability
and willingness to be examined can be significantly compromised if the patient did not request the evaluation (such
as when the patient is in emergency protective custody or when an examination is requested by the courts), and
additional sources of information may need to be pursued more diligently if questions of safety or reliability are
present.
Ascertaining the reason for the evaluation is imperative in order to collect sufficient information and make
appropriate recommendations. Generally, when a patient requests an evaluation, the reason for assessment is to
determine appropriate interventions for distressing symptoms. However, when someone other than a patient
requests an evaluation, it is essential to determine the specific reason why the evaluation is needed, again, so that
specific and appropriate recommendations can be made.
Finally, determining what services are to be rendered by the psychiatrist will influence what recommendations
are made. For instance, if the evaluation is for purposes of disability determination, the psychiatric examination
and recommendations will be somewhat different than if the psychiatrist is expected to be the treating physician.

❍ What information should be included in the history of present illness?
The severity and duration of current symptoms, as well as identifiable stressors. Pertinent negatives as well as
statements regarding dangerousness to self and others should also be included.

❍ True/False: A substance abuse history is not a component of the psychiatric evaluation.
False. A substance abuse history is critical to every psychiatric evaluation, even if it is negative. The use of
substances during any psychiatric illness does tend to expand the differential diagnosis and is a major risk factor
in dangerousness to self or others.

❍ Past psychiatric history should include what information?
The past psychiatric history should include information about any inpatient psychiatric hospitalizations, the reason
for hospitalization, and diagnoses, if available. Information about index hospitalizations are often very helpful as to
the severity of illness and diagnosis, especially if the patient is presenting for treatment in a stable condition. In
addition, prior outpatient services by psychiatrists and other mental health providers should be included, as well as
a history of previous medication trials and the response thereof.

❍ Why is past medical history an essential component of the psychiatric evaluation?
Past medical history is essential in ruling out medical causes of psychiatric symptoms, as well as assessing for
medication interactions that may be present. In addition, a medical illness may be a major stressor, particularly
when that illness is disabling or disfiguring.

❍ What information should be included in a developmental history?
Information regarding birth history, developmental milestones, relationships, and level of functioning in those
relationships are the items that are generally included in a developmental history.

❍ What clinical implications does a family history of psychiatric disorders?
A positive psychiatric family history may help with establishing risk factors for particular diagnoses, predicting
response to various medications, and in developing a greater understanding of the patient’s past and current family
milieu.
❍ What is one of the best means for evaluating the distribution of mental illness in a family?
A genogram.

❍ What does the occupational and social history tell the examiner about a patient’s level of functioning?
An occupational and social history gathers information about a person’s ability to “work and love.” The ability to
hold a job for a period of time demonstrates an ability to structure daily activities, meet expectations, relate
adequately with peers and supervisors, and take on a certain minimum level of responsibility. The ability to have a
long-term relationship indicates an ability to attend to someone else’s needs, control impulses, and make a
commitment.

❍ List some questions pertaining to a patient’s religious background.
Questions to ask about the role of religion in a person’s life could include some of the following: Were there
conflicts between the patient’s and parent’s religious beliefs? How large a role does religion play in the patient’s life?
How do the parent’s religious beliefs impact on the patient’s attitude toward emotions, conflict, and psychiatric
treatment?

❍ An extensive legal history can lead one to consider which two diagnoses?
Antisocial personality disorder, and alcohol and/or substance dependence.
❍ Is physical examination included in a psychiatric evaluation?
Yes. Particularly because some physical findings may be directly related to the patient’s psychiatric condition or
psychotropic medication side effects.

❍ What conditions can cause increased psychomotor activity?
Anxiety, akathesia, hyperactivity associated with attention deficit hyperactivity disorder, elevated mood, agitation
during psychotic episodes, confusional states due to delirium or dementia, and iatrogenic causes.

❍ What are the components of a mental status examination?
The components of a mental status examination include general appearance, movements, speech, attitude, thought
process, mood, affect, thought content, orientation to time and place, immediate and short-term recall,
concentration, fund of knowledge, insight, judgment, and estimate of intelligence.

❍ What aspects of the patient’s speech should be assessed?
Rate and rhythm, quality, volume and tone, grammar and syntax, and vocabulary.

❍ List some possible causes of muteness.
Aphasia, acute depression, conversion disorder, psychosis, and secondary gain.
❍ What is motor aphasia?
Motor aphasia is a disturbance of speech in which understanding remains intact but the ability to speak is grossly
impaired. Speech is halting, laborious, and inaccurate. Motor aphasia is also known as expressive aphasia, Broca’s
aphasia, or nonfluent aphasia.

❍ What is echopraxia?
The pathological imitation of one person’s movements by another.

❍ What is alexithymia?
Alexithymia is the inability or difficulty a person has in describing or even being aware of their emotions or
moods.

❍ A patient states, “It’s one or my mother, I mean, one or another.” Of what psychological phenomenon is this
an example?
Parapraxis or Freudian slip.

❍ What is the difference between a neologism and a word salad?
Neologisms are new, nonsensical words created by the patient, while word salad is an incoherent mixture of words
and phrases.

❍ How is affect characterized?
Affect is described by its range, lability, appropriateness, intensity, relatedness, and congruence with mood.

❍ How is a patient’s mood described in a mental status examination?
In the patient’s own words, usually.

❍ What aspects of thought content are generally included in a psychiatric evaluation?
The patient’s thought content is examined for suicidal or homicidal ideation (and intent): perceptual disturbances such as auditory, visual, tactile, or gustatory hallucinations; delusions, ideas of reference, and ideas of influence.

❍ Name five risk factors for suicide.
Previous attempts, seriousness of attempts, a history of alcohol or drug usage, lack of social support, and presence
of an Axis I disorder.

❍ Does the risk of suicide increase with direct questioning about suicide?
There is no evidence that it increases risk, and it is likely to increase communication and trust with the
patient.

❍ While interviewing a potentially violent patient, what precautions should be taken?
Do not interview the patient alone. Leave the door to the interview room open, and sit between the patient and the
door to allow for unrestricted exit.

❍ What factors are involved in assessing acute dangerousness?
History of violent behavior, current violent ideation, a realistic and premeditated plan, and intent.

❍ Name three kinds of normal perceptual disturbances?
Illusions, hypnagogic hallucinations, and hypnopompic hallucinations.

❍ Should a patient’s delusions be directly confronted?
No, the patient will generally become more defensive and even more fixed in their beliefs.

❍ What exactly is a delusion?
A delusion is a false belief not based on reality.

❍ List five types of delusions?
Paranoid, somatic, delusions of infidelity, delusions of poverty, and delusions of grandeur are five types of
delusions. Other types of delusions include, but are not limited to those of control (thought withdrawal,
thought broadcasting, thought insertion, thought control), erotomania, nihilistic delusions, and bizarre
delusions. In general, delusions can form about anything or anyone, and may not fit into any particular type of
delusion.

❍ How is concentration assessed on a mental status examination?
By patient report, behavioral observation, serial 7’s (or 3’s if there are educational or developmental deficits noted),
or by spelling the word “world” backward.

❍ In a patient who is disoriented, which sphere is the last to be affected; which is the first?
Orientation to person; orientation to time.

❍ What is the best way to infer a patient’s level of intellectual functioning?
By considering the patient’s vocabulary and ability to interpret proverbs.

❍ What is considered to be a normal digit span?
The majority of people are able to recall seven digits forward and five to seven digits backward.

❍ What are the essential differences between delirium and dementia?
Delirium is characterized by an acute state of confusion, disorientation, and varying levels of consciousness, while
dementia is a gradual or step-wise decline in intellectual functioning.

❍ What are the characteristic features and course of delirium?
Delirium is characterized by an acute onset of impaired consciousness, with global impairment of cognitive
functions. The course is usually brief and fluctuating, and rapid improvement occurs when the underlying etiology
resolves.

❍ How can agitation be distinguished from anxiety in the geriatric population?
Agitated individuals do not generally complain of a sense of impending doom or dread.

❍ In distinguishing between schizophrenia and bipolar disorder, what single finding on mental status examination would most likely lead to a diagnosis of schizophrenia?
Flat affect.

Ways on how to easily remember clinical facts

1. To remember the difference between
transudate and exudate, focus on
the prefixes …
• Trans- means “across,” as in the
transcontinental railroad
• Ex- means “out of,” as in exhale.

2. To remember the difference between
aerobic and anaerobic, think of jogging …
• When you jog, an aerobic activity, your
body needs oxygen, or air— aerobic means
oxygen is required.
• Anaerobic means without oxygen.

3. To remember what allergies to ask your
patient about before a CT scan that
requires contrast medium, think of SIC …
Shellfish
Iodine
Contrast media (prior sensitive reaction).

4. To remember the signs and symptoms
of a hypersensitivity reaction to contrast
media, think PURR …
Pruritus
Urticaria
Rash
Respiratory distress.

5. To remember what to assess when
evaluating a skin lesion, think of A, B, C, D …
A for asymmetry
B for border
C for color and configuration
D for diameter and drainage.

6. To remember that cones are cells in
the eyes that respond to color, think of
brightly colored ice cream cones.

7. To remember which direction to move
the syringe when you want to slow down
the flow through the tube, think of …
• lower is slower, or …
• slow DOWN.

8. To remember the meaning of myasthenia
gravis …
think of grave muscle weakness.

9. To remember the progression of ARDS,
think of …
Assault to the pulmonary system
Respiratory distress
Decreased lung compliance
Severe respiratory failure.

10. To remember the progression of
signs and symptoms of Lyme disease,
remember LIME …
Lesions, lymph node swelling, like the flu (Stage 1)
Innervation problems, such as meningitis and
peripheral neuropathy (Stage 2)
Movement problems, such as arthritis (Stage 3)
Everything else, such as myocarditis and
arrhythmia (Stage 3).

11. To remember the difference between
depolarization and repolarization, think of …
the R in repolarization as standing for Rest.
Repolarization is the resting phase of the
cardiac cycle.

12. When performing an assessment, remember
this CAUTION from the American Cancer
Society…
Change in bowel or bladder habits
A sore that doesn’t heal
Unusual bleeding or discharge
Thickening or lump
Indigestion or difficulty swallowing
Obvious changes in a wart or mole
Nagging cough or hoarseness.

13. To remember the four causes of cell injury,
think of how the injury tipped (or TIPD)
the scale of homeostasis …
Toxin or other lethal (cytotoxic) substance
Infection
Physical insult or injury
Deficit or lack of water, oxygen, or nutrients.

14. When combining insulins, to remember
which to draw first, think of
“clear before cloudy.”
Who doesn’t prefer a clear day to a cloudy one?

15. Remember this jingle when
converting inches to centimeters …
“ 2.54, that’s 1 inch and no more.”

16. Remember that X factor is often used to
describe a person or event that could cause
uneXpected, or unknown, outcomes.
Keep this in mind when performing dosage
calculations and you’ll remember that X
represents the unknown part of a ratio or fraction.

17. To remember the conditions that affect
the length of patient stay, think of FOCUS …
Functional skills (and disabilities)
Other diseases
Chronicity
Urgency of needs
Support of systems.

18. To remind yourself of the need to
check and adjust flow rates, remember
the following tongue twister …
Fight fickle flow with frequent follow-up.

19. To remember which drugs can be given
safely through an endotracheal tube, think
of ALE…
Atropine
Lidocaine
Epinephrine.

20. To remember which drug should be
inhaled FIRST, think about your ABCs…
A Bronchodilator comes before a Corticosteroid.

21. When using an IN-LINE nebulizer,
remember to…
connect it to the IN-SPIRATORY side
of the ventilatory circuit.

Ways on how to gain weight

As requested,Ive researched on some tips on how to gain weight safely:

Tip 1:Eat the Right Foods
The most obvious way to gain weight is by increasing your food intake. But don’t binge on those Krispy Kremes just yet. Yes, you can easily gain weight by eating donuts and other junk food, but that’s not a healthy way to do it. You’ll consume lots of fats and sugars, and that’s not good for your body. Choose healthier food options instead: lean meats, poultry, fish, vegetables, fruits, and whole grains. This way you’ll get all the nutrition your body needs.

How To Do It: Do a health and wellness assessment first. If possible, approach a nutritionist about it. You need to find out your height, weight, and describe your lifestyle (e.g. eating habits, leisure activities). Based on all these information, the nutritionist will recommend the foods you should consume and how often you should eat.

Possible Problems: You might be exposed to unhealthy foods at home or when you’re dining out. Just control your junk food cravings (say “no" to pizza). Also, managing your calorie intake could be a daunting task, so just be particular about your diet.

Tip 2: Cut out the Bad Fat!

Avoid trans fats like the plaque, and go for the “good fats”. Yes, you want to gain weight, however you don’t want to gain weight that is in fact just fat. So, cut out the cakes, chips and candy. No more visits to McDonalds and steer clear of anything fried. High protein low fat foods like tuna fish (and other seafood), chicken breast, turkey, lean meats, fruits and vegetables etc, are the good clean foods to eat.

Tip 3: Get Drinking!

Drink around a half gallon of water a day and even more if you can. Sure, that’s a lot of water, but believe it or not, it’s that water you need for the energy you need to gain weight! Dehydration can lead to all sorts of health problems, including less stamina at the gym.

Tip 4: Sleep more

Get lots of sleep. This is one of the easiest yet most neglected weight gain tips. Sleep for a minimum of 8 hours night. You’re body needs it to function properly.

Tip 5: Lift

Get in the gym and lift! This is another important step in how to gain weight, so make sure you are doing it correctly. Try at least to increase your protein intake and add some resistance training on top of your other attempts to gain weight and it will make you a bit more filled out while retaining your shape.

Unlock your brain's potential

Unlock your brain's potential

Scientist suggest that Einstein was no smarter than the average person, but he knew how to tap into his full brain power. By the end of this guide you will learn the methods that could make you use as much of your brain as Einstein!
The methods that we were taught in school to use for learning are over three thousand years old and they simply do not work. Most of us have been convinced that we only use about 10% of our brain on a daily basis. Unfortunately the number is more like only 1%, but it doesn’t have to be that way. We can learn to use almost all of our brain all of the time. We simply just need to change our way of learning. What we were taught in school did not work for most people and left many people feeling inadequate, slow and downright stupid. We have used an inadequate and primitive method to learn which is slow, makes learning more work than it has to be and hinders learning challenges instead of facilitating them.


Scientist studied the EEG readings of two groups of people. One group worked on painting masterpieces while the other group just doodled. The scientist expected the group working on the masterpieces to have higher EEG readings than the doodlers. To their amazement, both groups had roughly the same EEG readings. It doesn’t take any more brainpower to paint a masterpiece than it does to doodle stick people. If it takes as much energy to goof off as it does to paint a masterpiece, you might as well work on a masterpiece. The masterpiece in this article is your brain. It deserves your attention and it deserves to be used to its fullest capacity and be filled with information and knowledge that you can use.

People focus on writing things down way to much. This is a very bad habit to get into, and can decrease your ability to remember things. Here are some tips on how to remember things a bit better:

1. Believe you’ll remember it to focus your whole brain on the effort.
2. Will yourself to remember it to activate the internal brain.
3. Visualize, clearly in your mind what it is you want to remember to bring it into focus of your whole mind.
4. Tell yourself to remember it so your unconscious will mark it as special and make it stand out more.
5. Mentally review it the next morning.
6. Review the material again to refresh and reinforce it.

When you first wake up in the morning, you are a lot smarter than you are the rest of the day. Your brain is open. You are in the genius state. This occurs when you first wake up, and Einstein found that out. So, he did something incredible... He learned how to get into it. What he did is sit down holding a ball in his hand. He closed his eyes and relaxed. Then as he started to fall alseep, his muscles would loosen and the ball would drop, thus waking him up. When he awoke, he was in the genius state. Another state that geniuses used taps into your brain, and takes experience from any part of your life, and pretty much gives yourself advice. Here are the steps:

1. Sit in a quiet place where you won’t be interrupted.
2. Close your eyes.
3. Imagine that you are in a lush green forest. Imagine it more vividly with each step you take. Invoke the senses so that you not only see the forest, but you can also hear the sounds and smell the scents of the forest.
4. Then imagine that on your path you come to a rustic cabin, a quaint little house. See the house as vividly as you can with colors, shapes of windows, curtains, etc. Also imagine the landscape—what does the yard look like? Imagine it as vividly as possible too.
5. Imagine that you walk up to the door, you see and feel the doorknob, you open the door and then walk inside.
6. Next you visualize that a wise old man or woman is in the middle of the room. Visualize the person as fully as possible. Go to the wise old man/woman and tell him/her your problem.
7. Listen closely to what you think the person might say.

You will sometimes be amazed at what your own unconscious mind will tell you. This is also the part of your mind that spits out things you were trying to remember days or weeks before. It’s that time you are driving along or see something that sparks your memory and all of a sudden the answer comes to you.

We need to reprogram our minds with positive thoughts and messages to change our negative thinking about learning into positive ones. Think about all the things you have learned so far. Tell yourself that you will remember what you’re learning and what you need to remember. Working on these simple tricks will help your memory improve tremendously.

Here are some more small, but extremely useful things you can do to get the most out of your brain:


Deep breathing- Taking deeper breaths enhances your brain's power.See, your brain (all of your body for that matter) needs oxygen to function; And it is proven that the more you get the better.
Not only will this help you think better, but it will increase the strength of your lungs which can help in various circumstances.

Meditation- This isn't a long term thing, but more of a cooldown. Meditating when you are stressed, or are about to do something important is very helpful. Sitting down, closing your eyes, and focusing on nothing but your breath.
This relaxes you, and clears your mind. Do this for 5-10 minutes, and you will feel rejuvinated afterwards.

Using Dead time- When you are in the car, or walking to school, or other things like that just waste your time. Yes, you are getting somewhere, but what more do most people do besides talk or listen to an I-pod while doing it?
Find an audio file that is educational, and burn it to a CD, then whenever you are in the car, you can still be learning something. Or find a video file (like how to setup a rat, etc.) and put it on your I-pod for when you are walking to school, or riding passenger.


Rosemary- There isn't an absolute proven study that this is a working method, but some people swear that their brains get woken up just from inhaling the scent or Rosemary. No harm could be done, so why not try it? Maybe it will work for you.

Music- This isn't about listening to rap or hard rock, but things like Mozart. There was a study at the University of California, that kids who listened to piano and/or sang in a daily chorus were much better at solving puzzles, and scored 80% higher in spacial intellenigence.

Sugar- Do not eat sugar before a test, or something that requires thinking like that. Sugar can cause "Brain fog" and mess up your train of thought.

Fun- Don't be all work. Even if you try to be the smartest person in the world all day long, you will still feel empty. Find a balance that it suitible for you between working and doing something you enjoy. It will relieve a lot of stress, and can take your mind off of things that could be bothering you.

Fish- Eating fish actually speeds up your brain waves. Faster brain waves means faster thinking when you are in a fast situation. There are also fish-oil pills that you can use like vitamins, which takes the place of eating fish.

Puzzles- Grab a cross word once every other day, or whatever schedule you want, or even a couple riddles. This makes you think outside the box, and a great way to do get brain exercise. It is even god to do while at an airport, or waiting for a dentist appointment.

Questions- Ask yourself questions, then ponder it for awhile and find the most logical solution possible. If you can't find an answer, ask someone else, because an unanswered question can drive you crazy. Things like "Why are taller buildings better" or "What is the purpose of a curb" or things that you see in your everyday life that can be further thought about.

Exercise- Research shows that exercising for just 12 minutes a day can increase your brain power by 30%!

Memory- If you need to remember something short-term, then is is best to do it in the morning, because of the genius state that Einstein used. Long-term on the other hand is proven to be better in the afternoon. Also, if you are learning the words to a song, or studying for a test, it is best to sleep on it after studying. Before you go to bed, take some problems and put them on a paper, when you wake up, do the problems, then review the informatin, to recap what you learned the previous day (only used for tests or school work).

Listen- When you listen, knowlege comes rushing into your brain through your ears. You will become more aware of your surroundings, understand things better, and a keen ear is a great skill.

Getting dressed- When you get dressed, do it in the dark. It makes you use different senses, and increases awarness.

Soduko- It is a simple game that falls under the category of puzzles mentioned earlier, but it is one of the most powerful and effective ways to exercise your brain.

heart attack key points

1. Heart attack and strokes are major killers in all parts of the world. But they can often be prevented

2 You can project yourself from heart attacks and strokes by investing a little time and effort

3 Tobacco use an unhealthy diet and physical inactivity increase the risk of heart attacks and strokes

4 Stopping tobacco use reduce the chance of a heart attack or stroke from the moment you stop

5 Engaging in physical activity for a least 30 minutes on most days of the week will help help to keep away heart attacks and strokes

6 Eating at least 5 servings of fruits and vegetables a day and limiting your salt intake to less than one teaspoon a day can help to prevent heart attacks and strokes

7 High blood pressure has no symptoms but can cause a sudden stroke or heart attack. Have your blood pressure checked regularly.

8 Diabetes increase the risk of heart attacks and strokes if you have diabetes control your blood pressure and blood sugar to minimize your risk.

9 Being overweight increase the risk of heart attacks and strokes. To maintain an ideal body weight takes regular physical activity to eat and healthy diet.

10 heart attacks and strokes can strike suddenly and can be fatal if assistance is not sought immediately.

Understanding heart attacks and strokes
Every year about 12 million people throughout the world die of a heart attack or a stroke. These diseases affect the poor as well as the rich .Most people think that they are disease of middle aged men .the truth is that both men and women suffer from heart attacks and strokes . Women are much more at risk after menopause.
The good news is that you can take steps to help prevent heart attacks and strokes.

Top Ten Weight Loss Tips

Here is a list of the Top Ten Weight Loss Tips

1. There is no substitute for working out: If you are not going to work out, none of the pills, diets or anything is going to work for you. If you go on a diet without working out, your body thinks it's in a huge trouble and starts saving your fat instead of burning it. This is one thing that you absolutely must do in order to be successful with any weight loss plan. There is no quick and easy magic formula to weight loss if you do not work out.

2. Know what your ideal weight is: I know we would all love to look like those sexy models but knowing your ideal weight is very important. Think of weight loss as being healthy and not as become too skinny. The point is to make you feel good about yourself not to make you unhealthy because you don't have enough fat/muscles to support yourself.

3. Take those Pictures: I know taking those before pictures can be depressing but that's ok, at least they will keep you motivated at trying hard to achieve your goal. I would also recommend using Photoshop to create an after picture of yourself that you can put up on your walls so you can focus on your goals and feel motivated.

4. Know your limits: Install a little calorie counter on your computer or use a notebook to track your daily calorie limits. You need to plan your diet and know what you should and should not eat everyday before you start.

5. Read those labels: Yeah I know, reading those labels is boring but you have to do it if you want to stay on top and make sure that you are only consuming what is right and healthy for you.

6. Read up on Substitutes: There are substitutes for almost everything. Read up on those and make sure you are choosing the ones that are healthiest for you.

7. Tell everyone: I know it sounds intimidating but telling everyone will keep you motivated and help you stop procrastinating with your weight loss because all your friends will be watching your progress. It adds the little bit of pressure that almost everyone seems to need, especially procrastinators.

8. Join Online and Offline Support Groups: It's really helpful to talk to people who are doing the same thing. It keeps you motivated and also helps you make a lot of good friends. So, do not hesitate to join online and offline weight loss clubs.

9. Drink lots of water: Water is good for everyone and for everything. Water also helps you function at your peak which is what you need when you work out. Drinking lots of water balances your body. So, put up reminders or ask someone to remind you to drink lots of water.

10. Do it!: Don't be too scared of whether you can reach your goals or not, just get up and do it. You'll learn lots even if you don't succeed first. Nothing can be achieved by staying home and reading books and tips on weight loss unless you start taking actions.

Being healthy is about a lot more than just going on a diet. It does not help if you lose some weight and go back to junk food and lack of exercise. Healthy living is a lifestyle and I hope some of my tips above will help you not only with your weight loss but also with living a healthy life.

Eating fruits

We all think eating fruits means just buying fruits, cutting it and just popping it into our mouths. It's not as easy as you think. It's important to know how and when to eat.

What is the correct way of eating fruits?

IT MEANS NOT EATING FRUITS AFTER YOUR MEALS!
FRUITS SHOULD BE EATEN ON AN EMPTY STOMACH.

If you eat fruit like that, it will play a major role to detoxify your system, supplying you with a great deal of energy for weight loss and other life activities

FRUIT IS THE MOST IMPORTANT FOOD.
Let's say you eat two slices of bread and then a slice of fruit. The slice of fruit is ready to go straight through the stomach into the intestines, but it is prevented from doing so.
In the meantime the whole meal rots and ferments and turns to acid. The minute the fruit comes into contact with the food in the stomach and digestive juices, the entire mass of food begins to spoil....
So please eat your fruits on an empty stomach or before your meals! You have heard people complaining ” every time I eat watermelon I burp, when I eat durian my stomach bloats up, when I eat a banana I feel like running to the toilet, etc ” actually all this will not arise if you eat the fruit on an empty stomach. The fruit mixes with the putrefying other food and produces gas and hence you will bloat!


Graying hair, balding, nervous outburst, and dark circles under the eyes all these will NOT happen if you take fruits on an empty stomach.

There is no such thing as some fruits, like orange and lemon are acidic, because all fruits become alkaline in our body, according to Dr. Herbert Shelton who did research on this matter. If you have mastered the correct way of eating fruits, you have the Secret of beauty, longevity, health, energy, happiness and normal weight.


When you need to drink fruit juice - drink only fresh fruit juice, NOT from the cans. Don't even drink juice that has been heated up. Don't eat cooked fruits because you don't get the nutrients at all. You only get to taste. Cooking destroys all the vitamins.

But eating a whole fruit is better than drinking the juice. If you should drink the juice, drink it mouthful by mouthful slowly, because you must let it mix with your saliva before swallowing it. You can go on a 3-day fruit fast to cleanse your body. Just eat fruits and drink fruit juice throughout the 3 days and you will be surprised when your friends tell you how radiant you look!

KIWI
Tiny but mighty. This is a good source of potassium, magnesium, vitamin E & fiber. Its vitamin C content is twice that of an orange.
APPLE:
An apple a day keeps the doctor away? Although an apple has a low vitamin C content, it has antioxidants & flavonoids which enhances the activity of vitamin C thereby helping to lower the risks of colon cancer, heart attack & stroke.
STRAWBERRY:
Protective Fruit. Strawberries have the highest total antioxidant power among major fruits & protect the body from cancer-causing, blood vessel-clogging free radicals.
ORANGE :
Sweetest medicine. Taking 2-4 oranges a day may help keep colds away, lower cholesterol, prevent & dissolve kidney stones as well as lessens the risk of colon cancer.
WATERMELON:
Coolest thirst quencher. Composed of 92% water, it is also packed with a giant dose of glutathione, which helps boost our immune system. They are also a key source of lycopene — the cancer fighting oxidant. Other nutrients found in watermelon are vitamin C & Potassium.

GUAVA & PAPAYA:
Top awards for vitamin C. They are the clear winners for their high vitamin C content.. Guava is also rich in fiber, which helps prevent constipation. Papaya is rich in carotene; this is good for your eyes.

Drinking Cold water after a meal = Cancer!
Can u believe this?? For those who like to drink cold water, this article is applicable to you. It is nice to have a cup of cold drink after a meal. However, the cold water will solidify the oily stuff that you have just consumed. It will slow down the digestion. Once this 'sludge' reacts with the acid, it will break down and be absorbed by the intestine faster than the solid food. It will line the intestine. Very soon, this will turn into fats and lead to cancer. It is best to drink hot soup or warm water after a meal.

A serious note about heart attacks
HEART ATTACK PROCEDURE':
(THIS IS NOT A JOKE!)
Women should know that not every heart attack symptom is going to be the left arm hurting. Be aware of intense pain in the jaw line. You may never have the first chest pain during the course of a heart attack. Nausea and intense sweating are also common symptoms.. Sixty percent of people who have a heart attack while they are asleep do not wake up. Pain in the jaw can wake you from a sound sleep. Let's be careful and be aware. The more we know the better chance we could survive.
A cardiologist says
if everyone who gets this mail sends it to 10 people,
you can be sure that we'll save at least one life.