⭐️ASCITES – Fluid accumulation in abdomen
Ascites is the abnormal collection of fluid in the peritoneal cavity, most commonly due to liver cirrhosis

🔍 Common Signs:
✔ Abdominal distension
✔ Rapid weight gain
✔ Shortness of breath
✔ Fluid wave positive

⚠ Complications:
• Spontaneous bacterial peritonitis
• Hepatorenal syndrome
• Respiratory distress

Early diagnosis saves

🔴Organs and their coverings

आप सभी को महाशिवरात्री की हार्दिक शुभकामनाएं 🤗

💉 Heparin – Summary

🔹 Introduction

Heparin is a parenteral anticoagulant used to prevent and treat thromboembolic disorders.

🔹 Classification

-Unfractionated Heparin (UFH)
-Low Molecular Weight Heparin (LMWH)
Example: Enoxaparin

🔹 Mechanism of Action

-Activates Antithrombin III
Inactivates:
-Thrombin (Factor IIa)
-Factor Xa
-Prevents conversion of fibrinogen → fibrin
👉 Works immediately (IV route)

🔹 Indications

-Deep Vein Thrombosis (DVT)
-Pulmonary Embolism (PE)
-Myocardial Infarction (MI)
-Atrial Fibrillation
-During dialysis
-Prophylaxis in bedridden patients

🔹 Routes

-IV (continuous infusion)
-Subcutaneous (abdomen)

❌ Never IM (risk of hematoma)

🔹 Dosage Monitoring

-Monitor aPTT (Activated Partial Thromboplastin Time)
Normal: 25–35 sec
-Therapeutic range: 1.5–2.5 times normal

🔹 Side Effects

-Bleeding
-Thrombocytopenia (HIT – Heparin Induced Thrombocytopenia)
-Bruising
-Osteoporosis (long-term use)

🔹 Antidote

-Protamine sulfate

🔹 Contraindications

-Active bleeding
-Severe thrombocytopenia
-Hemophilia
-Recent brain/spinal surgery

🔹 Nursing Responsibilities

✅ Check baseline aPTT before starting
✅ Monitor platelet count
✅ Assess for bleeding (gums, urine, stool)
✅ Use infusion pump for IV
✅ Rotate SC injection sites
✅ Do not massage injection site
✅ Keep antidote ready

🔹 Important Exam Points

⭐ Heparin is safe in pregnancy
⭐ Monitor aPTT
⭐ Antidote → Protamine sulfate
⭐ HIT is serious complication
⭐ Never give IM

💊 Vitamin K –Summary

🔹 Definition

Vitamin K is a fat-soluble vitamin essential for blood clotting and bone metabolism.

🔹 Types of Vitamin K

-Vitamin K1 (Phylloquinone) – Found in green leafy vegetables
-Vitamin K2 (Menaquinone) – Produced by intestinal bacteria
-Vitamin K3 (Menadione) – Synthetic form (rarely used)

🔹 Sources

-Spinach, cabbage, broccoli
-Mustard greens
-Liver
-Egg yolk
-Soybean oil
-Intestinal bacterial synthesis

🔹 Functions

🩸 1. Blood Clotting

-Required for synthesis of clotting factors:
-Factor II (Prothrombin)
-Factor VII
-Factor IX
-Factor X
-Also Protein C & Protein S

🦴 2. Bone Health

Activates osteocalcin → Helps calcium binding in bones

🔹 Recommended Daily Allowance (RDA)

Adult male: 120 mcg/day
Adult female: 90 mcg/day
Infants: 2–2.5 mcg/day

🔹 Deficiency

Causes:

-Newborns (low gut flora)
-Prolonged antibiotic therapy
-Liver disease
-Fat malabsorption (e.g., obstructive jaundice)

Signs & Symptoms:

-Bleeding gums
-Epistaxis
-Hematuria
-GI bleeding
-Prolonged PT/INR
-Hemorrhagic disease of newborn (HDN)

🔹 Vitamin K in Newborn

-1 mg IM injection at birth
-Prevents Hemorrhagic Disease of Newborn (HDN)

🔹 Therapeutic Uses

Treatment of Vitamin K deficiency bleeding
Antidote for Warfarin toxicity

Management of hypoprothrombinemia

🔹 Nursing Responsibilities

✅ Monitor PT/INR levels
✅ Assess for bleeding signs
✅ Administer IM injection in newborn (vastus lateralis)
✅ Educate patients on green leafy vegetables
✅ Caution with patients on anticoagulants

🔹 Important Points
⭐ Vitamin K is fat-soluble
⭐ Newborn prophylaxis is mandatory
⭐ Deficiency → Prolonged PT first
⭐ Antagonist: Warfarin

Advt-1.pdf
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🚑 🇮🇳 *PM RAHAT Scheme*
(Pradhan Mantri Road Accident Victim Hospitalisation & Assured Treatment)

✨ Add programme to your notes

🚨 *For Road Accident Victims*
Provides immediate medical help to people injured in road accidents.

💰 *Coverage Amount*
*Up to ₹1.5 lakh per victim*
🏥 Cashless Treatment
Treatment is completely cashless at empanelled hospitals — no advance payment required.
Nursing warrior

⏳ Coverage Period
Medical expenses are covered for the first 7 days after the accident.

📄 No Prior Registration Needed
Victims do not need to enroll beforehand.

🎯 Objective
To ensure immediate emergency treatment and prevent deaths due to delay or lack of money.