Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+, Exams of Nursing

Download Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ and more Exams Nursing in PDF only on Docsity! Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ by Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Kaplan→ Med Surg 1, 2 & Comprehensive Rationales Med Surg 1A Topics 1. Cushing’s Syndrome (2 questions) → hypersecretion of ACTH (hormone that allows body to react to stress) ○ https://www.youtube.com/watch?v=ea1sXgd5ui8 ● Signs & Symptoms → fatigue, muscle weakness, weight gain, thinning extremities, thin & fragile skin, moon face & ruddy complexion, hirsutism, truncal obesity, broad purple striae, bruising, impaired wound healing, increased blood pressure & sodium, hypokalemia, hyperglycemia, buffalo hump, DM ● Treatment → restore hormone balance by radiation, drug therapy or adrenalectomy (removal of one or both adrenal glands) ● Nursing Considerations → Frequently monitor VS (especially BP), monitor labs for electrolyte changes, monitor daily weight, check for signs of infection, perform passive range of motion for those that have osteoporosis or are bedridden ○ Post-surgery nursing considerations → encourage Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ ○ Assist in removing calculi from the urethra, bladder and ureter ○ Performed in both lower and upper tract ● Lower tract cystoscopy ○ Pt. is usually awake; discomfort is equal to that of catheterization ○ Viscous lidocaine can be injected prior to the study to minimize post-test discomfort Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ ○ General anesthesia is usually administered ● Upper Tract cystoscopy ○ Pt. usually kept NPO for several hours before test ○ A sedative may be administered ○ Pt. can expect some burning on voiding, blood in urine, urinary frequency ○ Heat applications are helpful in relieving pain and relaxing muscles ● Nursing Care → monitor pt. with prostatic hyperplasia (enlarged prostate that can cause urine difficulty) for urine retention, suggest warm sitz baths and antispasmodic meds, monitor for s/s of UTI 4. Diabetes Mellitus (4 questions) → know setting priorities → Condition is characterized by a high level of glucose in the body ○ Signs & Symptoms → THE POLY’s (polyuria,polydipsia, polyphagia), weakness, dizziness, fatigue i. In Children → those above + enuresis (bed- wetting), unusual fatigue & irritability Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ ○ Type 1 → beta cells in pancreas are destroyed and produce no insulin i. Treatment → insulin injections, continuous infusion via pump & diet control ○ Type 2 → beta cells in pancreas secrete insulin, but the body is resistant to its effects i. Treatment → insulin, oral hypoglycemic injections & diet control ○ Diet Management → monitor total calories, carbs & timing of food ○ Diet Intake → meals with complex carbs, ↓ fat, ↑ fiber, some protein i. Time meals with peak effect of insulin ii. Provide extra snacks for unplanned physical activity iii. Substitute soft foods 6-8 times per day if you cannot stick with the usual meal plan iv. If vomiting, diarrhea or fever persist take in some liquids like ½ cup coke, juice, broth or 1 cup of gatorade to maintain caloric intake every ½ hour or hour Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ edema, symptoms of shock, probable hematuria (RBC in urine) and hemolysis (break down of RBC’s) ● First responder interventions : ensure safety of yourself, extinguish flames, cool burn by briefly applying cool water to burn and clothing covering burn, remove other clothing, cover wound to prevent contamination, irrigate chemical burns, asses ABC’s ● Treatment: grafts → use of skin or other materials to cover burned areas ● Nursing Care: IV Lactated Ringers, plasma; F/C to monitor I/O (should be 30ml/hr), check for s/s of fluid overload vs. dehydration, monitor BP, v/s, weight, electrolytes, wound care at least once a day (administer pain meds 30min before wound care), sterile technique, tetanus prophylaxis; high caloric, high-carb, high- protein diet, may require parenteral nutrition; estimate TBSA (total body surface area) with the Rule off 6. Herpes Zoster (Shingles) → Acute infectious viral disease that is reactive of chickenpox virus, presents as unilateral, painful rash, group of vesicles on an erythematous base along a dermatome Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ ○ Treatment → calamine lotion to soothe itching & pain, Acyclovir, corticosteroids to reduce inflammation, vaccination to prevent or modify the disease course ● Nursing considerations: minimize pain & prevent complications, analgesics, apply compresses (wet dressings to skin lesions & cold compresses to ruptured vesicles), administer systemic corticosteroids to diminish severity, prevent spread- contagious to anyone who has not had chickenpox or is immunocompromised 7. Hernia (2 questions → know Umbilical Hernia) → protrusion of intestines through a weakness in the umbilical ring, muscle & fascia Types of Hernias ● https://www.youtube.com/watch? v=3wUrJGDgGO4 ● Umbilical → Hernia occurring at the naval ; more common in women who are obese or multiparous ○ S/S → bulging protrusion at the umbilicus → pain, discomfort at site ○ Treatment → Size of fascial ring less than 2 cm = none; larger = surgery → laparascope Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ ○ Nursing Care → do not use a belly band or tape a silver dollar to the area, keep pressure dressing in place until sutures are healed, sponge-bath child until the dressing is removed & keep diapers folded below the dressing ● Hiatal → opening in diaphragm through which esophagus passes ○ S/S: heartburn, full after meals, GI bleed and N/V (severe) ● Inguinal → Protrusion of the hernia sac containing the intestine of the inguinal opening 8. Incentive Spirometer → Breathing device used to maximize lung expansion by opening closed alveoli and mobilize secretions → facilitates tissue oxygenation!, prevents atelectasis ● Nursing considerations: instruct client to breath in and exhale normally, seal lips around mouthpiece, inhale slowly and deeply, holding breath for at least 3 seconds while keeping ball or cylinder elevate, exhale, take several normal breaths and repeat 4-5 to,es; client Med Surg 1, 2 & Comprehensive Rationales LATEEST Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ ○ Lube end of tube with water-soluble lubricant, insert tube through the nose to the stomach; offer sips of water and advance gently; bend head forward to close epiglottis, closing trachea ○ Observe for respiratory distress→ an indication of misplacement in the lungs ○ If in correctly, secure tube w/ hypoallergenic tape and verify placement by evaluating gastric aspirate; aspirate should have pH of =4 ■ If in lungs = resp. distress ○ Different types of tubes: ■ Lebin tube: used for decompression and tube feeding ■ Salem tube: decompression and suction ■ Seng-staken Blakemore tube: bleeding and esophageal varices 10. Diabetic Ketoacidosis → Life-threatening condition in type 1 DM; caused by lack of insulin; body drawing on fat & protein stores for energy; ketone of Na+, Cl-, K+, water, increased RR & urine output, & leads to dehydration & hypoxia ● When acidosis is severe, Pt can lose consciousness Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ (diabetic coma) ○ Indications of impending coma include HA, drowsiness, weakness, confusion, hypotension, tachycardia, warm dry flushed skin, dry mucous membranes, N/V, elevated temperature, polyuria, polydipsia, rapid & deep respirations (Kussmaul’s respirations), fruity odor to breath (from ketone bodies) ● Nursing intervention: administer insulin; IV fluids; electrolytes as ordered; monitor electrolytes status, I&O’s, blood glucose levels; insert & maintain NG tube & urinary catheter as needed ● Teach measures to prevent recurrence such as daily monitoring of blood glucose & monitoring ketones if blood glucose is over 250-300mg/dL, adherence to diabetes management program (including insulin administration), exercise, keeping appointments, recognizing symptoms of infection (a major cause of DKA), & phoning for assistance if symptoms noted 11. Th yr o i d D is o r d er s (5 questions → know Grave’s disease & Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Hypothyroid) → ○ Hyperthyroidism → hypersecretion of thyroid gland (Graves Disease) i. S/S → hyperthermia, HTN, tachycardia, heat intolerance, diaphoresis, increased appetite, irritability, muscle fatigue, hyperactivity, sleep deprivation, hyperreflexia ii. Treatment → radioactive ablation, complete or partial removal, anti-thyroid meds 1. Radioactive precautions: flush toilet twice, use gloves, put clothes in radioactive sealed bag, don’t hand wash clothes (machine wash only x 2 on hot) iii. Nursing Care → monitor for thyroid storm, heart failure, cardiac dysrhythmias, quiet environment with little stimulus iv. Patient Education → high protein, carb, vitamin & mineral diet, cool clothes, balance rest & activity, may need hormone replacement therapy ○ Thyroid Storm → hyperpyrexia (fever), cardiac dysrhythmias & altered mental status → hypothermic Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ & hypotension ○ Medical Causes → brain tumor, head injury, brain surgery & lithium therapy ○ Treatment → identify cause of diabetes insipidus & treat it! Until cause is identified, give vasopressin or vasopressin stimulate to control fluid balance & prevent dehydration. You may also give thiazide diuretics to ↓ fluid volume by creating mild salt depletion ○ Nursing Considerations → monitor I&O, urine specific gravity, skin condition, check weight daily weight, s/s of hypovolemic shock (BP, HR & respirations) & monitor labs for hypernatremia ○ Complications → hypernatremia, severe dehydration & vasoconstriction 14. Hyperglycemia → elevated blood glucose level, usually associated with diabetes ○ Signs & Symptoms → THE POLY’s (polyuria, polydipsia, polyphagia), vision changes, fatigue/weakness, dry skin, slow healing wounds, recurrent infections, numbness/tingling in hands or feet Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ ○ Treatment → varies depending on which type of diabetes i. Type 1 → insulin injections ii. Type 2 → Diet, exercise, oral hypoglycemic agents ○ Nursing Care → work with patients on management of the disorder & how to prevent acute & long-term complications 15. Hypoglycemia → abnormally low level of glucose in the blood, usually occurs suddenly as a complication of diabetes ○ Signs & Symptoms → sweating, tremors, tachycardia/palpitations, nervousness, hunger, confusion, headache ○ Treatment → give either 15 grams of carbs in the form of candy, juice or sugar, 1 mg subq or IM glucagon, 25-50 mL IV 50% dextrose in water to unconscious patients i. After symptoms resolve, give a snack of protein or starch 16. Liver: Cirrhosis (2 questions) → chronic, progressive liver disease caused usually by alcoholism, but can also be Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ caused by viral infections, toxins, bile stasis or obstruction ○ S i g ns & S ym p t o m s → indigestion, gas, constipation, N/V, esophageal varices, hematemesis, hemorrhage, ascites, anemia, edema in extremities, JAUNDICE, pruritus, DARK URINE, CLAY-COLORED STOOLS, palma erythemia ○ Treatment → must treat what is causing the cirrhosis! i. Lactalose → for ammonia ii. If ascites → paracentesis iii. Shunts to relieve portal hypertension Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ i. Nursing Care → Anti-histamines & topical anti- inflammatory drugs ○ Allergen Desensitization → used to treat the allergy when the patient is unable to avoid the allergy. Patient is exposed to larger and larger amounts of allergen in an attempt to change the immune system's response. i. Useful for environmental allergies, mostly ii. Serial injections given → start with small doses and gradually increased iii. Safety → Observe for anaphylaxis, have epi on hand, always keep client in office for 30 minutes ○ Eczema → itchy, red skin rash commonly seen in young children, may ooze and form a crust → can also form as a result of an allergen i. Common causes: milk, wheat, eggs ii. Treatment → avoid allergen, apply astringent solution, corticosteroid cream & antihistamines, keep patient from scratching 18. Dialysis (know AV fistula) → 2 types = Peritoneal & Hemodialysis Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ ○ h t t p s : // www . y o u t u b e . c o m / w a t ch ? v =mi 34 x C f mL h w → forward to 3:50 ○ Peritoneal → removal of excessive fluids & wastes through the peritoneal cavity by surgically inserted catheter Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ i. Before procedure → obtain baseline vitals, breath sounds, weight, glucose & electrolyte levels ii. During procedure → infuse 1-2 L of fluid into cavity by gravity using sterile technique, leave fluid in for 20 minutes & then remove it by gravity iii. After procedure → take vital signs, check for respiratory distress, pain or discomfort, assess dressing around catheter for wetness iv. Complications → peritonitis (fever, abd pain & cloudy dialysis drainage, swelling, tenderness, redness or purulent secretions at site), abdominal pain, insufficient return of fluid v. Nursing Care → instruct patient to consume high protein & fiber diet ○ Hemodialysis → removal of excess fluids & wastes by circulating patient’s blood through a semi-permeable membrane that acts as an artificial kidney i. Done through a mature AV shunt, fistula or graft (4- 6 weeks old) → created by surgical anastomosis of an artery & a vein (usually radial artery & cephalic vein) Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ than 100 mL/hr to MD ○ Patient Teaching → Record I&O’s to monitor kidney function, weigh yourself twice a week and report any rapid gain, avoid crowds or contact with people with known/suspected infections for 3 months after surgery, continue immunosuppressant therapy throughout the entire time to prevent rejection Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ 21. Fracture → break in continuity of the bone ○ Open vs. closed fracture i. Open/compound fracture: fractured bone that breaks through the skin ii. Closed/simple fracture: does not penetrate through the skin (skin is intact) ○ Complications of fracture: fat emboli, hemorrhage, sepsis, compartment syndrome ○ Emergency Care → immobilize joint above & below fracture, cover any wound with sterile dressings, check temperature, color, sensation & cap refill, elevate above heart level to reduce swelling i. Extreme caution with spinal fractures → C- spine & log- roll patient ○ Hip Fracture (common in the elderly) → one leg may be shortened, externally rotated or adducted, be very painful, possess a hematoma, muscle spasms i. Treatment → immobilize using Buck’s traction, open or closed reduction with internal fixation, hemiarthroplasty (femoral head prosthesis) ii. Bucks traction: https://www.youtube.com/watch? Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ v=2ZEWz_Ps7vo iii. Nursing Care → apply hip protector pads in patients at risk for falls, monitor for hypovolemic shock post surgery, use compression stockings/ICD’s or anti- coagulants to prevent DVT’s, encourage patient to keep moving by using trapeze, administer pain meds, monitor hydration/nutrition/urine output, access the 6 P’s (pain, paresthesia, pallor, paralysis, pulse, poikilothermia (unable to regulate temp.) ○ Skull Fracture → results from direct impact, signs & symptoms may not be evident immediately i. Signs & Symptoms → ecchymosis behind ears, over mastoid process (Battle’s sign) or around eyes (raccoon eyes), CSF leakage from nose or ears, cranial nerve injury manifestations 1. Complications → brain abscess, meningitis, increased ICP 22. Lyme Disease → Inflammatory disorder caused by a spirochete (Borrelia burgdorferi) → spread to humans by deer tick bites Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ ○ D ia g no sti c T est s → X-rays, bone scans, blood studies (↑ WBC), wound & blood cultures to identify bacteria ○ Treatment → IV antibiotics around the clock for 3- 6 weeks followed by 3 months oral antibiotic therapy i. Immobilization of the affected limb ii. Warm soaks to increase circulation iii. Surgery to expose & remove the abscess (debridement), irrigate with saline solution & apply antibiotic beads to the wound iv. Amputation to relieve pain & avoid therapy resistant osteomyelitis ○ Patient Teaching/Nursing Considerations → support affected extremity with pillows & splints to maintain proper body alignment i. Sterile technique when changing wounds ii. IV fluids, prevent dehydration, diet high in protein and vitamin C 24. Urinary Tract Infection → infection that begins in the urethra, bladder, ureters or bladder usually caused by Gram negative bacteria, more common in females than Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ males ○ Cystitis → bladder inflammation ○ Pyelonephritis → inflammation of the kidney ○ Signs & Symptoms → frequent urination, urges, pain/burning when urinating, nocturia, pain/tenderness over bladder, cloudy or foul smelling urine, fever, retroperitoneal pain & N/V, confusion in the elderly ○ Diagnostic Tests → Clean-catch mid-stream UA, culture & sensitivity ○ Treatment → antibiotics, pyridium, vaginal estrogen therapy, ↑ fluid intake to 3000 mL/day, vitamin C & cranberry juice ○ Nursing Care → preventative education, empty bladder after sex, avoid douche/powders, wipe from front to back 25. Therapeutic Communication (2 questions) → listening to & understanding the client while promoting clarification & insight → occurs in stages during nurse interaction ○ Purpose → develops trust & promotes open communication ○ G o a l → understand the client’s message, facilitate Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ client’s verbalization of feelings, communicate nurses understanding & acceptance ○ Techniques → silence, general leads or broad openings, clarification & reflection Nurse-Patient Relationship Stages ● Pre-Interaction → review patient data ● Orientation → introduction to patient - use verbal & non- verbal skills ● Working → team building phase between you, patient & health care team ● Termination → discharge planning, nurse is no longer needed 26. Ileostomy (2 questions → know how to care for one) → surgical passage through abdominal wall (R lower quadrant) into the ileum → drains GI contents when rest of GI system cannot function properly ○ Drainage → liquid stool containing proteolytic enzymes & bile salts ○ Nursing Care → empty the bag when ⅓-½ full, change the bag every 3-7 days during inactive time (before Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ (hypotension & cyanosis), profound weakness & fatigue, severe N/V, dehydration, H/A, confusion, abdominal pain ○ S i g ns & S ym p t o m s → weakness/fatigue, anorexia/weight loss, N/V, constipation/diarrhea, BRONZE skin discoloration, increased pigmentation of the mucous membranes, poor coordination, fasting hypoglycemia, craving salty food, amenorrhea ○ Treatment → corticosteroid replacement therapy → cortisone or hydrocortisone i. Fludrocortisone to prevent dehydration & hypotension ii. In crisis → give dexamethasone, hydrocortisone or both ○ Nursing Care → monitor vitals & for s/s of shock, hyperkalemia before treatment & hypokalemia after therapy i. Glucose levels checked if patient also has diabetes ii. Diet → sodium & potassium balance iii. Record weight & monitor fluid/electrolyte intake 29. Impaired: Integument → disruption of skin surface or skin layers Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Secondary LesionsPrimary Lesions lesions…. Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ ○ Great indicator of overall health status & can provide info that could indicate underlying disease ○ Nursing Assessment → nails (shape, angle, texture, color), skin (vascularity, bleeding, bruising)), hair & scalp (lesions, infestations) Types of Wounds ❏ Abrasion → denuded skin ❏ Avulsion → tissue torn away from supporting structures ❏ Cut → longer than deeper, edges well defined ❏ Ecchymosis/Contusion → blood trapped under the skin ❏ Hematoma → tumorlike mass of blood trapped under the skin ❏ Laceration → irregular edges & vein bridging at site of skin tear ❏ Patterned → wound caused by object which leaves imprint ❏ Stab → deeper thain longer, well-defined edges Assess wounds for S/S of infection → purulent drainage, pain, redness, swelling, ↑ temperature & WBC ● Signs of Infection? → wound culture to determine bacteria type Types of Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ ○ Causes → rubbing, scratching, allergies, hyperbilirubinemia ○ Treatment → remove causative agent, corticosteroid, anti- histamines ○ Nursing Care → soothing tepid baths, short nails & mittens ● Psoriasis → chronic, noninfectious inflammatory disease of the skin ○ Signs & Symptoms → thick, itchy, silvery-white scales with symmetrical distribution → common areas are scalp, knees, sacrum, elbows & behind ears ○ Nursing Considerations → oil or coal tar bath, topical steroids, soft brush, anti- metabolites, UV light 30. SIADH → Syndrome of Inappropriate Antidiuretic Hormone → excessive amounts of antidiuretic hormone that results in water imbalance causing water intoxication caused by fluid retention ○ Signs & Symptoms → decreased LOC (cerebral edema, ↑ ICP, HA, irritability, delirium), seizures, coma, sodium less than 120 ○ Treatment → treat the underlying cause! Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ i. Fluid restriction (500-600 mL/24 hours) ii. Sodium replacement iii. Diuretics ○ Nursing Care → daily weight, neuro checks, I&O, check electrolytes,BUN & creatinine, position flat in bed 31. Osteoarthritis (degenerative bone disease) (2 questions) → chronic degenerative disorder that causes deterioration of the joint cartilage; most common form of arthritis ○ S/S → joint pain/atrophy in the hips, knees, hands & cervical/lumbar spine & stiffness in the morning or after exercise (relieved by rest), decreased ROM, crepitus, Heberden’s & Bouchard’s nodes (bony, cartilaginous enlargements in the joints of the hands) ○ Treatment → PALLIATIVE to reduce pain, NOT CURATIVE i. Aspirin, phenylbutazone, indomethacin, ketolorac ii. Intra-articular injections of corticosteroids iii. Glucosamine & Chondroitin → improve tissue function & retard breakdown of cartilage iv. Massage, Acupuncture, moist heat, rest Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ perfusion. 34. Kidney: Nephrectomy → Removal of kidney because of tumor, infection, anomalies, advanced kidney cancer that is refractory to chemo. ○ Nursing Considerations → position client in lateral recumbent position, patient will have drains and indwelling catheter, check urine output closely (color, consistency, output → blood in urine is not normal, report to doctor), administer analgesics as prescribed, encouraged to cough and deep breathe, use incentive spirometer, splint incision to help with coughing and encourage early ambulation. i. Four Types of nephrectomy that are performed: 1. Partial Nephrectomy: portion of kidney is removed 2. Simple Nephrectomy: entire kidney is removed 3. Radical Nephrectomy: entire kidney, adrenal gland, and surrounding fat tissue are removed. Patients are placed in a side- lying position during surgery. A 7-inch flank incision just below the diaphragm is needed to perform an open Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ radical nephrectomy. This involves removal of the 12th rib. 4. Nephroureterectomy: entire kidney, surrounding fat tissue, and entire ureter are removed. 35. Colonoscopy : direct visualization of the colon with a fiberoptic colonoscope ○ Purpose: Aids the diagnosis of inflammatory and ulcerative bowel disease, pinpoints lower GI bleeding, detects lower GI abnormalities including, polyps, hemorrhoids, and abscesses. Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ ○ Pre-test: clear liquid diet 24 to72 hours before exam (nothing with red dye), cathartic in evening for 1-2 days before exam, enema the morning of the exam, take enema morning of exam ○ Post-test: allowing client to rest, observing for passage of blood, abdominal pain, signs of perforated bowel (fever, chills, N/V, severe abdominal pain), hemorrhage, and respiratory distress, monitor for resp. distress 36. Irritable Bowel Syndrome: Functional disorder of bowel motility ○ Cause: certain foods, food allergies ○ S/S: Constipation, diarrhea, combination of constipation and diarrhea, pain, bloating, abdominal distension. Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ i. Postoperative nursing care: checking for fever and hypotension, checking dressing, performing neurovascular (circulation, movement, and sensation) assessment, client should wear antiembolic stockings, log roll every 2 hours by two people, when out of bed, back should be kept straight 38. Cast Care: ○ Immediate cast care: avoid covering cast until dry, handle with palms, not fingertips (plaster cast). Avoid resting cast on hard surfaces or sharp edges. Keep affected limb elevated above heart on soft surface until dry. Observe for blueness or paleness, pain, numbness on affected area. ○ Intermediate care: encourage client to perform prescribed exercises, report any break in cast or foul odor, inform client to not scratch skin underneath cast and avoid putting anything underneath cast. ○ Types of Casts: i. Non-plaster or fiberglass cast: Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ 1. Consist of open-weave, nonabsorbent fabric impregnated with cool water-activated hardeners. Used for nondisplaced fracture and long-term wear. ii. Plaster cast: 1. Rolls of plaster are wet with cool water and smoothed onto body; a crystallizing reaction occurs and heat is given off. ○ Complications: Pressure ulcers, Disuse syndrome, Compartment syndrome and delayed union or nonunion of fractures 39. Urinary Calculi → (urolithiasis [kidney stone disease]) calcifications in urinary system, commonly called stones; formed in any part of the urinary tract, usually kidney (nephrolithiasis), and can migrate within tract; may be composed of one type of crystal or a combination, calcium being most common; others oxalate, struvite, uric acid, cystine, xanthine. Important to collect stones to determine composition and appropriate treatment. ○ Indications S/S : sharp, severe, sudden pain depending on Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ iii. Treatment: Antibiotic therapy, Pyridium, Vaginal estrogen therapy, increased fluids, and increased vitamin C and cranberry juice intake. iv. Pt. teaching: females void following intercourse, avoidance of douche or powders, bladder cath care, clean properly after defecation (wipe front to back). ○ Children: i. Indications S/S: Hematuria, enuresis, fever, foul- smelling urine, poor appetite, painful urination ii. Parent instructions: administration of prescribed antibiotics, encourage child to drink clear liquids, instruct parents of good perineal hygiene, avoid tight clothing or diapers, encourage child to void frequently. ○ Cystitis → Bladder inflammation i. S/S: burning or pain on urination, urinary frequency, urinary urgency, bladder spasms. ii. Treatment: Symptomatic, organism-specific antibiotic iii. Nursing considerations: Monitor urination for frequency and amount, assess urine for cloudiness Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ and hematuria, obtain specimen for analysis and culture and sensitivity, iv. Client Education: increase fluid intake to dilute urine, use heating pad on lower abdomen for bladder spasms, take meds as directed. ○ Pyelonephritis: Inflammation of the kidney caused by bacterial infection, UTI, pregnancy, tumors, or urinary obstruction. i. S/S: chills, fever, malaise, flank pain, costovertebral angle tenderness ii. Nursing care: bed rest during acute phase, administer and teach about antibiotics, encourage fluids. 41. HIV/AIDS (3 questions) ○ HIV (Human Immunodeficiency Virus) i. Virus that causes immunodeficiency that can lead to AIDS 1. Transmitted: via blood and body fluids 2. S/S: early stage: asymptomatic, later as immune system Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ for oral infections, assessing breath sounds, monitoring weight, encouraging nutritional supplements, assessing hydration, encouraging client to express feelings. ○ AIDS Dementia Complex: Dementia resulting from effects of HIV ○ Children with AIDS: 91% of children with AIDS were infected through perinatal transmission. i. Indications: lymphadenopathy, hepatosplenomegaly, Candida albicans stomatitis, chronic or recurrent diarrhea, failure to thrive, developmental delays; Pneumocystis jiroverci pneumonia most common opportunistic infection in children. ii. Treatment → antiretroviral drugs iii. Nursing considerations: scrupulous handwashing, instructing child and family about importance of handwashing, children from being around persons who are infectious, restricting infected children who bite or do not have control of bodily functions, providing high-calorie, high- protein meals and Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ snacks, monitoring child’s weight and height, encouraging child to participate in activities with other children, providing anticipatory guidance to the family because child has potentially fatal disease. 42. Chronic Kidney Disease (2 questions) → know a lot of nursing judgment and concepts ○ Irreversible, progressive reduction of functional kidney tissue resulting in inability of kidneys to excrete wastes, concentrate urine, and conserve electrolytes. i. Indications S/S: anemia, acidosis, azotemia, fluid retention, hypertension, hypocalcemia, anorexia, N/V, constipation, impaired insulin action. ii. Interventions: to slow progression, control blood pressure and make fluid and dietary adjustments. Dialysis or transplantation may be done when these measures are no longer effective. iii. Nursing interventions: Monitor fluid status, encourage nutrition by decreasing nausea, vomiting and Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ iv. Nursing considerations: small, frequent feedings if not taking antacids or histamine blocker, avoid coffee, alcohol, seasonings if use causes discomfort, reduce stress. Instruct patient to take medication 1 hour before meals. v. Treatment therapy: 1. Antacids a. Proton pump inhibitors or H2 receptor antagonists 2. Anticholinergics a. Inhibit the vagus nerve effect on parietal cells and reduce gastrin production. 3. Physical rest to promote healing 4. Gastroscopy to facilitate coagulation of bleeding site 5. Surgery if patient: a. Does not respond to treatment, has perforation, or suspected cancer or other complications Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ 44. Gastrointestinal Tests: Upper GI →allows practitioner to visualize the upper GI organs and sphincters for diagnosis of anatomic or functional abnormalities. Used to diagnose ulcers, varices, tumors, regional enteritis, malabsorption syndromes, gastritis, cancer, hiatal hernia, diverticula, and strictures. ○ Upper GI is ingestion of barium sulfate to determine patency and size of esophagus, size and condition of gastric walls, patency of pyloric valve, and rate of passage to small bowel. i. Preparation: Maintaining NPO after midnight, informing client that stool will be light-colored after procedure. ii. Post-test: encouraging fluids, administering laxatives to prevent constipation, and informing client that stool will be white from barium 45. Esophagogastroduodenoscopy ○ Visualization of esophagus, stomach, and duodenal mucosa through light, flexible fiberoptic tube. Identifies ulcerations, tumors, and obtains tissue biopsy (detect Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ presence of Helicobacter pylori or to rule out gastric carcinoma) or fluid samples. i. Preparation: verify informed consent has been obtained, maintain NPO at least 8 hours before procedure, teach client about numbness of throat due to local anesthetic applied to posterior pharynx. ii. Post Procedure: maintain NPO until gag reflex returns, observe for vomiting of blood, respiratory distress, inform client to expect sore throat for 3-4 days after procedure. ○ Description of Procedure: i. Patient is sedated ii. Lubricated endoscope is passed through the mouth and into the esophagus for visualization of the gastric wall and sphincters. iii. Endoscope is advanced to duodenum iv. Still and video images are taken, or images are shown on a monitor for continuous viewing during the procedure. v. Biopsy forceps are passed through the scope to Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ calorie, low-fat, low-fiber diet, administer medications, maintain fluid and electrolyte balance. ii. Ulcerative colitis: Inflammatory condition of colon characterized by eroded areas of mucous membrane and tissue beneath it. 1. Indications: rectal bleeding, blood, pus, mucus in stool, abdominal pain occurs pre defecation, may have 20 to 30 diarrhea stools daily, nutrition deficit, weight loss, anemia, dehydration. 2. D i e t : High-protein, high-calorie, low- fat, low- fiber diet, TPN used for bowel rest, analgesics, anticholinergics, antibiotics, corticosteroids to reduce inflammation, ileostomy. 3. Nursing Considerations: Instruct client about medications and diet, maintain fluid/electrolyte balance, monitor electrolytes, promote rest, relieve anxiety. 47. Lithotripsy: Extracorporeal Shock-wave → noninvasive Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ iii. Client Education: rationale for use of machine, expected time in device, degrees of flexion and extension. 50. Pancreatitis →Inflammation of pancreas that can be acute or chronic. ○ Acute: mild inflammation with minimal discomfort to severe disease that is unresponsive to any medication, ending in death. This is caused by the premature activation of enzymes, particularly trypsin, which then self-digest the pancreas. The process of self-digestion is often triggered by the obstruction of the common bile duct by gallstones, causing bile to reflux back into the pancreatic duct, which stimulates the premature activation of the pancreatic enzyme (normally, activation begins later in the duodenum.) i. S/S: Severe, acute abdominal pain, back pain, abd distension, N/V, decreased intestinal motility, fever, jaundice, ALOC, Hypotension, ARF, Tachycardia, Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Respiratory distress, Hyperglycemia, Hypocalcemia. ii. Treatment: Parenteral nutrition, withhold oral intake so pancreatic enzymes are not stimulated. Nasogastric suction, Biliary drains and stents, surgery, and intravenous fluids after the initial crisis is over to restore electrolytes. 1. Meds: a. Histamine-2 (H2) antagonists. (cimetidine {Tagamet}, ranitidine {Zantac}), to decrease gastric acid production b. Analgesics for pain c. Antiemetics to prevent vomiting. iii. Nursing Care: 1. Record I & O hourly, and monitor electrolyte levels. 2. Patients with NG, good mouth and nose care and assess respiratory patterns regularly. 3. Administer pain meds 4. Watch for complications from parenteral nutrition (hypokalemia, overhydration, metabolic acidosis) and watch for signs of a Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ (alcohol) 3. Diet, insulin, or oral antidiabetic agents, to treat diabetes if present 4. Pancreatic enzyme replacement, to treat malabsorption and steatorrhea Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ 5. Surgery (pancreaticojejunostomy, pancreaticoduodenectomy or the Whipple procedure, to relieve pain, restore proper drainage of pancreas and to reduce the frequency of attacks. 51. Intestinal Obstruction: Partial or complete blockage of lumen of large or small intestines; compression of the bowel lumen leading to blockage of passage through intestines. ○ Causes: May be mechanical (tumor, hernia, adhesions, intussusception, volvulus) or nonmechanical (paralytic ileus, abdominal infections, intestinal ischemia.) Manifestations depend on location of obstruction. ○ S / S : absence of bowel sounds, intermittent and severe abdominal pain and distension, vomiting, tympanitic and tender abdomen, obstipation (absence of stool or gas), obstruction of ileum causes fecal vomiting, nausea, abdominal tenderness, decreased bowel movements. ○ Treatment: NPO, insertion of NG or Intestinal tube for decompression, IV fluid and electrolyte replacement, Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ blood count), which reveal dehydration, loss of plasma volume, and sometimes infection ii. Abdominal x-ray, which show abnormal amounts of gas and/or fluid in the bowel. In large bowel obstruction, they show a distended colon. iii. Barium studies are contraindicated. 52. Hyperglycemic, Hyperosmolar, Nonketotic syndrome → know Hyperosmolar Nephrotic Syndrome is a complication of hyperglycemia, which also involves hyperosmolarity, minimal to absent ketosis, and altered sense of awareness. Occurs in type 2 diabetics over 50 years of age ○ Pathophysiology: i. Uncontrolled hyperglycemia causes the kidneys to excrete the excess glucose with water and electrolytes (osmotic diuresis). ii. Water then shifts from intracellular fluid space to extracellular fluid space, causing hypernatremia and increased osmolarity. 1. Indications: glucose levels greater than 800 Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ mg/dL, hypotension, dry mucous membranes, poor skin turgor, tachycardia, altered awareness, seizures, hemiparesis; ketosis and acidosis do not occur. 2. Nursing Care: Administer normal saline and regular insulin, assess vital signs, blood glucose, central venous pressure, LOC, urine output, and temperature. Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ test urine for albumin, measure abdominal girth, protect from upper respiratory infection, instruct parents about S/S to observe for at home, how to administer steroid therapy, and adverse effects. ○ Diagnostic tests: Urine specimen (reveals low specific gravity, hematuria, proteinuria), Blood studies (reveals elevated BUN, creatinine, potassium), Creatinine Clearance test (measures glomerular filtration rate), and Ultrasonography of kidneys, renal scan and CT scan. 54. Thyroidectomy → complete or partial excision of the thyroid gland ○ Purpose → corrects hyperthyroidism, removes breathing obstruction caused by goiter, treats thyroid cancer, treats hyperparathyroidism ○ After surgery → monitor respiratory status, ensure that incision drains properly, monitor pulse & temperature for indications of thyrotoxicosis or thyroid storm ( fever, tachycardia > 130, delirium, coma) i. Monitor for tetany → could indicate that Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+ parathyroid glands were damaged during surgery which would cause hypocalcemia (Chovsteks & Trousseau’s sign) ii. Keep patient in Semi-Fowlers position, apply ice to reduce the swelling iii. Make sure to have suction, O2, trach set, IV calcium & suture removal kit at bedside iv. Ask patient to speak every 2 hours to check tone & hoarseness v. Emphasize importance of adhering to thyroid replacement therapy after discharge vi. Keep incisions clean & dry Med Surg 1, 2 & Comprehensive Rationales LATEEST UPDATE ,100% CORRECT RATED/UPGRADED A+