Med/Surg Final Review

Acute Compartment Syndrome S/Sx

Acute Compartment Syndrome S/Sx ● Swelling / Cramping in affected area ● Unresolved constant pain ● Pallor with delayed capillary refill ● Diminished pulses ● Cyanosis with or without Paresis / (incomplete paralysis)

COPD Complication: ARF Classification

COPD Complication: ARF Classification Increased CO2 in the Blood - HYPERCAPNEIA: Inadequate carbon dioxide removal ● pCO2 is higher than normal >45mmHg ● pH < 7.35 ● Evidence of inability to compensate

Cerebral Vascular Accident - TIA

Cerebral Vascular Accident - TIA Transient Ischemic Attacks (TIAs) "Angina of the brain" or "mini stroke" manifested by signs and symptoms of a stroke without evidence of cerebral infarction. May be "progressing" or "completed" if lasting over 24 hrs. However, 5% of patients with an event of TIA will have a stroke within two days.

Laennec's Cirrhosis

Decreased nutrition r/t alcoholism; watch for symptoms of delirium tremors r/t alcohol withdrawals (decreased LOC, restlessness) - Librium prescribed. Early in Disease: Liver becomes large and is loaded w/ fat cells. Malaise, RUQ pain, GI probs, Spider Tangiectasis Late in the Disease: Scar tissue contracts & liver becomes smaller, portal hypertension develops

Pre-Op Teaching

Deep breathing, coughing, incentive spirometry, splinting, promoting mobility (improves circulation, prevents venous stasis, promotes optimal resp function), pain management (PCA, epidural, oral), fasting (adults are advised to fast for 8 hrs after eating fatty food and 4 hrs after ingesting milk products, allowed clear liquids up to 2 hrs before surgery), shower w/ Dial. The major purpose of withholding food & fluid before surgery is to prevent aspiration.

Gout Risk Factors

Men > Women or Women with menopause ETOH use Diuretic Tx or hydrochlorothiazide use ● Lifetime Medication Regime ● Allipurinol ● Colchicine

Examine community resources available for the patient and family with anemia.

Follow-up appointments with primary care providers and specialists Support Groups Counseling Family Learning Groups Nutritionalist Social Worker State and Federal Organizations

Dumping Syndrome

Food "dumps" into small intestine rapidly causing sensations of fullness, weakness, faintness, low BP, dizziness, pallor; rapid rise in blood glucose leads to insulin secretion which causes reactive hypoglycemia.

Laproscopic Cholecystectomy

Formed through small incisions in abd, then abd cavity inflated w/ CO2. Post-Op: No special care to abd incisions. May feel bloated and have shoulder pain due to CO2. Sitting up, ambulation, and heating pad may help pain. Diet: gradually introduce fatty foods.

Care of Client in PACU

Frequent assessments of the patient's airway, respiratory function, cardiovascular function, skin color, level of consciousness, and ability to respond to commands. Signs of Airway Occlusion: choking, noisy and irregular respirations, decreases O2 sat, and cyanosis after a few minutes. Because movement of the thorax and the diaphragm does not necessarily indicate that the patient is breathing, the nurse needs to place the palm of the hand at the patient's nose and mouth to feel the exhaled breath. The anesthesiologist may leave simple oral airway, a hard rubber or plastic airway, in the patient's mouth to maintain a patent airway. It holds the tongue back, and usually the patient pulls it out. Such a device should not be removed until signs such as gagging indicated that reflex action is returning.

Fracture Assessment

Frequent neurovascular checks (5 P's) distal to injury, skin color, temperature, sensation, cap refill, mobility, pain, pulses, CMS (circulation, movement, sensation). Factures of bone predispose client to anemia, especially if long bones are involved. Check hematocrit and hemoglobin every 3-4 days to monitor erythropoiesis. Hemoglobin around 8 = transfusion.

GLAUCOMA

GLAUCOMA Pharmacological treatments for glaucoma center on reduction of or draining or the aqueous humor, thus reducing intra-optical pressure, not increasing it. Repair or replacement of lenses is done with cataracts and there is no pharmacological treatment for macular degeneration.

GastroEsophageal Reflux Disease (GERD)

GastroEsophageal Reflux Disease (GERD) 90* angle is a condition in which the stomach contents (food or liquid) leak backwards from the stomach into the esophagus (the tube from the mouth to the stomach). This action can irritate the esophagus, (Reflux esophagitis); causing heartburn and other symptoms.

Describe signs and symptoms of common types of anemia.

General Anemia S&S: Pallor, Angina, Fatigue, Dyspnea on exertion, Night cramps, Bone pain, HA, Dizziness, Dim vision, Petechiae, Purpura Bloss Loss Anemia - Increased reticulocyte level; normal Hgb and Hct if measured soon after bleeding starts, but levels decrease thereafter. Acute/chronic bleeding Iron Deficiency Anemia - Decreased reticulocytes, iron, ferritin, iron saturation. Patients with iron deficiency primarily have symptoms of anemia. If the deficiency is severe or prolonged, they may also have a smooth, sore tongue; brittle and ridged nails; and angular cheilosis. These signs subside after iron re- placement therapy. The health history may be significant for multiple pregnancies, GI bleeding, and pica. Pernicious Anemia (B12) - Decreased vitamin B12 level. Paresthesias = numbness, tingling, altered proprioreception. Smooth, beefy red tongue - glossitis. Diarrhea. Folic Acid Anemia - Decreased folate level. Glossitis, cheilosis, diarrhea. Can lead to spinal tube defects in fetus. Anemia of Chronic Disease - similar to iron deficiency anemia - pts with chronic kidney disease have pallor of conjunctiva Hemolytic Anemia - Decreased MCV; fragmented RBCs; increased reticulocyte level Sickle Cell Anemia - characterized by abnormal HbS in the RBC - affects how they react to stressors. Crisis: sudden onset of INTENSE pain usually in the abdomen, chest, back, joints, multiple infarctions, may become jaundiced. Aplastic Anemia - Aplastic anemia is a rare disease caused by a decrease in or damage to marrow stem cells, damage to the microenviron- ment within the marrow, and replacement of the marrow with fat. pancytopenia, tachycardia

Addison's NI

Get out of bed slowly. Crackers between meals for hypoglycemia. Sensitive to opiates & barbiturates. Follow diet orders exactly (low K, some sodium, high carb). Avoid stressful situations. Observe for Addisonian Crisis. Avoid change of position if hypotensive. Keep IV sodium choride & solu cortef on hand! Lab tests reveal low sodium & elevated potassium, low blood sugar. Teaching - drug dosage during stress situations. Medic alert card so that they can get steriods immediatly in ER.

Glomerulonephritis - Glomeruli Inflammation Common Causes

Glomerulonephritis - Glomeruli Inflammation Common Causes ● Bacterial infection: A patient may get it during or after an infection in the throat (streptococcal), or on the skin (impetigo). ● Viral infections: Among the viral infections that may trigger glomerulonephritis are the human immunodeficiency virus (HIV), which causes AIDS, and the hepatitis B and hepatitis C viruses. ● Various disease processes: leading to progressive damage and destruction of the glomeruli.

HYPOXEMIA:

HYPOXEMIA: Inadequate oxygen transfer to the blood ● Normal Arterial O2 tension (PaO2)= 80-100 mmHg <80mmHg inadequate room air (RA) oxygen saturation ● Patient receiving O2 concentration >60% mm Hg (RA O2=21%) . . . is hypoxic if <60mmHg inadequate with supplemental oxygen saturation

laproscopic cholecystectomy

Heating Pad 15-20 min hourly, Analgesic Agents. Use of a pillow or binder over incision may reduce pain. Help pt turn, cough, breathe deeply, ambulate as indicated.

Lithotripsy or Extracorporeal Shock Wave Lithotripsy (ESWL)

Lithotripsy or Extracorporeal Shock Wave Lithotripsy (ESWL) involves a medical procedure that uses shock waves to break up stones in the gallbladder, kidney, bladder, or ureters. 1) Emptying of the bowel is important for visualization of the kidneys and the stones.

Treatment for hypothyroidism

Medication: Synthroid or Levothyroxine

how do contractures form and affects of muscle tension

a pathologic contracture is permanant muscle shortening caused by muscle spasticity, as seen in central nervous system injury or severe muscle weakness

hypocapnia

a state in which the level of carbon dioxide in the blood is lower than normal

Supraventricular Rhythms

above the ventricles

tachypnea

an abnormally rapid rate of respiration, usually >20 breaths per minute

hyperventilation

an increased depth and rate of breathing greater than demanded by the body needs

Discuss the dietary restrictions on a cholesterol/fat controlled diet.

avoid processed foods, do not add extra salt to diet, avoid or severely limit red meat intake, eat the minimum amount of required vegetables and fruits.

Hemothorax

blood in the pleural space

define and discus causes of disuse atrophy (ischemic vs. disuse)

describes the pathologic reduction in normal size of muscle fibers after prolonged inactivity from bed rest, trauma (casting), or local nerve damage.

dyspnea

difficult or labored respiration

dyspnea on exertion

difficulty of breathing or breathlessness that is associated with activity, such as climbing stairs

define: dislocation, subluxation

dislocation is a complete loss of contact between the surfaces of two bones. Subluxation is partial loss of contact between two bones. As a bone separates from a joint, it may damage adjacent nerves, blood vessels, ligaments, tendons, and muscle. Dislocation and subluxation are associated with fractures, muscle imbalance, rheumatoid arthritis, or other forms of joint instability

dominant vs. recessive traits

dominant: A characteristic determined by an allele that is expressed over any other alleles for a given trait. recessive: The form of a trait that is hidden, or masked, in the hybrid generation.

Who is at risk for pulmonary embolus?

risk increases with age

Explain the use of vitamin and mineral supplements in the treatment of anemia.

see above

Ventricular Tachycardia (V-tach)

short bursts or runs

bradypnea

slow respiratory rate, usually below 10 respirations per minute

Explain the main uses of Digoxin.

slows the rate (av conduction), strengthens the contractions of the ventricles.

Premature Atrial Contractions

ectopic atrial beats, irregular rhythm. Occur in a non diseased heart. If they occur frequently they may lead to a more serious atrial dysrhythmias. They can also result fom CHF, ischemia and COPD., PAC's occur early in the cycle and they usually do not have a complete compensatory pause.

Premature Ventricular Contractions

ectopic ventricle beats, ventricular beats (QRS) are wide and bizarre, may be isolated or occur in patters (bigeminy, trigeminy), risk of legal arrythmias.

Junctional

escape or ectopic beats Rate: 40-60 Rhythm: Varies P-waves: Inverted or Missing QRS waves: <0.12 P-QRS: 0.12-0.20 Other:

pulmonary edema

excess water in the lung caused by disturbances of capillary hydrostatic pressure, capillary oncotic pressure, or capillary permeability. A common cause is left heart failure that increases the hydrostatic pressure in the pulmonary circulation. Clinical manifestation: dyspnea, hypoxemia, and increased work of breathing. PE may reveal inspiratory crackles (rales) and dullness to percussion over the lung bases. In severe edema, pink frothy sputum is expectorated and PaCO2 increases.

Ventricular Fibrillation (V-fib)

extremely rapid, chaotic ventricular beats, indicates a dying heart, ventricles quiver and stop contracting = > heart does not pump => cardiac arrest

Discuss nutritional considerations for patients with inflammatory/ infectious disease of the heart.

fluid restriction, low-salt diet, interactions of foods with medications, using food/milk/antacids with inflammatory meds to minimize GI upset.

Valium

flumazolil is the antidote

orthopnea

form of dyspnea in which the person can breathe comfortably only when standing or sitting erect

genotype vs. phenotype

genotype: The set of genes possessed by an individual organism. phenotype: The set of observable characteristics of an individual resulting from the interaction of its genotype with the environment

chemoreceptor action

helps determine how much oxygen can be safely administered to a person

COPD

hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise, use of accessory muscles of respiration. Chest x-rays reveal a hyperinflated chest and a flattened diaphragm if the disease is advanced.

AV Conduction

impaired conduction from the atria to the ventricles

gall bladder disease

sudden or gradual onset of severe pain after a heavy fatty meal, which peaks after 1-3 hours and resolves in <10 hours, intense apin in right upper quadrant of the abdomen, the right posterior subscapular area, right shoulder, jaundice, feeling of fullness, excessive belching or flatulence and + Murphy's sign are sxs of what

pathophysiology and clinical manifestations of gout

syndrome caused by defects in uric acid metabolism and characterized by inflammation and pain of the joints. Either excessive uric acid production or underexcretion of uric acid by the kidneys will cause hyperuricemia. When the uric acid reaches a certain concentration in fluids, it crystallizes, forming insoluble precipitates that are deposited in connective tissues throughout the body. Crystallization in synovial fluid causes acute, painful inflammation of the joint, a condition known as gouty arthritis. gout is related to purine (adenine and guanine) metabolism. Manifestations: -an increase in serum urate concentration (hyperuricemia) -recurrent attacks of monoarticular arthritis (inflammation of a single joint) -deposits of monosodium urate monohydrate (tophi) in and around the joints -renal disease involving glomerular, tubular, and interstitial tissues and blood vessels -formation of renal stones

Discuss the nursing considerations for an elderly patient who experiences a MI.

teach smoke cessation, healthy weight, exercise, control high blood pressure - diabetes - lipid levels, reduce stress Many patients who present with acute coronary events are elderly. THey are the most likely to due from AMI. They often have chronic conditions such as diabetes or arthritis. Elderly patients have traditionally been managed conservatively with medications, but currently interventions such as cardiac catheterization may be recommended. These patients look to their family members for help with treatment decisions. elderly AMI patients were more likely to have complications of cardiac failure and cardiogenic shock vs their younger counterparts.

types of joint inflammation: tendinosis, tendinitis, bursitis

tendinitis: inflammation of the tendon tendinosis: painful degradation of collagen fibers bursitis: inflammation of a bursa. skin over bone, skin over muscle, muscle and tendon over bone. caused by repeated trauma. septic bursitis is caused by a wound infection

Deep Venous Thrombosis

the formation of a blood clot in a vein that is deep inside a part of the body, usually the legs. prevention: blood thinners, don't smoke, wear pressure stockings possible complications: A blood clot can break free in the leg and travel to the lungs (pulmonary embolus) or anywhere else in the body, and can be life threatening. Rapid treatment of DVT helps prevent this problem. clinical manifestiations: no symptoms usually but if so... -Swelling in one or both legs -Pain or tenderness in one or both legs, which may occur only while standing or walking -Warmth in the skin of the affected leg -Red or discolored skin in the affected leg -Visible surface veins -Leg fatigue

hypercapnia

the presence of an abnormally high level of carbon dioxide in the circulating blood

Erythropoiesis

the process of producing red blood cells by the stem cells in the bone marrow

Discuss the major causes of an MI.

thrombus in an area of artherosclerotic narrowing. risk factors like gender, age, race, diet, exercise, stress, family hx, all play a part.

Discuss the nursing implications for each category of drug used for CAD.

toxic effects could lead to liver failure

types of fluid that might be seen in a pleural effusion

transductive- watery exudative- high concentrations of wbc and plasma protein hemothorax- blood emphyema (pus)- infected plural effusion chylothorax (chyle)- milky fluid containing lymph and fat droplets

T tube

tube placed in the bile duct for drainage into a small pouch (bile bag) on the outside of the body

EGD (esophagogastroduodenoscopy

NPO 6-12 before; IV valium or diprovan to sedate and atropine to lower secretions; glucagon to relax smooth muscle; place on left side. Post procedure: NPO until gag reflex returns, assess for signs of perforation (pain, dysphagia, fever). Minor sore throat. Recovery short (3 hrs).

muscle strain vs strain

muscle strain: sudden, forced motion causing the muscle to become stretched beyond its normal capacity; local muscle damage; muscle strains can also involve the tendons STrain: tear or injury to a Tendon

Isometric Exercises

muscular contractions where tension is created in the muscle, but its length remains the same

Atrial Fibrillation

no p wave identified =>chronic Electrical impulses move randomly throughout the atria, causing the atria to quiver instead of contracting with a normal rhythm.

Asthma Prevention

PREVENTION ● Lifestyle Changes ● Relaxation Techniques ● Seek Treatment or Professional Counseling ● Prophylactic Inhalors: Albuterol 10-15min before Exercise (EIA) Stridor breath sounds are heard with acute asthma and reactive airway diseases.

PE Definition

PULMONARY EMBOLISM Deep Vein Thrombosis dislodges from bilateral lower extremeties, following Surgery, Thromboplebitis, or Immobility, and travels to the right side of the heart, circulates, and lodges in the branches of the Pulmonary Artery causing partial or completed occlusion Always Life

Discuss the nursing care of the patient with a valvular disorder.

nursing care focuses on maintaining the cardiac output, managing manifestations of the disorder, teaching about the disease and its treatment, and preventing complications. teach: early treatment for strep throat, completion of antibiotics (eat yogurt before starting), monitor for blood in stools, teach about side effects of anticoagulants, management and prevention of heart failure symptoms (weight gain of 2+/24hrs or 3-5+lbs/week), keep all lab workups (CBC, BUN+Creatinine, PT/INR, digitalis serum levels, BMP (electrolytes), BNP.

Atrial Flutter

rapid & regular atria beats, 'sawtooth'

Laminectomy Pre-Op

Strict bedrest on firm matress; neck traction if in cervical, pelvic traction if lumbar; local heat; analgesics; muscle relaxants; steroid injections

paroxysmal nocturnal dyspnea

Sudden attacks of SOB that usually occur during sleep. Person wakes gasping forbreath and sits up to relieve symptoms; associated with left ventricular heart failure.

Pneumonia S/Sx

Sudden onset of chills, rapidly rising fever (101-105), pleuritic chest pain that is aggravated by breathing & coughing. Px is severely ill, w/ tachycardia (25-45), & other signs of respiratory distress (shortness of breath, use of accessory muscles). Pulse is rapid & bounding. Predominant symptoms may be headache, low grade fever, pleuritic pain, myalgia, rash, pharyngitis. Px may exhibit orthopnea (shortness of breath when reclining), perferring to be propped up or sitting in the bed leaning forward (orthopneic position) in an effort to achieve adequate gas exchange w/out coughing or breathing deeply. Appetite is poor, and px is diaphoretic (sweaty) & tires easily. Sputum is often purulent. Rusty, blood-tinged sputum may be expectorated w/ streptococcal (pnemococcal), staphylococcal, and Klebsiella pneumonia.

Ulcerative Colitis Meds

Sulfonamides (antibiotic: Azulfidine,Bactrim, Gantrisin) treats inflammation, not infection. Steroids (taper off). No laxatives or barium enemas. Anticholinergics to decrease intestinal motility. Immunomodulators (Asacol)

Hypothyroid Nursing Interventions

Teach s/sx of myxedema coma (hypotension, hypothermia, hyponatremia, hypoglycemia, resp failure), high fiber low calorie diet (need bulk to prevent constipation), lots of water, increase activity, no enemas or laxatives. Avoid administering sedatives or hypnotics, can lead to resp failure. Prevent chilling. Myxedema Coma: replace missing hormone (Synthroid, levothyroid). If dose is adequate, sx will disappear rapidly. Px must take meds for life.

PaO2

80-100

Eye Drops

Irrigate inner canthus to outer canthus. Pressure for 10 sec. Mydriatic - dilates Miotic - constricts (little word, little pupil) Put in ointments at bedtime due to blurred vision.

Gonorrhea

"Clap, drip" Females: majority asymptomatic Males: Dysuria, yellowish-green discharge, urinary frequency Dx: smears, cultures Often coexists w/ Chlamydia

Hypoglycemia

"Insulin shock." Blood glucose falls below 50-60 because of too much insulin or oral hypoglycemic agents, too little food, or excessive physical activity. As blood glucose falls, sympathetic nervous system (fight/flight) stimulated, resulting in surge of epinephrine & norepinephrine. This causes sx sweating, tremor, tachycardia, palpitation, nervousness, hunger, restlessness, nightmares. It often occurs before meals, especially if meals are delayed or snacks are omitted. Midmorning hypoglycemia occurs when the morning insulin is peaking, whereas hypoglycemia in the late afternoon may coincide with NPH insulin. Middle of the night hypoglycemia may occur becuase of peaking evening or presupper NPH, especially in px who have not eaten a bedtime snack.

Discuss the nursing implications of medications including administration, dosage, route, interactions and adverse reactions for the treatment of anemia.

(Depends on the cause) Iron Replacement - 1 hour before or two hours after meals Vitamin B12 Folic Acid Hydroxyurea Immunosuppressive therapy (or androgens)

cancer of the liver

(primary hepatocellular carcinoma or cholangiocarcinoma and metastatic cancers, usually from other parts of the gastrointestinal tract). Colon cancer spreads immediately into the liver.

Open-Angle Glaucoma Treatment

**Pupillary dilating (mydriatic) meds are contraindicated for px w/ glaucoma (atropine, neosinephrine not ok!).** Parasympathomimetics (Pilocarpine) - drug of choice. Mimics paraysympathetic nervous system (rest, peace). Enhances pupilary constription. Blurred vision tends to decrease w/ regular use. Meds that end in -carpine are always for glaucoma. Beta-Andrenergic Antagonists (Timolol, timoptic, betagan) - Reduce IOP by decreasing aqueous humor formation. Precautions w/ heart patients. Meds that end in -olol lower BP & HR. Be sure to press inner canthus to reduce risk of systemic absorption. Cabonic Anhydrase Inhibitors - decrease aqueous humor formation (Diamox only po med for glaucoma)

rhabdomyolysis and causes

*life threatening complication of severe muscle trauma with muscle cell loss -crush syndrome -compartment syndromes- volkmann ischemic contracture -malignant hyperthermia

Myxedema Crisis

-Mechanical ventilation if respiratory acidosis/hypercapnia/hypoxia is significant -Immediate intravenous thyroid hormone replacement while awaiting confirmatory test results (T4 and TSH) -Treatment of hypoglycemia, hypotension, & hyponatremia -Correction of infection -Passive rewarming w/ blankets & warm room

chronic pancreatitis

-Progressive permanent damage to pancreas leads to impaired secretion of digestion enzymes & bicarbonate, Clients with this should have small, frequent, high calorie diet with Increased carbs, increased proteins and DECREASED fats, No coffee or alcohol. Weight loss, jaundice, steatorrhea, foul smelling stools & signs of DM will most likely present. Will have ab pain, continuous burning in the area and a gnawing dull pain.

pagent disease

-aka osteitis deformans -excessive resorption of spongy bone and accelerated formation of softened bone -disorganized, thickened, but soft bones -most often affects the axial skeleton -thickened bones can cause abnormal bone curvatures, brain compression, impaired motor function, deafness, atrophy of the optic nerve, etc.

oxyhemoglobin curve

-an important tool for understanding how our blood carries and releases oxygen -A sigmoid plot of the percentage of hemoglobin bonding sites occupied by oxygen versus the partial pressure of oxygen, which illustrates the affinity of hemoglobin for oxygen

describe osteomyelitis and manifestations and differenciate btwn exogenous and endogenous osteomyelitis

-often caused by a stasphlococcal infection -most common cause is open wound (exogenous); also can be from a blood-borne (endogenous) infection -manifestations: acute and chronic inflammation, fever, pain, necrotic bone -treatment: very difficult to treat; antibiotics, debridement, surgery, hyperbaric, oxygen therapy

primary function of the pulmonary system

-ventilate of the alveoli -diffuse gases into and out of the blood -perfuse the lungs so the body receives oxygen -ventilation *mechanical movement of gas or air into and out of the lungs *minute volume- ventilatory rate multiplied by the volume of air per breath *alveolar ventilation

What is the best indicator of FVE/FVD?

...

Identify therapeutic digoxin level.

0.8-2 nanograms/mL is the therapeutic range

Discuss four classes of drugs used to treat CAD.

1. Vasodilators 2. Calcium channel blockers 3. Beta blockers 4. Antilipidemics

Determine the nursing care of a patient with CAD.

1. decreased cardiac output > assess patient's condition> monitor and record vital signs> encourage patient to verbalize concerns > encourage patient to change position every two hours > encourage patient to do relaxation techniques > encourage patient to engage in divertional activities such as chatting with family and friends. 2. ineffective tissue perfusion >assess pt.'s condition. >monitor and record v/s. >note color and temperature of the skin. >monitor peripheral pulse. >provide a warmth environment. >encourage active rom. 3. acute pain >assess pt.'s condition. >monitor and record v/s. >assess pains location and intensity/severity arising with. >provide comfort measures like stretching of linens and assisting in position. > provide diversional activities like having conversation w/ the pt. >stress to pt the importance of providing adequate rest period to the pt. >administer meds as ordered. >monitor urine output. > reinforced low salt and low fat diet 4. activity intolerance > monitor and record vital signs > teach method to increase activity level > plan care with rest periods between activities > provide positive atmosphere > assist with activities > promote comfort measures > encourage participation and diversion of activities 5. fatigue > monitor vital signs >determine ability to participate in activities/level of mobility. >establish realistic activity goals with client >plan care to allow individually adequate rest periods, schedule activities for periods when client has the most energy >provide environment conducive >give medication as doctors ordered

HCO3 (bicarb)

22-26; base

Hyperglycemia Symptoms

3 P's: Polydipsia (thirst), polyuria (pee), polyphagia (hunger), weakness, weight loss, agitation

PaCO2

35-45; acid

pH

7.35-7.45

ABCDs of Moles

A - asymmetry; is it balanced on both sides B - Border (Irregular) C - Color (varieted) D - Diameter (exceeding 6 mm) Common sites of melanomas are the back, legs, between toes, feet, face, scalp, fingernails, backs of hands.

Discuss atherosclerosis.

A cardiovascular disease in which fatty deposits called plaques develop in the inner walls of the arteries, obstructing the arteries and causing them to harden. The cause is unknown. These substances block and narrow the coronary vessels in a way that reduces blood flow to the myocardium. Atherosclerosis involves a repetitious inflammatory response to injury of the artery wall and sub- sequent alteration in the structural and biochemical prop- erties of the arterial walls. New information that relates to the development of atherosclerosis has increased the under- standing of treatment and prevention of this progressive and potentially life-threatening process.

Circulating Nurse

A circulating nurse operates as a go-between for the operating room and the rest of the hospital. She is not scrubbed in. A circulating nurse does the initial assessment of the patient as he is wheeled into the operating room and makes sure that the patient is comfortable. The circulating nurse also assists the surgeon and scrub nurse as they clean up and prepare for the surgery. During the surgery, circulating nurses hand packages of supplies to the scrub nurse as necessary. If something is required from outside of the room, or if the surgeon needs a message passed on to another staff or family member, it falls to a circulating nurse. After the surgery, the circulating nurse counts opened packages and used supplies, to make sure the numbers add up correctly. This is to ensure that there were no supplies accidentally left inside the patient during the surgery.

hepatitis b

A form of hepatitis that is transmitted through contact with infected blood, body fluids (sexually transmitted), contaminated needles

Types of fractures: pathologic, open, closed, fatigue/stress, complete/incomplete

A fracture is a break in the continuity of a bone. A break occurs when force is applied that exceeds the tensile or compressive strength of the bone. Pathologic: fracture at a point where the bone has been weakened by disease, for example, by tumors or osteoporosis. Open: communicating wound between bone and skin Closed: noncommunicating wound btwn bone and skin Fatigue: caused by abnormal stress or torque applied to a bone with normal ability to deform and recover. Usually occur in individuals who engage in new or different activity that is both strenuous and repetitive. Stress: occur in normal or abnormal bone that is subject to repeated stress, ex athletics Complete fracture the bone is broken all the way through, whereas in an incomplete fracture, the bone is damaged but is still in one piece.

Hiatal Hernia

A portion of the stomach protrudes upward into the chest, through an opening in the diaphragm. Symptoms: heart burn, regurgitation, dysphagia. Small, frequent meals; don't lay down for 1 hr after eating to prevent reflux; elevate HOB; bland diet; avoid coffee, alcohol, smoking; Neissen Fundoplication:

hepatitis a

A virus that is spread by the fecal-oral route through contaminated food and water or by close and intimate contact and results in liver inflammation, flu-like symptoms, nausea, poor appetite, abdominal pain, fatigue, yellow eyes and skin, and dark urine that can last weeks to months.

ACUTE Renal failure- Intervention

ACUTE - Intrarenal Catagory Diuretics (Lasix) are used to increase urinary output. As a result, it may be able to assist in flushing out some of the toxins that have contributed to the acute renal failure. Stages of Renal Failure

Liver Function Tests

AST/ALT elevated Alkaline Phosphate elevated Bilirubin elevated Serum Albumin low (watch for edema) Serum Globulin elevated 70% of liver may be damaged before any tests become abnormal

Abnormal Breath Sounds

Abnormal Breath Sounds ● Crackles ● Rhonchi ● Wheezes ● Rales ● Stridor ● Friction rubs ● Cheyene Stokes

Shock

Abnormality of the circulatory system that results in inadequate organ perfusion and tissue oxygenation. One of the most serious postop complications. Can result from hypovolemia and decreased intravascular volume. The body responds to shock by activating the sympathetic nervous system and mounting a hypermetabolic and inflammatory response. Confusion and more than 20 breaths/min are some of the earliest signs of shock. Vital signs are key indicators of hemodynamic status and BP is an indirect measure of tissue hypoxia (lack of oxygen). The nurse should report a systolic BP lower than 90 or a drop in systolic of 40 from baseline. By the time BP drops, damage has already been occurring at the cellular and tissue levels. Therefore, the patient at risk for shock must be assessed and monitored closely before the BP falls. A lack of adequate blood supply leads to dysrhythmias and ischemia. The heart rate is rapid, sometimes over 150 bpm. The patient may complain of chest paid and even suffer a myocardial infarcation (heart attack). More than 500 mL of blood loss could require transfusion.

Joint Replacement

Accurate fitting is essential, infection is common postoperatively, check drains often (200-400 mL/24 hrs ok), CMS, provide aBductor appliance (A-frame, pillows between knees). Encourage 3 L fluid/day. Get client out of bed ASAP and as much as possible, keep abductor pillow in place while client is in bed (hip replacement), do not flex hip more than 90 degrees (hip replacement). Turn to unaffected side w/ pillow between legs.

pancreatic cancer

Adenoma or carcinoma of head, body, or tail of pancreas. Usually the diagnosis is made later on. 5th Leading cause of cancer death. Alcohol, fat intake, cigarette smoking, chronic pancreatitis., Abd pain; not severe(dull ache, non specific at first

Adrenal Cortex Disorder - Addison's

Adrenal Cortex Disorder - Addison's (Deficiency of adrenocorticosteroid hormones) Addison's disease - Hypocortisol: Decreased cortisol levels Addison's disease is a result of too little cortisol and corticosteroids. These patients need to be given steroids to help normalize their bodies. These patients also need to remain well hydrated. Dehydration could lead to an Addisonian Crisis.

Adrenal Cortex Disorder - Cushings (Hypercortisolism)

Adrenal Cortex Disorder - Cushings (Hypercortisolism) Cushing's syndrome - Hypercortisol: Increased cortisol levels. The patient with Cushing's syndrome is at risk for infection due to the overproduction of glucocorticoids. The nurse should teach the importance of increasing intake of protein and vitamins C and A, which are all needed to support and repair body tissues. Calcium, Vitamin D, and Potassium should also be increased in the diet. Rest periods and daily weights are recommended in the care of a client with Cushing's, but neither will directly address the problems of frequent infections as much as the diet change.

Adrenal Cortex Pathophysiology

Adrenal Cortex Pathophysiology ● Hyper: Increased levels are consistent with Cushing's syndrome would reveal an elevated cortisol level. ● Hypo: Decreased levels are consistent with Addison's disease and hypothyroidism.

Adrenal Cortex Physiology

Adrenal Cortex Physiology Adrenal Cortex is primary to essential hormones, while the Adrenal Medulla is non-essential for life. ● Aldosterone: helps maintain fluid balance by retaining salt in the body ● Glucocorticoids: glucose and protein metabolism; B/P; response to physical stress; pituitary hormones A cortisol level is a serum test done to measure the amount of total cortisol in the serum and evaluate adrenal cortex function.

risk factors of down syndrome

Advancing maternal age.

Diabetes Mellitus

Affects the metabolism of protein, carbs, and fat. Diagnosted when fasting glucose is over 126. Glycosated hemoglobin A1c (presence cofirms existence of hyperglycemia in previous 4 months). 7 & below is norm.

Fat Emboli

After fracture of long bones or pelvic bones, or crush injuries, fat emboli may develop. Occurs most frequently in adults younger than 40 and px w/ multiple fractures. Onset is rapd, typically within 12-48 hrs after injury. S/S - Personality changes, restlessness, confusion, irritability, hypoxia (inadequate tissue oxygenation, check blood gas for PO2), tachycardia, tachypnea, chest pain, cough, large amounts of thick white sputum, petechiae. Can easily go into shock. Prevention - Immediatly immbolize fracture Interventions - high flow oxygen, steroids via IV, I&O, vasopressor meds, pain control Notify physician stat, draw blood gases, administer O2, endotracheal intubation.

Discuss appropriate teaching for the patient with a pacemaker.

After pacemaker insertion, the patient's hospital stay may be less than 1 day, and follow-up in an outpatient clinic or office is common. The patient's anxiety and feelings of vulnerability may interfere with the ability to learn information provided. Nurses often need to include home caregivers in the teaching and provide printed materials for use by the patient and caregiver. Priorities for learning are established with the patient and caregiver. Teaching may include the importance of periodic pacemaker monitoring, promoting safety, avoiding infection, and sources of electromagnetic interference.

Explain the benefits of cardiac rehabilitation.

After the patient with an MI is free of symptoms, an active rehabilitation program is initiated. Cardiac rehabilitation is an important continuing care program for patients with CAD that targets risk reduction by means of education, in- dividual and group support, and physical activity. It is con- sidered to be an important part of continuing care for pa- tients with CAD.

Chest Tubes

After thoracic surgery, used to re-expand the involved lung and removed excess air, fluid, and blood. Mark drainage level (no more than 100 mL/hr), gentle tidling, observe for leaks, breathe quietly. If tube comes out, place end of tube in sterile water. Removal: Help dr or np. Need suture remover kit, dressings. Instruct px to breathe in deeply, hold it, take out, dress wound.

Osteoporosis

Age-related bone demineralization causing loss of bone tissue and decreased bone mass resulting in fragile porous bone mass. Risk for fractures.

Surgical Tx of Ruptured Varicosities r/t Portal Hypertension: Shunts

Aims to reduce portal pressure and control bleeding esophageal varices by diverting blood from the portal venous system's collateral vessels. Risks: hemorrhage, liver failure (due to surgery meds), thrombosis, electrolyte imbalances, alcohol withdrawal.

Asthma

Air flow into lungs is unobstructed, however mucus holds stale air in the bases forcing air out of the upper respiratory passages only.

Chronic Pancreatitis Causes

Alcohol & malnutrtion - major causes; smoking. Long-term alcohol consumption causes hypersecretion of protein in pancreatic secretions, resulting in blockages in ducts. Alcohol also has a direct toxic effect on cells & is more likely to be severe in px w/ diets poor in protein & high or low in fat. Smoking cigarettes causes your pancreas to produce less bicarbonate, a substance used to neutralize stomach acid in digestive system. If px doesn't produce enough bicarb, more prone to GI ulcers.

hepatitis c

An RNA virus that is transmitted primarily by blood and blood products and sometimes through sexual contact and may become chronic with few to no symptoms while causing long-term damage to the liver, such as cirrhosis and hepatocellular carcinoma.

define proband and how it relates to pedigree

An individual who presents with a genetic disorder or other specific characteristic, when this leads to the investigation of the individual's family

Glomerulonephritits Treatment

Antibiotics to prevent secondary infection, bedrest, protein & sodium restriction, I&O, daily weight, lung sounds

UTI Treatment

Antibiotics, fluid intake of 3,000 ml/ day, I&O, administer mild analgesics (phenazopyridine/Pyridium, acetaminophen, aspirin), macrodantin, cypro, bactrim (sulpha allergies), void every 2-3 hrs,

PUD Meds

Antacids, anticholinergics to block stimulation of acid secretion, H2 receptor antagonists (Zantac), PPI (Nexium, Protonix), Carafate to cover area of irritation

Discuss medications utilized for patients with valvular disorders including uses, administration, interactions, adverse reactions, lab values, patient/family teaching.

Anticoagulant therapy - guiac stools, assess oral cavity, skin for bruises, use caution with ASA/NSAIDS, soft toothbrush, electric razor, monitor labs: HTC, HGB, PLT, PT, PTT, INR

Treatment of Vaginal Candidiasis

Antifungal suppository agents like Monistat, Mycostatin, Lotrimin, Terazol. **Use at bedtime** Oral Diflucan available in 1 pill dose. Relief should be noted within 3 days.

Rheumatoid Arthritis Meds

Asa (aspirin), NSAIDs, Placlin, steroids, immunosuppressives (methotrexate, Imuran), DMAR's (Enbrel, Avar, Remicade, Humira)

Discuss the nursing care of patients with digoxin toxicity.

Assess for signs: GI - anorexia (usually the first sign), nausea, vomiting, diarrhea Muscular - weakness, lethargy CNS - HA, drowsiness, visual disturbances (blurred vision, disturbance in yellow green vision, halo effect around dark objects), confusion, disorientation, delerium Cardiac - changes in pulse rate or rhythm: electrocardiographic changes, such as bradycardia, tachycardia, premature ventricular contractions Observe for toxicity q2-4hrs during digitalization,and 1-2 times a day when a maintenance dose is given. Check serum blood levels for digitalis Atropine will treat severe bradycardia. Digibind in the antidote for digoxin toxicity, but simple withdrawl of the drug usually rectifies toxicity because of the short duration of action. Hypokalemia usually coexists with toxicity.

hepatitis infection

Asymptomatic hepatitis with fecal-oral transmission. No one is a carrier of this virus. Can be transmitted by sex and blood. (Virus)

Pyelonephritis - Kidney Infection

At-Risk Populations ● Pregnancy History of: ● Chronic kidney stones ● Benign Prostate Hypertrophy ● Diabetes Mellitus

Pre-Op Meds

Atropine -dries up resp. secretions; can cause urinary retention Valium - anxiolytic (anti-anxiety) Corticosteroids - Cardiovascular collapse (shock) can occur if discontinued suddenly. Therefore, a bolus of corticosteroid may be administered IV immediately before & after surgery. Patients who have received corticosteroids are at risk for adrenal insufficiency. Therefore, the use of corticosteroids for any purpose during the preceding year must be reported to the anesthesiologist and surgeon. The patient is monitored for signs of adrenal insufficiency. Insulin - Interaction between anesthetics & insulin must be considered when a patient w/ diabetes is undergoing surgery. IV insulin may need to be administered to keep the blood glucose w/in normal range. Anticoagulants (Warfarin/Coumadin) - Can increase risk of bleeding during intra/post-op periods; should be discontinued in anticipation of elective surgery. The surgeon will determine how long before the elective surgery the patient should stop taking an anticoagulant. Herbal Products - recommended discontinuation 2-3 weeks before surgery

Addisonian Crisis Medical Management

Attempt to discover source of infection (or dehydration) which may have triggered the crisis, combat shock. Position px in recumbent (laying flat/modified Trendelenburg) position with legs elevated for venous return to heart. Hydrocortison given IV follwed with D5 NS. Vasopressor amines required if hypotension persists. Teach prevention (avoid stressful situations, take basal dose of cortisol during stress). Teach s/sx of excessive or insufficient amounts. Excessive will lead to Cushing's.

Acute Pancreatitis

Autodigestion of pancreas by pancreatic enzymes. Causes - alcohol abuse, gallstones Labs - high amylase, lipase, glucose, WBC, low calcium Sx - mid-epigastric pain radiating to back, usually r/t alochol ingetions or a fatty meal; abd guarding, rigid, board-like abd; nausea, vomiting Cullen's Sign - bluish discoloration of periumbilical area

Rheumatoid Arthritis definition

Autoimmune disease is a long-term disease that the body's immune system mistakenly attacks healthy tissue and leads to inflammation of the joints and surrounding tissues. It can also affect other organs.

Rheumatoid Arthritis

Autoimmune; classic feature: joint swelling as a result of inflammation. Primary process is synovial inflammation of the joint with accumulation. Results in joint rigidity, immobility. Symptoms (Joint Involvement): stiffness in am or after periods of inactivity, observable joint swelling w/ redness, tenderness, and nodules in subcutaneous tissue, joints may be spongy or boggy. Marked stiffness, joint deformity, subluxation, and dislocation of involved joints. Ulnar drift.

Urinary Calculi Prevention

Avoid intake of oxolate-containing foods (spinach, strawberries, rhubarb, tea, peanuts, wheat bran). Drink fluids every 1-2 hrs during the day (enough to excrete 3k-4k ml every 24 hrs). Avoid foods high in purine (shellfish, anchovies, asparagus, mushrooms, and organ meats).

Meds for Bladder Spasms

B&O suppository, Ditrapan

Diabetic Abbreviations

BBG - bedside blood glucose FSBG - fingerstick blood glucose IDDM - insulin-dependent diabetes mellitus SMBG - self-monitoring blood glucose

BRONCHITIS

BRONCHITIS Etiology: Development from a Viral Infection like the Common Cold or Influenza with Abnormal Breath Sounds: crackles, rhonchi / wheezing ● Acute Manifestations: ● Fever / Chills / Malaise ● Chest / Back / Muscle Pain ● Chronic Manifestations (COPD): ● Chronic Productive Cough / Use of Accessory Muscles ● Hyper Secretions ● Lasts >3mo/yr /2 years ● Peripheral Edema

BRONCHITIS COMPLICATIONS

BRONCHITIS COMPLICATIONS Chronic Bronchitis may involve Right-sided Ventricular Heart Failure (vs. Left Ventricular Heart Failure or Congestive Heart Failure -CHF due to an MI) from hypertrophy or thickening of the right ventricular heart wall due to Pulmonary Hypertension (Cor Pulmonale) and pulmonary shunting from one vascular system to another, without picking up O2, also creating Jugular Venous Distension (JVD).

BRONCHITIS DIAGNOSIS

BRONCHITIS DIAGNOSIS ● Chest X-ray delineates between Acute Bronchitis and Pneumonia ● ECG ● Stress Test ● Because bronchitis occurs in the medium sized lung passage ways of the bronchial tree, rhonchi and wheezing are the sounds that will be most like to be heard in this patient.

BUN Normal Value:

BUN Normal Value: 8-20 mg/dL

Crohn's Disease Diagnosing/Management

Barium enema reveals classic "string sign" on x-ray of terminal ileum (constriction of that segment of the intestine). If mild, low residue (no milk), bland diet w/ vitamin supplements. If severe, monitor weight, Hgb & Hct, fluid balance, steroids. May need surgery.

Thyroidectomy

Be prepared for possibility of laryngeal edema. Put a tracheostomy set at the bedside w/ O2 and a suction machine. Keep drainage devices compressed & empty. Check frequently for bleeding behind neck (hemorrhage - px will c/o pressure under dressing, check for hematoma). Move them very carefully. Semi-Fowler's & support head w/ pillows. Limit px talking & note change in voice. Injury to laryngeal nerve will be exhibited by aphonia (loss of voice). Tetany can occur, resulting from loss of calcium (thyroid regulates calcium & phosphorus metabolism, norm calcium 8-10). Causes hyperirritability of nerves. Sx numbness, tingling of fingers, spasms of hands/feet, muscular twitching. Trousseau's- tap cheek, Chevostek's- hand twitches when bp cuff is on. Treat w/ IV Calcium Gluconate. Make sure in vein because it's highly necrotic to tissues. Extravasation - when med gets into tissues rather than staying in blood stream.

Benign Prostate Hyperplasia (BPH) S/Sx

Benign Prostate Hyperplasia (BPH) S/Sx ● Frequency ● Nocturia ● dribbling ● hard to start ● hard to stop ● incontinence ● small amounts of urine at a time.

Benign Prostate Hyperplasia (BPH) Definition and S/Sx

Benign Prostate Hyperplasia (BPH) Condition found in all geriatric males in some degree S/Sx ● Male > 50yo ● Difficulty starting urine stream ● Frequent urination, especially nocturia ● Urinary retention ● Hematuria

Fast-Acting Asthma Meds

Beta 2 Adrenergic Agonists (Bronchodilators); Relax smooth muscle. : Albuterol (Proventil, Ventolin) - Rescue inhaler, increases heart rate Xopenex - (cardiac friendly)

Osteoporosis Meds

Biophosphonates: Fosamax, Boniva, Actonel (Take 1st thing in morning on empty stomach w/ full glass of water. Wait 30 minutes before eating or drinking anything. Stay upright for 30 min.)

Hep C

Blood, sex; no vaccine; can cause chronic liver probs & cancer

Hep B

Blood, sex; vaccine

Osteomyelitis

Bone infection; s/s - pain in bone, tenderness, heat, redness, swelling, fever, tachycardia, elevated WBC and ESR (erythrocyte sedimentation rate), positive blood or wound cultures, bone scan

osteoarthritis definition

Breakdown of articular cartilage in weight-bearing spine, joints, and hands due to mechanical stress,trauma, overuse, infection, obesity, or genetic predisposition.

cholelithiasis

Breakdown of hemoglobin leads to production of Bilirubin. Too much bilirubin leads to gallstones. May cause steady pain lasting 30 minutes or more in upper right side of belly, under right shoulder, or between shoulder blades. Symptoms may include: Nausea, vomiting, fever, sweating, chills, clay-colored stools, or jaundice., "The 4 (or 5, or 6) F's": Fat, Forty, Female, Fertile, Feather, F

COPD COMPLICATIONS

COPD COMPLICATIONS ● Pneumonia ● Atelectasis ● Pneumothorax ● Acute Respiratory Distress Syndrome (ARDS) ● Acute Respiratory Insufficiency or Failure (ARF) ● Pulmonary Edema ● Pulmonary Hypertension ● Congestive Heart Failure Chronic bronchitis contributes to it.

Discuss the major symptoms of Coronary Artery Disease (CAD).

CAD produces symptoms and complications according to the location and degree of narrowing of the arterial lumen, thrombus formation, and obstruction of blood flow to the myocardium. CAD may be asymptomatic, or experience episodic chest pain (angina pectoris), or may have a myocardial infarction resulting from complete obstruction of blood flow to part of the muscle. Patients with myocardial ischemia may present to an emergency department or clinic with a variety of symptoms other than chest pain. Patients who are older or have a history of diabetes or heart failure may report symptoms such as shortness of breath. Many women have been found to have atypical symptoms, including dyspnea, nausea, and weakness.

Discuss laboratory and diagnostic tests that are significant when caring for the patient with anemia.

CBC Iron Levels Serum Ferritin Sickle Cell Screening Hemoglobin Electrophoresis Schilling's Test Bone Marrow Aspiration

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

CHRONIC OBSTRUCTIVE PULMONARY DISEASE A chronic, progressive group of obstructive airflow diseases including chronic bronchitis, asthma, and emphysema. Involves increasing airway resistance with permanent lung distention. ● CHRONIC BRONCHITIS ● ASTHMA ● EMPHYSEMA ● COPD ● SIGNS AND SYMPTOMS ● Dyspnea ● Wheezing / Crackles ● Productive Cough ● Intolerance to Exercise ● Tachypnea / Tachycardia ● Cyanosis: (5gm of unsaturated hemoglobin) ● Hypoxemia - reliance; to stimulate breathing= low oxygen Pursed-lip breathing helps keep the alveoli open, thus improving gas exchange. ● Peripheral Edema ● Increased Anterior-Posterior Chest Diameter ● Use of Accessory Muscles for Respiration

COPD Complication: PULMONARY EDEMA S/Sx

COPD Complication: PULMONARY EDEMA ● Crackles or rales, will be heard in the alveoli and is more associated with pneumonia and pulmonary edema. ● Medications for Pulmonary Edema ● Diuretics - reduce fluid volume ● Oxygen ● Cardiac glycoside (Digoxin) - increase cardiac output ● Vasodialator (Nitroglycerin) -decrease preload ● Pressor (Dobutamine) or a Antihypertensive - decrease afterload ● Morphine Sulfate - dialating blood vessels around the heart and decreases preload and reduces anxiety

COPD TREATMENT

COPD TREATMENT ● Immunizations ● Antibiotics ● Bronchodialators ● Corticosteroids - Oral and Inhaled ● Beta-Adrenergic Agonists ● Oxygen Therapy - Low flow rate: Normally, CO2 stimulates breathing b/c it initiates Hypoxic Drive. Chronic COPD patients have chronic elevated carbon dioxide levels. They "retrain" their bodies to breath when they are low in oxygen. High rate flow may actually stop breathing. This will increase PaC02 leading to somulence and respiratory failure.

Discuss classifications, actions, side effects and nursing implications of drugs used to treat dysrhythmia.

Calcium Channel Blockers - Calcium channel blockers decrease the workload of the heart and decrease the heart's oxygen demands and are used to treat variant angina pectoris, HTN, and dysrhythmias. S&S: hypotension, bradycardia, may precipitate AV block, HA, constipation, nausea, peripheral edema NI: administer before meals to reduce GI upset, check liver/renal function tests, weigh patient and report wt gain, avoid grapefruit, increase fiber. ie Veropamil, Nifedipine, Diltiazem Potassium Channel Blockers (Class III) - delays repolarization of fast potentials, prolong action potential duration and effective refractory period. S&S: pulmonary toxicity, visual impairment, hypotension, fatigue, bradycardia ie Amiodarone Sodium Channel Blockers - Reduces automatically in ventricles and bundle of HIs-Purkinje system IA: Slows conduction; prolongs repolarization S&S Toxicity for Lidocaine: (SAMS) Slurred/Difficult speech (paresthesias, numbness of lips/tongue), Altered CNS (drowsiness, dizziness, dysrhythmias, restlessness, confusion), Muscle twitching (tremors), Seizures (convulsions, respiratory depression, respiratory and cardiac arrest). S&S cinchonism, cardiotoxicity, arterial embolism, tinnitus, HA, N/V/D dizziness, hypotension, fatigue, bradycardia NI: assess LOC, pulse checks, seizure precautions, VS frequently, monitor ECG, assess respiratory system and gas exchange, never give IV if prepared with epinephrine - can cause severe hypertension and life-threatening dysrhythmias. ie Lidocaine (Lidocaine used for local anesthesia often contains epinephrine), Quinidine, Procainamide Beta Blockers - blocks beta-receptors in the heart causing decreased HR, decreased force of contraction, decreased rate of AV conduction, and reduces contractibility in the atria and ventricles. S&S: bradycardia, lethargy, GI upset, CHF r/t AV block, hypotension, depression, bronchospasm NI: assess for symptoms of heart failure,evalute BP and pulse for significant changes: hold if systolic BP is below 90mmHg, monitor pts with diabetes. 1st, 2nd, and 3rd generations of drugs, no urinary retention issues. ie Inderal, Tenormin, Bystolic, metroprolol Cardiotonic Glycosides - decrease conduction through the AV node and reduce automaticity of the SA node. used for heart failure, a-fib/flutter. S&S: dizziness, HA, malaise, fatigue, muscle weakness, visual disturbances, anorexia, hypokalemia, dysrhythmias, bradycardia NI: monitor digoxin serum levels, monitor apical pulse: report below 60 in adults and 90 in children and hold the dose, administer IV slowly over 5 minutes, do not double up with missed doses, teach patients about early signs of hypokalemia and digitalis toxicity (N/V/D, blurred or yellow disturbances). ie Digoxin, Adenosine General Nursing Implications: take apical + radial pulse, blood pressure, baseline respiratory rate, while beginning medication take VS q1hrs-4hrs, skin color monitoring, LOC change monitoring, any subjective complaints from pt needs to be followed up, monitor labs - electrolytes, CBCs, liver enzymes, DVTs

Hyperthyroidism Nursing Interventions

Calm atmosphere, observe for signs of thyroid storm, teach daily hormone replacement drugs

Discuss cardiomyopathy and nursing management.

Cardiomyopathy affects the structure and function of the heart muscle. Causes is often known, but can be related to chronic alcohol abuse, myocardial ischemia, or a viral infection. Dilated cardiomyopathy - Microscopic examination of the muscle tissue shows dimin- ished contractile elements of the muscle fibers and diffuse necrosis of myocardial cells. The result is poor systolic function. These structural changes decrease the amount of blood ejected from the ventricle with systole, increasing the amount of blood remaining in the ventricle after contraction. Less blood is then able to enter the ventricle during diastole, increasing end-diastolic pressure and eventually increasing pulmonary pressures. Altered valve function can result from the enlarged stretched ventricle, usually resulting in regurgitation. Embolic events caused by ventricular and atrial thrombi as a result of the poor blood flow through the ventricle may also occur. Most people die within 2 years of symptoms but can last for years asymptomatically. Dysrhythmias Hypertrophic cardiomyopathy - The increased thickness of the heart muscle reduces the size of the ventricular cavities and causes the ventricles to take a longer time to relax, making it more difficult for the ventricles to fill with blood during the first part of di- astole and making them more dependent on atrial contraction for filling. The increased septal size may misalign the papillary mus- cles so that the septum and mitral valve obstruct the flow of blood from the left ventricle into the aorta during ventricular contraction. Hence, HCM may be obstructive or nonobstructive. It is a hereditary disorder, and can be treated. Angina, dyspnea, syncope (loss of oxygen to the brain which causes brains). May be surgically treated by reseceting excess muscle away from aortic valve outflow tract. Restrictive cardiomyopathy - Restrictive cardiomyopathy is characterized by diastolic dysfunction caused by rigid ventricular walls that impair ventric- ular stretch and diastolic filling. Systolic function is usually normal. It is a hereditary disorder (cannot be treated with a transplant because the body will do the same thing) Poor prognosis. Minimize heart failure, treat dysrhythmias, preventing cardiac death, physical activity restricted. nursing goals for a client with cardiomyopathies ar to prevent complications, assist the client to conserve energy while encouraging self-care, and support coping skills.

Differentiate cardioversion and defibrillation.

Cardioversion and defibrillation are treatments for tachydysrhythmias. They are used to deliver an electrical current to depolarize a critical mass of myocardial cells. When the cells repolarize, the sinus node is usually able to recapture its role as the heart's pacemaker. One major difference between cardioversion and defibrillation has to do with the timing of the delivery of electrical current. Another major difference concerns the circumstance: defibrillation is usually performed as an emergency treatment, whereas cardioversion is usually, but not always, a planned procedure. Cardioversion involves the delivery of a "timed" electrical current to terminate a tachydysrhythmia. In cardioversion, the de- fibrillator is set to synchronize with the ECG on a cardiac monitor so that the electrical impulse discharges during ventricular depo- larization (QRS complex). Defibrillation is used in emergency situations as the treatment of choice for ventricular fibrillation and pulseless VT. Defibrilla- tion depolarizes a critical mass of myocardial cells at once; when they repolarize, the sinus node usually recaptures its role as the pacemaker. The electrical voltage required to defibrillate the heart is usually greater than that required for cardioversion. If three de- fibrillations of increasing voltage have been unsuccessful, cardio- pulmonary resuscitation is initiated and advanced life support treatments are begun.

Crohn's Disease (Regional Enteritis)

Chronic inflammatory disease affecting small intestine. Extends through all layers of the bowel wall.

Causes for Metabolic Alkalosis

Cause: ● Prolonged Vomiting - (loss of Na, K, H, and Cl) ● Gastrointestinal Suctioning ● Increased Bicarb Intake / Administration ● Excessive Adrenal Corticoid hormone /Hyperaldosteronism ● Diuretic Therapy ● Hypokalemia ● Excessive Baking Soda Ingestion

Respiratory alkalosis causes

Cause: Hypoventilation ● Opiate Overdose - Late Shock ● Dep of Resp Center of Medulla- Brain Stem Trauma Oversedation (morphine) ● Hypercapnia ● Respiration Muscle Paralysis ● Disorders of Lung - Pnuemonia, late emphysema, Asthma, Chronic Bronchitis, Chronic Pulmonary Dx / Edema; COPD ● Disorders of Chest Wall - Kyphoscoliosis, Flail Chest Chest Traum Pickwickian ● Foreign Body aspiration

Bacterial Vaginosis

Caused by an overgrowth of Gardnella vaginalis and an absence of lactobacilli. Risk factors include douching after menses, smoking, multiple sex partners, STDs. Can occur throughout menstrual cycle and does not produce local discomfort or pain. Discharge, if noted, is heavier than normal and gray to yellowish white in color. It is characterized by a fishlike odor that is particularly noticable after sex or during menstration as a result of increase in vaginal pH (usually more than 4.7). Metronidazole (Flagyl), Clyndamycin (Cleocin). Treat partner.

Spinal Headache

Caused by cerebrospinal fluid (cushions brain) leakage following spinal puncture for anesthesia. Treatment: lay completely flat, force fluids, blood patch by dr, pain relievers. To perform a blood patch, a doctor needs to first draw blood from the patient. Then the blood is inserted around the area where the spinal tap occurred. The blood clots, which helps reduce or stop the leaking of spinal fluid.

HIV

Caused by retrovirus that attacks CD4 T cells, lymphocytes, macrophages, and cells of the CNS. Normal CD4 count is 600-1200, under 200 = at risk for opportunistic infection (pneumocystis Carinii, Kaposi's Sarcoma, TB, candidiasis of mouth/esophagus).

Addison's/Adrenal Crisis

Causes are overexertion, stress, infection, dehydration, surgery. Symptoms occur abruptly: pallor, fever, headache, fatigue, restlessness, confusion, circulatory collapse (shock), renal shutdown due to shock.

Open Fracture

Causes break in skin; complex, compound; much more prone to infection

Amputation

Causes include: Peripheral vascular disease (80%, 75% are diabetics), trauma, deformities, malignant tumors, infection. Keep lg tourniquet at bedside. Elevate stump for the first 24 hrs postop. Intermittently elevate after 48 hrs postop (contracture can occur). Monitor for signs of infection (fever, tachycardia, redness). Maintain proper body alignment in and out of bed.

Respiratory Alkalosis Causes

Causes: ● Early Shock ● Alveolar Hyperventilation ● Hypocapnia; Hypokalemia; Hypocalcemia ● Hypoxemia due to pulmonary Dx ● Thyrotoxicosis ● Hysteria (psychogenic anxiety-induced hyperventilation) ● Cirrosis ● Hypermetabolic States: Fever, Anemia ● Improper use of Ventilators using Hyperventilation ● Early emphysema; Early Salicylate intoxication

Causes for Metabolic Acidosis

Causes: ● Lactic Acidosis (Marathon runner / severe Motor Vehicle Accident) ● Renal Failure ● Cardiac Arrest ● Diabetic Ketoacidosis ● Hyperkalemia; Hypovolemia ● Hyperchloremic Acidosis by NaCl IV solutions ● Diarrhea or Ileostomy drainage ● CNS Depression ● Salicylate Ingest (aspirin overdose)

cirrhosis

Chronic disease of the liver characterized by formation of dense connective tissue in hepatic cells.

Asthma (Reactive Airway Disease)

Chronic inflammatory disease of airways that causes airway hyperresponsiveness, mucosal edema, and mucous production. S/S cough, chest tightness, wheezing, dyspnea. Unlike other obstructive lung diseases, asthma is largely reversible, either spontaneously or w/ treatment. Allergy is the strongest predisposing factor. Common triggers are air pollutants, cold, heat, weather changes, strong odors, perfumes, smoke, exercise, stress, emotional upset, rhinosinusitis w/ postnasal drip, meds, viral resp tract infections, & gastroesophageal reflux.

Peptic Ulcer Disease Risk Factors

Chronic use of aspirin, NSAIDs, steroids, presence of H. pylori (breath test)

UTI Diagnosis

Clean-catch; IVP to determine kidney functioning (know allergies to iodine); Cystogram to determine bladder functioning; Cystoscopy to determine bladder or urethral abnormalities;

acute pancreatitis

Clients with this describe excruciating epigastric pain that radiates to the back, may be decreased by leaning forward or lying in a fetal position. Labs will show elevated serum amylase, elevated urine amylase & serum lipase, leukocytosis, increased Hct, Glucose, alkaline phosphatase & bilirubin may also be elevated., Can be caused by gall stones and alcohol abuse for almost 80% of hospital admissions. Pancreatic duct is blocked by a gall stone stuck in the sphincter, stopping the flow of pancreatic fluid. Blockage is temporary and causes limited damage. However, if it continues, pancreas will release its own enzymes and start to eat itself.

Chronic Pancreatitis

Clients with this should have small, frequent, high calorie diet with Increased carbs, increased proteins and DECREASED fats, No coffee or alcohol. Weight loss, jaundice, steatorrhea, foul smelling stools & signs of DM will most likely present. Will have ab pain, continuous burning in the area and a gnawing dull pain.

Pneumothorax

Collection of air in the pleural space; can be complication of central line insertion (subclavian). S/S dyspnea, low O2 sat, no air movement auscultated

Colostomy / Ileostomy

Colostomy / Ileostomy A sigmoid colostomy is the most common permanent colostomy performed, particularly for cancer of the rectum. It is usually created during an abdominoperineal resection. Other colostomies ● Duodenal ● Double-barrel ● Transverse loop Gallbladder - Cholecystitis Inflammation of the gallbladder Gallbladder - Cholelithiasis A formation of stones within the gall bladder or biliary duct. Gallbladder - Treatment

Trichomoniasis

Common, usually sexually transmitted disease known as "trich." Signs/Sx Vaginal discharge that is thin (somtimes frothy), yellow to yellow-green, malodorous, and very irritating. Vulvitis may occur. Vaginal and cervical erythema. pH greater than 4.5 Metronidazole or tinidazole (Tindamax). Both partners receive a one-time loading dose or a smaller dose 3 times/day for a week. **Flagil (Anabuse) - Don't drink alcohol!**

Colon Cancer Treatment - Colostomy

Complications: proplase of stoma (obesity), perforation (improper irrigation), stoma retraction, fecal impaction, peristomal skin irritation Temporary - Double barrel; Hartmann's for diverticular disease Permanent - Abdomino perineal (A&P) resection; remove rectum, suture area, drain is present. Unable to sit comfortably after surgery. Check incisional site, stoma, turn over and look at incision between buttocks, JP drain.

Asthma Nursing Management

Constantly monitor px for 12-24 hours, or until asthmaticus is under control. Assess skin turgor for dehydration. Fluid intake is essential to combat dehydration, loosen secretions, and facilitate expectoration. Nurse administers IV fluids as prescribed, up to 3-4 L/day. BP and cardiac rhythm monitored. Conserve px energy. Nonallergenic pillow.

Continuous Bladder Irrigation (CBI)

Continuous Bladder Irrigation (CBI) continuous infusion of a sterile solution into the bladder, usually by using a three-way irrigation closed system with a triple-lumen catheter. One lumen is used to drain urine; another is used to inflate the catheter balloon, and the final lumen carries the irrigation solution. CBI is primarily used following genitourinary surgery to keep the bladder clear and free of blood clots or sediment. ANYTHING RED COULD INDICATE CLOT. Need to flush catheter for clots.

Meniere's Disease Treatment

Control vertigo w/ antivert, Dramamine. For tinnitus, vasodilating drugs (Nicotinic acid, Banthine) Salt-free diet w/ a diuretic Avoid alcohol, excessive smoking, and caffeine. Surgery: Endolymphatic shunts or decompression; **vestibular nerve sectioning (leads to deafness)**

Long-Term Asthma Control Meds

Corticosteroids (Beconase-AQ, Azmacort). S/e high sodium, high blood sugar, low potassium, retain fluids, leaches calcium, ulcerogenic. Cromolyn Sodium (Crolom, NasalCrom) and nedocromil (Alocril, Tilade) stabilize mast cells. Prevents histamine release. Maintenace therapy. Used to prevent exercise-induced asthma or in unavoidable exposure to known triggers. Possibly 4-6 weeks before it works. Methyxanthines (Theophilline) - causes GI distress, take w/ food; px builds up toxicity, requires serum levels

Steroids

Cortisone, prednisone, hydrocortisone. Adverse effects: immunosuppression, peptic ulcers (take w/ food), high blood glucose, high sodium (leads to water retention, high BP), low K, moon face, hirstuism, leaches calcium from bones, mood swings, restlessness, depression, sleeplessness. Give med EARLY in morning to prevent insomnia: 7 or 8 am (this is when the adrenal gland is most active & would normally produce the most steroids for the day). Avoid infections (steroids can mask sx of infection because they prevent the normal inflammatory response). Never stop steroids abruptly (can cause adrenal crisis/shock)

Pulmonary Embolus

DVT dislodges & obstructs pulmonary circulation; 4-10 days after trauma; Tachypnea Hypertension Sudden acute dyspnea Anxiety (feeling of impending doom) Chest or pleuritic pain Hypoxemia Diaphoresis Hemoptysis (coughing up blood)

Diagnosis Seizure

DIAGNOSIS ● Symptoms of MS may mimic those of many other nervous system disorders. The disease is diagnosed by ruling out other conditions.

Thyroid Diagnostic Tests

DIAGNOSTIC TESTS ● Serum thyroid function tests: ● 1) elevated / decreased TSH, or thyroid stimulating hormone ● 2) elevated / decreased T3, or triodothyronine ● 3) elevated / decreased T4, or thyroxine ● BMR, or basal metabolic rate ● Radioactive iodine uptake ● Thyroid scan ● T3 resin uptake

Dementia - Alzheimer's Disease

Dementia - Alzheimer's Disease ● Alzheimer's disease may progress rather quickly resulting in death within 4 to 6 years or it may move a little more slowly and linger for up to 20 years. ● Dopamine inhibits and acetylcholine excites the muscles. When the patient does not produce enough dopamine, acetylcholine is allowed to over stimulate the basal ganglia, leading to the physical manifestation effects of tremors and shaking.

Diabetes Mellitus

Diabetes Mellitus is chronic disorder characterized by hyperglycemia and glycosuria manifested by inadequate production or utilization of insulin. There are 25.8 million people in the United States, or 8.3% of the population, who have diabetes. ● Obesity, family history, and higher than normal levels of blood glucose, a condition called prediabetes, also called impaired glucose tolerance. ● The results of the Diabetes Prevention Program (DPP) showed that weight loss through moderate dietchanges and physical activity can delay and prevent type 2 diabetes. Regular insulin - SSI Management

Microvascular Complications of DM

Diabetic Retinopathy: caused by hemorrhages in small blood vessels in retina Nephropathy: Declining kidney function. Albumin leaks into urine. ACE inhibitors prescribed early on to protect kidneys by controlling hypertension and reducing microalbuminuria. Prevention & treatment of UTI. Avoid nephrotoxic substances. Adjust meds as renal function changes. Low sodium, low protein diet. Neuropathy: Paresthesias (prickling, tingling) burning (esp at night). As the nueropathy progresses, the feet become numb. Decrease in proprioception (awareness of posture & movement of body, leads to unsteady gait). Autonomic neuropathies - cadiac, GI, renal. Slightly tachycardic, orthostatic hypotension, silent MI. Delayed gastric emptying, bloating, nausea, vomiting, "diabetic constipation/diarrhea." Hypoglycemic unawareness - Px may no longer feel the typical shakiness, sweating, nervousness, and palpitations r/t hypoglycemia. Sexual dysfunction can occur.

Bronchoscopy Purposes

Diagnostic: Examine tissue, collect secretions, biopsy, diagnose bleeding sites (source of hemoptysis) Therapeutic: Remove foreign bodies, remove secretions, treat postop atelectasis, destroy/excise lesions.

Cushing's Nursing Care

Diet - high protein, low carbs, low sodium, potassium supplements. Teach client to follow diet and fluid intake exactly. I&O. Emotional support. When giving insulin for high blood sugar, explain it's r/t steroids, not diabetes

inflammatory vs. noninflammatory joint disease

Differentiated by: >Absence of synovial membrane inflammation > Lack of systemic signs and symptoms > Normal synovial l fluid analysis

Digoxin

Digoxin OD is like an upside down EKG ?

Bronchoscopy

Direct inspection of larynx. Signed consent, NPO 6 hrs before to prevent aspiration, atropine given to dry secretions, sedative or opioid given to inhibit vagal stimulation (guarding against bradycardia, dysrhythmias, hypotension). The client should be assessed for signs of complications, which would include cyanosis, dyspnea, stridor, bronchospasm, hemoptysis, hypotension, tachycardia, and dysrhythmias. Ensure gag reflex has returned before administering food. If px can swallow, gag & cough reflexes have returned.

Hips - Total Hip Replacement

Discharge teaching plan for a patient after having a total hip replacement: ● Weight-bearing limits ● Use of assistive devices ● Gradual increase in activity ● Medication therapy ● Periods of rest ● Shower after first few days

Vaginal Candidiasis S/sx

Discharge that causes pruritis and irritation. Discharge may be watery or thick but has a white, cottage cheese like appearance. Symptoms are usually more sever just before menstration and may be less responsive to treatment during pregnancy. pH will be 4.5 or less.

Dumping Syndrome Treatment

Don't take fluids w/ meals, small/frequent meals, meal should be more dry than liquid, sucrose/glucose avoided, high fat, high protein, low carb, supplement w/ vitamins (iron, B12), lie down after eating 20-30 min to delay gastic emptying, antispasmotics, anticholinergics (bentil, provantin).

DKA Patho

Due to insulin deficiency, body breaks down fat (lipolysis) into free fatty acids, which are converted into ketone bodies by the liver. Ketone bodies are acids; their accumulation leads to metabolic acidosis. Review ABG values.

Peptic Ulcer Disease Symptoms

Dull, gnawing pain in mid epigastric area or back. Relieved by eating. Heart burn. Melena. No pain in AM because flow of gastric acid is at lowest level.

Discuss the nursing management of a patient who has had a MI.

During onset, in the presence of chest pain in an acute setting, nurse's have 10 minutes to get that patient checked in and put on a EKG. An IV line is established to allow rapid administration of emergency drugs. Oxygen is administered for nasal cannula at 2 to 6L/min. VS are monitored frequently, prepare for post-op as necessary . 1. Initially assess, document, and re- port to the physician the following: a. Thepatient'sdescriptionofchest discomfort, including location, in- tensity, radiation, duration, and factors that affect it. Other symp- toms such as nausea, diaphoresis, or complaints of unusual fatigue. b. The effect of coronary ischemia on perfusion to the heart (eg, change in blood pressure, heart rhythm), to the brain (eg, changes in LOC), to the kidneys (eg, de- crease in urine output), and to the skin (eg, color, temperature). 2. Obtain a 12-lead ECG recording during symptomatic events, as pre- scribed, to assess for ongoing ischemia. 3. Administer oxygen as prescribed. 4. Administer medication therapy as prescribed and evaluate the patient's response continuously. 5. Ensure physical rest: backrest ele- vated to promote comfort; diet as tolerated; use of bedside commode; use of stool softener to prevent straining at stool. Provide a restful environment, and allay fears and anx- iety by being calm and supportive. Individualize visitation, based on patient response.

Meniere's Disease

Dysfunction of labyrinthe (inner ear, deals w/ balance & hearing). Sx: paroxysmal whirling vertigo w/ nausea & vomiting; tinnitus (low buzzing); neurosensory hearing loss, esp to low tones; sense of pressure in ear; Nystagmus(fast, uncontrollable movements of eyes), Ataxia (unsteady gait). **Vertigo is most outstanding symptom. Occurs as a sudden attack, may last from hours to days. Usually only one ear involved.**

Discuss the treatment of potential complications of a MI.

Dysrhythmias - The major goals for the patient may include eradicating or decreasing the incidence of the dysrhythmia (by decreasing contributory factors) to maintain cardiac output, minimizing anxiety, and acquiring knowledge about the dysrhythmia and its treatment. -Cardiogenic shock - o2 therapy, pain control, hemodynamic monitoring, lab marker monitoring (BNP, cardiac enzymes, ECG), fluid therapy (never IV bolus due to risk of acute pulmonary edema with pts with cardiac failure), med therapy: Dobutamine enhances the strength of cardiac contraction, improving stroke vol- ume ejection and overall cardiac output. Nitroglycerin IV nitroglycerin in low doses acts as a venous vasodilator and therefore reduces preload. At higher doses, nitroglycerin causes arterial vasodilation and therefore re- duces afterload as well. These actions, in combination with dobutamine, increase cardiac output while minimizing car- diac workload. In addition, vasodilation enhances blood flow to the myocardium, improving oxygen delivery to the weakened heart muscle. Dopamine is a sympathomimetic agent that has varying vasoactive effects depending on the dosage. It may be used with dobutamine and nitroglycerin to improve tissue perfusion. Additional vasoactive agents that may be used in managing cardiogenic shock include norepinephrine, epinephrine, milrinone, vasopressin, and phenylephrine. Each of these medications stimulates different receptors of the sympathetic nervous system. A combination of these medications may be prescribed, depending on the pa- tient's response to treatment. All vasoactive medications have adverse effects, making specific medications more useful than others at different stages of shock. Diuretics such as furosemide may be administered to reduce the workload of the heart by reducing fluid accumulation. Antiarrhythmics - Multiple factors, such as hy- poxemia, electrolyte imbalances, and acid-base imbalances, contribute to serious cardiac dysrhythmias in all patients with shock. Pericarditis - reduce activity, watch for signs of cardiac tamponade, analgesics, NSAIDS Risk of extensions of an MI Ventricular Aneurysms

Most Common Infectious Agent w/ UTI

E. Coli

Describe nursing care including patient teaching for common diagnostic tests.

EKG - noninvasive. very tense muscles (for example, a highly anxious client) and movement can interfere with results. note current medications because some drugs affect the ECG. Stress Electrocardiography: the client's ECG, heart rate, and blood pressure are monitored continuously during testing. Stress testing may cause a cardiac emergency. TTE (transthoracic echocardiogram) : noninvasive; performed at the client's bedside. conductive gel may be cold. provide washcloth.

EMPHYSEMA Physical Findings

EMPHYSEMA ● Physical Findings ● Clubbed Fingers ● Ruddy Skin Color ● Pursed-lip Breathing ● Decreased Diaphragmatic Excursion ● Asymmetrical Thorasic Movements ● Use of Accessory Muscles for Breathing ● Increased Anter-Posterior Chest Diameter

Hypothyroid (Hashimoto's, Myxedema)

Early sx are nonspecific, but gradually intensify. Low basal metabolic rate. Fatigue; thin, dry hair; dry skin; thick, brittle nails; constipation; bradycardia, hypotension; goiter (enlarged thyroid gland); periorbital edema, facial puffiness; cold intolerance; weight gain; dull emotions & mental processes.

Discuss diagnostic tests used to diagnose valvular Disorders.

Echocardiogram. This test uses sound waves to produce an image of your heart. In an echocardiogram, sound waves are directed at your heart from a wand-like device (transducer) held on your chest. The sound waves bounce off your heart and are reflected back through your chest wall and processed electronically to provide video images of your heart. An echocardiogram helps your doctor get a close look at your aortic valve. A specific type of echocardiogram, a Doppler echocardiogram, may be used. It allows measurements of the volume of blood flowing backward through an aortic valve. This volume is expressed in cubic centimeters per beat. Chest X-ray. With an X-ray of your chest, your doctor can study the size and shape of your heart to determine whether your left ventricle is enlarged — a possible sign of damage to the aortic valve. Electrocardiogram (ECG). In this test, patches with wires (electrodes) are attached to your skin to measure the electrical impulses given off by your heart. Impulses are recorded as waves displayed on a monitor or printed on paper. An ECG can provide clues about whether the left ventricle is enlarged, a problem which can occur with aortic valve regurgitation. Transesophageal echocardiogram. This type of echocardiogram allows an even closer look at your aortic valve. The esophagus, the tube that runs from your throat to your stomach, lies close to your heart. In a traditional echocardiogram, a device called a transducer is moved across your chest to produce the sound waves necessary to create the image of your beating heart. In a transesophageal echocardiogram, a small transducer attached to the end of a tube is inserted down the esophagus. Because the esophagus lies close to your heart, having the transducer there provides a clearer picture of your aortic valve and blood flow through it. Exercise tests. Different types of exercise tests help measure your tolerance for activity and check your heart's response to exertion (exercise). Cardiac catheterization. Your doctor may order this procedure if noninvasive tests haven't provided enough information to firmly diagnosis the type or severity of your heart condition. Your doctor threads a thin tube (catheter) through a blood vessel in your arm or groin, into your heart. Dye is injected through the catheter into your heart, making details visible on an X-ray. Cardiac catheterization can show if blood is leaking back from the aorta into the heart's left ventricle. Some catheters with special sensors also can measure pressure within heart chambers, such as the left ventricle. Pressure may be increased in the left ventricle with aortic valve regurgitation.

Discuss the teaching components for the patient having diagnostic testing related to an MI.

Echocardiography: Before traditional echocardiography, the nurse informs the patient about the test, explaining that it is painless. Echocardiographic monitoring is performed while a transducer that emits the sound waves is moved about the chest. Gel applied to the skin helps transmit the sound waves. Periodically, the patient will have to turn onto the left side or hold a breath. The test takes about 30 to 45 minutes. If the patient is to undergo an exercise or phar- macologic stress test with echocardiography, information on stress testing is also reviewed. In preparation for a TEE study, the following information is reviewed: • The patient must fast for 6 hours before the study. • An intravenous line is started for administering a sedative and any pharmacologic stress testing medications. • The patient's throat is anesthetized before the probe is inserted. • BP and the ECG are monitored throughout the study. • The patient will be kept comfortable but not heavily sedated. The patient must be alert enough to follow instructions and to report symptoms such as chest pain. After the study, monitoring continues for 30 to 60 minutes. The patient is to continue fasting for 4 hours. The patient may have a sore throat for the next 24 hours.

Rheumatoid Arthritis Labs

Elevated Erythrocyte Sedimentation Rate (ESR) - indicates inflammation Elevated WBC Positive Rheumatoid Factor (RF) C-Reactive Protein - due to inflammation Anti-Nuclear Antibody (ANA)

Open Pneumothorax

Emergency; opening in the chest wall that allows air to pass freely in & out of thoracic cavity; if caused by stab wound, don't remove weapon. S/S: low cardiac output, low BP, high HR Management: Plug hole w/ towel or heel of hand, instruct client to inhale then strain as if pooping. Vaseline gauze.

Describe teaching needed by the patient /family related to CAD, including meds, diets, and exercise.

Encourage disuse of tobacco products, discuss role of diet, refer to dietitian, encourage daily physical activity, discuss the importance of controlling hypertension and diabetes. Statin teaching: tell them to inform their doctor if they are taking other meds or natural remedies. promptly report muscle pain, tenderness, or weakness; skin rash, hives, or color changes; abdominal pain, nausea, vomiting. Do not use if pregnant. Nicotinic Acid teaching: tell them that the drug can cause flushing of the face, neck, ears; these effects diminish over tie, but are aggravated by alcohol use. change positions slowly to reduce the risk of injury. report dizziness or weakness to the doctor. Bile acid sequestrant teaching: drink ample amounts of fluid to reduce risk of constipation. do not omit does. promptly report back or abdominal pain, nausea/vomiting, or black or bloody stools to the doctor.

End Stage Renal Disease (ESRD): priority diagnosis.

End Stage Renal Disease (ESRD): Patients with ESRD are at risk for fluid volume overload and this would be the priority diagnosis. Fluid volume overload could lead to other serious conditions like Congestive Heart Failure (CHF),respiratory distress, and other disorders.

End-stage Renal Failure / Disease (ESRD) COMMON PROBLEMS

End-stage Renal Failure / Disease (ESRD) COMMON PROBLEMS ● Chronic Anemia ● Azotemia ● Metabolic Acidosis ● Hypocalcemia Hydroxycholecalciferol Deficiency ● Hyperphosphatemia ● Carbohydrate Intolerance ● Hyperlipidemia ● Glucose Intolerance ● Hypoproteinemia

Peptic Ulcer Disease (PUD)

Erosion in (upper GI) esophagus, stomach, pylorus, and duodenum due to increase in concentration or activity of acid secretion or a decrease in the normal resistance of the mucosa.

Osteoporosis Teaching

Estrogen replacement encouraged 5 yrs through early menopause to prevent osteoporosis; encourage ambulation, physical activity, and exercise (weight bearing). Ensure adequate intake of protein, calcium, and Vit D. Estrogen/androgen combination hormonal therapy increases both bone formation & absorption of protein & calcium. Estrogen is important for keeping calcium in bones. Osteoporosis affects thin women because estrogen is stored in fat.

SIADH (Syndrome of Inappropriate Antidiuretic Secretion)

Excessive release of antidiuretic hormone from the posterior pituitary gland or another source. The result is hyponatremia and sometimes fluid overload. ADH is released by the pituitary gland & helps the kidney to function properly. It helps maintain the balance of water and minerals like sodium and potassium in the urine and the bloodstream. An excess of this hormone leads to the expulsion of large amounts of sodium through urine while the water level remains almost unchanged. Sx r/t hyponatremia: fatigue, nausea, restlessness, headache, confusion, seizures, fainting Nursing Interventions: Fluid restriction, correction of low Na Found in px w/ head trauma & pneumonia.

Hyperthyroid (Graves Disease)

Excessive secretion of thyroid gland which increases basal metabolic rate; May be precipitated by emotional shock; May be mild w/ remissions & exacerbations; Cause of death: most common is cardiac failure - heart can't sustain tachycardic rate forever, races itself to death; thyroid gland is enlarged, soft, may pulsate, a thrill (hard pulsing) is felt and a bruit is heard over the thyroid arteries.

Laminectomy

Excision of lamina (posterior arch of vertebrae) to relieve pressure on the spinal nerves r/t herniated disc

Diabetic Exercise

Exercise lowers blood glucose levels by increasing the uptake of glucose by body muscles and by improving insulin utilization. Px should eat a 15 g carbohydrate snack if exercising. Daily exercise encouraged. Patients who have blood glucose over 250 w/ ketones in urine should not begin to exercise until the urine test results are negative for ketones & the blood glucose is closer to normal. Exercising w/ elevated blood glucose levels increases the secretion of glucagon, growth hormone, catecholamines. The liever then releases more glucose, and the result is an increase in blood glucose. Avoid smoking, as it causes vasoconstriction, which can lead to slowed peripheral healing.

Explain the steps involved with performing an EKG.

Explain to the patient the need to lie still, relax, and breathe normally during the procedure. Note current cardiac drug therapy on the test request form as well as any other pertinent clinical information, such as chest pain or pacemaker. Explain that the test is painless and takes 5 to 10 minutes. Place the patient in a supine or semi-Fowler's position. Expose the chest, ankles, and wrists. Place electrodes on the inner aspect of the wrists, on the medical aspect of the lower legs, and on the chest. After all electrodes are in place, connect the lead wires. Press the START button and input any required information. Make sure that all leads are represented in the tracing. If not, determine which electrode has come loose, reattach it, and restart the tracing. All recording and other nearby electrical equipment should be properly grounded. Make sure that the electrodes are firmly attached. Nursing Interventions Disconnect the equipment, remove the electrodes, and remove the gel with a moist cloth towel. If the patient is having recurrent chest pain or if serial ECG's are ordered, leave the electrode patches in place.

Factors That Slow Fracture Healing

Extensive local trauma, bone loss, weight bearing prior to approval, malalignment of fracture fragments, inadequate immobilization, space or tissue between bone fragments, infection, local malignancy, metabolic bone disease, avascular necrosis, age, corticosteroids

Hip Fracture

External rotation and short leg. Thromboembolism most common complication. Prevention includes passive ROM exercise, use of elastic stocking, elevation of HOB 25 degrees, low-dose heparin.(given in love handles, flank)

Symptoms of HIV

Extreme fatigue, loss of appetite, unexplained weight loss, swollen glands, leg weakness or pain, unexplained fever, night sweats, dry cough (may represent PCP), diarrhea, white spots in mouth (candidiasis), painful blisters (shingles), painless purple-blue lesions on skin, confusion, disorientation, recurrent vaginal infections that are resistant to treatment

Eyes & Ears - Cataracts Risk factors for CATARACTS

Eyes & Ears - Cataracts Risk factors for CATARACTS ● Lighting ● Trauma ● Smoking ● Age ● Hereditary ● Diabetes ● Excessive exposure to the sun ● Chronic corticosteroid use

Eyes & Ears - Ears: Hearing Assessment

Eyes & Ears - Ears: Hearing Assessment ● The nurse should stand 1 to 2 feet away from the patient and ask the patient to block one external ear canal. The nurse quietly whispers a statement and asks the patient to repeat it. Each ear is tested separately.

Eyes & Ears - Prevention of Hearing Loss

Eyes & Ears - Prevention of Hearing Loss ● Use ear protection devices when involved with exposure to high-intensity noise. ● Keep the volume as low as possible when using headphones for listening. ● No objects should be placed in the ear. ● Have a physician remove any foreign objects that may get in the ear.

Describe the signs and symptoms seen with aortic and mitral valve disorders.

Fatigue and weakness, especially when you increase your activity level Shortness of breath with exertion or when you lie flat Chest pain (angina), discomfort or tightness, often increasing during exercise Fainting Irregular pulse (arrhythmia) Heart murmur Heart palpitations — sensations of a rapid, fluttering heartbeat Swollen ankles and feet (edema) diastolic murmur (mitral stenosis) crackles in the lungs (mitral stenosis) dyspnea on exertion (mitral stenosis) high BP until collapse (mitral stenosis) hemoptysis (cough blood) (mitral stenosis) pulmonary congestions (mitral stenosis) stresses right side of heart (mitral stenosis) right side = a-fib a-fib leads to stroke, pulmonary embolism, etc fatigue, weakness, exertion dyspnea, orthopnea, left heart symptoms: pulmonary congestion/edema, murmur: loud, high-pitched (mitral regurgitation) chest pain r/t fatigue, dysrhythmias, cause palpitations, light-headedness, syncope, murmur (MVP) light-headedness (aortic stenosis) dyspnea upon exertion (aortic stenosis) murmur (aortic stenosis) palpations, distended neck veins, dizziness, exercise intolerance, fatigue, exertional dyspnea, angina, murmur is heard in diastolic (aortic regurgitation)

Hep A

Fecal-Oral; hand hygiene, vaccine

UTI Signs/Symptoms

Fever, chills, frequency, urgency, dysuria, hematuria, pain at costovertebral angle, elevated serum WBCs (over 10,000)

Hyperthyroid S/sx

Fine tremors of hands, nervousness, emotiona hyperexcitability, irritability, palpitations, tachycardia, heat intolerance, sweating, exopthalmos, increased appetite, diarrhea, weight loss, increased BP T3 over 220 T4 over 12 Radioactive iodine uptake (indicates presence of goiter - enlarged thyroid)

Blocks

First Degree Blocks: no threat Second Degree Block: usually asymptomatic Third Degree Block: atrial impulses completely blocked - pacemaker necessary immediately

FIVE STAGES OF PARKINSON's

First: Unilateral shaking and tremors in one limb. Second: Bilateral limb involvement and difficulty with walking and balance Third: Physical movements slow significantly, affecting walking more Fourth: Tremors may decrease, but akinesia and rigidity begin to develop Fifth: Unable to stand / walk, dependent for care, may exhibit dementia

Neurogenic Bladder

Flaccid/spastic bladder; can be cause of urinary obstruction

Shock position

Flat on back; legs elevated at 20 degree angle; knees straight.

Diabetic Diet

Goal - avoid sharp, rapid rises in blood glucose levels after food is eaten. Guidelines: Combine starchy foods w/ protein and fat containing foods to slow their absorption and lower glycemic response. Eating foods that are raw and whole results in a lower glycemic response than eating chopped, pureed, or cooked foods. Eating whole fruit rather than drinking juice decreases the glycemic response, because fiber in the fruit slows absorption. Adding foods w/ sugars to the diet may result in a lower glycemic response if these foods are eaten w/ foods that are more slowly absorbed. If a patient w/ diabetes consumes alcohol on an empty stomach, there is an increased likelihood of hypoglycemia. A bedtime snack can prevent insulin reactions. Carbs - Fruits, grains, veg. Px needs higher carbs than fat or protein. Carbs have the greatest effect on blood glucose levels because they are more quickly digested than other foods and are converted into glucose rapidly. 50-60% of calories should be derived from carbs. 20-30% of calories from fat. 10-20% from protein.

Ulcerative Colitis Management

Goal: Decrease inflammation, suppress inappropriate immune response & provide rest for diseased bowel. If acute, NPO, NG to decompress bowel. Total parenteral nutrition (TPN). Stop the diarrhea, no milk, low residue diet, high protein, vitamins, iron. IV fluids to correct fluid/electrolyte imbalance. Avoid cold foods; smoking cessation (smoking increases GI motility).

Hyperthyroid Management

Goal: Reduce hyperactivity of thyroid & provide symptom relief. Meds: Prevent synthesis (formation) of thyroid hormones. Blocks conversion of T4 to T3. PTU (Propylthiouracil) or Tapazole: Given until signs of hyperthyroidism have disappeared (euthyroid). Takes 3 weeks to stabilize px. Call dr if signs of infection or bleeding present. Iodine/Iodine Compounds: Potassium Iodide, Lugol's Solution, SSKI. Drink through straw, stains teeth, serve in milk or juice, rinse mouth. Prescribed before PTU to reduce size & vascularity of gland so surgery can be done. Monitor for iodine toxicity (swelling of buccal mucosa, increased salivation, skin eruptions). If iodine toxicity present, discontinue immediatly. Beta Blockers: control sympathetic nervous system. Inderal given to control nervousness, tachycardia, tremor, anxiety, not used in asthma (bronchodilates)

PUD Complications

Hemorrhage: Hematemesis, coffee ground emesis, melena, distention. Observe for shock. Dark tarry stools. Perforation: Sudden, sever abd. pain, pain reffered to right shoulder (phrenic nerve irritation), vomiting, syncope, rigid/board-like abd.

Recognize and report basic abnormalities on a cardiac monitor.

High T waves indicate arrhythmias or tachycardia

Colon Cancer Surgery - Pre-op

High calorie, low residue diet for several days. Intestinal microbials (kanamycin, neomycin) several days to decrease bacterial content of colon & to soften and decrease the bulk of the colon. I & O to correct fluid/electrolyte imbalances. Mechanical cleaning of the bowel w/ lax, enemas, NPO after midnight prior to surgery, surgeon or ET nurse will mark the area for stoma placement if colostomy is indicated

Cushing's Disease

Hypersecretion of adrenal cortex of steroids. Usually caused by long-term steroid use. S/Sx: Increase in blood sodium (Na), increase in blood sugar, decrease in blood potassium (K); reduction of eosinophils (lowered ability to fight infection); disappearance of lymphoid tissue; hypertension due to Na & water retention; hyperirritability; mental aberrations (alterations between mania & depression, suicidal); sleep disturbances; obesity (heavy trunk, thin extremities); Buffalo hump on neck & back; bruise easily; skin thin, fragile, friable (tears easily); edema (F/E imbalance, leads to elevated BP and CHF); hirsutism; muscular weakness r/t protein depletion; moon face; osteoporosis (steroids leach calcium)

Diabetes Insipidous

Hyposecretion of posterior lobe. Abnormally large amounts of dilute urine excreted due to insufficient ADH. Cause unknown, may be secondary to head trauma, brain tumor, surgical ablation (something removed), or irradiation of pituitary. Sx: poluria, dilute urine, specific gravity very low (1.001-1.005), urinating 2-20 L/day, polydipsia (thirst). Management: Fluid replacement, vasopressin replacement (don't use insulin syringe) usually lifelong. Desmopressin (sniff nasally BID). ADH IM every 24-96 hrs. Carry medic alert info. Nursing: Daily weights, I&O, F/E, Labs: urine specific gravity, Na, K

Hypoxic Drive-

Hypoxic Drive-A normal person is stimulated to take in breaths when they are high in carbon dioxide, rather than being stimulated by the need for oxygen.

Benign Prostate Hyperplasia (BPH) INTERVENTION

INTERVENTION Transurethral Resection Procedure (TURP) with CBI -remove area of prostate restricting flow

Seizure interventions

INTERVENTION ● Long-term medications used to slow the progression: Interferons , glatiramer acetate, mitoxantrone (Novantrone), and natalizumab (Tysabri), Fingolimod (Gilenya ) Methotrexate, azathioprine (Imuran), ● Intravenous immunoglobulin (IVIg) and cyclophosphamide ● Steroids, Methylprednisone, may be used to decrease the severity of attacks and exacerbations.

Acute Closed-Angle Glaucoma Treatment

IV Mannitol or oral (glycerol). Monitor I&O. Laser surgery when medicaiton is poorly tolerated. Iridectomy - remove a portion of the iris to allow aqueous humor to flow from posterior chamber to anterior chamber. Tabeculectomy - creates a new drainage pathway through sclera

Colostomy Vs. Ileostomy

Ileostomies are performed under a number of different circumstances where there is damage to the colon or rectum. Most ileostomy patients suffer from some sort of inflammatory bowel disease or colon or rectal cancer. Abdominal infections, like an abscess or a perforated diverticulitis, colon or rectal injury, or large bowel blockage, can led to a colostomy. Patients with rectal or colon cancer, as well as those with injuries in the perineum area, may also require this sort of surgery. Ileostomies are usually close to the belly button. Colostomies are lower than ileostomies.

Factors That Enhance Fracture Healing

Immbolization of fracture, maximum bone fragment contact, sufficient blood supply, nutrition, excercise: weight bearing for long bones, hormones: growth hormone, thyroid, calcitonin, vitamin D, anabolic steroids, electric potential across fracture

Emphysema

Impaired oxygen & carbon dioxide exchange results from destruction of the walls of overdistended alveoli, causing deadspace (lung area where no gas exchange occurs). Progesses slowly for many years. S/S: chronic cough, sputum production, dyspnea on exertion, barrel chest. As it progresses, dyspnea may occur at rest. Weight loss is common. In later stages, carbon dioxide elimination is impaired, resulting in increased carbon dioxide tension in arterial blood (hypercapnia), leading to respiratory acidosis. Frequent ventilation-perfusion mismatches produce chronic hypoxemia, hypercapnia, polycythemia (many more RBC, high hematocrit, hemoglobin), right-sided heart failure. Px develop peripheral edema, which is treated w/ diuretics.

Priority nursing intervention after a stroke (CVA):

In any unconscious client, the airway must be protected. Assessment of the current airway and breathing status is of highest priority and will continue to be.

What are some of the signs and symptoms of hyperthyroidism that might indicate the need for a thyroidectomy?

Increased appetite, weight loss, fatigue, insomnia, heat intolerance, goiter, exophthalmos (protruding eyeballs).

Jaundice (Icterus)

Increased bilirubin in blood. Bilirubin is the orange/yellow pigment of bile; biproduct of hemoglobin metabolism. If the liver doesn't get rid of bilirubin from expired RBCs, the bilirubin in the blood will increase, leading to jaundice. Sx: Yellow sclera, yellow skin, sever puritus (itch) due to bilirubin salts in skin

Glaucoma

Increased intraocular pressure, loss of vision, leading cause of blindness, usually over 40. Aqueous humor can't drain, causes pressure and damage to optic nerve.

Peritonitis

Infection of the lining of the abdominal cavity caused by leakage of contents from abdominal organs into abd cavity. Sx: diffuse pain becoming constant, aggravated by movement. Abd. tender, rigid, rebound tenderness, n/v, decreased peristalsis, increased temp, increased pulse, increased leukocytes, shock from hypovolemia or septicemia Tx: IV, NPO, gastric suction (decompression w/ NG), fluid/electrolyte replacement, O2, antibiotics, I &O

Rheumatoid Arthritis Systemic Changes

Inflammation & nodule formation can affect many parts of body; px may experience organ malfunction in addition to bone/joint deformity. Fever, weight loss, fatigue, anemia, generalized aching. Remissions & exacerbations may be r/t mental & physical stress. Women 30-50 yo most often affected, but can occur at any age.

Discuss nutritional interventions for the patient with anemia.

Iron: (Heme Fe) meats, poultry, fish (absorbed twice as fast) (Non-heme Fe) green leafy veggies, fruits, whole grains, brown rice, dried beans, eggs. B12: meat, poultry, egg, fish, shellfish Folic Acid: Asparagus, okra, spinach, broccoli, green beans, legumes, dried beans, fortified grain products

Inflammatory Bowel Disease - Treatment

Inflammatory Bowel Disease - Treatment ● The patient would be NPO to put the bowel at rest, which is the rationale for administering TPN ● ALWAYS IN A PICC LINE TPN is high in dextrose, which is glucose; therefore the patient's blood glucose level must be monitored very closely. The patient may be on sliding-scale regular insulin coverage for the high glucose level. NEVER PIGGY BACK ANYTHING TO TPN ● TPN must be administered through a central line because of the high glucose levels.

Inflammatory Bowel Disease - Ulcerative Colitis

Inflammatory Bowel Disease - Ulcerative Colitis A chronic inflammatory bowel disorder of the large intestine, colon and rectum.

Ulcerative Colitis

Inflammatory disease that affects the mucosa & submucosa of the colon. Usually begins in the rectum and sigmoid colon & extends upward into the entire colon. Produces congestion, edema, and ulcerations that develop into abcesses. Has systemic complications. Sx: Diarrhea (mucousy & bloody), passing 10-20 stools/day, intermittent tenesmus (straining to defecate), anorexia, weight loss, fever, vomiting, dehydration, hypocalcemia, anemia (r/t bloody diarrhea)

Contact Dermatitis

Inflammatory reaction of the skin to physical, chemical, or biologic agents. Soothe & heal the involved skin and protect it from further damage. Soap is not used until healing occurs. Avoid heat, soap, rubbing. Fragrance free. Don't use dryer sheets. Avoid topical meds, lotions, ointments, except those prescribed. Wet dressings usually help clear the oozing eczematous lesions. A thin layer of cream or ointment containing a corticosteroid then may be used. Medicated baths at room temp are prescribed for larger areas. For severe, widespread conditions, a short course of corticosteroids may be used.

Urinary Calculi Diagnosis

Intravenous Pyelogram - An intravenous pyelogram (IVP) allows for visualization of the kidney and its associated structures via placement of radioactive contrast dye to visualize the stone and its location. ** Make sure px is not allergic to iodine. **

Informed Consent

It's the surgeon's responsibility, but the nurse clarifies it with the patient. The patient personally signs the consent if of legal age and mentally capable. Permission is otherwise obtained from a surrogate, usually a responsible family member or legal guardian. In an emergency, it may be necessary for the surgeon to operate w/out the patient's informed consent; however, every effort must be made to contact the patient's family. Informed consent must include an explanation of procedure & risks, description of benefits & alternatives, an offer to answer questions, instructions that the patient may withdraw consent, a statement informing the patient if the protocol differs from customary procedure.

KIDNEY STONES: renal calculi S/Sx:

KIDNEY STONES: renal calculi S/Sx: Intense pain is usually associated with the stones leaving the kidney and moving down the ureter. ● Stones in the renal pelvis primarily cause flank pain ● Stones in the ureter cause severe left flank pain, sweating, agitation/restlessness ● Stones in the bladder and/or urethra will be associated with lower abdominal pain, radiating to the scrotum and testes, or the vulva, with dysuria.

Hypocalcemia in Acute Pancreatitis

Keep a supply of IV calcium gluconate readily available. Make sure you're in IV correctly, as calcium gluconate is highly necrotic to tissues. (tetany, muscle twitching, cramping, Trousseau's- tap cheek, Chevostek's- hand twitches when bp cuff is on)

Laminectomy Post-Op: Lumbar

Keep bed flat, firm mattress, bedboards; logroll; when on back, don't flex just the knees (puts stress on spine), support entire length of legs on pillows; when on side, logroll into position keeping spine straight, supoort legs w/ pillow between knees, head w/ small pillow roll in continuous motion and support back with pillows. May have drain. Assess ability to move & sensation of extremities (if c/o numbness and tingling in lower extremities, compare with preop status). Check dressing for bleeding and CSF leakage (headache). Monitor for urinary retention. Postural hypotension. Instruct px to keep spine straight while doing ADLs. Will be more comfortable lying in bed or walking than sitting. Educate px: hard, firm mattress at home; straight, firm chairs; avoid driving, lifting weights, and stair climbing until permitted by physician; squat, don't bend.

Diabetic Sick Day Rules

Keep taking insulin, monitor glucose more frequently, watch for signs of hyperglycemia. Illness & other stressors causes blood sugar to rise, so the px does not need to decrease insulin to compensate for decreased food intake, and may even need to increase the insulin dose.

DKA

Ketones in urine signal there is a deficiency of insulin and control of type I diabetes is deteriorating. Risk for DKA is high. When there is almost no effective insulin available, the body starts to break down stored fat for energy. Urine testing is the most common method used for self-testing of ketone bodies by px. Urine testing should be performed when px have glycosuria or persistent elevated blood glucose levels (over 240 for two test periods in a row) and during illness or stress. Glucose 350 and up, ketonuria, excessive urination, dehydration, electrolyte loss (sodium, potassium), acidosis (pH 6.8-7.2), fruity breath, hyperventilation (deep but unlabored) Causes: Infection, stress, missed insulin dose Usually treated w/ isotonic IV fluids, slow IV infusion or regular insulin, careful replacement of potassium (major loss of K from intracellular-to-extracellular shift, insulin administration enhances move of K back in cells; if px is not peeing, don't give K). When glucose gets to 250-300, start introducing glucose so that hypoglycemia doesn't occur.

Knees - Post-op Interventions

Knees - Post-op Interventions ● Pulses and circulation checks should be done every one (1) to two (2) hours postoperatively. ● Weight-bearing limits on the affected leg. Knee with an immobilizer on the affected joint to provide stability. ● Elevated while the patient is sitting in the chair to minimize edema. ● Do not encourage range of motion until the surgeon gives permission for flexion of the knee. . . . Then ● Continuous Passive Motion (CPM) is used only while the patient is in bed and ordered with support from Physical Therapy.

LABS - Hyperthyroidism

LABS - Hyperthyroidism 1) decreased TSH, or thyroid stimulating hormone comes from the pituitary gland, trys to bring T3 and T4 to normal range 2) increased T3, or triiodothyronine 3) increased T4, or thyroxine

LABS - Hypothyroidism

LABS - Hypothyroidism 1) elevated TSH, or thyroid stimulating hormone comes from the pituitary gland, trys to bring T3 and T4 to normal range 2) decreased T3, or triiodothyronine 3) decreased T4, or thyroxine

apnea

LACK OF BREATHING

Cataracts

Lens becomes opaque, cause unknown, looks milky. S/S: Alteration in vision (hazy, blurred, no pain), can't distinguish objects, visual loss is gradual. Treatment: Usually extracapsular. After removal of lens, they are aphakic (without lens). They will most commonly will get IOL implants (intraocular lens).

HPV

Lesions may be small, wartlike, or clustered, flat or raised; paint on podophyllum resin; Trichloracetic acid (TCA); laser; cryotherapy

Tension Pneumothorax

Life threatening emergency. Air is drawn into the pleural space w/ each respiration and is trapped there; can't be expelled. Tension builds up within the pleural space causing collapse of lung and shift of heart, vessels, and trachea toward unaffected side. This impedes cardiac functino. Decreased cardiac output leads to cardiac arrest. S/S: Low O2 sat, high heart rate, cyanosis, trachea across midline (pushed to unaffected side). Management: Ventilate, get air out w/ lg needle, chest tube up high to get air out (tube is low to get out fluid)

Insulins

Lift skin, 90 degree angle. Rapid Acting: Novolog. Have food in front of them. Onset 5-15 min. Peak 1 hr. Duration 2-4 hrs. Delay food until 5-15 min after injection of rapid-acting insulin. Short-Acting/Regular: Humalog R, Novolin R. Only insulin that can be given IV. Onset 30 min. Peak 2-3 hrs. Duration 4 hrs. Usually administered 20-30 min before meal. Intermediate-Acting: NPH, Humulin N, Novolin L, Novolin N. Onset 2-4 hrs. Peak 4-12 hrs. Usually taken after food. Cloudy. (Mix clear to cloudy, roll, don't shake). Very Long-Acting/Basal: Levemir, Lantus. Onset 1 hr. Duration 24 hrs. Acts like pancreas. Clear. Can't be mixed.

Discuss the nursing care for a patient undergoing cardiovascular diagnostic tests.

Lipid Profile - should be preformed fasting for 12 hours before testing, and to avoid alcohol 24 hours before testing. C-Reactive Protein - none Serum Cardiac Monitors - some drugs may interfere. must be obtained necessitating blood draws every 12-24 hours for several days. 12-lead ECG - noninvasive - very tense muscles and movement can interfere with results Stress ECG - have resuscitation supplies available TTE - noninvasive; performed at the client's bedside. conductive gel may be cold. provide a washcloth or wash the chest wall following the exam for comfort. TEE - the client is sedated and the throat anesthetized to allow passage of the endoscope into the esophagus. Monitor breathing, cough, and gag reflexes following the exam. Keep NPO until the gag reflex returns and the client is fully awake. Echocardiogram - same as stress ECG Doppler - monitor BPs X-Rays/CT/EBCT - if contract is injected, ask about allergies (iodine, seafood) before exam; ensure good hydration before and after the exam to reduce the risk of kidney damage. exposes to radiation. Angiography/cardiac catheterization - closely monitor the client, the insertion site, and the extremity after the procedure. Immediately report evidence of bleeding, pain, or a pale, pulseless extremities. MRI - the client is not exposed to radiation, ask about implantable metal or electronic devices. Radionuclear scans - the amount of radioisotope injected is very small; no special radiation precautions needed. encourage increased fluid intake. Telemetry

Urinary Calculi Treatment

Lithotripsy or Extracorporeal Shock Wave Lithotripsy (ESWL); Stones over 1 cm may need surgery removal (cystoscopy); Morphine, Torodol, Phenergren, NSAIDs; high fluid intake; warm bath once stone has passed; strain urine to collect stones for lab Percutaneous Nephrostomy - A needle or catheter is inserted through the skin into the calyx of the kidney. The stone may be dissolved by percutaneous irrigation w/ a liquid through the needle/catheter.

Osteomyelitis Care

Long-term antibiotics (6 weeks, IV, sterile technique, PICC line), debridement of bone, position to promote circulation to area, increase fluids, diet high in protein, Vit C&D (to create positive nitrogen balance), rest bone (cast or traction), may be discharged w/ wound care and antibiotics; if chronic, surgically remove infected, necrotic bone

Lung Physiology

Lung Physiology The vascular system of the lungs consists of the pulmonary arteries, which deliver de-oxygenated blood to the lungs for oxygenation; and the pulmonary veins, which deliver oxygenated blood to the heart. Bronchial arteries and veins are located within the lungs and are not directly involved with transporting oxygenated blood to the heart.

Stroke Manifestations

MANIFESTATIONS CT scan will diagnose if the stroke is ischemic or hemorrhagic ● 87% due to ischemia: an occlusion with disruption of blood flow to regions of the brain causing cerebral infarction and neurological impairment ● 13% due to hemorrhagic: rupture of a blood vessel sending blood to surrounding tissue. Also called intracerebral hemorrhage (ICH). Patients on warfarin have an increased incidence of hemorrhagic stroke.

METABOLIC ACIDOSIS Compensation:

METABOLIC ACIDOSIS Compensation: Respiration by Hyperventilation eliminating pCO2 Deep Rapid Kussmaul Resp

METABOLIC ALKALOSIS Compensation:

METABOLIC ALKALOSIS Compensation: Respiratory Hypoventilation with Slow shallow breathing, retaining CO2

Hypothyroid Cardiac Implications

MI may occur in response to therapy in px w/ hypothyroidism. Heart rate lower. They have increased cholesterol, atherosclerosis, and coronary artery disease. Body & heart tissue are used to a decreased oxygen supply. When therapy is started, oxygen demand by the tissues is increased but oxygen delivery cannot be increased unless or until atherosclerosis improves. Be alert for angina (chest pain).

Pneumonia Diagnosis

Made by chest x-ray, sputum examination, and blood culture (bacteremia often occurs)

Laminectomy Post-Op: Cervical

Maintain spine in correct alignment at all times, have suction available, check dressing (serosanguinous drainage may indicate a dural leak of CSF, leading to possible meningitis, hematoma), neuro checks for upper & lower extremity weakness indicating cord compression, potential damage to laryngeal nerve (dysphagia - difficulty swallowing), elevate head of bed 30-45 degrees, logroll with head firmly aligned to body. Flexoril. Steroid may be injected into disc itself.

Hepatitis Sx

Malaise, fever, anorexia, mild flu-like upper resp sx, headache, chills, nausea/vomiting, jaundice, dark urine, light stools, puritus

Glaucoma Patient Teaching

Matter of control - no cure, importance of meds rest of life, **Avoid antihistamines, sympathomimetic drugs, no anticholinergics (atropine)**

Ascites

Measure abd girth. Results from high pressure in the blood vessels of the liver (portal hypertension) and low levels of albumin.

Pyridium/phenazopyridine

Med for pain and burning associated w/ UTI; Turns urine orange/red. Stains clothing.

Urinary Vocabulary

Micturition - the act of voiding Antidiuretic Hormone (ADH) - causes kidneys to reabsorb more water; secreted by the posterior pituitary gland; aka vasopressin Creatinine - waste product of muscle energy metabolism Anuria - total urine output less than 50 mL in 24 hours Oliguria - total urine output less than 500 mL in 24 hours Bacteriuria - bacteria in urine; count higher than 100,000 colonies/mL Diuresis - increased formation/secretion of urine Frequency - voiding more frequently than every 3 hrs. Dysuria - painful or difficult urination Hematuria - RBCs in urine Pyuria - WBC in urine Nocturia - awakening at night to urinate Proteinuria - protein in urine Renal Glycosuria - recurring or persistant excretion of glucose in urine Specific Gravity - reflects the weight of particles dissolved in the urine; expression of the degree of concentration of the urine

Glomerulonephritis Signs/Sx

Mild to moderate edema (often confined to face - periorbital), irritability, HPTN, tea-colored urine due to hematuria, proteinuria, elevated ASO, elevated BUN/creatinine as urinary output decreases, azotemia (urea in blood), anemia

Glaucoma Meds

Miotic eye drops are used to cause pupil restriction because movement of the muscles to constrict the pupil also allows aqeuous humor to flow out, thereby decreasing the pressure in the eye. Pilocarpine is commonly used. Caution client that vision may be blurred 1-2 hrs after administration of pilocarpine and that adaption to dark environments is difficult becuase of pupillary constriction.

Peptic Ulcer Disease (PUD)

Most common ulcer of an area of the gastrointestinal tract that has breaks in the gastrointestinal mucosa and is usually acidic and thus extremely painful. It is defined as mucosal erosions equal to or greater than 0.5 cm. As many as 70-90% of such ulcers are associated with Helicobacter pylori, a spiral-shaped bacterium that lives in the acidic environment of the stomach; however, only 40% of those cases go to a doctor. Ulcers can also be caused or worsened by drugs such as aspirin, ibuprofen, and other NSAIDs. ● Use of NSAIDs places the patient at risk for peptic ulcer disease and hemorrhage. Any patient suspected of having peptic ulcer disease should be questioned specifically about the use of NSAIDs. ● If a patient has an extensive peptic ulcer disease, they may develop pernicious anemia. Pernicious anemia (vitamin B12 anemia) is a result of the lack of intrinsic factor secreted by the gastric mucosal cells.

Open-Angle Glaucoma

Most common; difficult to recognize early - asymptomatic. Peripheral vision loss, painless, bilateral. Halos around lights.

Chlamydia

Most commonly reported communicable diseas in US Females: Many asymptomatic, but may exhibit dysuria, urgency, vaginal discharge Males: Leading cause of nongoncoccal urethritis Dx: tissue culture, Chlamydiazyme, MicroTrak Treatment: Doxycycline hyclate or Tetracycline HCl (take on empty stomach, avoid milk, dairy, iron, antacids)

Discuss labs and diagnostic testing utilized for patients with inflammatory/infectious disease of the heart and nursing implications.

Myocarditis: Cardiac MRI with contrast may be diagnostic and can guide clinicians to sites for endocardial biopsies, which may be diagnostic for an organism or its genome, immune process, or a radiation reaction causing the myocarditis. Pa- tients without any abnormal heart structure (at least initially) may suddenly develop dysrhythmias or ST-T-wave changes. If the patient has structural heart abnormalities (eg, systolic dys- function), a clinical assessment may disclose cardiac enlarge- ment, faint heart sounds (especially S1), a gallop rhythm, or a systolic murmur. The WBC count and ESR may be elevated. Pericarditis: An echocardiogram may detect in- flammation, pericardial effusion or tamponade, and heart failure. It may help confirm the diagnosis and may be used to guide pericardiocentesis (needle or catheter drainage of the pericardium). TEE may be useful in diagnosis but may underestimate the extent of pericardial effusions. Com- puted tomography (CT) may be the best diagnostic tool for determining the size, shape, and location of pericardial ef- fusions and may be used to guide pericardiocentesis. MRI may assist with detection of inflammation and adhesions. Occasionally a video-assisted pericardioscope-guided biopsy of the pericardium or epicardium is performed to obtain tis- sue samples for culture and microscopic examination. Be- cause the pericardial sac surrounds the heart, a 12-lead ECG may show concave ST elevations in many, if not all, leads (with no reciprocal changes) and may show depressed PR segments or atrial dysrhythmias. Endocarditis: A definitive diagnosis is made when a micro-organism is found in two separate blood cultures, in a vegetation, or in an abscess. Three sets of blood cultures (with each set including one aerobic and one anaerobic cul- ture) drawn over a 24-hour period (or every 30 minutes if the patient's condition is unstable) should be obtained be- fore administration of any antimicrobial agents. Negative blood cultures do not definitely rule out infective endo- carditis. Patients may have elevated white blood cell (WBC) counts. Doppler echocardiography may assist in the diagnosis by demonstrating a mass on the valve, prosthetic valve, or sup- porting structures and by identifying vegetations, abscesses, new prosthetic valve dehiscence, or new regurgitation. The echocardiogram may reveal the development of heart failure. TEE may provide better data than transthoracic imaging.

ABG Values

NORMAL VALUES pH = 7.35 - 7.45 pCO2 = 35 - 45 Po2 = 80 - 100 HCO-3 = 22-26

Cirrhosis

Necrosis of liver cells which are replaced by scar tissue. Causes: alcoholism, hepatitis, hepatoxins (Tylenol)

Cirrhosis Meds (Goal: Lower Ammonia)

Neomycin sulfate - antibiotic that suppresses ammonia-forming bacteria in gut Lactulose - sugar-based laxative; promotes excretion of ammonia in stool; s/e is diarrhea. Aim for 3-4 soft stools/day. Normal ammonia levels 15-110.

Hypoglycemia Treatment

Non-emergency: 15 g carbs (1/2 cup juice or reg soda, tube glucose gel, 6-10 hard candies, 2-3 teaspoons sugar or honey); Emergency: In hospitals, for patients who are unconscious or can't swallow, 25-50 mL of 50% dextrose in water may be administered IV. The effect is usually seen within minutes. Px may complain of headache & pain at injection site. Assure patency of IV line used for injection of D50W is essential because hypertonic solutions are very irritating to veins. An injection of glucagon 1 mg can be administered either subQ or IM. Glucagon is the hormone produced by the alpha cells of the pancreas that signals the liver to breakdown stored glucose. Packaged as 1 mg vials and must be mixed with a diluent immediatly before being injected. May experience nausea (turn to side to prevent aspiration.)

ESWL

Noninvasive; need informed consent; coordinated w/ heart beat; anesthesia used; monitor/teach about hematuria; pain control; KUB to see if stones are moving; high fluid intake

pH

Normal 7.35-7.45 ROME - respiratory opposite, metabolic equal. Review compensation.

Renal Labs

Normal BUN 10-20 Normal Creatinine .5-1.1 Both elevated in renal dysfunction. Uric Acid - Norm 3 - 8.2 High levels noted in gout, infections, kidney damage, alcoholism, high protein diets; low levels may indicate kidney damage, malabsorption, poor diet, liver damage, or overly acidic kidneys.

Addison's Disease

Not enough steroids. Hyposecretion of adrenal cortex caused by a destructive lesion (TB, cancer, surgically removed adrenals) Sx: Hypotension, muscular weakness, fatigue, GI disturbances, nausea, vomiting, anorexia, emaciated appearance, bronzing of skin (look at sclera, mucous membranes to differentiate from jaundice), poor response to stress situations, F/E imbalance (low sodium, high potassium), feminism in male, weight loss, low blood sugar (administer IV glucose), dehydration. Skin is bronze due to low secretion of cortisol which in turn causes pituitary to excrete excessive MSH (melanite stimulating hormone).

Osteoarthritis at risk populations

Nurses Construction Workers Athletes Poor Posture - Cubicle Workers

Discuss the nursing care of the patient with chest pain.

Nurses and other health care professionals need to be aware that "atypical" symptoms of angina and myocardial infarction, such as shortness of breath or left-sided chest pain, are common, especially among African Americans. Any patient with shortness of breath or left-sided chest pain should be assessed for other symptoms of CAD. Assess the pain: location, character, intensity, radiation, timing, duration, etc. obtain hx of meds and family history of heart disease. assess for risk factors like HTN, diabetes, high blood cholesterol levels, smoking/alcohol use, high stress levels, menopause, hormone replacement therapy, or oral contraceptives. Obtain VS and ECG tracing during chest pain within 10 minutes of report of the pain. Measure the effectiveness of the relief measures (oxygen, NTG, rest), obtain labs: cardiac enzyme levels, serum cholesterol and glucose, hemoglobin and hematocrit. If the patient reports pain (or the person's prodromal symp- toms suggest anginal ischemia, which may include sensa- tions of indigestion or nausea, choking, heaviness, weakness or numbness in the upper extremities, dyspnea, or dizziness), the nurse takes immediate action. When a patient experiences angina, the patient is directed to stop all activ- ities and sit or rest in bed in a semi-Fowler's position to re- duce the oxygen requirements of the ischemic myocardium. The nurse assesses the patient's angina, asking questions to determine whether the angina is the same as the patient typically experiences. A change may indicate a worsening of the disease or a different cause. The nurse then continues to assess the patient, measuring vital signs and observing for signs of respiratory distress. If the patient is in the hospital, a 12-lead ECG is usually obtained and scrutinized for ST- segment and T-wave changes. If the patient has been placed on cardiac monitoring with continuous ST-segment monitoring, the ST segment is assessed for changes. Nitroglycerin is administered sublingually, and the patient's response is assessed (relief of chest pain and effect on blood pressure and heart rate). If the chest pain is unchanged or is lessened but still present, nitroglycerin administration is repeated up to three doses. Each time blood pressure, heart rate, and the ST segment (if the patient is on a monitor with ST-segment monitoring capability) are as- sessed. The nurse administers oxygen therapy if the patient's respiratory rate is increased or if the oxygen saturation level is decreased. Oxygen is usually administered at 2 L/min by nasal cannula, even without evidence of respiratory distress, although there is no documentation of its effect on out- come. If the pain is significant and continues after these in- terventions, the patient is further evaluated for acute MI and may be transferred to a higher-acuity nursing unit.

Crohn's Disease S/sx

Onset insidious, abd pain, diarrhea, weight loss, crampy pains. Steatorrhea (fatty stools) due to decreased bile salt resorption. Ulcers form due to inflammation & irritating discharge. Inflammed intestine can perforate & form intra abdominal and anal abcesses. Melana (dark stools) & malabsorption syndrome. Intestinal mucosa has a "cobblestone" appearance.

Open Reduction and Internal Fixation (ORIF)

Open Reduction and Internal Fixation (ORIF) Surgical realignment of the open fractured bones, with placement of pin(s) or rod(s) to stabilize the fracture with a subsequent cast and/or traction.

Acute Pancreatitis NI

O (food causes pancreas to excrete more enzymes, causing further autodigestion), NG tube (suction), TPN, pain meds (Demerol/Morphine), call dr. if severity of pain increases (could indicate hemorrhage), meds to stop digestive enzyme secretion, fetal position, avoid alcohol/fat/caffeine/spicy, blood sugar monitoring and insulin coverage, monitor for hypocalcemia (tetany, muscle twitching, cramping, Trousseau's- tap cheek, Chevostek's- hand twitches when bp cuff is on), bedrest, monitor for hypovolemic shock, f/e disturbances, and sepsis. Hypotension reflects hypovolemia and shock caused by large amounts of protein-rich fluid into the tissues and peritoneal cavity. Px may develop tachycardia, cyanosis, and cold, clammy skin. Renal failure, resp distress (ARDS - won't take deep breaths due to pain), hypoxia, pulmonary infiltrates, dyspea, tachypnea, myocardial depression, hypocalcemia, hyperglycemia, blood clots.

Kaussmal Respirations

Occurs in DKA; hyperventilation w/ deep but unlabored resp; body's attempt to decrease acidosis, counteracting the effect of ketone buildup

Postacute Diet

Oral feedings (high carb, low protein, low fat - don't overexert pancreas) brought back gradually. Caffeine & alcohol are eliminated.

pathophysiology and clinical manifestations of osteoarthritis and rheumatoid arthritis

Osteoarthritis (also referred to as degenerative joint disease or wear-and-tear arthritis) is caused by the breakdown of joint cartilage. Cartilage acts as a cushion between the bones that form a joint. Cartilage loss can cause bone to rub on bone in a joint -- a condition that is very painful. Usually osteoarthritis begins in a single joint. osteoarthritis is mostly a consequence of aging. Water content of cartilage increases while protein composition of cartilage degenerates. Other factors that may increase the risk of developing osteoarthritis include: joint injury repetitive use or stress of joints being overweight family history/genetics Osteoarthritis primarily affects the joints. The most common symptom associated with osteoarthritis is pain in the affected joint after repetitive use or activity. Morning stiffness lasts a half hour or less. Joint pain is often worse later in the day. The affected joint can also swell, feel warm, and become stiff after prolonged inactivity. Bone spurs, bony enlargements (Heberden's nodes and Bouchard's nodes), and limited range of motion are also characteristics of osteoarthritis. Rheumatoid arthritis is a chronic, inflammatory type of arthritis. It is also classified as an autoimmune disease (i.e., immune cells attack the body's own healthy tissues). The synovium (lining of the joint) is primarily affected by rheumatoid arthritis, but organs body-wide can be affected as well. Multiple joints are usually involved with rheumatoid arthritis. No single cause has been found. Common theories point to a genetic predisposition and a triggering event. Rheumatoid arthritis symptoms include: joint pain joint swelling or effusion joint stiffness redness and/or warmth near the joint restricted range of motion Morning stiffness lasting more than an hour, involvement of the small bones of the hands and feet, extreme fatigue, rheumatoid nodules, and symmetrical joint involvement (both knees, not just one) are all characteristics of rheumatoid arthritis. There also can be lung, kidney, or cardiac involvement.

osteoporosis vs. osteomalacia (risk factors in men and women)

Osteoporosis: Most commonly occurs in Post menopausal women, where there is a loss of bone density. A number of factors can increase the likelihood that you'll develop osteoporosis — including your age, race, lifestyle choices, and medical conditions and treatments. Your sex. Women are much more likely to develop osteoporosis than are men. Age. The older you get, the greater your risk of osteoporosis. Race. You're at greatest risk of osteoporosis if you're white or of Asian descent. Family history. Having a parent or sibling with osteoporosis puts you at greater risk, especially if you also have a family history of fractures. Frame size. Men and women who have small body frames tend to have a higher risk because they may have less bone mass to draw from as they age. Osteomalacia: Adult form of Vitamin D deficiency = soft bones (no calcium) The risk of developing osteomalacia is highest in people who have both inadequate dietary intake of vitamin D and little exposure to sunlight, such as older adults and those who are housebound or hospitalized.

Ostomies

Ostomies Radical surgery that results in a drastic change in the way waste products may be dispelled by the body affects body image. A fear of smell or other accidents may alter the patient's ability to feel attractive or effective in work or social roles. Patients may defer this lifesaving surgery to postpone this disfiguring intervention or therapy.

Chronic Pancreatitis Nursing Interventions

Pain control, administer pancreatic enzymes [pancreatin (Creon) or pancrelipasae (Viokase)] w/ meals or snacks (helps w/ digestion), monitor stools to determine effectiveness of enzyme replacement (if effective, won't have steatorrhea), bland low-fat diet, avoid rich foods, alcohol, caffeine, monitor for signs of diabetes mellitus

TURP Post-Op

Pain from bladder spasms, bleeding, shock, clots, urine is reddish pink and should clear to pink in 24 hrs, and yellow in 4 days. Some clots in urine = normal. Watch drops in hemoglobin & hematocrit. Avoid straining.

5 P's That May Indicate Ischemia

Pain, Pallor, Pulselessness, Paresthesia (tingling), Paralysis

Acute Closed-Angle Glaucoma

Pain, halo vision, redness, rapid rise in IOP, pain accompanied by nausea & vomiting, sweating, bradycardia (slow), corneal edema (halovision, episodic blurring vision). Surgical emergency. Early detection is important.

Major Complications of Renal Surgery

Paralytic Ileus; absent bowel sounds, nausea, vomiting, distention

Parasthesia

Parasthesia (numbness or tingling ) Measure circumference of both legs. Notify physician immediately and assist with measuring compartment pressures and cast cutting or bivalving (the technique consists of cutting the plaster as well as the cast padding on both sides of the extremity) or a fasciotomy (a surgical procedure that cuts away the fascia to relieve tension or pressure) .

Discuss the nursing care of the patient with myocarditis.

Patients are given specific treatment for the underlying cause if it is known (eg, penicillin for hemolytic streptococci) and are placed on bed rest to decrease cardiac workload. Bed rest also helps decrease myocardial damage and the complica- tions of myocarditis. In young patients with myocarditis, ac- tivities, especially athletics, should be limited for a 6-month period or at least until heart size and function have returned to normal. Physical activity is increased slowly, and the pa- tient is instructed to report any symptoms that occur with increasing activity, such as a rapidly beating heart. If heart failure or dysrhythmia develops, management is essentially the same as for all causes of heart failure and dysrhythmias (see Chapters 27 and 30), except that beta-blockers are avoided because they decrease the strength of ventricular contraction (have a negative inotropic effect). The nurse assesses for resolution of tachycardia, fever, and any other clinical manifestations. The cardiovascular as- sessment focuses on signs and symptoms of heart failure and dysrhythmias. Patients with dysrhythmias should have con- tinuous cardiac monitoring with personnel and equipment readily available to treat life-threatening dysrhythmias. Patients with myocarditis are sensitive to digitalis. Nurses must closely monitor these patients for digitalis toxicity, which is evidenced by dysrhythmia, anorexia, nausea, vomiting, headache, and malaise. Anti-embolism stockings and passive and active exer- cises should be used because embolization from venous thrombosis and mural thrombi can occur, especially in patients on bed rest.

Discuss the nursing care of the patient with pericarditis.

Patients with acute pericarditis require pain management with analgesics, positioning, and psychological support. Patients with chest pain often benefit from education and reassurance that the pain is not due to a heart attack. To minimize complications, the nurse helps the patient with activity restrictions until the pain and fever subside. As the patient's condition improves, the nurse encourages gradual increases of activity. However, if pain, fever, or friction rub reappear, activity restrictions must be resumed. The nurse educates the patient and family about a healthy lifestyle to enhance the patient's immune system. Nurses caring for patients with pericarditis must be alert to cardiac tamponade. The nurse monitors the patient for heart failure. Patients with he- modynamic instability or pulmonary congestion are treated as they would be if they had heart failure. Peripheral pulses should be monitored. Dx include: Pain, Ineffective Breathing Pattern, Risk for Decreased Cardiac Output

Complications of Ileostomy

Peristomal skin irritation; diarrhea [electrolyte disturbances (Na & K) early post op due to a lot of effluent) Stenosis (nutrition - avoid cellulose food products like celery, nuts, seeds, peanuts) Formed stool out of ileostomy = dehydration; need "toothpastey" consistency

Phases of Chronic Renal Failure

Phases of Chronic Renal Failure Each stage involves increasing loss of nephron function and less glomerular filtration rate Renal Impairment - 40-75% nephron loss; no s/sx Renal Insufficiency - 75-85% nephron loss with polyuria/ nocturia Renal Failure - 15% nephrons remaining End-stage Renal Failure/Dx< 15% nephrons < 10% glomerular rate

Pituitary Gland Physiology

Pituitary Gland Physiology ● The pituitary gland is often called the "master gland" because its hormones regulate many body functions. The anterior pituitary secretes at least 5 major hormones: thyroid stimulating hormone(TSH) . The posterior pituitary stores and releases antidiuretic hormone and oxytocin. The pituitary influences renal function, bone density, and arterial blood flow via the hormones that it releases.

DM - Type I

Polydipsia (thirst), polyphagia (hunger), polyuria (pee), weight loss, weakness, ketosis, DKA, lack of insulin production, rapid onset, usually thin.

Post -op Joint Repl. Interventions

Post -op Joint Repl. Interventions ● Pain control management with PCA Morphine or Hydromophone (Dilaudid). ● Continuous infusion local anesthetic into joint with catheter - "baby bottle" Fentyl infusion. ● Abduction pillows / wedge for hip replacement pts. ● Rationale for continuous passive motion (CPM) machine and frequency of use 8-12 hours/day. ● Cryopac therapy or Ice packs to reduce swelling and inflammation. ● Hemovac to negative pressure drain - JP drain or accordian drain.

Post op The patient is instructed to wear a metal or plastic shield to protect the eye from accidental injury and is instructed not to rub the eye.

Post op The patient is instructed to wear a metal or plastic shield to protect the eye from accidental injury and is instructed not to rub the eye. ● Glasses may be worn during the day, and an eye shield is worn at night. ● Aspirin or medications containing aspirin are not to be administered or taken by the patient; the patient is instructed to take acetaminophen (Tylenol) as needed for pain. ● The patient is instructed not to sleep on the side of the body that was operated on because this action will cause edema and increased intraocular pressure. ● The patient is not to lift more than 5 pounds

Post-laparoscopic Cholecystectomy Thorasic pain

Post-laparoscopic Cholecystectomy Thorasic pain in the shoulder or upper backpain after a laparoscopic abdominal surgery is a result of the free air that is placed in the abdomen during surgery to make room for the instruments and to complete the surgery. Ambulation is usually helpful for this type of pain.

traditional cholecystectomy

Post-op-- ? Cholecystectomy: Opioids, T tube, antiemetics, wound care, NPO.

Colostomy Post-Op

Post-op: mucous & serosanguinous drainage at first. May start in 24 hrs. Appliance over stoma to prevent wound contamination. Feces 2-6 days post-op. Possible complications: paralytic ileus, peritonitus, infection of surgical wound, dehiscence, fistula

Stroke- ED Considerations

Post-stroke (CVA) who has altered LOC, the nurse should place the patient in a side-lying position. The side-lying position is the safest position to allow adequate drainage of fluids without aspiration.

Adrenalectomy

Pre-Op: Correct hyperglycemia & protein deficits (Cushing's). Treat hypertension & hypokalemia (Aldosteronism). 3.Administer glucocorticoid preparation on the morning of surgery as ordered to prevent acute adrenal insufficiency. Post-Op: Administer IV therapy and vasopressors as ordered.Administer cortisone or hydrocortisone as ordered to maintain cortisol levels. Provide general care for the client with abdominal surgery. Teaching: -Self-administration of replacement hormones -Bilateral adrenalectomy: lifelong replacement of glucocorticoids and mineralocorticoids -Unilateral adrenalectomy: replacement therapy for 6-12 months until the remaining adrenal gland begins to function normally -Signs and symptoms of adrenal insufficiency

Liver Biopsy

Pre-Op: Informed consent; liver very vascular, so do coagulation studies (ptt, pt, platelets) Intra-Op: Inform px to exhale & hold breath, lay on L side w/ arm up Post-Op: Lay on R side to splint liver (reducing hemorrhage risk), lots of vital

Cataract Surgery

Pre-Op: Local anesthesia, clear liquid breakfast (NPO), sedative, local block, topical mydriatic (dilate) facilitates lens removal. Intra-Op: May attach lens (contact w/ wings for sutures), otherwise use contacts or glasses. Post-Op: Drops (steroids, anti-inflammatory, antibiotic), may stay 24 hrs, usually outpatient procedure, *irrigate inner canthus to outer canthus*, prevent hemorrhage & tension on suture lins, only operative eye is covered, notify physician if severe pain occurs that is not relieved by Tylenol, keep follow-up appt w/ physician. Glasses (if not IOL): everything appears 1/3 larger than it is, distort peripheral images (turn head), heavy plastic lenses, colors distorted.

Corticosteroids

Prednisone, Deltasone Should be used w/ caution & tapered to minimal maintenance dose if possible; Administer w/ food - ulcerogenic; Toxic Effects: osteoporosis (leaches calcium from bones), fractures, avascular necrosis, gastric ulcers, psychiatric problems, infection susceptibility, hirsutism (hairiness), acne, moon face, abnormal fat deposition, edema, emotional disorders, menstrual disorders, hyperglycemia, hypokalemia, hypertension, cataracts, glaucoma

List dysrhythmias originating in the AV node.

Premature Atrial Contractions (PACs): A premature atrial complex (PAC) is a single ECG complex that occurs when an electrical impulse starts in the atrium before the next normal impulse of the sinus node. The PAC may be caused by caffeine, alcohol, nicotine, stretched atrial myocardium (as in hypervolemia), anxiety, hypokalemia (low potassium level), hypermetabolic states, or atrial ischemia, injury, or infarction. PACs are often seen with sinus tachycardia. PACs are common in normal hearts. The patient may say, "My heart skipped a beat." A pulse deficit (a difference between the apical and radial pulse rate) may exist. If PACs are infrequent, no treatment is necessary. If they are frequent (more than 6 per minute), this may herald a worsening disease state or the onset of more serious dysrhythmias, such as atrial fibrillation. Treatment is directed toward the cause. Atrial Flutter: Atrial flutter occurs in the atrium and creates im- pulses at an atrial rate between 250 and 400 times per minute. Because the atrial rate is faster than the AV node can conduct, not all atrial impulses are conducted into the ventricle, causing a ther- apeutic block at the AV node. This is an important feature of this dysrhythmia. If all atrial impulses were conducted to the ventri- cle, the ventricular rate would also be 250 to 400, which would result in ventricular fibrillation, a life-threatening dysrhythmia. Causes are similar to that of atrial fibrillation. Atrial flutter can cause serious signs and symptoms, such as chest pain, shortness of breath, and low blood pressure. Atrial Fibrillation: trialfibrillationcausesarapid,disorganized, and uncoordinated twitching of atrial musculature. It is the most common dysrhythmia that causes patients to seek medical atten- tion. It may start and stop suddenly. Atrial fibrillation may occur for a very short time (paroxysmal), or it may be chronic. Atrial fibrillation is usually associated with advanced age, valvular heart disease, coronary artery disease, hypertension, cardiomyopathy, hyperthyroidism, pulmonary disease, acute moderate to heavy in- gestion of alcohol ("holiday heart" syndrome), or the aftermath of open heart surgery. A rapid ventricular response reduces the time for ventricular filling, resulting in a smaller stroke volume. Because this rhythm causes the atria and ventricles to contract at different times, the atrial kick (the last part of diastole and ventricular filling, which accounts for 25% to 30% of the cardiac output) is also lost. This leads to symptoms of irregular palpitations, fatigue, and malaise. There is usually a pulse deficit, a numerical difference between apical and radial pulse rates. The shorter time in diastole reduces the time available for coronary artery perfusion, thereby increas- ing the risk for myocardial ischemia. The erratic atrial contraction promotes the formation of a thrombus within the atria, increas- ing the risk for an embolic event. There is a two- to five-fold increase in the risk of stroke (brain attack).

List types of dysrhythmias originating in the ventricles.

Premature Ventricular Complex (PVC): Premature ventricular com- plex (PVC) is an impulse that starts in a ventricle and is con- ducted through the ventricles before the next normal sinus impulse. PVCs can occur in healthy people, especially with the use of caffeine, nicotine, or alcohol. They are also caused by car- diac ischemia or infarction, increased workload on the heart (eg, exercise, fever, hypervolemia, heart failure, tachycardia), digitalis toxicity, hypoxia, acidosis, or electrolyte imbalances, especially hypokalemia. In the absence of disease, PVCs are not serious. In the patient with an acute MI, PVCs may indicate the need for more aggressive therapy. Ventricular Tachycardia (V-Tach): Ventricular Tachycardia. Ventricular tachycardia (VT) is de- fined as three or more PVCs in a row, occurring at a rate exceed- ing 100 beats per minute. The causes are similar to those for PVC. VT is usually associated with coronary artery disease and may precede ventricular fibrillation. VT is an emergency because the patient is usually (although not always) unresponsive and pulseless. The patient's tolerance or lack of tolerance for this rapid rhythm depends on the ventricular rate and underlying disease. If the patient is stable, continuing the assessment, especially ob- taining a 12-lead ECG, may be the only action necessary. Cardio- version may be the treatment of choice, especially if the patient is unstable. VT in a patient who is unconscious and without a pulse is treated in the same manner as ventricular fibrillation: immediate defi- brillation is the action of choice. Ventricular Fibrillation (V-Fib): Ventricular fibrillation is a rapid but dis- organized ventricular rhythm that causes ineffective quivering of the ventricles. There is no atrial activity seen on the ECG. Causes of ventricular fibrillation are the same as for VT; it may also re- sult from untreated or unsuccessfully treated VT. Other causes include electrical shock and Brugada syndrome, in which the pa- tient (frequently of Asian descent) has a structurally normal heart, few or no risk factors for coronary artery disease, and a family his- tory of sudden cardiac death. This dysrhythmia is always characterized by the absence of an audible heartbeat, a palpable pulse, and respirations. Because there is no coordinated cardiac activity, cardiac arrest and death are im- minent if ventricular fibrillation is not corrected. Treatment of choice is immediate defibrillation and activation of emergency services. After defibrillation, eradicating causes and administering vaso- active and antiarrhythmic medications alternating with defibrillation are treatments used to try to convert the rhythm to normal sinus rhythm. Ventricle Asystole: Commonly called flatline, ventricular asystole is characterized by absent QRS complexes, al- though P waves may be apparent for a short duration in two different leads. There is no heartbeat, no palpable pulse, and no respiration. Without immediate treatment, ventricular asystole is fatal. Cardiopulmonary resuscitation and emergency services are necessary to keep the patient alive. lyte imbalance, drug overdose, or hypothermia. Intubation and establishment of intravenous access are the first recommended ac- tions. Transcutaneous pacing may be attempted. A bolus of intra- venous epinephrine should be administered and repeated at 3- to 5-minute intervals, followed by 1-mg boluses of atropine at 3- to 5-minute intervals. Because of the poor prognosis associated with asystole, if the patient does not respond to these actions and others aimed at correcting underlying causes, resuscitation efforts are usually ended ("the code is called") unless special circumstances (eg, hypothermia) exist.

Preparing Patient for Surgery

Preparing the Bowel - Enemas are not commonly prescribed preoperatively unless the patient is undergoing abdominal or pelvic surgery. In this case, a cleansing enema or laxative may be prescribed the evening before surgery & may be repeated the morning of surgery. Preparing the Skin - The goal of preop skin prep is to decrease bacteria w/out injuring skin. Patient may be instructed to cleanse the skin area for several days before surgery to reduce the number of skin organisms. Hair is generally not removed preop unless the hair at or around the incision site is likely to interfere w/ the operation. If hair must be removed, electric clippers are used. Jewelry is not worn in the OR. If a patient objects to removing a ring, some institutions allow the ring to be securely fastened to the finger w/ tape.

Function of Kidneys

Primary purpose - maintain homeostasis by regulating fluid/electrolytes, removing wastes. Urine formation, excretion of waste products, regulation of electrolytes, regulation of acid-base balance, control of water balance, control of BP, renal clearance, regulation of RBC production, synthesis of vitamin D to active form, secretion of prostaglandins, regulates calcium and phosphorus balance.

ORIF Priority Nursing Diagnoses

Priority Nursing Diagnoses ● Risk for Acute Compartment Syndrome ● Ineffective tissue perfusion related to neurovascular constriction ● Potential for Fat embolism ● Potential for Hypovolemic Shock ● Potential for Osteomyelitis ● Potential for Thrombophlebitis ● Potential for Avascular Necrosis ● Potential for Delayed Healing ● Activity Intolerance ● Self-care Deficit ● Malnutrition ● Nonunion

Chronic Pancreatitis

Progressive destruction of pancreas. As cells are replaced by fibrous tissue w/ repeated attacks of pancreatitis, pressure w/in pancreas increases.

BPH Meds

Proscar, Flomax - watch BP because meds can drop it.

Confusion r/t Pneumonia

Px w/ pneumonia is assessed for confusion & other more subtle signs of changes in cognitive status. Confusion may be r/t hypoxemia, fever, dehydration, sleep deprivation, or developing sepsis.

Pyelonephritis - Kidney Infection

Pyelonephritis - Kidney Infection ● Kidney infection (pyelonephritis) is a specific type of urinary tract infection (UTI) that generally begins in your urethra or bladder and travels up into your kidneys. ● Acute pyelonephritis is a potentially organ- and/or life-threatening infection that characteristically causes

R.I.C.E. Intervention

R.I.C.E. Intervention REST ICE COMPRESSION ELEVATION MUSCULOSKELETAL INJURY / DISORDERS

RESPIRATORY ACIDOSIS Compensation:

RESPIRATORY ACIDOSIS Compensation: Metabolic kidneys conserve bicarb and excrete H Deep and Slow Resps

RESPIRATORY ALKALOSIS Compensation:

RESPIRATORY ALKALOSIS Compensation: Metabolic kidneys excrete bicarb and conserve H; cellular buffering Shallow RapidBreaths

Whipple Procedure

Reconstruction consists of attaching the pancreas to the jejunum (pancreaticojejunostomy) and attaching the hepatic duct to the jejunum (hepaticojejunostomy) to allow digestive juices and bile respectively to flow into the gastrointestinal tract and attaching the stomach to the jejunum (gastrojejunostomy) to allow food to pass through. Complications - Diabetes (removal of pancreatic tissue may cause the body to release less insulin). Stomach paralysis (need a feeding tube in order to obtain necessary nutrients because they will not be able to tolerate a normal diet). Malabsorption (pancreatic enzymes help w/ digestion, have steatorrhea, need enzyme replacement). Post-op - observe for hemorrhage, pancreatic enzyme replacement, low-fat diet, vitamin supplementation

Chronic Pancreatitis S/Sx

Recurring attacks of severe upper abdominal & back pain, vomiting. Often so painful that large doses of opioids don't provide relief. Antioxidants may provide some relief.

Functions of Liver

Regulates blood glucose concentration, Protein metabolism (makes albumin and blood clotting factors like prothrombin, liver needs potassium to make prothrombin) Depot for vitamins (Vit A, B12, Vit D, B-complex) Detox center

TAHBSO: Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy

Removal of entire uterus, the ovaries, fallopian tubes and the cervix; usually performed in the case of uterine and cervical cancer. This is the most common kind of hysterectomy. Removal of the ovaries eliminates the main source of the hormone estrogen, so menopause occurs immediately. Teaching: Discontinue anticoagulants, NSAIDs such as aspirin, and vitamin E to reduce risk of bleeding. Prophylactic antibiotics may be administered prior to surgery but discontinued the next day. May take heparin to prevent clots. Major risk are infection and hemorrhage. Not a lot of vaginal drainage expected post op; three peripads saturated in 1 hr is too much bleeding. Edema or nerve trauma may cause temporary loss of bladder tone (bladder atony), and catheter may be inserted. Since ovaries are removed, hormonal therapy may be needed. Avoid straining/lifting and sex until okayed by dr.

whipple procedure

Removal of gallbladder, CBD, antrum of stomach, duodenum, proximal jejunum, head of pancreas. Used to treat cancers of the head of the pancreas, the CBD and the duodenum.

Renal Insufficiency / Failure oliguria .

Renal Insufficiency / Failure oliguria ● HTN leads to damage of the afferent and efferent arterioles of the renal vascular system, leading to poor perfusion of the kidney and poor kidney function. ● Chronic renal failure may involve a bridge to a kidney transplant with hemodialysis and/or peritoneal dialysis.

PUD Management

Rest, stress reduction, smoking cessation (smoking reduces secretion of bicarb from pancreas). Diet: avoid temp extremes of food, alcohol, coffee, caffeine, dairy; eat 3 reg meals/day; high water intake; if a food is tolerated, eat it. Avoid aspirin.

Macrovascular Complications of DM

Result from changes in medium to large blood vessels; vessel walls become thickened, sclerose, and become occluded by plaque that adheres to vessel walls. Eventually, blood flow is blocked. Coronary artery disease, cerebrovascular disease, and peripheral vascular disease are the three main types. Myocardial infaraction (MI) common. S/Sx peripheral vascular disease: diminished peripheral pulses, intermittent claudication (pain in buttock, thigh, or calf during walking)

Traction

Review traction in CM.

Risk Factor Seizures

Risk Factors head injuries put a person at risk for seizures Priority nursing intervention during a seizure: Protect the head and the rest of the body during the seizure, safety is the primary concern. Afterwards, reduce stimuli and allow rest. A progressive central nervous system disease, MS is characterized by exacerbations and remissions of widespread, varied neurologic dysfunction resulting in slowed transmission and conduction of impulses. Symptoms reflect gradual demyelination of the white matter of the brain and spinal cord, a major cause of chronic disability in young adults. Secondary Disorders: MS may suffer muscle spasticity, difficulty chewing/swallowing, urine retention and urinary tract infections, constipation, joint contractures, pressure ulcers, rectal distension, and pneumonia. As the disease advances, it may cause blurred vision, eye pain, blindness, ataxia, incontinence, muscle atrophy, spastic paraplegia, hemiplegia, and complete paralysis.

Skin Cancer

Risk Factors - Fair skinned, fair haired, blue eyed, can't tan; chronic sun exposure; sun damaged skin (elderly); history of x-ray therapy for acne or benign lesions; scars from severe burns; chronic skin irritations; immunosuppression; genetic factors Basal Cell/Squamous Cell Carcinoma - Most common; good prognosis Patient teaching after therapy - dressing changes; drink from straw if near mouth; watch circulation/bleeding; emollient may be used after sutures removed; follow up every 3 months for a year

Risk factors for IBD

Risk factors for IBD ● Female ● Stress ● High Fat Diet ● Caffeine The term inflammatory bowel disease (IBD) covers a group of disorders in which the intestines become inflamed (red and swollen), probably as a result of an immune reaction of the body against its own intestinal tissue.

Vaginal Candidiasis

Risk factors: premenarche, pregnancy, perimenopause, menopause, poor personal hygiene, tight undergarments, synthetic clothing, frequent douching, allergies, oral contraceptives, antibiotics, diabetes, low estrogen levels, oral-genital contact, HIV Recurrent yeast infections may be sign of unknown diabetes.

Risks of long-term Steroid use:

Risks of long-term Steroid use: ● Symptoms of Cushing's syndrome ● Weight gain ● Decreased immunity ● Blood sugar levels should be monitored ● Steroids do not strengthen the immune system. ● Medications should never be stopped abruptly ● Bone density wasting

cholecystitis

S & S: client describes pain in RUQ radiating to the right scapular area that occurs 2-4 hours after a meal containing fats. Will also have nausea, flatulence and indigestion. Will present with steatorrhea, clay colored stools, dark amber urine. Increased alkaline phosphatase, GGT, WBCs and bilirubin.

Glomerulonephritis - Glomeruli Inflammation S/Sx

S/Sx Symptoms associated with glomerulonephritis are the same symptoms as fluid overload, since the kidney is unable to process and waste the fluid properly. ● Crackles in the lungs ● Orthopnea ● Edema, ● Shortness of breath ● Mild to severe hypertension

Rheumatoid Arthritis -S/Sx

S/Sx ● Inflammation ● Bilateral and systemic ● Multiple joints ● Affects upper extremities first then systemic, sparing joints of the hands ● Elevated rheumatoid factor, ANA, ESR

S/Sx of Cushings Disease

S/Sx of Cushing's ● Altered fat metabolism: face/neck/trunk / buffalo hump ● Muscle wasting extremities; Bone demineralization ● Ruddy complexion with moon face ● Abdominal striae and thin, easily bruised skin ● Hyperglycemia ● Excess hair growth in women ● Hypertension electrolyte imbalances ● Prolonged use of corticosteroids: prednisone Cushing's Syndrome Weight gain is a common symptom of Cushing's syndrome, a condition in which you are exposed to too much of the hormone cortisol, which in turn causes weight gain and other abnormalities. Cushing's syndrome can occur if you take steroids for asthma, arthritis, or lupus. It can also occur when your adrenal glands produce too much of the hormone, or be related to a tumor. The weight gain may be most prominent around the face, neck or upper back, or waist.

S/Sx Thyroid Storm

S/Sx: fever and tachycardia, chest pain, palpitations, SOB, fever, disorientation, flushing/sweating, disorientation

Iodine Allergy w/ IVP Symptoms/Treatment

SOB, tingling in mouth, tightening in throat. Epi, Benadryl, steroids.

strain vs. sprain vs. avulsion

STrain: tear or injury to a Tendon Sprain: tear or injury to a ligament Avulsion: complete separation of a tendon or ligament from its bony attachment site

What infection can glomerulonephritis arise from?

Strep

SURGERY TransUrethral Resection of the Prostate (TURP)

SURGERY TransUrethral Resection of the Prostate (TURP) ● During transurethral resection of the prostate (TURP), an instrument is inserted up the urethra to remove the section of the prostate that is blocking urine flow. TURP usually requires hospitalization and is done using a general or spinal anesthetic.

Seizure Disorder Definition

Seizure Disorder ● Characterized by abnormal cell firing in the brain.

Pneumonia

Serious infection or inflammation of the lungs in which the smallest bronchioles and alveoli fill with pus and other liquid; meds given include cipro & z-pack.

Serum Creatinine

Serum Creatinine Creatinine is a normal product of muscle metabolism. Creatinine clearance test measures Serum creatinine for renal function based on the rate and the amount of creatinine in the blood, excreted by the kidney, and is measured to evaluate kidney function. Serum Creatinine Normal Value 0.7-1.4 mg/dL

Serum Creatinine Normal Value

Serum Creatinine Normal Value 0.7-1.4 mg/dL

Hemorrhage

Severe bleeding that can result in hypovolemic shock and death. It can present insidiously or emergently at any time in the immediate postoperative period or up to several days after surgery. Patient presents with hypotension; rapid, thready pulse, disorientation; restlessness; oliguria; and cold, pale skin. The early phase of shock will manifest in feelings of apprehension, decreased cardiac output, and vascular resistance. Breathing becomes labored and "air hunger" will be exhibited; the patient will feel cold (hypothermia) and may experience tinnitus. If shock symptoms are left untreated, the patient will continually grow weaker but can remain conscious until near death. Transfusing blood or blood products and determining the cause of hemorrhage are the initial measures. The surgical site/incision should be inspected for bleeding, and if bleeding is evident, a sterile gauze pad and a pressure dressing are applied, and the site of the bleeding is elevated to heart level if possible. The patient is placed in the shock position (flat on back; legs elevated at a 20 degree angle; knees kept straight).

Thyroid Storm

Severe hyperthyroidism w/ abrupt onset precipitated by stress. Can be caused by thyroidectomy, hyperpyrexia, injury, tooth extraction, abrupt withdrawal from antithyroid drug. S/sx: tachycardia over 130, temp above 100, restlessness, delirium. Management: Immediatly reduce body temp & heart rate (ice packs, hypothermia mattress), apply oxygen, cardiac drugs to reduce heart rate, hydrocortisone to treat shock. Give Lugol's solution or SSKI to decrease the thyroxine output.

Hypoglycemia Client Teaching

Shakiness, sweating, nervousness, hunger, weakness. TIRED (tachycardia, irritability, restlessness, excessive hunger, diaphoresis/depression). Hot & Dry, Sugar High. Cold & Clammy, Need Some Candy Causes: too much insulin, too much exercise, not enough food Prevention: Avoid meal delays, eat meal or snack every 4-5 hr when awake, don't skip meals, increase food intake before exercise if blood glucose is less than 100, check blood glucose regularly, safe insulin dosing, carry a form of fast-acting sugar at all times, wear medical ID bracelet

Pap Smear

Should begin w/in 3 yrs of having intercourse or no later than 21 yo, whichever comes first. Should be performed annually until age 29 and then may be done every 2-3 yrs if a woman has three consecutive normal results. After age 70, client may stop if she has three consecutive normals and no abnormals in the past 10 yrs. Women at high risk should have annual screenings. After age 30, women should be screened for HPV. Cervical cancer easily detected w/ Pap.

Explain how the sickle cell trait is inherited and how the shape of the RBC can effect circulation with sickle cell anemia.

Sickle cell anemia is a severe hemolytic anemia that results from inheritance of the sickle hemoglobin gene. This gene causes the hemoglobin molecule to be defective. The sickle hemoglobin (HbS) acquires a crystal-like formation when exposed to low oxygen tension. The oxygen level in venous blood can be low enough to cause this change; consequently, the erythrocyte containing HbS loses its round, pli- able, biconcave disk shape and becomes deformed, rigid, and sickle shaped. These long, rigid erythrocytes can adhere to the endothelium of small vessels; when they adhere to each other, blood flow to a region or an organ may be reduced. If ischemia or infarction results, the patient may have pain, swelling, and fever. The sickling process takes time; if the erythrocyte is again exposed to adequate amounts of oxygen (eg, when it travels through the pul- monary circulation) before the membrane becomes too rigid, it can revert to a normal shape. For this reason, the "sickling crises" are intermittent. Cold can aggravate the sickling process, because vasoconstriction slows the blood flow. Oxygen delivery can also be impaired by an increased blood viscosity, with or without occlusion due to adhesion of sickled cells; in this situation, the effects are seen in larger vessels, such as arterioles.The HbS gene is inherited in people of African descent and to a lesser extent in people from the Middle East, the Mediterranean area, and aboriginal tribes in India.

Pelvic Inflammatory Disease (PID)

Signs/Sx - vaginal discharge, dyspareunia (painful intercourse), lower abdominal pelvic pain, and tenderness that occurs after menses. Pain may increase w/ voiding or defecation. Fever, general malaise, anorexia, nausea, headache, and possibly vomiting. On pelvic examination, intense tenderness may be noted on palpation of the uterus or movement. Sx may be acute or mild. Pelvic or generalized peritonitis, abscesses, strictures, and fallopian tube obstruction may develop. Obstruction can cause an eptopic pregnancy in the future. Adhesions are common and often result in chronic pelvic pain; they may require removal of the uterus, fallopian tubes, and ovaries. Other complications include bacteremia w/ septic shock and thrombophlebtitis. Manage pain w/ analgesics & warm sitz bath. Bed rest. Antibiotics. **Sterility** **Keep head of bed elevated to keep infection localized & promote drainage.** **Stop spread of infection - careful handling of OB pads & handwashing.**

List common dysrhythmias originating in the SA node.

Sinus Bradycardia: Sinus bradycardia occurs when the sinus node creates an impulse at a slower-than-normal rate. Causes include lower metabolic needs (eg, sleep, athletic training, hypothermia, hypothyroidism), vagal stimulation (eg, from vomiting, suctioning, severe pain, extreme emotions), medications (eg, calcium channel blockers, amiodarone, beta-blockers), increased intracranial pressure, and myocardial infarction (MI), especially of the inferior wall. All characteristics of sinus bradycardia are the same as those of normal sinus rhythm, except for the rate. Sinus Tachycardia: Sinus tachycardia occurs when the sinus node creates an impulse at a faster-than-normal rate. It may be caused by acute blood loss, anemia, shock, hypervolemia, hypovolemia, congestive heart failure, pain, hypermetabolic states, fever, exercise, anxiety, or sympathomimetic medications. All aspects of sinus tachycardia are the same as those of normal sinus rhythm, except for the rate. As the heart rate increases, the diastolic filling time decreases, possibly resulting in reduced cardiac output and subsequent symptoms of syncope and low blood pressure. If the rapid rate persists and the heart cannot compensate for the decreased ventricular filling, the patient may develop acute pulmonary edema. Sinus Arrhythmia: Sinus arrhythmia occurs when the sinus node creates an impulse at an irregular rhythm; the rate usually in- creases with inspiration and decreases with expiration. Non respiratory causes include heart disease and valvular disease, but these are rarely seen. Usually not treated.

Emphysema Treatment

Smoking cessation; bronchodilators (take first), corticosteroids (take second), rinse mouth. Oxygen therapy's aim in COPD is to achieve acceptable O2 levels without a fall in the pH (increasing hypercapnia). People w/ chronically low O2 levels don't need O2 sat over 90%. Teach diaphragmatic (reduces resp rate, increases alveolar ventilation, helps expel more air) & pursed lip breathing (slows expiration, prevents collapse of small airways, helps px control rate & depth of respiration). PLB also promotes relaxation, enabling px to gain control of dyspnea & reduce anxiety. Review pages 615-619.

Inidicators of Readiness for Discharge from PACU

Stable BP, adequate respiratory function, and adequate O2 sat compared w/ baseline. Throughout the recovery period, the patient's physical signs are observed & evaluated by means of a scoring system (Aldrete Score). The patient is assessed at regular intervals, and a total score is calculated. The Aldrete score is usually 8 to 10 before discharge from the PACU. Patients w/ a score of less than 7 must remain in the PACU until their condition improves or they are transferred to an ICU.

Bladder Irrigation - TURP Post-Op

Sterile saline; 3 way catheter (CBI, Murphy Drip) - 1st for urine, 2nd for saline to go in balloon, 3rd for saline irrigation

GERD

Stomach contents (food or liquid) leak backwards from the stomach into the esophagus (the tube from the mouth to the stomach). This action can irritate the esophagus, causing heartburn and other symptoms. Risk Factors: Smoking, hiatal hernia, smoking Diagnosed by EGD (esophagogastroduodenoscopy). Treatment: Proton pump inhibitors (PPIs) decrease the amount of acid produced in stomach; H2 blockers (antagonists) lower the amount of acid released in the stomach .

Pneumonectomy

Surgical removal of a lung (usually to treat lung cancer); **Post-Op: Don't lay on the "good" unoperative side, it squishes the lung.** Elevate HOB. Breathing exercises, O2 sats, possible ventilation. **No lung to re-expand, so no chest tube.** Mobility & **Shoulder Exercises:** Don't let shoulder freeze up. See book pg. 665, 675.

Compartment Syndrome

Swelling in a confined space that produces dangerous pressure; may cut off blood flow or damage sensitive tissue. Involves a sudden & severe decrease in blood flow to the tissues distal to an area of injury that results in ischemic necrosis if not intervened. Prevention: Elevation, ice. Deep, throbbing, unrelenting pain that continues to increase despite opioid administration. Pain intensifies w/ stretching. Monitor 5 P's. Notify surgeon immediatly if neurovascular compromise is suspected. Maintain extremity at heart level (not above), and opening and bivalving the cast w/ Ace bandages. Fasciotomy - slic down dead tissue so px's extremity can "breathe"

VTE (Venous Thrombolitic Event)

Swelling, pain, redness, warmth of the affected extremity; common in knee surgeries & other immobilizations

Asthma Treatment

TREATMENT 1) MILD: Short-Acting Bronchodilator (Albuterol) 2) add: Low-Dose Inhaled Corticosteroid 3) MODERATE: add: Long-Acting Bronchodialator 4) SEVERE: Short-Acting Bronchodilator plus High-Dose Inhaled Corticosteroid plus Long-Acting Bronchodialator plus giving @ night, must rinse out mouth. Oral Corticosteroids (Prednizone) - rinse mouth Also: Begin using a spacer with current Inhalers

TREATMENT: Hyperthyroidism

TREATMENT: Hyperthyroidism ● Medications: Importance for timely dosing and Side effect of drossiness ● Methimazole ● Propylthiouracil ● Radioactive Iodine: only gland to absorb iodine ● Surgery removal of thyroid tissue with thyroid hormone supplement taken for life

TURP with Post-Op CBI

TURP with Post-Op CBI Post-OP: CBI requires monitoring for dark red urine and blood clots in the catheter of the patient. This indicates that the irrigation fluid is not going fast enough to irrigate the bladder properly, which could lead to blockage of the urethra/bladder and urine retention. Increasing the rate of the irrigation fluid is the first priority to avoid a potential emergent situation. Second - flushing line to remove clots.

Rheumatoid Arthritis Teaching

Teach to rest joints and avoid undue strain or force on affected joints. Px to avoid lifting heavy objects, walking or standing for long periods, and mechanical trauma. Prevent flexion contraction and muscular deformity by isometric exercises and ROM activities. Excercise should not excessively strain the joint capsule. Sufficient nightly sleep, daily naps, and good nutrtion help combat anemia, weight loss, fatigue, and exacerbations. Hydroptherapy and heat therapy help relieve joint stiffness. Help prevent flexion contracture by nightly application of lower limb braces, splints to knees, wrists, fingers, avoidance of pillows under joints, and a firm mattress. During exacerbation, splints are frequently ordered and bed rest is common for total joint rest. Handle painful joint carefully and gently; bed cradle helps to relieve the weight of sheets. Crutches, cane, or walker may be used to relieve stress when ambulating.

Describe the types of artificial pacemakers.

Temporary pacemakers have an external generator attached to an electrode threaded intravenously into the right ventricle or to temporary pacing wires implanted during cardiac surgery. Permanent pacemakers have an implanted pulse generator attached to electrodes that are sewn directly onto the heart or passed into the heart via the subclavian or jugular vein. The implantable cardioverter defibrillator (ICD) is a device that detects and terminates life-threatening episodes of VT or ventricular fibrillation in high-risk patients. Patients at high risk are those who have survived sudden cardiac death syndrome, usu- ally caused by ventricular fibrillation, or have experienced symp- tomatic VT (syncope secondary to VT). In addition, an ICD may be indicated for patients who have survived an MI but are at high risk for cardiac arrest. An ICD consists of a generator and at least one lead that can sense intrinsic electrical activity and deliver an electrical impulse. The device is usually implanted much like a pacemaker. ICDs are designed to respond to two criteria: a rate that exceeds a predetermined level, and a change in the isoelectric line seg- ments. When a dysrhythmia occurs, rate sensors take 5 to 10 sec- onds to sense the dysrhythmia.

BPH

Tends to occur in men over 40. Intervention is required when obstruction occurs. Most common treatment is transurethral resection of the prostate gland (TURP). Prostate is removed by endoscopy (no surgical incision is made), allowing a shorter hospital stay. A patient voiding diary is used to record voiding frequency and volume. A urinalysis to screen for hematuria and UTI is recommended. A PSA level is obtained if the patient has at least a 10-year life expectancy and for whom the presence of prostate cancer is would change management. A urinary flow-rate recording and measurement of post-void residual (PVR). Goals: improve quality life, improve urine flow, relieve obstruction, prevent disease progression, and minimize complications. If a patient is admitted on an emergency basis because he is unable to void, he is immediately catheterized. The ordinary catheter may be too soft and pliable to advance through the urethra into the bladder. In such cases, a thin wire (stylet)is introduced by a urologist into the catheter to prevent the catheter from collapsing when it encounters resistance. A metal catheter with a pronounced prostatic curve may be used if obstruction is severe. An incision into the bladder (a suprapubic cystostomy) may be needed to provide urinary drainage.

Colon Cancer Diagnosing

Test stool for guaiac (occult blood). Barium enema, colonoscopy, elevated carcinoembryonic antigen (CEA)

Hypocalcemia S/Sx

Tetany, muscle twitching, cramping, Trousseau's- tap cheek to induce twitch Chevostek's- hand twitches when bp cuff is on

Hypovolemic Shock

The body can't perfuse (oxygenate) tissues a because there just isn't enough blood in the body to go around. External risk factors involve fluid losses and include trauma, surgery, vomiting, diarrhea, diuresis, and diabetes insipidus. Internal risk factors involve fluid shifts and include hemorrhage, burns, ascites, peritonitis, and dehydration. Classic signs are pallor; cool, moist skin; rapid breathing; cyanosis of the lips, gums, and tongue; rapid, weak, thready pulse; narrowing BP (top number and bottom number close); low BP; concentrated urine. Can be avoided largely by the timely administration of IV fluids, blood, blood products, and medications that elevate BP. The primary intervention for hypovolemic shock is volume replacement, with an infusion of lactated Ringer's solution, 0.9% sodium chloride solution, colloids, or blood component therapy. Oxygen is administered. If fluid administration fails to reverse hypovolemic shock, then various cardiac, vasodilator, and corticosteroid meds may be prescribed to improve cardiac function and reduce peripheral vascular resistance. The patient is placed flat with the legs elevated. Respiratory rate, pulse rate, BP, blood oxygen concentrations, urinary output, level of consciousness, central venous wedge pressure, and cardiac output are monitored to provide information on the patient's respiratory and cardiovascular status. Vital signs are monitored continuously until the patient's condition has stabilized. Other factors can contribute to hemodynamic instability, like body temp and pain. The nurse manages these factors.

Discuss the structure and function of the heart.

The heart is covered by the pericardium (two layers of the pericardium is the parietal and epicardium). The myocardium is the middle layer, and is the muscle of the heart. Then there is the innermost layer, the endocardium - which lines the inside of the heart's chambers and great vessels. There are four chambers; two upper - atria, two lower - ventricles. These are divided by septum and valves. Right atrium receives deoxygenated blood => Right ventricle pumps blood into lungs => left atrium receives oxygenated blood from the lungs => left ventricle pumps oxygenated blood to the body => AV valve closure; S1 heart sound (lub) => semilunar valve closure; S2 heart sound (dub).

Discuss the mechanical and electrical properties of the heart.

The heart is covered by the pericardium (two layers of the pericardium is the parietal and epicardium). The myocardium is the middle layer, and is the muscle of the heart. Then there is the innermost layer, the endocardium - which lines the inside of the heart's chambers and great vessels. There are four chambers; two upper - atria, two lower - ventricles. These are divided by septum and valves. Right atrium receives deoxygenated blood => Right ventricle pumps blood into lungs => left atrium receives oxygenated blood from the lungs => left ventricle pumps oxygenated blood to the body => AV valve closure; S1 heart sound (lub) => semilunar valve closure; S2 heart sound (dub). The Conducting System of the Heart It is a network of specialized cardiac muscle cells that (1)initiates and (2) distribute select electrical impulses. It is composed of the following: •1-Sinoatrial (SA) node, •2-Atrioventricular (AV) node, •3-Bundle of His •4-continues down the inter-ventricular septum through the right and left bundle branches, and out into the Perkinje Fibers in the ventricular walls. At rest the myocardial cells are POLARIZED (negative charge). When the electrical impulse goes through 1-4, it causes ions to move across cell membranes, making the cells more positive. This is known as DEPOLARIZATION. The electrical impulse (also known as the Action Potential) and depolarization causes the muscle to contract. REPOLARIZATION begins immediately following DEPOLARIZATION. For a brief period before and after repolarization, the cells resist stimulation, which is known as the refractory period. This refractory period protects the heart from going into spasm or tetany.

Discuss the nursing care of a patient with a pacemaker.

The major goals for the patient may include absence of infection, adherence to a self-care program, effective coping, and maintenance of pacemaker function. The nurse changes the dressing regularly and inspects the insertion site for redness, swelling, soreness, or any unusual drainage. An increase in temperature should be reported to the physician.

Explain the nursing care of a patient with a dysrhythmias.

The major goals for the patient may include eradicating or decreasing the incidence of the dysrhythmia (by decreasing contributory factors) to maintain cardiac output, minimizing anxiety, and acquiring knowledge about the dysrhythmia and its treatment.

Risk factors for osteoporosis in women and in men

The major risks for persons with osteoporosis are fractures. Men lose bone density with aging but because they begin with a higher bone density, they reach osteoporotic levels at an older age than do women.

Stoma Care

The more distal the stoma is, thre greater the chance for continence. Lower in the GI tract, the more solid the effluent. Ileostomy drains liquid material. Pouch should be emptied when 1/3 to 1/2 full. Ileostomy Diet: Chew food thoroughly. Avoid high-fiber foods (popcorn, peanuts, unpeeled veg), as these can cause severe diarrhea. Colostomy Diet: Reg diet. Pre-op problem foods should be tried w/ caution. After surgery - drainage mucousy, serosanguinous 6 days Postop - bowel movement

Develop a plan of care for a patient with a valvular disorder.

The nurse educates the patient about the diagnosis and the possibility that the condition is hereditary. First-degree relatives (eg, parents, siblings) may be advised to have echocar- diograms. Patients with mitral valve prolapse may be at risk for infectious endocarditis that results from bacteria entering the bloodstream and adhering to the abnormal valve struc-tures. The nurse teaches the patient how to minimize this risk: practicing good oral hygiene, obtaining routine dental care, avoiding body piercing and body branding, and not using toothpicks or other sharp objects in the oral cavity. Because most patients with mitral valve prolapse are asymptomatic, the nurse explains the need to inform the health care provider about any symptoms that may develop. Medical management is directed at controlling symptoms. If dysrhythmias are documented and cause symptoms, the patient is advised to eliminate caffeine and alcohol from the diet and to stop smoking. Most patients do not require any medications. Teach about completion of antibiotics, explain all procedures to pts, explain management and prevention of heart failure symptoms, keep lab and MD appointments, monitor for blood in stools. Monitor VS, LOC, skin color, u/o, peripheral edema, neck vein distension, I&O, daily wt, fluid restriction, 02, elevate HOB, 02 sats, meds as ordered, guiac stools if on Coumadin, use caution with ASA/NSAIDS, soft toothbrush, electric razor, monitor labs: HTC, HGB, PLT, PT, PTT, INR

Discuss the nursing care of the patient with infective endocarditis.

The objective of treatment is to eradicate the invading organism through adequate doses of an appropriate antimicrobial agent. Antibiotic therapy is usually administered parenterally in a continuous IV infusion for 2 to 6 weeks. Parenteral therapy is administered in doses that produce a high serum concentration for a significant period to ensure eradication of the dormant bacteria within the dense vege- tations. This therapy is often delivered in the patient's home and is monitored by a home care nurse. Serum levels of the antibiotic are monitored. If there is insufficient bactericidal activity, increased dosages of the antibiotic are prescribed or a different antibiotic is used. Numerous antimi- crobial regimens are in use, but penicillin is usually the medication of choice. Blood cultures are taken periodically to monitor the effect of therapy. In fungal endocarditis, an antifungal agent, such as amphotericin B (eg, Abelcet, Amphocin, Fungizone), is the usual treatment. In addition, the patient's temperature is monitored at regular intervals because the course of the fever is one indication of the effectiveness of treatment. However, febrile reactions also may occur as a result of medication. After adequate antimicrobial therapy is initiated, the infective organism is usually eliminated. The patient should begin to feel better, regain an appetite, and have less fatigue. During this time, patients require psychosocial support because although they feel well, they may find themselves confined to the hospital or home with restrictive IV therapy.

Describe the treatment of a patient who has had an MI.

The patient with suspected MI is given aspirin, nitroglycerin, morphine, an IV beta-blocker, and other medications as indicated while the diagnosis is being confirmed. Patients should continue the beta-blocker throughout hospitalization and after discharge because long-term therapy with beta- blockers can decrease the incidence of future cardiac events. Unfractionated heparin or an LMWH is prescribed along with platelet-inhibiting agents to prevent further clot formation. Nonsteroidal anti-inflammatory drugs (NSAIDS) may be discontinued because of their association with adverse cardiac event. Beta Blockers - blocks beta-receptors in the heart causing decreased HR, decreased force of contraction, decreased rate of AV conduction. S&S: bradycardia, lethargy, GI upset, CHF r/t AV block, hypotension, depression, bronchospasm NI: assess for symptoms of heart failure,evalute BP and pulse for significant changes: hold if systolic BP is below 90mmHg, monitor pts with diabetes. 1st, 2nd, and 3rd generations of drugs. ie Inderal, Tenormin, Bystolic, metroprolol ACE Inhibitors - suppress formation of angiotensin II from the renin-angiotensin-aldosterone system, reduces peripheral resistance, and improves cardiac output. S&S: HA, angioedema, postural hypotension, altered sense of taste, hyperkalemia, nonproductive cough NI: monitor VS especially for two hours after first dose, administer on empty stomach It is important to ensure that a patient is not hypotensive, hyponatremic, hypovolemic, or hyper- kalemic before administering ACE inhibitors. Blood pressure, urine output, and serum sodium, potassium, and creatinine levels need to be monitored closely. IV NTG antidysrhythmics meds revascularization -angioplasty with STENT (In angioplasty, a balloon-tipped catheter is used to open blocked coronary vessels and resolve ischemia. After angioplasty, the area that has been treated may close off partially or completely, a process called restenosis. The in- tima of the coronary artery has been injured and responds by initiating an acute inflammatory process. This process may include release of mediators that leads to vasoconstriction, clotting, and scar tissue formation. A coronary artery stent may be placed to overcome these risks.) -intra-aortic balloon pump -ventricular assistive device

Compare and contrast early and late symptoms of infectious endocarditis.

The primary presenting symptoms of infective endocarditis are fever and a heart murmur. The fever may be intermit- tent or absent, especially in patients who are receiving an- tibiotics or corticosteroids, in those who are elderly, or those who have heart failure or renal failure. A heart murmur may be absent initially but develops in almost all patients. Murmurs that worsen over time indicate progressive damage from vegetations or perforation of the valve or the chordae tendineae. In addition to the fever and heart murmur, clusters of pe- techiae may be found on the body. Small, painful nodules (Osler nodes) may be present in the pads of fingers or toes. Irregular, red or purple, painless, flat macules (Janeway le- sions) may be present on the palms, fingers, hands, soles, and toes. Hemorrhages with pale centers (Roth spots) caused by emboli may be observed in the fundi of the eyes. Splinter hemorrhages (ie, reddish-brown lines and streaks) may be seen under the fingernails and toenails, and petechiae may appear in the conjunctiva and mucous membranes. Cardiomegaly, heart failure, tachycardia, or splenomegaly may occur. Central nervous system manifestations of infective endocarditis include headache; temporary or transient cerebral ischemia; and strokes, which may be caused by emboli to the cerebral arteries. Embolization may be a presenting symptom, and it may occur at any time and may involve other organ systems. Embolic phenomena may occur, as dis- cussed in the previous section on rheumatic endocarditis. Heart failure, which may result from perforation of a valve leaflet, rupture of chordae, blood flow obstruction due to vegetations, or intracardiac shunts from dehiscence of prosthetic valves, indicates a poor prognosis with medical therapy alone and a higher surgical risk (Libby, et al., 2008). Valvular stenosis or regurgitation, myocardial damage, and mycotic (fungal) aneurysms are potential cardiac complica- tions. First-degree, second-degree, and third-degree atri- oventricular blocks may occur and are often a sign of a valve ring abscess. Emboli, immunologic responses, abscess of the spleen, mycotic aneurysms, cerebritis, and hemodynamic deterioration may cause complications in other organs.

BPH (Benign Prostatic Hyperplasia)

The prostate is a male reproductive gland that produces the fluid that carries sperm during ejaculation. It surrounds the urethra, the tube through which urine passes out of the body. Prostate enlargement happens to almost all men as they get older. As the gland grows, it can press on the urethra and cause urination and bladder problems. It is not cancer, and it does not raise the risk for prostate cancer. Less than half of all men with BPH have symptoms of the disease, which include: Dribbling at the end of urinating Inability to urinate (urinary retention) Incomplete emptying of your bladder Incontinence Needing to urinate two or more times per night Pain with urination or bloody urine (these may indicate infection) Slowed or delayed start of the urinary stream Straining to urinate Strong and sudden urge to urinate Weak urine stream

central and peripheral chemoreceptors

The respiratory chemoreceptor control system is comprised of central and peripheral respiratory chemoreceptors that operate in a classic feedback loop to control breathing. The central chemoreceptors detect brain tissue carbon dioxide and the peripheral chemoreceptors detect blood oxygen and carbon dioxide levels. Using different time scales, inputs from central and peripheral chemoreceptors are integrated in the central nervous system to precisely match pulmonary ventilation to metabolic demands and maintain blood gases within narrow limits during wakefulness and sleep. Location - Peripheral chemoreceptors (carotid and aortic bodies) and central chemoreceptors (medullary neurons).

Discuss the S&S of myocarditis.

The symptoms of acute myocarditis depend on the type of infection, the degree of myocardial damage, and the capacity of the myocardium to recover. Patients may be asymptomatic, with an infection that resolves on its own. However, they may develop mild to moderate symptoms and seek medical attention, often reporting fatigue and dyspnea, palpitations, and occasional discomfort in the chest and upper abdomen. The most common symptoms are flulike. Patients may also sustain sudden cardiac death or quickly develop severe congestive heart failure.

acute respiratory failure

This is not a disease but a condition which occurs as a result of the client literally becoming too tired to continue the "work" of breathing. Clients w/preexisting pulmonary conditions COUPLED with acute respiratory tract infections are at risk for this.

Thyroid Cancer:

Thyroid Cancer: hard painless nodule, hoarseness Displacement of trachea, enlarged thyroid gland

Thyroid Physiology

Thyroid Physiology The thyroid is the largest endocrine gland in the body butterfly shaped and wrapped around the trachea producing thyroid hormones that control the body's metabolism by producing thyroxine (T4) and triiodothyronine (T3) called follicular cells that regulate metabolic rate and (c-cells) that make calcitonin and the amount of calcium in the blood.

Surgical Complication- Thyroid Storm

Thyroid StormTSH and T3 and T4 must be within normal ranges or Risk of Thyroid Storm may follow a surgical thyroidectomy:

Discuss nutritional considerations for a patient with a valvular disorder.

To minimize symptoms, the nurse teaches the patient to avoid caffeine and alcohol. The nurse encourages the pa- tient to read product labels, particularly on over-the-counter products such as cough medicine, because these products may contain alcohol, caffeine, ephedrine, and epinephrine, which may produce dysrhythmias and other symptoms.

Ulcerative Colitits Surgical Management

Total colectomy - excise entire colon w/ ileostomy Kock pouch - pouch of small intestine, insert cath to drain Total colectomy w/ ileoanal anastomosis Segmental colectomy - remove only a segment, anastomose remaining ends Subtotal Colectomy - remove nearly all of colon w/ ileorectal anastomosis Enemas contraindicated w/ active inflammatory disease of colon. Active GI bleed = no lax or enema Barium Enema contraindicated w/ perforation or obstruction.

Routes for Infection (UTI)

Transurethral (ascending from urethra - fecal contamination, most common) Bloodstream (hematogous spread) Fistula (direct extension)

Treatment Respiratory Alkalosis

Treatment: Rapid Shallow Rebreathing and correct hypoxemia

Treatment respiratory acidosis

Treatment: Renal Compensation over days to restore alveolar ventilation

Treatment for Metabolic Acidosis

Treatment: Sodium Bicarb

Treatment for Metabolic Alkalosis

Treatment: Sodium Chl with hypochloremic or K+ hypoaldosteronism and hypokalemia

Syphilis

Up to 90 days postexposure: chancre, highly infectious 6 weeks - 6 months: Flu-like symptoms, generalized rash that affects palms of hands & soles of feet, lesions contagious 10-30 years postexposure: cardiac & neurologic destruction Diagnosed w/ VDLR (blood test) Treated w/ penicillin

Urine Output Impairments

Urine Output Impairments ● Dysuria: Painful urination or troubles urinating ● Hematuria: Blood in the urine ● Oliguria: decreased urine output ● Polyuria: increased urine output ● Nocturia: Urine output increasing at night ● Anuria: nonpassage of urine ● Proteinuria: elevated protein levels ● Azotemia: elevated BUN and creatinine

Urine Specific Gravity

Urine Specific Gravity Shows the concentrating and diluting ability of the kidneys. Urine Specific Gravity Normal Value:1.020 -1.030 g/ml Renal dysfunction due to any chronic renal disease, such as chronic glomerulonephritis, chronic pyelonephritis, hypertensive renal vascular disease, diabetic nephropathy, chronic obstructive uropathy, and hereditary nephropathies.

Urine Specific Gravity

Urine Specific Gravity Normal Value:1.020 -1.030 g/ml

Paralytic Ileus

Usually temporary paralysis of intestinal wall that may occur after abdominal surgery or peritoneal injury and that causes cessation of peristalsis; leads to abdominal distention and symptoms of obstruction

Fluid Volume Excess S/sx

VS, Weight gain, Peripheral Edema, Neck vein distention, Moist crackles in the lungs, Hand vein emptying > 3 sec. Bounding pulse, tachycardia, increased respiratory rate, SOB, increased blood pressure, pitting edema; can be caused by kidney probs, IV fluid excess, heart failure

PUD Surgical Treatment

Vagotomy - severing of vagus nerve to reduce gastric acid secretions Pyloroplasty - enlarges outlet and relaxes muscle Antrectomy - Removal of distal stomach; postop px will c/o fullness after eating, dumping syndrome, anemia, malabsorption, diarrhea, wt loss Bilroth I - removal of distal third of stomach w/ anastomosis w/ duodenum. Will have above sx. Biroth II - Few hours post op, drainage will be dark red.

Intra-Op Meds

Vecuronium (Norcuron) - intubation; maintenance of relaxation (IV) Pancuronium (Pavulon) - maintenance of relaxation (IV) Ketamine(Ketalar ) -Vitamin K; need darkened, quiet room for recovery; often used in trauma cases Medazolam (Versed) - IV anesthetic; hypnotic, anxiolytic, sedation Propofol (Dipirivan) - Milky white, continuous drip; induction and maintenance, sedation with regional anesthesia

Herpes

Vesicles (blisters) in clusters that rupture & leave painful erosions that cause painful urination; initial infection usually very painful & lasts about 1 week; remissions & exacerbations that are often associated w/ stress, sunburn, dental work, or inadequate rest and nutrition; may be contagious even when asymptomatic; can be trasmitted from wet surfaces or by self-transmission (auto-innoculation); symptoms controlled w/ Acyclovir (Zovirax), lidocain topically paito ease pain, keep lesions clean & dry

Colon Cancer

Warnings: change in bowel habits (diarrhea alternating w/ constipation), rectal bleeding, mucous, rectal/abd pain, persistent narrowing of stool, tenesmus (straining), anemia, weight loss, fatigue, sudden obstruction

Cataract Home Care

Wear eye patch for 24 hrs post-op to prevent accidental poking or rubbing. Shaded lenses during waking hours. Eye shield during sleeping hours. No picking up anything over 15 lbs, bending straining, coughing, or anything else that increases IOP. Avoid lying on operative side. Px may experience blurring of vision for several days to weeks. Vision gradually improves as eye heals. Px w/ IOL implants have functional vision on the first day after surgery. Vision is stabilized when the eye is completely healed, usually within 6-12 weeks, when final prescription is complete. May experience increased night glare and contrast sensitivity.

Nursing Care for Cirrhosis

Weight Loss & Fatigue - high protein, high calorie diet, small frequent meals, B-vitamins, oral hygiene, rest (permits liver to restore itself). If px has ascites, edema, or encephalopathy, restrict protein. Hematemesis - vomiting blood, look for shock symptoms, Vit K, blood transfusions Jaundice - Good skin care to help puritus, mild soap, lots of lotion, short hairs Edema of Extremities - I &O, daily weights, diuretics (Aldactone), passive ROM, watch for skin breakdown, restrict sodium, fluid restrictions

bleeding esophageal varices

a life-threatening medical emergency. There can be severe blood loss, resulting in shock from hypovolemia. Bleeding may be either hematemesis or melena - can occur with no precipitating factors or with activity that increases abdominal pressure (heavy lifting, vigorous physical exercise, etc), Epinephrine, cauterize, ng tube, sclerotherapy, esophageal ligation, Minnesota or Sengstaken-Blakemore tube, Portosystemic shunt or TIPS.

Discuss the appropriate teaching/learning needs of the patient with cardiac dysrhythmias.

When teaching patients about dysrhythmias, the nurse presents the information in terms that are understandable and in a manner that is not frightening or threatening. The nurse explains the importance of maintaining therapeutic serum levels of anti- arrhythmic medications so that the patient understands why medications should be taken regularly each day. In addition, the relationship between a dysrhythmia and cardiac output is explained so that the patient understands the rationale for the medical regimen. If the patient has a potentially lethal dysrhythmia, it is also important to establish with the patient and family a plan of action to take in case of an emergency. This allows the patient and family to feel in control and prepared for possible events. A referral for home care usually is not necessary for the patient with a dysrhythmia unless the patient is hemodynamically un- stable and has significant symptoms of decreased cardiac output. Home care is also warranted if the patient has significant comor- bidities, socioeconomic issues, or limited self-management skills that could potentiate the risk for nonadherence to the therapeutic regimen.

Scrub Nurse

Works in the sanitized area of the surgery. He is "scrubbed in," putting on sterile masks and clothing before approaching the surgical station. The scrub nurse hands the surgical tools and other supplies to the doctor performing the operation. A scrub nurse maintains the sanitation of the operating area, making sure everything stays sterile to reduce the likelihood of contamination. Scrub nurses are also responsible for the care of the surgeon. If her glasses are foggy, or if she is sweating, the scrub nurse is in charge of taking care of those problems, allowing the surgeon to continue her work unhindered. During the surgery, the scrub nurse is also responsible for monitoring the health of the patient. This involves keeping track of the patient's vital signs. If there are potential problems, it is the scrub nurse's job to alert the doctor.

S/Sx Addison's Disease

`S/Sx ● Chronic fatigue / muscle weakness ● Weight loss /loss of appetite /Abdominal pain ● N/V/D ● Low B/P ● Irritability ; depression; confusion ● Salt loss - craving salty foods ● Hypoglycemia ● Irregular or absent menstrual cycles ● Skin changes: darkening areas : toes/lips/scars/knees etc SEVERE CRISIS: May involve circulatory collapse, shock, or coma Intervention: rapid IV fluid resuscitation and glucocorticoids.

cyanosis

a bluish discoloration of the skin and mucous membranes

common factors, pathophysiology, and clinical manifestations of fibromyalgia

a chronic musculoskeletal syndrome characterized by diffuse pain, fatigue, and tender points. Increased sensitivity to touch, the absence of systemic or localized inflammation, and the presence of fatigue and non-restorative sleep are common because symptoms are vague. A common misdiagnosis has been chronic fatigue syndrome. Common factors: flulike viral illness, chronic fatigue syndrome, hiv infection, lyme disease, physical trauma, presistant stress, chronic sleep disturbance Manifestations: prominent symptoms is diffuse, chronic pain that is burning or gnawing in nature; profound fatigue; presence of multiple tender points; the pain is often begins in one location, especially the neck and shoulders, but then becomes more generalized

Identify potential stressors and lifestyle issues. (for dysrhythmias)

anorexia, thyroid disorders (and secondary a-fib), cardiac disorders.

Discuss the components of a cardiac rehab program.

assess previous activity and exercise habits, gradually increase activity and exercise in a planned manner, evaluate and monitor the client's responses to increasing activity levels, teach the client to monitor his or her tolerance activity.

acid-base imbalance in major type of pulmonary dysfunctions

asthma- respiratory alkalosis to respiratory acidosis pneumonia- respiratory acidosis chronic bronchitis- respiratory acidosis emphysema- respiratory acidosis pulmonary emboli- respiratory alkalosis

risk of autosomal dominant and autosomal recessive traits when: both parents have the trait, when only one parent has the trait, or when neither parent displays the trait (know how to do a punnett square)

autosomal dominant 1- 50% 2-75% 0-0% autosomal recessive 1- won't have it but could be carriers 2- 25% 0- 0%

process of bone healing following a fracture and manifestation of bone fractures

bone forming cells in the periosteum, endosteum, and marrow are activated to produce subperiosteal procallus along the outer surface of the shaft and over the broken ends of the bone. closed manipulation, traction, and open reduction internal and external fixation Manifestation: often numbness up to 20 minutes following injury; unnatural alignment, swelling, muscle spasm, tenderness, pain, impaired sensation, and possible muscle spasms

Discuss the medical treatment of CAD.

change in diet - low-fat, low-cholesterol, reduction of 25-35% calories, saturated fats should be less than 7% of total daily calorie intake. exercise - Management of an elevated triglyceride level focuses on weight reduction and increased physical activity. medications - If diet alone cannot normalize serum cholesterol levels, medications can have a synergistic effect with the prescribed diet and control cholesterol levels. Lipid-lowering medications can reduce CAD mortality in patients with elevated lipid levels and in at-risk patients with normal lipid lev- els. The lipid-lowering agents affect the lipid components somewhat differently and can be grouped into six types: 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) (or statins), nicotinic acids, fibric acids (or fibrates), bile acid sequestrants (or resins), cholesterol absorption inhibitor, and omega-3 acid-ethylesters.

Atropine

cholinergic blocker cardiac, inc HR, velocity, force, for bradycardia

Discuss teaching associated with the management of the patient with infections/inflammatory diseases of the heart.

chronic may cause scar tissue development leading to restrictive pericarditis, chronic restricts cardiac filling (dyspnea, fatigue, weakness, distended neck veins, ascites), uncomfortable but usually self-limiting.

hemoptysis

coughing up blood from the respiratory tract

pulmonary function test abnormalities seen with obstructive disease

decreased forced expiratory volume in one second (FEV1)

pulmonary function test abnormalities seen with restrictive disease

decreased in forced vital capacity (FVC)

hypoxemia

deficient amount of oxygen in the blood

hypoventilation

deficient movement of air in and out of the lungs causing hypercapnia

Discuss the signs and symptoms of a pericardial effusion.

is the accumulation of excess fluid around the heart. The heart is surrounded by a double-layered, sac-like structure called the pericardium. The space between the layers normally contains a very small amount of fluid. Pericardial effusion is often related to inflammation of the pericardium that's caused by disease or injury, but pericardial effusion can also occur without inflammation. Sometimes, pericardial effusion can be caused by the accumulation of blood after a surgical procedure or injury. When the volume of fluid exceeds the pericardium's "full" level, pericardial effusion puts pressure on the heart, causing poor heart function. If left untreated, pericardial effusion can cause heart failure or death. S&S include: Shortness of breath or difficulty breathing (dyspnea) Shortness of breath when lying down (orthopnea) Chest pain, usually behind the breastbone or on the left side of the chest that often feels worse when you breathe and feels better when you are sitting up, rather than lying down Cough Painful breathing, especially when inhaling or lying down Fainting or dizziness Low-grade fever Rapid heart rate A feeling of anxiety ****In pericarditis, the fluid collects gradually, nd the pericardial sac stretches to accommodate it. Heart function, then, is not affected, although heart sounds may be muffled.

hypoxia

lack of oxygen

Sinus Bradycardia

less than 60bpm; , When the SA node fires at a rate of less than 60 beats per minute. The P wave and the QRS complex are normal.

late stage cirrhosis

liver becomes nodular and shrinks in size as it loses its ability to carry out its functions; a sign of ascites

Fluid Volume Deficit

loss of water and electrolytes in equal (isotonic) proportions. Due to vomiting, gastric suctioning, hemorrhage, diaphoresis, fever, decreased oral intake, diuretics. Signs/symptoms: dry skin and mucous membranes, poor skin turgor, flat jv. Treatment: oral replacement, electrolyte replacement if necessary

Explain impact of nutrition on cardiac rhythms.

low-calorie (eating disorders or extreme dieting) puts unneeded stress on the heart. Taurine, CoQ-10, and Berberine seem to be beneficial in preventing dysrhythmias.

Discuss disorders that commonly affect the heart valves.

mitral stenosis - Mitral stenosis is a heart valve disorder that involves the mitral valve. This valve separates the upper and lower chambers on the left side of the heart. Stenosis refers to a condition in which the valve does not open fully, restricting blood flow. mitral regurgitation - Mitral regurgitation is a disorder in which the heart's mitral valve suddenly does not close properly, causing blood to flow backward (leak) into the upper heart chamber when the left lower heart chamber contracts. mitral valve prolapse - Mitral valve prolapse (MVP) occurs when one of your heart's valves doesn't work properly. MVP is one of the more common heart valve conditions. Most often, it's a lifelong condition that a person is born with. Most people with MVP have no symptoms or problems, need no treatment, and are able to lead normal, active lives. Its incidence declines with age. aortic stenosis - The aorta is the main artery carrying blood out of the heart. When blood leaves the heart, it flows through the aortic valve, into the aorta. In aortic stenosis, the aortic valve does not open fully. This decreases blood flow from the heart. As the aortic valve becomes more narrow, the pressure increases inside the left heart ventricle. This causes the left heart ventricle to become thicker, which decreases blood flow and can lead to chest pain. As the pressure continues to rise, blood may back up into the lungs, and you may feel short of breath. Severe forms of aortic stenosis prevent enough blood from reaching the brain and rest of the body. This can cause light-headedness and fainting. aortic regurgitation - is a condition that occurs when your heart's aortic valve doesn't close tightly. Aortic valve regurgitation allows some of the blood that was just pumped out of your heart's main pumping chamber (left ventricle) to leak back into it. The leakage of blood may prevent your heart from efficiently pumping blood out to the rest of your body. As a result, you may feel fatigued and short of breath.

Discuss factors that influence HDL and LDL, and triglyceride levels.

optimal total cholesterol is 200, HDL is greater than 40-50, LDL less than 100 especially if there is other risk factors. Genetic factors such as a family history of heart disease could predispose someone to high cholesterol. Medical conditions such as diabetes also make it more difficult to control cholesterol levels. Cholesterol levels also tend to rise as you get older. Diet influences cholesterol: eat low-cholesterol foods, low-fat, low-salt to improve levels.

Ventricular

originates in the ventricles

effect of osteoporosis on the bone

osteoporosis decreases bone density; Osteoporosis causes bones to become weak and brittle so brittle that a fall or even mild stresses like bending over or coughing can cause a fracture. Osteoporosis-related fractures most commonly occur in the hip, wrist or spine.

types of musculoskelatal tumors and their clinical manifestations: (osteosarcoma, chondrosarcoma, ewing's sarcoma)

osteosarcoma: Osteosarcoma is a cancerous (malignant) bone tumor that usually develops during the period of rapid growth that occurs in adolescence, as a teenager matures into an adult. Symptoms: Bone fracture (may occur after what seems like a routine movement); Bone pain; Limitation of motion; Limping (if the tumor is in the leg); Pain when lifting (if the tumor is in the arm); Tenderness, swelling, or redness at the site of the tumor chondrosarcoma: a type of cancer that begins in the bone (primary bone cancer). Chondrosarcoma cells produce cartilage as they invade the bone. Less commonly, chondrosarcomas can arise outside the bone, usually within adjacent muscles. Swelling and Pain that gradually increases ewing's sarcoma: Ewing's sarcoma is a malignant (cancerous) bone tumor that affects children.The tumor may arise anywhere in the body, usually in the long bones of the arms and legs, the pelvis, or the chest. It may also develop in the skull or the flat bones of the trunk. Symptoms: There are few symptoms. The most common is pain and occasionally swelling at the site of the tumor.Children may also break a bone at the site of the tumor after a seemingly minor injury (this is called a "pathologic fracture"). Fever may also be present.

Sinus Tachycardia

over 100bpm; s&s chest pain

Differentiate the sign/symptoms of a myocardial infarction (MI) from that of angina.

pain does not go away with NTG tablets, pain is crushing and severe, radiates to the shoulders/neck/jaw/arm, lasts more than 15-20min, sense of impending doom. women and older adults may not have typical symptoms, upper abdominal or back pain may be present instead, or SOB, nausea/vomiting, jaw pain. This can be called "silent" MI, chest pain only when resting or when stressed, extreme fatigue, abdominal pain and nausea makes them think that is just heartburn pain.

possible pulmonary effects of aspiration

passage of fluid and solid particles into the lungs -choking, vomiting, wheezing

Explain the difference between a digitalization dose and maintenance dose.

patients started on therapy with a cardiotonic drug are being "digitalized". Digitalization may be accomplished by two general methods: -rapid digitalization (accomplished by administering a loading dose) -gradual digitalization (a maintenance dose is given, allowing therapeutic drug blood levels to accumulate gradually) Digitalization involves giving a series of doses until the drug begins to exert a full therapeutic effect. The digitalizing, or loading dose, is administered in several doses, with approximately half the total digitalization dose administered as the first dose. Once a full therapeutic effect is achieved, the primary health care provider usually prescribes a maintenance dose schedule. The nurse will: take VS q2-4hrs while being digitalized. measurement of serum levels may be ordered daily. any signs of dig toxicity should be reported. labs should be drawn immediately before the next dose or 6-8hrs after the last dose regardless of route.

liver transplantation

procedure to remove a severely damaged liver from a patient with end stage liver disease and insert a new liver from a donor. the patient (the recipient) is matched by blood type and tissue type to the donor. liver transplant patients must take immunosuppressant drugs for the rest of their lives to keep their bodies from rejecting the foreign tissue that is their new liver.

causes a flail chest

results from the fracture of several constructive ribs in more than one place or the fracture of the sternum plus several consecutive ribs. This disrupts the mechanics of breathing.

pneumothorax

types: open, tension, spontaneous, secondary -air in the pleural cavity, can cause lung to collapse -risk factors: smoking, tall strature, and history of lung disease or previous pneumothorax -manifestations: sudden chest pain, chest tightness, dyspnea, tachypnea, decreased breath sounds over the effected area, asymmetrical chest movement, trachea and mediastinum deviation, anxiety, tachycardia, pallor, and hypotention

Examine community resources available for the patient and family with valvular disorders.

visiting nurse, home health care

Bronchitis Treatment

● Acute Bronchitis ● Fluids ● Cough Suppressants / Humidified Air ● Antipyretics ● Antibiotics ● Rest ● Chronic Bronchitis ● Fluids ● Antibiotics ● Bronchodialators ● Pulmonary Rehabilitation ● Pneumococcal / Influenza Immunization

JOINT REPLACEMENT - Hip / Knee Risk Factors

● Advancing age >40yr ● Occupational Joint Stress / Trauma ● Genetic Predisposition / Congenital Bone ● Hx of Endocrine / Metabolic / Inflammatory Dx ● Obesity with joint degeneration ● Poor Posture

Risk Factors Osteoporosis:

● Age / Family Hx / Smoking ● Menapause ● Medication tx: Corticosteroids; Diuretics, Convulsant ● High Alcohol or Caffiene Intake ● Sedentary Lifestyle / Immobility ● Poor calcium absorbtion ● Hyperparathyroidism - pulling Calcium from bones / Cushings / Hyperthyroidism

Asthma Risk Factors

● Asthma Risk Factors ● Individual or Family History or asthma / allergies ● Exposure to Second-hand smoke / pets / pollution ● Viral respiratory infections ● Exercise / Stress ● Chronic Lung Disease Characteristics ● Recurring Episodes of Wheezing ● Shortness of Breath with Forced Exhalation ● Chest Tightness ● Coughing at Night or after Exercising ● Acute Manifestations: tachypnea / tachycardia / anxiety /agitation /apprehension

● Blood urea nitrogen (BUN)

● Blood urea nitrogen (BUN) measures the amount of nitrogen in your blood that comes from the waste product urea. Urea is made when protein is broken down in your body. Urea is made in the liver and passed out of the body in the urine. If kidneys are not able to remove urea from the blood normally, BUN level rises. BUN Normal Value: 8-20 mg/dL Azotemia is an elevation of blood urea nitrogen (BUN) and serum creatinine levels

COPD Complication: PNEUMONIA S/Sx

● Crackles or rales, will be heard in the alveoli and is more associated with pneumonia and pulmonary edema.

Elderly clients' thyroid glands

● Elderly clients' thyroid glands could be more fibrotic and nodular as a normal finding. Without other assessment or supporting data, a palpable thyroid gland does not explain the onset of hypertension

Emphysema Risk Factors

● Emphysema Risk Factors ● Smoking ● Exposure to pollutants ● Antitrypsin Deficiencies ● Family History ● Increasing Age ● Emphysema Characteristics ● Thick Productive Cough ● Wheezing ● Weakness / Lethargy ● Difficulty breathing with Activity

F.A.S.T. with a STROKE

● F - - Facial Weakness, one-sided drooping or smile fallen to one side. ● A - - Arms when both raised manifests one-sided weakness or numbness; can't hold both. ● S - - Speech slurred; confusion, no understanding blurred vision. ● T - - Time noted of last normal assessment,

● Hyperthyroidism

● Hyperthyroidism: too much hormone - Graves Dx

● Hypothyroidism:

● Hypothyroidism: too little hormone - Hashimoto Dx

Interventions for Osteoporosis:

● It is important to get an adequate daily intake of protein, calcium, and vitamin D. ● I should do all I can to avoid smoking and excessive alcohol and caffeine intake. ● It is important to do some weight bearing exercises on a regular basis: Active / Passive ROM. ● 5 to 30 minutes of sunlight, at least twice a week.

Highest priority when caring for a client diagnosed with rheumatoid arthritis?

● Pain is priority over psychological problems and activity. ● Simple exercises, a warm shower and maintaining a regular medication regimen are all good things to do to help decrease morning stiffness and soreness. ● Ice will increase pain in a stiff and sore joint. (Only used to help decrease swelling / edema by causing vasoconstriction)

PE Signs and Symptoms

● Signs and Symptoms ● Dyspnea ● Tachypnea ● Sudden Onset of Chest Pain ● Tachycardia ● Anxiety ● Cough ● Hemoptysis ● Diaphoresis ● At Risk Population ● Patient with a DVT ● Orthopedic, pelvic, gynecologic, abdominal surgery ● Hypercoagulability disorders associated with anemia ● Estrogen therapy / birth control pills ● Smoking ● Pregnancy ● Obesity ● Congestive Heart Failure ● Advanced Age ● Prolonged Immobility ● Interventions ● Administer Warfarin (Coumadin) - prevention ● Administer Enoxaparin (Lovenox) - prevention LMWH - Low Molecular Weight Heparin ● Administer pain medication ● Monitor for therapy effectiveness and complications of bleeding Arterial / Venous Blood Gases

● Two major types of IBD are

● Two major types of IBD are described: Crohn's Disease (CD) and Ulcerative Colitis (UC). Although Crohn's disease can involve any part of the gastrointestinal tract from the mouth to the anus, it most commonly affects the small intestine and/or the colon. As the name suggests, ulcerative colitis is limited to the colon (large intestine).