Med/Surg Remediation

Grade I Ankle Sprain

elevate the extremity above heart level to decrease swelling and edema, take NSAIDs around the clock for several days (clients who have muscle strain should take muscle relaxants), apply a compression bandage for a couple of days to reduce swelling and promote joint support; if the client report throbbing, discomfort, or tight bandage- rewrap w less bandage. Apply intermittent cold compress for first 24-48 hrs for pain relief and limit swelling.

acute pancreatitis

elevated amylase serum, hypotension, tachycardia, increased leukocyte.

Dumping Syndrome

encourage the client to lie in supine position following meals to delay gastric emptying, instruct client not to consume fluids with meals as to allow for ingestion of high protein foods, and offer the client 6 small meals daily; low fiber diet high fat diet

peritoneal dialysis at home

enforce sterile technique, warm the dialysate fluid before instillation, outflow should be clear, and the client may move about during dwell time.

Primary Open Angle Glaucoma (POAG)

eye drops will not improve vision, however, they can reduce intraocular pressure and prevent further vision loss. The drops are administered on a regular schedule to reduce intraocular pressure. Vision loss caused by POAG does not improve with glasses- presbyopia is the decrease in near vision that occurs after 40 YOA, not related to POAG. Driving can be dangerous dt th loss of peripheral vision and laser surgery can help reestablish the flow of aqueous humor. Report severe eye pain, halos around lights, blurred vision, headaches, brow pain, and N/V.

Hearing impaired

face the client allowing them to see who is speaking and have visual cues by observing facial expression; avoid high pitched tones because they are difficult to understand and distort vowels and consonants. Use gestures to enhance communication and rephrase other than repeat misunderstood conversation.

Cushing's syndrome

increased cortisol release; hypertension, hyperglycemia, weight gain, hypokalemia, dependent edema, risk for osteoporosis, tachycardia (3 ups 2 downs)

Corticosteroid use

increases appetite, moon face, hyperglycemia, frequent colds- immunosuppressed, decreased urination dt sodium and water retention

External ostitis

inflammation of the external auditory canal often dt retention of water after swimming; after inflammation is gone the client can instill diluted alcohol drops to decrease bacteria and dry the external ear canal. Never insert anything smaller than a finger in the ear canal that can cause damage and injure delicate tissue of the ear canal, push wax further back against the tympanic membrane, or puncture the membrane. Apply a warm, moist towel or a heating pad at the lowest setting to the ear to reduce pain. Using cool water to irrigate the ear can cause nausea or dizziness dt to balance centers in ear- use warm water to irrigate the ear to remove wax after inflammation is gone.

Mastoiditis

inflammation of the temporal bone behind the ear; manifestations include pain and swelling behind the ear. A red, thick eardrum is also a manifestation.

Open radical Prostatectomy

instruct client to shower rather than take a tub bath for 2-3 wks following procedure; avoid aspirin and NSAID use for 3 wks following surgery to decrease risk for bleeding- may use acetaminophen when in pain. Use of stool softeners to prevent constipation. Once indwelling catheter is removed, bladder control may not return immediately and practicing kegel exercises can help with continence. Urinary incontinence can last 1-2 years following surgery.

Dialysis disequilibrium syndrome

occurs during the first few dialysis tx because of rapid decrease in blood volume, which can lead to cardiac dysrhytmias and death. Monitor for and report feelings of nausea and vomiting.

Glomerulonephritis

periorbital edema dt fluid retention, dry itchy skin, anuria or oliguria, hypertension

Dehydration

poor skin turgor or tenting of the skin, increased respiratory rate, tachycardia, and hypotension. Decreased UO or less than 30 ml/hr

Crohn's disease

Avoid food high in fiber like bran and sunflower seeds and foods containing lactose like yogurt. Th client should eat foods high in protein like poultry and other meats.

suspecting phlebitis/infiltration

Check the IV site, stop the infusion, remove the IV catheter, elevate the extremity, notify the charge nurse

Hepatitis A

Children and young adults are more likely to get hepatitis A dt the disease being transmitted oral fecal route rt poor hygiene, hand to mouth contact and another form of close contact. The hepatitis A vaccine is recommended for anyone traveling esp military personel. Good hand hygiene is a must.

Salem Sump tube

Instill 20 ml of air into the lumen vent while the suction is on to ensure patency and function of the vent. Measure abd girth daily- increase can indicate worsening of the condition. Irrigate the tube with 30 ml of sterile saline Q 4 hrs and obtain a x ray to confirm placement of tube following insertion.

Myasthenia Gravis

Progressive autoimmune disease that produces severe muscular weakness. Characterized by periods of exacerbations and remission. Muscle weakness improves w rest and worsen w increased activity. Infection, stress, fatigue, pregnancy, and increase in body temp may trigger exacerbations. S/S- progressive muscle weakness, diplopia, difficulty chewing/swallowing, respiratory dysfunction, BB dysfunction, poor posture, fatigue after exertion. Drooping eyelids, incontinence.

Autonomic dysreflexia

a neurologic emergency that occurs in a client who have a cervical or thoracic spinal cord injury above T-6. manifestations include flushing above the level of injury and pallor below the level of injury. extreme HTN, bradycardia, severe throbbing headache, flushing of the face and neck are other manifestations.

Amyotropic Lateral Sclerosis (ALS)

a progressive neurodegenrative disease that affects the motor nerve cells in the brain and spinal cord; causes muscle wasting, spastiscity, and eventually paralysis. Early manifestations include: increasing muscle weakening especially involving the distal arms and legs (hands and feet), speech, swallowing, and breathing.

Sequential Compression Devices (SCDs)

allow placement of 2 fingers between the sleeves and clients legs to ensure adequate blood flow. place the client in a dorsal recumbent or semi fowler's to ensure proper placement of scds. remove the scd sleeves q 8-12 hrs to check for skin integrity and circulation. turn on the scd after applying the sleeve to ensure proper placement and maintain adequate blood flow once sleeves inflate.

Celiac disease

autoimmune disorder characterized by a permanent intolerance to wheat, barley, and rye. Any foods containing gluten.

Multiple sclerosis

autoimmune disorder characterized by development of plaque in the white matter of the CNS; this plaque damages the myelin sheath and interferes w impulse transmission between the CNS and the body. Marked by relapses and remissions that may not return to baseline functioning-- may eventually progress to quadriplegia. Triggers- viruses/infectious agents, cold climates, emotional stress, overexertion (exercising), temperature extremes and Hot shower/bath. Occurs typically between 20-40 and 2X more in women. S/S- fatigue esp in LE, pain,parathesia, diplopia, tinnitus, vertigo, decreased hearing acuity, dysphagia, muscle spasticity, Dysarthria (slurred and nasal speech), nystagmus, ataxia, muscle weakness, bladder/ bowel dysfunction, cognitive changes.

Intraocluar lens implant

avoid activities that increase IOP such as placing the head in an dependent position ( lifting, bending, coughing, performing valsalva maneuver); IIOP can result in intraocular hmorrhage. Avoid aspirin use as it increase risk of bleeding. No specific diet

esophageal varices

avoid taking any OTC medications including multivitamins and NSAIDs, elevate the HOB while sleeping to prevent aspiration of blood from the varices or SOB from pressure from the ascites. Consume diet high in fiber to prevent straining and bleeding dt constipation while having a bowel movement.

Osteoporosis

avoid using throw rugs on any type of floors, take calcium supplements 30-60 minutes prior to meals take with vitamin D to improve absorption, and do weight bearing exercises 3-4 x a week to promote bone formation. Do not lie down for at least 1 hr after talk biophosonates.

Transient ischemic attacks (TIA)

brief episodes of a neurologic deficit that last less than 24 hours after onset without permanent damage. TIAs are caused by a temporary reduction of oxygen supply to the brain such as from a thromboembolism or cerebral vasospasm. TIAs are considered a manifestation of advanced arthrosclerotic disease and often precede an ischemic stroke. Manifestations include loss of vision in one eye, inability to speak, transient hemiparesis, vertigo, diplopia, numbness and weakness.

Ostits media

can develop low pitch sound in the affected ear, can develop nystagmus or rapid eye movement, and feeling of fullness in the ear other manifestations include ear pain, a cracking sound when yawning or swallowing, and mild dizziness.

Myasthenia Gravis

client is at risk for aspiration because of progressive weakness of the oopharyngeal muscles; causes muscle weaknss dt an autoimmune disease that affect the acetylcholine receptors. The nurse should place oxygen and oral/nasal suction equipment at the bedside in the event of aspiration or respiratory distress.

Cyclosporine

client may experience nephrotoxicity, hypertension, weight loss and oily skin.

Meniere's disease

client will be placed on fluid restrictions because increasing fluids can cause the pts condition to worsen. The client should limit frequent position changes- it can cause pt to experience vertigo dizziness and nausea. The client should rest in a dark room, quiet and calm room. The client may receive an antiemetic for nausea dizziness and vertigo.

Repairing detached sclera

client's vision is not restored immediately because of the swelling and dilating effects of eye drops, vision should gradually return within several weeks. The client should expect to see flashing lights in front of the affected eye for several weeks following the procedure. The client should wear an eye shield for 2-6 weeks after surgery when sleeping to protect eye from injury. The client should not lift objects more than 20 lbs to avoid IIOP. The client may also experience multiple floaters, or dark spots floating.

addison's disease

decreased production of cortisol; hypotension, hyponatremia, hypoglycemia, and hyperkalemia. BUN and Cr increased (3 downs 2 ups)

Amytrophic sclerosis "Lou Gehrig's"

degenerative neurological disorder of the upper and lower motor neurons that results in deterioration and death of the motor neurons. This results in progressive paralysis and muscle wasting that eventually causes respiratory paralysis and death. Death usually occurs to respiratory failure within 3-5 yrs of initial manifestations. ALS affect men > women between ages 40-70. S/S- fatigue, twitching and cramping muscles, muscle weakness/atrophy, dysphagia, dysarthria, hyperreflexia of DTR. may have increased CK-MB.

Methylprednisolone

instruct the client to take it each day between 6-8 am when the body releases steroids naturally- help decrease adrenal insufficiency from occurring. Take w food to decrease GI upset or black stools. Avoid individuals that are sick- corticosteroids are immunosupressants. Weigh daily to monitor for weight gain which can indicate Cushings syndrome.

Cataract surgery

intraocular hemorrhage is an adverse effect; immediately report eye or brow pain and decreased vision to provider.

Continuous Enteral feeding

irrigate the tube with at least 30 ml of water q 4 hrs to decrease clogging of tube, elevate HOB 30 degrees to prevent aspiration, auscultate BS prior to NG tube inititation, Change the tubing and feeding bag q 24 hrs to decrease infection, never mix medications in the bag with feeding.

Lithium toxicity

more than 2 mEq; giddiness, ataxia, muscle twitching, blurred vision, and coarse tremors. If not treated promptly can lead to seizure, coma, and death.

Hemovac drainage

secure the drainage tube to the clients gown to allow for ambulation, wear clean gloves to empty the drainage system because the outside is not sterile, use precut or folded gauze dressing to fit around the drainage tube-if the nurse cuts the gauze dressing, small threads and fibers can embed in the incision and increase inflammation and infection. The nurse should cleanse the drain opening and plug w alcohol swabs to remove excess drainage and discourage pathogens from entering the drainage system.

Testicular self examination

should be performed monthly after a warm shower; testicular cancer is typically painless therefore the client should report a lump that is painless, pea sized lumps are abn and should be reported.

Sulfadiazine

store medication at room temperature in a tight, light resistant container to promote stability of the med. Take on an empty stomach- 1 hr before or 2 hrs after eating. Increase fluids while taking this med because it promotes crystallization of urine. Increase large intake of oral fluids to promote urine output and decrease risk of damage to kidneys.

Thyroid storm

tachycardia, hypertension, restlessness, tremors that can progress to seizures.

Pacemaker

the client should report persistent hiccups to the provider- indicates stimulation of the diaphragm from a dislocated lead. Intermittent spikes are an expected find- but report a rate that is 5 or more bpm slower than the preset rate.

Left hemisphere of Brain

usually dominant side of brain and is responsible for language; because pyramidal pathways crosses at the base a left hemisphere stroke will cause right sided hemiplegia. The nurse should anticipate that the client will have aphasia and require speech therapy to establish communication. The client will be cautious (right side impulsive)

Risk Factors for Osteoporosis

women aged 65 or older post menopausal decreased estrogen lack of time outdoors w sun Hx of anorexia nervosa Inadequate protein intake Inadequate calcium and Vit D