med/surg final 3
nasal fractures complications
-Hematoma -Infection -Abscess -Avascular or septic necrosis -Vaso-skull fracture
interventions of hypervolemia
-I&Os and daily weights -monitor response to IV fluids -lung sounds and breath sounds -edema evaluation (pitting) -education on diet and fluid restrictions
treatment of hypercalcemia
-IV calcitonin -loop diuretics -plicamycin -aredia -IV NS-furosemide
treatment of hyperkalemia
-IV calcium gluconate: force sodium ICF -IV insulin which is short acting -hypertonic dextrose -loop diuretics
interventions of hypercalcemia
-IV fluids -increase fluid intake -increasing mobility and encouraging fluids -cardiac rate and rhythm should be monitored
treatment of Paget's disease
-NSAIDS: pain usually responds to NSAIDs -Calcium and Vitamin D: asymptomatic patients may be managed with diets adequate in calcium and vitamin D -Anti-Osteoclastic therapy: for moderate to severe -reduce bone turnover, reverse the course of the disease, relieve pain, and improve mobility. -Bisphosphonates: stabilize the rapid bone turnover -reduce serum ALP and urinary hydroxyproline levels -Plicamycin (Mithracin): a cytotoxic antibiotic -reserved for severely affected patients with neurologic compromise and for those whose disease is resistant to other therapy
education of hypermagnesemia
-avoid medications that contain magnesium -avoid OTC antacids and laxatives
s/s of ulcerative colitis
-bloody diarrhea -left lower quadrant abdominal pain -10 to 20 stools a day -pallor -anemia -fatigue -anorexia -weight loss -fever -vomiting -dehydration
interventions of ulcerative colitis
-bowel rest -may need TPN or PPN -control inflammation: steroids -address infection with IV antibiotics -stress control and relieving symptoms -may get IV steroids for severe flare ups -avoid smoking and alcohol, and irritating foods -need adequate rest
s/s of flail chest
-bruising, discoloration, or swelling in the area of the broken bones -marks from being thrown against a seat belt (after a car accident) -sharp, severe chest pain -difficulty inhaling or getting a full breath
treatment of hypocalcemia
-calcium gluconate -calcium chloride
treatment of hypermagnesemia
-calcium gluconate -loop diuretics, sodium chloride, LR, -may need dialysis -if patient goes home on mag meds, need patient education on avoiding other meds with mag
education of hypocalcemia
-calcium replacement can cause postural hypotension; therefore, the patient is kept in bed during IV infusion, and blood pressure is monitored -advise the patient to consider calcium supplements if sufficient calcium is not consumed in the diet -avoid alcohol, smoking, and caffeine -cautioned to avoid the overuse of laxatives and antacids that contain phosphorus -vitamin D and calcium supplements -food high in calcium: milk, leafy greens, salmon
ulcerative colitis
-chronic ulcerative and inflammatory disease of the mucosal and submucosal layers of the colon and rectum that is characterized by unpredictable periods of remission and exacerbation with bouts of abdominal cramps and bloody or purulent diarrhea -occurs only in the colon and will not form fistulas -definite diagnosis is a rectal biopsy -megacolon can perforate
s/s of hypovolemia
-confusion -pale dry skin, poor skin turgor (tenting) -dry mucous membranes (early sign of dehydration) -decreased urine output & dark, concentrated urine -increased creatinine and BUN levels and maybe H&H -decreased urine output
Paget's disease
-disorder of localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae
education of hypomagnesemia
-educated about sources of magnesium-rich foods, including green vegetables, nuts, legumes, bananas, and oranges -limit alcohol intake -avoid diuretic abuse -avoid smoking
s/s of angina
-fatigue -dizziness -shortness of breath -rapid breathing -nausea -heart palpitations -sweating -anxiety
education of hypercalcemia
-fluids containing sodium should be given unless contraindicated -encouraged to drink 3 to 4 quarts of fluid daily -high fiber diet -avoid excess intake of calcium
flail chest
-frequently a complication of blunt chest trauma from a steering wheel injury -occurs when three or more adjacent ribs (multiple contiguous ribs) are fractured at two or more sites, resulting in free-floating rib segments -may result as a combination fracture of ribs and costal cartilages or sternum -chest wall loses stability, causing respiratory impairment and usually severe respiratory distress
Treatment of hypomagnesemia
-give Magnesium ( IV= 1-2 g) (PO= 400 mg) -treat underlying cause -mild can be corrected by diet alone -magnesium salts can be given orally in an oxide or gluconate form
interventions of hypovolemia
-give fluids (depends on how much they can tolerate) -I&Os q8h, maybe hourly -daily weights -assess mental status -look at CMP: electrolyte values -vital signs -parenteral fluids (IV), isotonic -rehydration is important for organ functions
s/s of hypercalcemia
-greater than 10.5 -increased urination -thrist -polyuria -muscle weakness -nausea -abdominal cramps -constipation or diarrhea -peptic ulcer symptoms -bone pain
s/s of hypernatremia
-greater than 145 -thirst -elevated temperature -swollen dry tongue and sticky mucous membranes -hallucinations -lethargy -restlessness -irritability
s/s hypermagnesemia
-greater than 3.0 -soft tissue calcifications -hypoactive reflexes -drowsiness -muscle weakness -depressed respirations -ECG changes -dysrhythmias -cardiac arrest
s/s of hyperkalemia
-greater than 5 -cardiac changes/dysrhythmias -muscle weakness -fatigue -confusion -paresthesias -anxiety -GI symptoms
education of Paget's disease
-hepatic, kidney, and bone marrow function must be monitored during Plicamycin therapy -patients and their families and caregivers should be educated about how to compensate for altered musculoskeletal functioning with an emphasis on the risk of falls in older patients. -strategies for coping with a chronic health problem and its effect on quality of life need to be developed -if age-related hearing loss is exacerbated by paget disease, alternative communication devices and home safety alarms may be indicated
treatment of hypernatremia
-hypotonic solution: 0.5 NS and D5W
treatment of hypokalemia
-if cannot be prevented by increased intake in the daily diet or by oral supplements, then treated cautiously with IV replacement therapy -administration of 40 to 80 mEq/day is adequate
education of hyperlipidemia
-if on meds still need to watch diet and exercise -reduce smoking -avoid foods with a lot of saturated fats: red meat, butter, fried foods, and cheese
education of hypokalemia
-intake of foods high in potassium: lean meats, bananas, milk, whole grains, beans
treatment of hypovolemia
-isotonic electrolyte solutions (LR or NS) are first-line choice to treat the hypotensive patient with FVD because they expand plasma volume -as soon as patient is normotensive, a hypotonic solution (0.45% NaCl) is often used to provide both electrolytes and water
s/s of hypomagnesemia
-less than 1.8 -Chvostek and Trousseau signs -neuromuscular irritability -muscle weakness -tremors -depressed mood -dysrhythmias
s/s of hyponatremia
-less than 135 -poor skin turgor -dry mucosa -headache and lethargy -decreased salivation -decreased BP -nausea and abdominal cramping -neurological changes -anorexia
s/s of hypokalemia
-less than 3.5 -respiratory distress -muscle weakness, difficulty walking -fatigue, anorexia, nausea/vomiting -EKG changes -dysrhythmias -dilute urine -excessive thirst
s/s of hypocalcemia
-less than 8.5 -Chvostek's sign: involuntary twitching of the check in response to tap -Trousseau's sign: involuntary twitching of the finger from BP cuff -numbness, tingling of fingers & toes -seizures -hyperactive deep tendon reflexes
assessment of ulcerative colitis
-look at patient history -what are some of the causative factors: alcohol, smoking, caffeine, diet -bowel assessment
management of angina
-low sodium and saturated fat diet -high fiber diet -smoking cessation -weight loss -manage HTN/diabetes
education of hypervolemia
-low sodium diet -increased protein intake -salt substitutes -fluid restrictions
education of hypovolemia
-maintain fluid volume at a functional level -report understanding of the causative factors of fluid volume deficit -maintain normal blood pressure, temperature, and pulse -maintain elastic skin turgor, most tongue and mucous membranes, and orientation to person, place, and time
education of hypernatremia
-make sure patient has access to water -stroke can cause thirst mechanism to decrease, nay need to encourage them to drink water or put them on a drinking schedule -avoid herbal supplements
assessment of angina
-monitor BP and HR -chest pain -intact mucous membrane and skin breakdown -headaches -good H&P related to s/s of ischemia -12 lead ECG: may show changes indicative of ischemia, such as T-wave inversion, ST-segment -cardiac biomarker testing to rule out Acute Coronary Syndrome and Myocardial Infarction section -exercise or pharmacologic stress test in which the heart is monitored continuously by an ECG, -may also be referred for a nuclear scan or invasive procedure: cardiac catheterization, coronary angiography
interventions of hypernatremia
-monitor fluid losses and gains -assess for abnormal losses of water or low water intake and for large gains of sodium -obtain medication history, because some prescription medications have a high sodium content -asses patient's thirst or elevated body temperature -monito the patient closely for changes in behavior, such as restlessness, disorientation, and lethargy
interventions of hypokalemia
-monitor for its early presence: fatigue, anorexia, muscle weakness, decreased bowel motility, paresthesias, and dysrhythmias are signals -replaced very slowly, should not exceed 10-20 mEq/hr -if vital signs are low, need cardiac monitoring (telemetry)
interventions of hypermagnesemia
-monitor vitals -patients who are renally impaired may need dialysis -monitor blood pressure and vitals -check labs for kidney function -monitors the signs, noting hypotension and shallow respirations -observe for decreased deep tendon reflexes (DTRs) and changes in LOC
s/s of rhinitis
-nasal congestion -sore throat -nasal discharge -sneezing -runny nose -pruritus (itchy) nose, mouth, throat, eyes, and ears
interventions of hyperkalemia
-need to bring down very quickly -need to monitor EKG, daily weights, and I&Os -limit dietary potassium intake
s/s hypervolemia
-peripheral edema and ascites -distended jugular (neck) veins -crackles -elevated BP and HR -low H&H -increased SOB -increased urine output
interventions of hyponatremia
-replace sodium -restrict water -monitor I&O intakes and daily weights -replacement needs to be slow no more than 12 mEq/hr, can cause demyelination syndrome leading to coma or death
management of rhinitis
-rest -fluids -humidified air -cough suppressants -analgesics
interventions of hypomagnesemia
-start IV fluids -oral magnesium -seizure precautions -monitor dysphagia -vital signs must be assessed frequently to detect changes in cardiac rate or rhythm, hypotension, and respiratory distress -monitor urine output
treatment of hypervolemia
-symptomatic treatment consists of administering diuretics and restricting fluids and sodium -thiazide diuretics (hydrochlorothiazide) -loop diuretics (lasix)
chronic stable angina
-syndrome characterized by episodes of pain or pressure in the chest caused by insufficient coronary blood flow, cardiac chest pain -reversible or temporary myocardial ischemia, predictable by events that the patient does, exercise induced -predictable and consistent pain that occurs on exertion and is relieved by rest and/or nitroglycerin
interventions of hypocalcemia
-treat underlying cause -seizure precautions are initiated if severe -status of the airway is closely monitored, because laryngeal stridor can occur -needs to be brought up quickly, may use calcium gluconate
treatment of hyponatremia
-treating underlying cause -most common treatment is administration of sodium by mouth, nasogastric tube, or a parenteral route -LR or isotonic saline (0.9% sodium chloride) solution -encourages foods and fluids with high sodium content
Flu diagnosis
-viral culture: gold standard, takes 48-72 hours -rapid flu swab: potentially has a lot of false negatives, takes 30 min
treatment of rhinitis
-viral: may be prescribed: nasal sprays, decongestants, antihistamines, may need a change of environment (dust, pollen, animals), lukotrothy modifiers, allegra, zyrtec -bacterial: may need antibiotics: augmentin, doxycycline, letoqin, intranasal lovage -allergies: immunotherapy: allergy shots, exposure to allergens in smaller doses
treatment of ulcerative colitis
Aminosalicylates: decrease inflammation Asacol: maintaining remishing and prevention of flare ups -may need methotrexate -immunosuppressants: imuran Corticosteroids than Imuran Monoclonal Antibiotics: remicade, humira Anti TNF: can cause TB or opportunistic infection (low immune response) -cannot get live vaccines during treatment -need to have PPD test on early basis when on medications
treatment of angina
Nitroglycerin ACE inhibitors Beta Blockers Calcium Channel Blockers Antiplatelets
treatment of hyperlipidemia
Statins: #1 class -Lipitor -watch for high doses, assess liver function Bile Acid Sequestrants: -won't cause liver issues -powder form -welcohl Fibrates -given for high triglycerides -tricor and lopid -given for high risk of pancreatitis Niacin -decreases progression of CAD -given for high triglycerides -causes facial flushing: aspirin will help -can combine with BAS Omega 3 Fatty Acids -given for high triglycerides -Loveza
