Med Surg weekly objectives

Isotonic solutions

most common, fluid with the same osmolality as the cell interior. Replace ECF volume deficit.

* D5W, NS (0.9%), LR is isotonic with lytes
* 0.9% sodium chloride
* lactated ringers solution
* 5% dextrose in water
* ringers solution

Hypertonic

greater concentration of sodium than plasma. Move water out of cells, which makes the cells shrink. Higher osmolality when compared to plasma.

3% NS, 5% NS

* 3% sodium chloride
* 5% sodium chloride
* 5% dextrose and 0.45% sodium chloride
* 5% dextrose and 0.9% sodium chloride

D5 1/2 NS

lactated ringer’s solution

isotonic

* contains sodium, potassium, chloride, calcium and lactate.
* Expands ECF- treat burns and GI losses, contraindicated with liver dysfunction, hyperkalemia, and sever hypovoemia

D5 1/2 NS

hypertonic

* common maintenance fluid
* replaces fluid loss
* KCL added for maintenance

D10W

hypertonic

* provides free water but no electrolytes

Hypotonic

containing solutions have a lower concentration of sodium than plasma. Promote movement of water into cells, making cells swell.

Hypotonic IVF: 0.45% NS, 0.33% NS

* sodium chloride 0.45%
* 0.33% sodium chloride
* 0.2% sodium chloride
* 2.5% dextrose in water

parenteral nutrition is

administration of nutrients directly into the blood stream.

* meet nutritional needs and allow growth of new body tissue

Composed of: dextrose and protein in the form of amino acids, prescribed electrolytes, vitamins, and trace elements and IV fat emulsion.

enteral nutrition

known as tube feeding

* administration of nutritionally balanced liquefied food or formula through tube inserted into stomach, duodenum, jejunum

indication for parenteral nutrition

* chronic diarrhea and vomiting
* complicated surgery or trauma
* GI obstruction
* anorexia nervosa
* malabsorption
* short bowel syndrome

central parenteral nutrition is used

for long term

peripheral parenteral nutrition is used for

short term therapy or special conditions

indications for enteral nutrition

anorexia, orofacial fractures, head/neck cancer, neurologic or psychiatric conditions, burns, critical illness, chemotherapy, radiation therapy

enteral nutrition is safer than

parenteral nutrition and less expensive, more physiologically efficient, and easier

what is anemia

deficiency in number of erythrocytes, quantity or quality of hemoglobin, volume of packed RBCs

anemia manifestations

caused by body’s response to tissue hypoxia

* HgB levels are used to determine severity of anemia
* fatigue

integumentary manifestations of anemia

pallor (Decreased HgB),

jaundice (increased serum of bilirubin),

Pruritus

Cardiopulmonary manifestations

cardiac output maintained by increasing heart rate and stroke volume.

* result from heart and lungs trying to provide adequate O2 tissues

nursing management for anemia blood loss

acute blood loss occurs by sudden hemorrhage, trauma, complications of surgery.

* replace blood volume to prevent shock, identify source of hemorrhage and stopping blood loss, correct RBC loss, provide supplemental iron

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leukemia

group of cancers affecting the blood and blood forming tissues of bone marrow, lymph system, spleen

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Clinical manifestations: Anemia, thrombocytopenia, decrease number of WBC

Acute myelogenous Leukemia (AML)

80% of the acute leukemias in adults, characterized by uncontrolled proliferation of myeloblasts. Hyperplasia of bone marrow

Acute lymphocytic leukemia (ALL)

most common type of leukemia in children

* immature, small lymphocytes proliferate in the bone marrow
* b cell origin
* signs and symptoms occur abruptly, fever at time of diagnosis

chronic myelogenous leukemia (CML)

* excessive development of neoplastic granulocytes in bone marrow
* move into peripheral blood in mass numbers
* infiltrate the liver and spleen

PHILADELPHIA CHROMOSOME

Chronic lymphocytic leukemia (CLL)

most common leukemia in adults

* production and accumulation of functionally inactive but long lived mature appearing lymphocytes
* \* b cell
* lymphocytes infiltrate bone marrow, spleen, liver

Multiple myeloma

cancerous plasma cells proliferate in bone marrow and destroy bone. excess production of plasma cells

* exposure to chemicals, herbicides, insecticides, viral infections

calcium loss from bones causes what in multiple myeloma

hypercalcemia

* leads to renal, GI, neurological manifestations

multiple myeloma nursing management include

immunotherapy and targeted therapy

* ambulation and adequate hydration
* braces and pain management
* chemotherapy
* corticosteroids

Antiretroviral therapy (ART) can

slow HIV progression but is a

* complex
* has side effects
* doesn’t work for everyone and expensive

ART therapy (antiretroviral therapy) is started

as soon as possible after diagnosis.

Adherence to drug regimens is critical to prevent

disease progression

opportunistic disease

viral drug resistance

* individualized approach is best

Unprotected sex with an HIV infected partner is most common mode of transmission is at greatest risk for

partner who receives semen

* prolonged contact with infected fluids
* women at higher risk
* trauma increases likelihood of transmission

breast cancer is

uncontrolled and unregulated growth of cell

* breast cancer metastasis can spread to the brain and to the liver.

What are the screening guidelines for breast cancer?

Yearly mammograms for average-risk women

* starting at age 45

EVERY 2 year ages 55 and older

Breast screening for women at risk for breast cancer

earlier 3D mammography screening

* breast MRI
* more frequent CBEs

What are the kinds of radiologic studies for breast cancer detection?

Mammography ( more accurate in younger women)

* 3-D mammography (tomosynthesis)

ultrasonography
* MRI (for women at high risk

BIOPSY (fine need aspiration (FNA))

what mutations can increase the risk for breast cancer

BRCA 1 or BRCA2 or P53

BRCA mutation has a 41% of developing into breast cancer.

Noninvasive breast cancer

20% of breast cancers

* ductal carcinoma in situ (DCIS)
* may progress to invasive if untreated

Clinical manifestations of breast cancer

detected as lump, thickening, or mammography abnormality in breast

* if palpable, hard, irregular, poorly delineated, nonmobile, and nontender
* may have nipple discharge or retraction

Benign breast disorder (benign = grow slowly and do no spread) manifestations

mastalgia (breast pain)

* lactational mastitis (inflammatory condition occurs in lactating women)
* lactational breast abscess (from persistent lactational mastitis; palpable mass with red, drainage of abscess is necessary)
* Fibrocystic changes (tissue changes)
* Fibroadenoma (discrete benign breast lumps in young women)

Ductal carcinoma

affects milk ducts

* may progress to invasive if untreated

lobular carcinoma

affects milk-producing glands

* reclassified as benign, risk for developing breast cancer

people who take hormones are at risk for?

breast cancer

Ex: women who go through menopause and take hormone pills are at risk for breast cancer.

assessment findings for women with breast cancer include

==__***Mass felt in the upper outer quadrant***__==

* Fixed irregular non encapsulated masses in the late stages
* nipple retraction and dimpling of skin
* non mobile and non tender, nipple discharge

types of therapy for breast cancer

* **Lumpectomy** ( tumor is taken out, a little bit of breast tissue might be removed)

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* Modified radical mastectomy ( breast tissue, nipple, lymph nodes, and chest wall muscles are removed)

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* **Radiation therapy**: radiation markings on skin, no use of powders or lotion.