Diseases and S/S and Treatments and Nutrition and Meds

Myasthenia Gravis

Autoimmune disorder that disrupts the neuromuscular junction (the communication in the PNS)

Manifestations for myasthenia gravis

• Diplopia

• Ptosis

• Specific muscular weakness

Parkinson’s disease

A progressive neurodegenerative disorder where brain cells that make dopamine die

Manifestations for Parkinson’s disease

• Blurred vision

• Emotional lability

• Generalized fatigues

• Muscle incoordination

• Neuropathic pain

• Urinary urgency

Multiple Sclerosis is what type of disorder??

Autoimmune

MS causes…

CNS inflammation

What does MS do to the body?

Damages and degrades the myelin sheath surrounding neurons

Signs of MS “TWO DANISHES”

• Tingling and numbness

• Weakness

• Optic neuritis

• Dysdiadochokinesia (inability to perform rapid, alternating movements)

• Ataxia

• Nystagmus

• Intentional tremor

• Scanning speech

• Hypotonia

• Epilepsy, seizures

• Spasticity (muscle, bladder)

Manifestations of MS

• Diplopia

• Emotional lability

• Generalized fatigues

• Muscle incoordination

• Diminished response to pain

• Heat sensitivity

• Urinary urgency

Interventions for MS include:

• No cure

• Corticosteroids to decrease inflammation

• Plasmapheresis (replacing plasma to have no antibodies)

Abx for bacterial pneumonia

Azithromycin or levofloxacin

Cholecystitis causes pain in the..

Right upper quadrant and can radiate to the right shoulder

Cause of pancreatitis

Alcoholism

Symptoms for pancreatitis

• Pain increased with eating

• Abdominal mass and distention

• Ascites

• Rigid abdomen

• Cullen’s sign (C shaped bruising above umbilicus)

• Gray Turner’s sign (Bruising along the flank)

• Fever

• N/V

• Hypotension

Labs for pancreatitis

• Increased WBCs

• Increased serum lipase

Nursing interventions for pancreatitis “PANCREAS”

• Pain control (fentanyl, hydromorphone, morphine)

• Antispasmodic drugs to reduce gut motility

• NPO/NGT suction, TPN for pancreatic rest

• Calcium replacement d/t hypocalcemia

• Replace fluids and electrolytes (fluid shift)

• Elevated enzymes (check amylase & lipase)

• Abx with fever

• Steroids or corticosteroids for acute attacks

Cholelithiasis is aka…

Gallstones

Causes of cholelithiasis

• Hyperlipidemia

• Hyperbilirubinemia

Signs of cholelithiasis

• Sudden sharp RUQ abdominal pain

• Pain continues to get worse, radiating to back between shoulder blades or R shoulder

• Pain gets worse at night or after a fatty meal

• N/V

Treatment for cholelithiasis

Cholecystectomy

Cholelithiasis can cause another condition called…

Cholecystitis

Causes of cholecystitis include

• Cholelithiasis

• Infection

• Blocked bile duct

Signs of cholecystitis

• Fever

• Leukocytosis

• Rebound tenderness

• Abdominal muscle guarding

Treatment for cholecystitis

• Pain control

• Replacement of fluids and electrolytes

• Fasting

• Abx

• Perforated gallbladder = immediate cholecystectomy

Signs of hyperglycemia

• Blurred vision

• Polyuria

• Tachycardia

• Orthostatic hypotension

• Polydipsia

• Polyphagia

• Weight loss

• Slow wound healing

Hypoglycemia

Peptic ulcer disease

Crohn’s Disease

Idiopathic inflammatory disorder and erosion of the ileum affecting any part of digestive tract from mouth to anus

Ulcerative Colitis

Chronic inflammatory disease of the large intestine (specifically colon and rectum)

Causes of ulcerative colitis

• Infection

• Autoimmune

• Dietary

• Genetics

UC is common in what age range and of what descent

20-40 years, Jewish

Pathophysiology of UC

Continuous lesions limited to the mucosa affecting the colon and rectum

Diverticulitis

Inflammatory stage of diverticulosis

Diverticulosis

Asymptomatic diverticular disease

What are diverticula?

Herniation of mucosa through the muscle layers of the colon wall

Possible causes of diverticular disease

• Decreased dietary fiber

• Abnormal neuromuscular function

• Alterations in intestinal motility

• >60 years of age

Intestinal disorders assessment findings

• Rebound tenderness

• Cramping

• Diarrhea

• Vomiting

• Dehydration

• Rectal bleeding

• Weight loss

• Bloody stools

• Anemia

• Fever (if inflamed)

Treatment for diverticulitis

Low fiber diet

Treatment for diverticula and diverticulosis

High fiber diet

What to avoid in intestinal disorders?

Cold/hot foods, smoking

Meds for intestinal disorders

• Antidiarrheals

• Abx

• Steroids

Would patients with Crohn’s disease most likely need an ileostomy or colostomy?

Ileostomy

Would patients with Ulcerative colitis most likely need an ileostomy or colostomy?

Colostomy

Would patients with Diverticulitis most likely need an ileostomy or colostomy?

Colostomy

Intestinal obstruction

A condition preventing flow of chyme through the intestinal lumen or failure of normal intestinal motility in the absence of an obstructing lesion

Clinical manifestations of a small intestine obstruction

• Colicky pains caused by intestinal distension

• N/V

Clinical manifestations of a large intestine obstruction

• Hypogastric pain

• Abdominal distension

Appendicitis

Inflammation of the appendix

What condition causes the most common abdominal surgery in children?

Appendicitis

Pain with Appendicitis

• Dull, steady periumbilical pain

• Over 4-6 hours pain progresses and localizes to RLQ

What does it mean when you have a sudden relief of pain when you have appendicitis?

Sign of appendix rupture can lead to peritonitis

What sign, if positive, is an indication of appendicitis?

McBurney’s sign

Appendicitis assessment (PAINS)

• Pain (RLQ)

• Anorexia

• Increased temperature & WBCs

• Nausea

• Signs (McBurney’s)

Treatment for appendicitis

Appendectomy

Pre-op for appendectomy

• No heat

• Position right side in low Fowler’s

Post-op for appendectomy

• IV fluids

• IV abx

• Pain management

• NPO until return of bowel sounds

• Wound care

Manifestations of Hyperemesis Gravidarum

• Nausea with excessive persistent vomiting

• N/V does not subside

• Causes dehydration, weight loss, and electrolyte imbalances

• Cannot keep any food down

HELLP Syndrome

Preeclampsia

When a >20 weeks gestation has a blood pressure of >140/90 2 times 4 hours apart

SIgns of preeclampsia

• Facial and hand swelling

• Frontal headache

• Elevated BP above 140/90

• Proteinuria

Signs that a woman is recovering from preeclampsia

• Diuresis (increased urinary output)

• Decreased protein in urine

• Return of normal BP

• Resolution of abnormal lab values

Neuroleptic Malignant Syndrome (NMS)

Severe adverse reaction to antipsychotic

Signs of NMS

• High fever rising above 100.4 and can exceed 104

• Severe muscle rigidity “lead-pipe”

• Altered mental status

• Autonomic instability (tachycardia, tachypnea, diaphoresis, fluctuating BP)

Treatment for NMS

• WIthdraw the implicated antipsychotic

• Cool the client passively

• Administer IV fluids and muscle relaxers (diazepam)

Hydromorphone

Potent opioid for severe pain

Ketorolac

Inflammatory and indicated for mild and moderate pain

Opioid side effects “MORPHINE”

• Miosis (pupil constriction), mood changes

• Out of it

• Respiratory depression, reduced salivation

• Pruritus, pneumonia (aspiration)

• Hypotension, headache

• Infrequent elimination (constipation, urinary retention)

• Nausea, nervousness

• Emesis

Treatment for hyperparathyroidism

Combination of normal saline followed by furosemide

Meds for DI include

• Desmopressin

• Thiazide diuretics

• Anti-inflammatories

Signs of a transfusion reaction “REACTION”

• Rash

• Elevated temperature

• Anxiety, apprehension

• Chills

• Tachypnea

• Increased pulse

• Oliguria and hemoglobinuria

• Nausea

Drugs to avoid with ACE inhibitors and why

Potassium-sparing meds, risk for hyperkalemia

Drugs to avoid with Nitroglycerine or other nitrate meds and why

Erectile dysfunction meds like Sildenafil, risk for profound hypotension

Drugs to avoid with Metformin and why

Contrast dye, risk for nephrotoxicity

Drugs to avoid with MAOIs and St. John’s Wort and why

Other antidepressants, risk for serotonin syndrome

PDE3 inhibitors indication

Acute HF and intermittent claudication in PAD

PDE3 Inhibitor examples

Milrinone and CIlostazol

PDE4 inhibitor indication

COPD, psoriasis, psoriatic arthritis

PDE4 inhibitors examples

Roflumilast and Apremilast

PDE5 inhibitors indication

ED, BPH, pulmonary arterial hypertension

PDE5 inhibitors examples

Sildenafil and tadalafil

Contraceptive devices containing ________ and __________ may cause thromboembolism

Estrogen and progesterone

How long can a contraceptive implant be used for…

3-5 years

When a client takes depot medroxyprogesterone acetate, what supplementation is recommended

Calcium and Vitamin D

How is HIV transmitted?

• Sexual (genital, anal, or oral)

• Parenteral (sharing needles)

• Perinatal (form placenta, contact with maternal blood and body fluids during birth, breast milk)

What drug is contraindicated with antiretrovirals?

Echinacea

ACE inhibitors SE

• Angioedema

• Nagging, dry cough

• Increase in serum potassium levels

• Dysgeusia (reduced taste sensation)

Nursing consideration for Lorazepam

Initiate fall precautions like raising side rails

Nursing consideration for Valproic acid

Monitor LFTS and CBC

Atomoxetine may cause what as an adverse effect

Hepatic injury

Important thing to monitor when taking atomoxetine

LFTs

Amphotericin B is for…

Systemic fungal infections

Nursing care for someone taking amphotericin b

• Premedicate client with isotonic saline, diphenhydramine, ondansetron, and acetaminophen

• Med decreases potassium

• Is nephrotoxic

• Monitor creatinine closely

Abx management “MEDICATE”

• Monitor for superinfections

• Evaluate renal and liver function

• Diarrhea management

• Inform provider if taking other meds

• Cultures before first dose

• Alcohol; don’t have it

• Take the entire course

• EValuate cultures: WBC, CRP, temp

Broad spectrum abx are for what type of bacterias

Gram positive and negative

Examples of broad spectrum drugs

• Ampicillin

• Cephalosporins (3rd gen) (ceftriaxone, ceftazidime)

• Tetracyclines (-cycline, doxycycline)

• Carbapenems (-penem)

• Sulfonamides (Sulf-, sulfamethoxazole/trimethoprim)

• Fluoroquinolones (-floxacin)

Examples of abx specifically for gram negative bacteria

• Aminoglycosides (-cin)

• Cephalosporins 1st/2nd gen (cephalexin, cefazolin, cefoxitin)

Examples of abx specifically for gram positive bacteria

• Penicillin G and V

• Erythromycin

• Clindamycin

Macrolides abx examples

• Azithromycin

• Clarithromycin

• Erythromycin

Aminoglycoside abx examples

• Gentamicin

• Tobramycin

• Amikacin

Abx for mycobacterium tuberculosis

• Isoniazid

• Rifampin

• Ethambutol

• Pyrazinamide