HESI NSG 123: Medical Surgical Nursing | 93 Expert curated questions and answers | verified for accuracy | 100% accuracy | Pass Guarantee

Ulcerative Colitis

Ulcerative colitis is a 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. The inflammatory changes typically begin in the rectum and progress proximally through the colon

Crohn's Disease

Crohn's disease is characterized by periods of remission and exacerbation. It is a subacute and chronic inflammation of the GI tract wall that extends through all layers (i.e., transmural lesion). Although its characteristic histopathologic changes can occur anywhere in the GI tract, it most commonly occurs in the distal ileum and the ascending colon. The onset of symptoms is usually insidious in Crohn's disease, with prominent right lower quadrant abdominal pain and diarrhea unrelieved by defecation

Crohn's Disease Diet

Oral fluids and a low-residue, high-protein, high-calorie diet with supplemental vitamin therapy and iron replacement are prescribed to meet nutritional needs, reduce inflammation, and control pain and diarrhea. Fluid and electrolyte imbalances from dehydration caused by diarrhea are corrected by IV therapy as necessary if the patient is hospitalized or by oral fluids if the patient is managed at home. Any foods that exacerbate diarrhea are avoided. Milk may contribute to diarrhea in those with lactose intolerance. Cold foods and smoking are avoided because both increase intestinal motility. Parenteral nutrition may be indicated.

Ulcerative Colitis-Goal

The major goals for the patient include attainment of normal bowel elimination patterns, relief of abdominal pain and cramping, prevention of fluid volume deficit, maintenance of optimal nutrition and weight, avoidance of fatigue, reduction of anxiety, promotion of effective coping, absence of skin breakdown, increased knowledge about the disease process and self-health management, and avoidance of complications.

Bariatric Surgery Post Op

After surgery, the nurse assesses the patient for complications from the bariatric surgery, such as hemorrhage, venous thromboembolism, bile reflux, dumping syndrome, dysphagia, and bowel or gastric outlet obstruction.

Eat smaller but more frequent meals that contain protein and fiber; each meal size should not exceed 1 cup.

Eat only foods high in nutrients (e.g., peanut butter, cheese, chicken, fish, beans).

Eat slowly and chew thoroughly

Assume a low Fowler position during mealtime and then remain in that position for 20-30 minutes after mealtime—this delays stomach emptying and decreases the likelihood of dumping syndrome.

Do not drink fluid with meals; instead, consume fluids up to 30 minutes before a meal and 30-60 minutes after mealtime.

Cholelithiasis- Jaundice

Jaundice occurs in a few patients with gallbladder disease, usually with obstruction of the common bile duct. The bile, which is no longer carried to the duodenum, is absorbed by the blood and gives the skin and mucous membranes a yellow color. This is frequently accompanied by marked pruritus (itching) of the skin.

Gallbladder Risk Factors

The risk of developing such stones is increased in patients with cirrhosis, hemolysis, and infections of the biliary tract.

Cholesterol stones account for most of the remaining 75% of cases of gallbladder disease in the United States

Two to three times more women than men develop cholesterol stones and gallbladder disease

Stone formation is more frequent in people who use oral contraceptives, estrogens, or clofibrate (Atromid-S); these medications are known to increase biliary cholesterol saturation. The incidence of stone formation increases with age as a result of increased hepatic secretion of cholesterol and decreased bile acid synthesis.

Peptic Ulcer Disease Complication

Although vomiting is rare in an uncomplicated peptic ulcer, it may be a symptom of a complication of an ulcer. It results from gastric outlet obstruction, caused by either muscular spasm of the pylorus or mechanical obstruction from scarring or acute swelling of the inflamed mucous membrane adjacent to the ulcer.

Seizure Precautions

Seizure precautions are maintained, including having available functioning suction equipment with a suction catheter and oral airway. The bed is placed in a low position with two to three side rails up and padded, if necessary, to prevent injury to the patient. The patient may be drowsy and may wish to sleep after the seizure; they may not remember events leading up to the seizure and for a short time thereafter.

Rheumatoid Arthritis S/S

The initial clinical manifestations of RA include symmetric joint pain and morning joint stiffness lasting longer than 1 hour. Over the course of the disease, clinical manifestations of RA vary, usually reflecting the stage and severity of the disease. Symmetric joint pain, swelling, warmth, erythema, and lack of function are classic symptoms. Palpation of the joints reveals spongy or boggy tissue. Often, fluid can be aspirated from the inflamed joint. Characteristically, the pattern of joint involvement begins in the small joints of the hands, wrists, and feet. In the early stages of disease, even before the presentation of bony changes, limitation in function can occur when there is active inflammation in the joints. Joints that are hot, swollen, and painful are not easily moved.

SLE Exacerbation

The lesions often worsen during exacerbations (flares) of the systemic disease and possibly are provoked by sunlight or artificial ultraviolet light. Oral ulcers, which may accompany skin lesions, may involve the buccal mucosa or the hard palate, occur in crops, and are often associated with exacerbations. Other cutaneous manifestations include splinter hemorrhages, alopecia, and Raynaud's phenomenon

Pre-Op Lab

Routine laboratory tests used to detect infection include the white blood count (WBC) and the urinalysis. Surgery may be postponed in the presence of infection.

Ambulation Post-Op

The patient should be taught that early and frequent ambulation postoperatively, as tolerated, will help prevent complications.

Malignant Hyperthermia

Malignant hyperthermia is a rare inherited muscle disorder that is chemically induced by anesthetic agents

The initial symptoms of malignant hyperthermia are often cardiovascular, respiratory, and abnormal musculoskeletal activity.

Tachycardia (heart rate greater than 150 bpm) may be an early sign.

Sympathetic nervous stimulation also leads to ventricular dysrhythmia, hypotension, decreased cardiac output, oliguria, and, later, cardiac arrest.

Hypercapnia, an increase in carbon dioxide (CO2), may be an early respiratory sign.

With the abnormal transport of calcium, rigidity or tetanus-like movements occur, often in the jaw. Generalized muscle rigidity is one of the earliest signs.

The rise in temperature is actually a late sign that develops rapidly; body temperature can increase 1°C to 2°C (2°F to 4°F) every 5 minutes, and core body temperature can exceed 42°C (107°F)

Post-Op Bowel Sounds Assessment

The nurse detects bowel sounds by listening to the abdomen with a stethoscope. Bowel sounds are documented so that diet progression can occur. The nurse should assess the abdomen for distention and the presence and frequency of bowel sounds. If the patient does not have a bowel movement by the second or third postoperative day, the primary provider should be notified and a laxative or other test or intervention may be needed.

Wound Dehiscence & Evisceration

Wound dehiscence (disruption of surgical incision or wound) and evisceration (protrusion of wound contents) are serious surgical complications. Dehiscence and evisceration are especially serious when they involve abdominal incisions or wounds. They may also occur because of increasing age, anemia, poor nutritional status, obesity, malignancy, diabetes, the use of steroids, and other factors in patients undergoing abdominal surgery.

An abdominal binder can provide support and guard against dehiscence and may be used along with the primary dressing, especially in patients with weak or pendulous abdominal walls or when rupture of a wound has occurred.

Galantamine hydrobromide (Razadyne, Razadyne ER): Contraindications & Common Adverse Effects

Contraindications include severe hepatic or renal impairment.

The most common adverse effects are insomnia, tremor, dizziness, somnolence, headache, bradycardia, and syncope.

Galantamine hydrobromide (Razadyne, Razadyne ER): Indications & Similar to what drug?

Galantamine hydrobromide (Razadyne, Razadyne ER) is similar to donepezil in its action. Indications include mild to moderate dementia.

Teaching Galantamine hydrobromide (Razadyne, Razadyne ER)

Patients and families should receive instructions about reporting any changes in mental status. To decrease gastric upset, it is necessary to take the medication with food.

Sinemet:

What two medications combined?

What disease?

What diet to avoid?

Levodopa and carbidopa are usually given together in a fixed-dose formulation called Sinemet

Levodopa-carbidopa is not administered with a high-protein diet. Adequate hydration is also necessary.

Given to patients with Parkinson's

Sinemet Teaching

Take the medication as prescribed.

Do not crush the sustained-release preparation.

Do not take multivitamin preparations containing pyridoxine.

Understand that there are adverse effects of medication, such as drowsiness, dizziness, and orthostatic hypotension.

Change positions slowly to prevent drop in blood pressure.

Avoid alcohol.

Take the medication with food to prevent nausea and vomiting.

Do not take the medication with a high-protein meal.

Report fainting, light-headedness, irregular heart rate, uncontrolled facial movements, urinary retention, nausea, and vomiting to the prescriber.

Notify the prescriber of any increase in symptoms such as static gait, altered mobility, and "pill rolling."

Parkinson's Diet

Patients may have difficulty maintaining their weight. Eating becomes a very slow process, requiring concentration due to a dry mouth from medications and difficulty chewing and swallowing. These patients are at risk for aspiration because of impaired swallowing and the accumulation of saliv. Monitoring weight on a weekly basis indicates whether caloric intake is adequate. Supplemental feedings increase caloric intake. As the disease progresses, a nasogastric or percutaneous endoscopic gastrostomy (PEG) tube may be necessary to maintain adequate nutrition. A dietitian can be consulted regarding nutritional needs.

Pre-Op Teaching: Incentive Spirometry

The patient is educated about breathing exercises and the use of an incentive spirometer, if indicated, to achieve optimal respiratory function prior to surgery. The potential compromise of ventilation during all phases of surgical treatment necessitates a proactive response to respiratory infections

Pneumonia Breath Sounds

Crackles

Pursed-Lip Breathing

Deep inspiration followed by prolonged expiration through pursed lips.

Pursed-lip breathing helps slow expiration, prevents collapse of small airways, and helps the patient control the rate and depth of respiration. It also promotes relaxation, enabling the patient to gain control of dyspnea and reduce feelings of panic.

COPD S/S

Although the natural history of COPD is variable, it is generally a progressive disease characterized by three primary symptoms: chronic cough, sputum production, and dyspnea

Prolonged expiratory phase, wheezes, decreased breath sounds, ↑ Anterior-posterior diameter (barrel chest), tripod position, pursed lip breathing

Distinguishing symptoms can be difficult with comorbidities

Asthma Trigger

Allergic asthma usually develops in childhood and is triggered by allergens such as pollen, dust mites, and certain foods.

Non-allergic asthma usually develops in patients over the age of forty and can have various triggers, such as cold air, medication (e.g., aspirin), exercise, and viral infection

Exercise induced/cold air exposure

May be seasonal or year-round

Cockroaches, furry animals, fungi, mold

Underlying respiratory infection

Steroids in Asthma

Glucocorticoids — Glucocorticoids are a class of medication that has anti-inflammatory properties. Glucocorticoids can be taken in different forms, including with an inhaler, as a pill, or through an IV.

A spacer should be used with inhaled corticosteroids, and patients should rinse their mouth after administration to prevent thrush, a common complication associated with the use of inhaled corticosteroids. A systemic preparation may be used to gain rapid control of the disease; to manage severe, persistent asthma; to treat moderate to severe exacerbations; to accelerate recovery; and to prevent recurrence.

GERD Meal Recommendations

Small, frequent feedings (6 to 8 per day) are recommended because large quantities of food overload the stomach and promote gastric reflux. The patient is advised to avoid any activities that increase pain and to remain upright for 1 to 4 hours after each meal to prevent reflux. The head of the bed should be placed on 4- to 8-inch (10- to 20-cm) blocks. Eating before bedtime is discouraged.

The patient is encouraged to eat slowly and to chew all food thoroughly so that it can pass easily into the stomach. Small, frequent feedings of nonirritating foods are recommended to promote digestion and to prevent tissue irritation. Sometimes liquid swallowed with food helps the food pass through the esophagus, but usually liquids should be consumed between meals. Food should be prepared in an appealing manner to help stimulate the appetite.

GERD Aspiration

The patient who has difficulty swallowing or difficulty handling secretions should be kept in at least a semi-Fowler position to decrease the risk of aspiration

GERD Avoid

Over using antacids

Irritants such as tobacco and alcohol should be avoided

Avoid eating before bed

GERD Assess

A baseline weight is obtained, and daily weights are recorded. The patient's intake of nutrients is assessed.

S/S Peptic Ulcer Disease

Many patients with peptic ulcers have no signs or symptoms. These silent peptic ulcers most commonly occur in older adults and those taking aspirin and other NSAIDs

As a rule, the patient with an ulcer complains of dull, gnawing pain or a burning sensation in the midepigastrium or the back.

Other nonspecific symptoms of either gastric ulcers or duodenal ulcers may include pyrosis vomiting, constipation or diarrhea, and bleeding. These symptoms are often accompanied by sour eructation (burping), which is common when the patient's stomach is empty.

Gastric vs. Duodenal Ulcers: Main way to determine which it is

There are few clinical manifestations that differentiate gastric ulcers from duodenal ulcers; however, classically, the pain associated with gastric ulcers most commonly occurs immediately after eating, whereas the pain associated with duodenal ulcers most commonly occurs 2 to 3 hours after meals.

DASH Diet

Dietary Approaches to Stop Hypertension includes consumption of a diet rich in fruits, vegetables, and low-fat dairy.

Grains 7-8 servings a day

Vegetables 4-5 servings per day

Fruits 4-5 servings per day

Low-fat or Fat-free dairy 2-3 per day

Lean meat, fish, and poultry less than 2 per day

Nuts, seeds, and dry beans 4 or 5 weekly

Oxalate Foods

Prevention of Kidney Stones:

Avoid intake of oxalate-containing foods (e.g., spinach, strawberries, rhubarb, tea, peanuts, chocolate, wheat bran).

Incontinence Bladder Training

Pelvic floor muscle exercises (sometimes referred to as Kegel exercises) represent the cornerstone of behavioral intervention for addressing symptoms of stress, urge, and mixed incontinence

Symptoms of BPH

Obstructive and irritative symptoms may include urinary frequency, urgency, nocturia, hesitancy in starting urination, decreased and intermittent force of stream and the sensation of incomplete bladder emptying, abdominal straining with urination, a decrease in the volume and force of the urinary stream, dribbling (urine dribbles out after urination), and complications of acute urinary retention and recurrent UTIs.

Symptoms of Hypothyroidism

Extreme Fatigue

Reports of hair loss, brittle nails, and dry skin are common, and numbness and tingling of the fingers may occur

Weight gain without increase in food intake

Hair Falls out and Thins

Constipation

Decreased libido

Irregular Period

Complaints of being cold in warm environment

Myxedema Coma: Hypo or Hyperthyroidism?

Myxedema coma is a rare life-threatening condition. It is the decompensated state of severe hypothyroidism in which the patient is hypothermic and unconscious. This condition may develop with undiagnosed hypothyroidism and may be precipitated by infection or other systemic disease or by use of sedatives or opioid analgesic agents. Patients may also experience myxedema coma if they forget to take their thyroid replacement medication. The condition occurs most often among older women in the winter months and appears to be precipitated by cold. However, the disorder can affect any age group.

What happens in Myxedema Coma?

In myxedema coma, the patient may initially show signs of depression, diminished cognitive status, lethargy, and somnolence. Increasing lethargy may progress to stupor. The patient's respiratory drive is depressed, resulting in alveolar hypoventilation, progressive carbon dioxide retention, narcosis, and coma. In addition, patients with myxedema coma can also exhibit hyponatremia, hypoglycemia, hypoventilation, hypotension, bradycardia, and hypothermia.

Characteristics of Thyrotoxicosis (Thyroid Storm)

High fever (hyperpyrexia), >38.5°C (>101.3°F)

Extreme tachycardia (>130 bpm)

Exaggerated symptoms of hyperthyroidism with disturbances of a major system—for example, gastrointestinal (weight loss, diarrhea, abdominal pain) or cardiovascular (edema, chest pain, dyspnea, palpitations)

Altered neurologic or mental state, which frequently appears as delirium psychosis, somnolence, or coma

What is Thyroid Storm precipitated by?

Life-threatening thyroid storm is usually precipitated by stress, such as injury, infection, thyroid and nonthyroid surgery, tooth extraction, insulin reaction, diabetic ketoacidosis, pregnancy, digitalis intoxication, abrupt withdrawal of antithyroid medications, extreme emotional stress, or vigorous palpation of the thyroid

Management of Thyroid Storm

A hypothermia mattress or blanket, ice packs, a cool environment, hydrocortisone, and acetaminophen (Tylenol)

Humidified oxygen is given to improve tissue oxygenation and meet the high metabolic demands.

IV fluids containing dextrose are given to replace liver glycogen stores that have been decreased in the patient who is hyperthyroid.

Propylthiouracil (PTU) or methimazole is given to impede formation of thyroid hormone and block conversion of T4 to T3, the more active form of thyroid hormone.

Hydrocortisone is prescribed to treat shock or adrenal insufficiency.

Iodine is given to decrease output of T4 from the thyroid gland. For cardiac problems such as atrial fibrillation, dysrhythmias, and heart failure, sympatholytic agents may be given. Propranolol, combined with digitalis, has been effective in reducing severe cardiac symptoms.

Graves Disease

Graves disease, the most common cause of hyperthyroidism, is an autoimmune disorder that results from an excessive output of thyroid hormones caused by abnormal stimulation of the thyroid gland by circulating immunoglobulins

Treatment of Graves Disease

The use of radioactive iodine is the most common form of treatment for Graves disease in North America.

Polyuria & Diabetes

Clinical manifestations depend on the patient's level of hyperglycemia. Classic clinical manifestations of diabetes include the "three Ps": polyuria, polydipsia, and polyphagia. Polyuria (increased urination) and polydipsia (increased thirst) occur as a result of the excess loss of fluid associated with osmotic diuresis

A1C Level for diabetes

Over 6.5%

Hypovolemia

• Deficient fluid volume

• Decreased cardiac output

• Risk for impaired oral mucous membranes

Hypervolemia: Potential Complication

• Potential complications: Pulmonary edema or crackles, ascites

• Watch HCT and BUN, decreased urine output

Hypovolemia Potential Complication

Potential complication: Hypovolemic shock

Watch NA+ and increased urine output

Hypervolemia

• Excess fluid volume

• Impaired gas exchange

• Risk for impaired skin integrity

• Activity intolerance

S/S Metabolic Acidosis

Decreased BP

Hyperkalemia

Muscle Twitching

Warm, Flush Skin

Nausea, Vomiting, Diarrhea

Changes in LOC

Insulin Pens

Insulin pens use small (150- to 300-unit) prefilled insulin cartridges that are loaded into a penlike holder. A disposable needle is attached to the device for insulin injection. Insulin is delivered by dialing in a dose or pushing a button for every 1- or 2-unit increment given. These devices are most useful for patients who need to inject only one type of insulin at a time (e.g., premeal rapid-acting insulin three times a day and bedtime NPH insulin) or who can use the premixed insulins. These pens are convenient for those who administer insulin before dinner if eating out or traveling. They are also useful for patients with impaired manual dexterity, vision, or cognitive function, which makes the use of traditional syringes difficult.

Emergent Treatment DKA & HHS

Emergent treatment for both DKA and HHS is IV insulin

Thyroid Storm Definition

• Physiologic effects/clinical syndrome of hyper-metabolism

• Results from increased circulating levels of T3, T4, or both

• Life threatening emergency

Myxedema Coma Things to Know

• Extreme, untreated hypothyroidism

• Will administer thyroid hormone IV- monitor for acute cardiac changes

• May worsen with infection, drugs, cold, trauma

• Patient will need to have temperature increased slowly!

Safety while Seizing

• Keep away from danger

• Do not hold patient down

• Turn on side

Often administer Ativan IV/IM

Migraine Treatment

• Acetaminophen- works well for intermittent issues with most populations

• Aspirin, Ibuprofen, or Naproxen- watch with blood thinners, pregnancy, or cardiac issues

• Caffeine- can worsen symptoms in some populations

Serotonin receptor agonist- Sumatriptan (Imitrex)- Can be IM, SQ or nasal routes. Focuses on vasoconstriction of cerebral blood vessels.Abortive therapy only, take early in migraine

Organic Causes of Erectile Dysfunction

• HTN, DMI/DMII, CKD, MS, acute spinal injury, endocrine disorders

Psychogenic Causes of Erectile Dysfunction

• Low energy, anxiety, depression, pressure to perform, trust or relationship issues

Erectile Dysfunction Assessment

• Determine if there is a secondary cause prior to treatment

• Phosphodiesterase type 5 (PDE-5) inhibitors (Sildenafil- Viagra, Tadalafil- Cialis) is often first line medication class.

• Watch cardiac history and do not take more than daily

• For more severe forms surgical intervention may be necessary

• Balloon pumps

• Patients can use self injections or suppositories

Peripheral Arterial Occlusive

The hallmark symptom is intermittent claudication described as aching, cramping, or inducing fatigue or weakness that occurs with some degree of exercise or activity, which is relieved with rest.

Statins improve endothelial function in patients with PAD. Studies suggest that statins improve symptoms of intermittent claudication and also increase walking distance to the onset of claudication

HF Lab Value

BNP

Left Heart Failure Symptoms

Paroxysmal Nocturnal Dyspnea

Cough

Crackles

Wheezes

Blood Tinged

Tachypnea

Restlessness

Confusion

Orthopnea

Tachycardia

Exertional Dyspnea

Fatigue

Cyanosis

Ways to Change Lifestyle for Hypertension

Weight Reduction

Adapt DASH eating

Dietary Sodium Reduction

Physical Activity

Moderation of alcohol

Powerpoint Gallbladder Risk Factors

Female gender

>40 years old

Hx of children

Obesity

Post Op Bariatric

Watch for dumping syndrome and vitamin/mineral imbalances

Ulcers can be possible

Bleeding

Three Top Symptoms of GERD

Heartburn- most common clinical manifestation

Dyspepsia (pain or discomfort centered in upper abdomen)

Regurgitation (Described as hot, bitter, or sour liquid coming into throat or mouth)

Common Symptoms of Crohn's

Diarrhea

Crampy abdominal pain (especially after meals)

Malnourishment (think- small intestine)

Secondary anemia

Things to know about Crohn's from Powerpoint

Inflammation involving all layers of the bowel wall

Occurring anywhere in the GI tract

"skip" lesions- areas of disease alternating with healthy GI tract

Ulcerations are deep, have a cobblestone appearance

Strictures at areas of inflammation may cause bowel obstruction

Oral fluids and a low-residue, high-protein, high-calorie diet with supplemental vitamin therapy and iron replacement

Because inflammation goes through the entire wall, microscopic leaks can allow bowel contents to enter the peritoneal cavity

Peritonitis or abscesses possible

Common Symptoms of Ulcerative Colitis

Bloody diarrhea

Mucus or pus may also be present

Left lower quadrant abdominal pain

What to know about Ulcerative Colitis from Powerpoint

Decrease inflammation and watch for changes

• Disease of the mucosal layer of the colon and rectum

• Typically starts in the rectum and moves inward

• Best viewed in colonoscopy

• Diarrhea with marked fluid loss

• Damage to mucosa, breakdown of cells, possible formation of pseudopolyps

Treatment of Asthma

Inhaled steroids for maintenance and long term control

Short acting Beta-2 agonist or bronchodilator for short term/immediate

Pneumonia Treatment

• Supportive care

• Oxygen for hypoxemia

• Analgesics for chest pain

• Antipyretics

• Individualize rest and activity

• PPSV 23 (Pneumovax)

• Antibiotic therapy

Symptoms should improve in 3-5 days, if not IV abx may be needed

Malignant Hyperthermia Treatment

Treatments:

• Cooling blanket

• IV fluids

• 100% oxygen

• Dantrolene (muscle relaxant)

Hyponatremia

Fluid Volume Loss, Hyponatremia occurs with increased thirst and ADH release.

Hyponatremia occurs with diuresis owing to increased release of ADH secondary to reduction in circulating volume

Dilutional Hyponatremia Definition

FROM GOOGLE (on study guide but not in realist):

Dilutional hyponatremia, also known as water intoxication, is a

potentially life-threatening condition which occurs when a person consumes too much water without an adequate intake of electrolytes

Hypokalemia - Diuretics

Hypokalemia can occur with all diuretics except those that work in the last distal tubule of the nephrons.

potassium-sparing diuretics (e.g., spironolactone, triamterene, amiloride)

Potassium supplements can be prescribed to avoid this complication.

SLE- Skin Care

Wear Sunscreen

Regular Insulin Onset, Peak, & Duration

Onset 30-60min

Peak 2-3 hours

Duration 4-6 hours

Usually give 20-30 minutes before meal. May be taken along or in combination with longer acting insulin

Rheumatoid Arthritis Plan of Care

• Meds:

• Methotrexate

• NSAIDS

• Short term steroid tapers

• PT and exercise used

• Energy conservation

• Avoid long term immobilization

Type One Diabetes

• Autoimmune- body destroys beta cells in islets of Langerhans

• Only treatment is close monitoring and insulin

• 3 P's

• DKA is extreme hyperglycemia

Type Two Diabetes

• Most common

• Body makes some insulin, but not enough to meet bodies needs

• Obesity is the most common risk factor

• HHS is extreme hyperglycemia

Renal Calculi

• Make pain meds a priority!

• Straining urine to collect stone

• Test stone to determine type

Prevent with diet

• Oxalate- Spinach, beets, rhubarb, nuts/ seeds, black tea

• Calcium Phosphate- dairy, rice, many green veggies, tofu

• Uric Acid- high purine foods- organ meat, salmon, beer, wine, aged cheeses

• Treat with lithotripsy

Hyperkalemia occurs with

Hyperkalemia occurs with adrenal insufficiency.

Hypernatremia Results From

Hypernatremia results from increased insensible losses and diabetes insipidus.

ABGs Bowel Obstruction

FROM GOOGLE (Nothing in Realizit)

Patients with an SBO are at risk for metabolic acidosis and alkalosis due to vomiting and malabsorption of gastric contents related to the obstruction. Metabolic acidosis and alkalosis typically resolve when the SBO resolves.

Proximal small bowel obstructions cause early and abundant vomiting with fluid, Cl, Na, and K loss, and consequently dehydration, hypokalemia, hyponatremia, hypochloremia, and metabolic alkalosis.

Methotrexate (Rheumatrex)

DMARD Used in Rheumatoid Arthritis

Immunosuppressant

Liver function tests help guide methotrexate dosage

Administration of methotrexate is weekly for rheumatoid arthritis or psoriasis, and patients should keep an accurate record of the date and time of each dose. To reduce gastric upset, they may take the drug with food. However, daily dosing for cytotoxic immunosuppressants should be consistent with regard to time and food (i.e., at the same time of day, with the same meal).

PAD Signs & Symptoms

• Intermittent claudication

• Dependent edema, but elevation increases discomfort

• Pain while exercising- will improve with rest

• Cyanosis common

• Unequal or absent pulses

Heart Failure Assessment

• Respiratory crackles, SOB. Excess sputum (pulmonary edema- pink, frothy sputum)

• Lower extremity swelling, reports of tight socks/shoes

• Weight gain (3lbs in a day, 5lbs in a week)

BPH (Powerpoint)

• Significant amount of men > 60yrs will be affected- common complaint

• Prostate enlarges over time and can impede urine flow

• Often diagnosed by patient report of symptoms

• Not cancerous or painful

• Chronic retention issues can lead to a lower urinary tract infection (UTI)

Right Sided Heart Failure

Fatigue

Distended Neck Veins

Anorexia & complaints of GI distress

Weight Gain

Dependent Edema

Enlarged liver and spleen

Increased venous pressure

Ascites