MedSurg Exam 2 Case Studies

major points!

How is bacterial meningitis different from viral meningitis?

Bacteria = BAD NEWS, most contagious, create congestion

Viral = VERY COMMON, most tested, less severe

What are two common signs of meningitis?

Kernig’s sign

Brudzinski’s sign

Diagnostic test that are used to diagnose meningitis:

Lumbar puncture w/ CSF analysis

CT scan w/ contrast

Skull, sinus, or CXR

Blood, urine, and sputum cultures

Isolation precautions for meningitis:

Private room

Wearing a surgical mask when entering room

Wearing gloves during contact w/ oral secretions

Route of entry for meningitis:

CSF → ear/sinuses, bloodstream, head wound

What are symptoms of Parkinson’s disease?

Bradykinesia, tremors, muscle rigidity, shuffling gait, mask-like expression, pill-rolling tremors

Nursing Interventions for seizures

observe + document

tilt head to side

maintain airway

do not put anything in mouth

if longer than 5 mins, call 911

safety → flat on ground

Phenytoin (Dilantin) for seizures

10-20 mcg

watch for gingival hyperplasia, bradycardia, rash

Carbamazepine (Tegretol)

watch for visual problems, vertigo, ataxia, blood dyscrasias

Valproic acid (Depakote)

First line (unless grand-mal → Dilantin)

watch for GI upset, hepatotoxicity, pancreatitis

Ways to diagnose diabetes

FPG greater than or equal to 126

HgA1C greater than or equal to 6.5%

RBG greater than or equal to 200

Type 1 diabetes

body does not make any insulin on it’s own, INSULIN DEPENDENT

usually younger onset

Type 2 diabetes

not usually insulin dependent

lifestyle (obesity, sedentary lifestyle, diet)

Foot care for people with diabetes

BECAUSE OF NEUROPATHY

• they will not know that their feet have issues (can’t feel them)

• daily foot checks

• wash daily

• don’t walk barefoot

• moisturize

Rapid acting insulin

Insulin Lispro (Humalog)

Onset is 15-30 mins

Lasts 3-6 hours

Give just before/at mealtime → ONLY COVERS MEALS

Long acting insulin

Lantus (glargine)

once per day at bedtime

Onset is 1-2 hours

Lasts 18-24 hours

AV fistula normal findings

hear the bruit, feel the thrill

this means blood is flowing properly

Do not take BP on this side!

Epoetin shots (erythropoetin)

Given to patients with renal disorders

They have anemia → need more RBCs

Epoetin stimulates the bone marrow to produce more RBCs

This will treat the anemia

Ferrous Sulfate (Iron Supplements)

Corrects iron-deficiency anemia, replenishes iron stores in the body