Medsurg Final

Pathophysiology of Peripheral Neuropathy

• Peripheral neuropathy includes two main forms:

  • Focal Neuropathies:

  • Caused by acute ischemic damage.

  • Diffuse Neuropathies:

  • More widespread and involve slow, progressive loss.

• Complications:

  • May lead to foot deformities and ulcers.

• Autonomic Neuropathy:

  • A specific form of diabetic neuropathy.

  • Affects the autonomic nervous system, minimizing manifestations of hypoglycemia.

Discharge Instruction About Meals for Parkinson’s Disease

• Discharge instructions regarding meals should include consultation with a dietitian for an appropriate diet.

  • Often consists of semisolid foods and thickened liquids.

• Key instructions for managing meals:

  • Sit the client upright to eat or drink.

  • Provide smaller, more frequent meals.

  • Encourage fluids and document intake.

  • Document the client’s weight at least weekly and maintain a diet intake log.

  • Consult with an occupational therapist for adaptive eating devices.

  • Determine the need for high-calorie, high-protein supplements to maintain the client’s weight.

Modifiable Risk Factors for Stroke

• Modifiable risk factors for stroke (including ischemic stroke) are conditions or lifestyle choices that can be controlled:

  • Diabetes Mellitus

  • Obesity

  • Hypertension

  • Atherosclerosis

  • Hyperlipidemia

  • Heart Disease:

  • Includes atrial fibrillation or cardiomyopathy.

  • Smoking

  • Alcohol Consumption:

  • More than 1-2 drinks per day.

  • Substance Use:

  • e.g., cocaine.

  • Use of Oral Contraceptives

Client Understanding of Cerebral Aneurysms

• Cerebral Aneurysm:

  • A significant risk factor for hemorrhagic stroke.

  • Can be an organic cause of secondary headaches.

• Client Education:

  • Sources lack specific information detailing client education points on understanding the diagnosis or pathophysiology of aneurysms outside of risk classification.

Identifying Pathophysiology of Cerebral Edema

• Cerebral Edema:

  • Occurs when a lesion or fluid accumulation takes up space within the cranium (a closed bony structure in adults that does not expand).

  • Increased pressure beyond expected levels leads to increased edema, which:

  • Decreases brain tissue perfusion, leading to impaired neurologic function and potential death.

• Can cause seizures; seizure activity often disappears once the edema is successfully treated.

Understanding a Parkinson’s Disease Diagnosis

• Parkinson’s Disease (PD):

  • A progressively debilitating disease significantly affecting motor function.

  • Characterized by four primary findings:

  • Tremor

  • Muscle Rigidity

  • Bradykinesia:

    • Slow movement.

  • Postural Instability

• Findings result from degeneration of the substantia nigra, leading to decreased dopamine production.

• Consequently, excitatory neurotransmitter acetylcholine dominates the basal ganglia, making smooth, controlled movements difficult.

• Diagnosis is based on observed manifestations, their progression, and ruling out other diseases, as there are no definitive diagnostic procedures.

Diagnostic Testing and Transient Ischemic Attacks (TIAs)

• TIA:

  • A transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia without acute infarction.

• Manifestations:

  • Transient findings such as visual disturbances, dizziness, slurred speech, or weakness in extremities, usually resolving within 1 to 24 hours.

• Diagnostic Tests:

  • Computed Tomography (CT) Scan:

  • Initial test, performed within 25 minutes of client arrival, determining stroke type and thrombolytic therapy candidacy.

  • Magnetic Resonance Imaging (MRI):

  • Identifies edema, ischemia, and necrosis.

  • Angiography:

  • Identifies abnormal vessel structures (e.g., AV malformation, aneurysms).

Care Plan for a Client at Risk of Cerebral Aneurysm Rupture

• Cerebral aneurysm as a high-risk factor for hemorrhagic stroke.

• General care to reduce risk and manage associated intracranial pressure (ICP):

  • Elevate the head of the bed to 30 degrees.

  • Maintain the client’s head in a midline neutral position.

  • Advise the client to avoid actions increasing ICP (e.g., coughing, sneezing).

  • Administer Nimodipine (a calcium channel blocker), reducing vasospasms related to subarachnoid hemorrhage.

Factors That Contribute to Tension and Cluster Headaches

• General factors:

  • Stress, muscle tension, colds, and allergies.

• Risk factors and triggers:

  • Anger outburst

  • Anxiety and prolonged anticipation or periods of stress

  • Excessive physical activity, fatigue

  • Altered sleep-wake cycles

  • Cluster Headaches:

  • Specifically triggered by alcohol.

Medication Administration for Increased Intracranial Pressure (ICP)

• Medications for managing increased ICP include:

  • Mannitol:

  • An osmotic diuretic, treating acute cerebral edema by drawing fluid from the brain into the blood.

  • Barbiturates (e.g., pentobarbital):

  • Inducing a coma to decrease cellular metabolic demand.

  • Phenytoin:

  • Prophylactically used to prevent or treat seizures.

  • Corticosteroids (e.g., dexamethasone):

  • Reducing cerebral edema.

Identifying Manifestations of Cushing's Triad

• Cushing’s Triad:

  • A late finding of increased ICP characterized by:

  • Severe Hypertension:

    • With a widening pulse pressure (systolic – diastolic).

  • Bradycardia

Planning Care for a Client Who Has a Severe TBI

• Care planning prioritizes:

  • Respiratory status

  • Stabilization

  • Managing ICP:

  • Maintain cervical spine stability until cleared by an X-ray.

  • Monitor respiratory status (priority data collection).

  • Monitor for manifestations of increasing ICP.

  • Implement measures to decrease ICP (e.g., elevating the head of the bed at least 30 degrees, avoiding extreme neck or hip flexion).

  • Prevent complications of immobility (turn every 2 hr, use footboards and splints).

  • Maintain a safe environment and implement seizure precautions.

Teaching about Coup and Contrecoup Injuries

• Specific terms and explanations for Coup and Contrecoup Injuries are not detailed in the sources provided.

Teaching about Mean Arterial Pressure (MAP)

• Information regarding Mean Arterial Pressure is not detailed in the sources provided.

High Risk for Sustaining Traumatic Brain Injuries (TBI)

• Clients at high risk for TBIs include those involved in:

  • Motor vehicle or motorcycle crashes

  • Illicit drug and alcohol use

  • Sports injuries

  • Assault

  • Gunshot wounds

  • Falls (especially older adults).

High Mortality Rates with Subarachnoid Hemorrhages (SAH)

• SAH: A type of hemorrhagic stroke.

• Prognosis is generally poor due to ischemia and increased ICP caused by the expanding collection of blood.

• Nimodipine used to decrease vasospasms related to SAH.

Basilar Skull Fracture Findings

• Basilar Skull Fracture:

  • Indicated by Cerebrospinal Fluid (CSF) leakage from the nose or ears.

  • Test for CSF leakage includes the “halo sign”, which shows a clear or yellow-tinted ring surrounding a drop of blood on gauze.

Cushing's Triad Purpose/Why it Occurs

• Cushing’s Triad occurs as a late physiological response to increased ICP.

• The purpose is diagnostic; its components signal severe neurologic deterioration.

Understanding Phases of Migraines

• Migraines are classified as follows:

  • With Aura:

  • Aura develops over minutes to an hour, including neurological findings such as numbness and tingling, acute confusion, or visual disturbances.

  • Followed by a severe, incapacitating, throbbing headache lasting about 1 hour.

  • Without Aura (Common Migraine):

  • Involves unilateral, pulsating pain aggravated by physical activity, often accompanied by manifestations such as photophobia, phonophobia, nausea, and/or vomiting

  • Persists for 4 to 72 hours.

Bowel and Bladder Management for Clients Who Have Spinal Cord Injuries

• Specific detailed plans for Bowel and Bladder Management are not explicitly provided in these sources.

Planning for Side Effects of Methylprednisolone

• Methylprednisolone: A corticosteroid used for acute exacerbations of multiple sclerosis.

• Monitor for side effects, including:

  • Increased risk of infection

  • Hypervolemia

  • Hypernatremia

  • Hypokalemia

  • Hyperglycemia

  • Gastrointestinal bleeding

  • Personality changes

Identifying Triggers for Autonomic Dysreflexia

• Triggers for Autonomic Dysreflexia are not explicitly detailed in the sources.

Identifying Different Types of Multiple Sclerosis (MS)

• The four types of MS are:

  • Relapsing and Remitting (RRMS): Most common type, involving relapses followed by remissions.

  • Primary Progressive (PPMS): Gradual, continuous CNS deterioration without remission.

  • Secondary Progressive (SPMS): Starts as RRMS, subsequently becomes continuously progressive.

  • Progressive Relapsing (PRMS): Frequent relapses with partial recovery without return to baseline.

Cauda Equina Syndrome in Clients Who Have Degenerative Disc Disease

• Specific findings or pathophysiology details of Cauda Equina Syndrome are not detailed in the text.

Identifying Mobility Options for Clients Who Have Spinal Cord Injuries

• Detailed mobility options for clients are not provided in the sources.

Providing Care for a Client Who Has Multiple Sclerosis (MS)

• Nursing care focuses on:

  • Fluid Management: Encourage fluid intake to decrease the risk of UTI.

  • Elimination: Assistance with bladder elimination, such as intermittent self-catheterization or voiding schedule.

  • Mobility: Encourage exercise and stretching while avoiding overexertion and overheating; promote use of assistive devices and maintain a safe environment.

  • Conservation: Energy conservation through grouped care and planned rest periods.

  • Triggers: Avoid overexertion, stress, temperature extremes, humidity, and contact with infections.

  • Vision: Consider eye patch application for diplopia; alternate patch placement frequently.

Pathophysiology of the Spinal Cord

• General pathophysiology details are not provided in the sources.

Caring for a Client Who Has a Transection of the Spinal Cord

• Specific care guidelines for clients with a spinal cord transection are not detailed in the sources.

Identifying Risk Factors for Spinal Stenosis

• Spinal Stenosis mentioned as a cause of low-back pain; specific risk factors are not detailed.

Retinal Detachment Causes

• Specific causes of Retinal Detachment are not detailed; it is mentioned as a complication leading to cataracts and a risk factor for glaucoma.

Medications for Ménière’s Disease

• Ménière’s Disease: Characterized by episodic vertigo, tinnitus, and fluctuating sensorineural hearing loss.

• For vertigo, Meclizine (an antihistamine and anticholinergic) is used.

Plan of Care for Cochlear Implant Insertion

• The device is implanted in the left chest wall and connected to the left vagus nerve.

• Postoperative Care:

  • After surgery, cochlear implant not turned on immediately; external unit is applied and speech processor programmed 2 to 6 weeks post-surgery.

• Client Education:

  • Avoid MRIs and follow precautions to prevent infection.

Post Op Care for Retinal Detachment

• Specific postoperative care instructions for retinal detachment are not detailed.

Clients About the Pathophysiology of Cataracts

• Cataracts: Opacity in the lens impairing vision.

• Pathophysiology includes:

  • Age-related Changes:

  • Drying of the lens due to water loss; increase in lens density from fiber compaction.

  • Traumatic Injury: Blunt or penetrating injuries.

  • Toxic Causes:

  • Long-term use of corticosteroids, phenothiazine derivatives, beta blockers, or miotic medications.

Pathophysiology of Open-Angle Glaucoma

• In Primary Open-Angle Glaucoma (POAG):

  • Aqueous humor outflow is decreased due to blockages in the eye’s drainage system (Canal of Schlemm and trabecular meshwork).

  • Results in a gradual rise in intraocular pressure (IOP).

Causes of Hearing Loss

• Hearing loss can be classified by cause:

  • Conductive Hearing Loss: Caused by factors such as otitis media, otosclerosis, and presence of a foreign body (e.g., impacted cerumen).

  • Sensorineural Hearing Loss: Caused by damage to cranial nerve VIII.

  • Other causes include environmental or workplace noise exposure and age-related changes (thickening of tympanic membrane and loss of sensory hair cells).

Lifestyle Modifications for Clients Experiencing Tinnitus

• Specific lifestyle modifications for clients experiencing tinnitus are not detailed.

Reviewing Home Medications with a Preoperative Cataract Extraction Client

• Long-term use of medications like corticosteroids, phenothiazine derivatives, and beta blockers considered toxic causes of cataracts.

• Preoperatively, anticholinergic agents (e.g., atropine 1% ophthalmic solution) are administered to dilate the eye for visualization and surgery.

Clinical Changes Caused by Retinal Detachment

• Specific clinical changes are not detailed in the sources.

Development of Cholecystitis: Calculous vs. Acalculous

• Calculous Cholecystitis: Most often caused by gallstones (cholelithiasis) obstructing cystic and/or common bile ducts.

  • Obstruction causes bile to back up, leading to gallbladder inflammation.

• Acalculous Cholecystitis: Listed as a study topic; mechanism is not detailed.

Teaching About Oral Cancer Risk Related to Tobacco

• Tobacco use (including smokeless tobacco, pipes, and cigars) is a major risk factor for oral cancer.

• Smokeless tobacco or pipe/cigar smoking often leads to lesions in the buccal mucosa and gingiva.

• Cigarette smokers consuming alcohol may develop lesions in the floor of the mouth, soft palate complex, or ventrolateral tongue.

• Promoting tobacco cessation is a key prevention strategy.

Crohn’s Disease Education

• Crohn’s Disease: Involves inflammation and ulceration of the gastrointestinal tract, often affecting the distal ileum and all bowel layers.

• Education focuses on:

  • Diet: High-protein, high-calorie, low-fiber diet.

  • Triggers: Avoid caffeine, alcohol, and lactose.

  • Meals: Small, frequent meals.

  • Complications: Seek emergency care for indications of bowel obstruction or perforation (e.g., fever, severe abdominal pain, vomiting).

Client Teaching on Risk Factors for Peptic Ulcers

• Most common cause: Infection from Helicobacter pylori (H. pylori).

• Other key risk factors:

  • NSAID and Corticosteroid Use

  • Excess Alcohol Consumption

  • Cigarette Smoking

  • Severe Stress

Benefits of Oral Care

• Routine oral hygiene and regular dental visits are necessary to minimize adverse effects of medication-induced oral gum overgrowth (gingival hyperplasia) from antiepileptic medications (e.g., phenytoin).

• After specific procedures (e.g., hypophysectomy), frequent mouth rinsing is recommended to minimize effects of mouth breathing.

Educating a Client Who Has a New Hiatal Hernia Diagnosis

• Education should include lifestyle changes similar to GERD:

  • Avoid eating immediately before bedtime.

  • Avoid foods/beverages that decrease LES pressure (e.g., fatty/fried foods, carbonated drinks, chocolate, coffee, peppermint, spicy foods, tomatoes, citrus fruits, alcohol).

  • Maintain a healthy weight.

  • Elevate the head of the bed on 6-inch blocks.

  • Avoid tight clothing around the abdomen.

Manifestations of End-Stage Liver Failure

• Clinical manifestations include:

  • Gastroesophageal Bleeding: Bursting varices.

  • Ascites: Fluid buildup in abdomen and legs.

  • Jaundice and icterus.

  • Petechiae and Ecchymoses.

  • Asterixis: Liver flapping tremor with coarse, nonrhythmic extension/flexion of wrists/fingers.

  • Fetor Hepaticus: Fruity or musty odor on breath.

  • Cognitive Changes/Confusion: Associated with hepatic encephalopathy.

  • Dark-Colored Urine: With foamy appearance, and clay-colored stools.

Discharge Teaching for Acute Pancreatitis

• Focus areas include:

  • Avoid alcohol consumption.

  • Avoid high-fat foods or heavy meals to prevent recurrence.

  • Resume a bland, high protein, low-fat diet with no stimulants (e.g., caffeine).

  • Consume small, frequent meals.

  • Utilize comfort positions (e.g., fetal position, side-lying, sitting upright, bending forward) to relieve pain.

  • Monitor blood glucose and administer insulin as needed (due to potential for hyperglycemia).

Reduce Stimulation for Acute Pancreatitis

• To rest the pancreas, keep the client NPO until pain-free.

• Administer antiemetics as needed.

• Promote comfort and administer analgesics to reduce stimuli.

Lifestyle Modifications for Client with GERD

• Primary treatments for GERD are lifestyle modifications:

  • Maintain weight below BMI of 30.

  • Stop smoking.

  • Limit or avoid alcohol.

  • Eat a low-fat diet.

  • Avoid foods relaxing LES (e.g., caffeinated drinks, chocolate, citrus fruits).

  • Avoid eating/drinking 2 hours before bed.

  • Avoid tight clothing.

  • Elevate the head of the bed 6 to 8 inches.

Anticipating Vital Sign Abnormalities

• Anticipated vital sign abnormalities related to specific conditions include:

  • Increased Intracranial Pressure (ICP): Cushing’s triad (severe hypertension with widened pulse pressure and bradycardia - late finding).

  • Hemorrhagic Shock: Hypotension and tachycardia.

  • Thyroid Storm: Hyperthermia, hypertension, tachydysrhythmias.

  • Acute Adrenal Insufficiency (Crisis): Hypotension and tachycardia.

Understanding Hemoglobin A1C

• Glycosylated Hemoglobin (HbA1c):

  • Best indicator of average blood glucose levels for the past 120 days, assisting in treatment effectiveness evaluation and regimen compliance.

  • Range Indications:

  • 5.9% or less: No diabetes mellitus.

  • Less than 7%: Good diabetes control (target goal).

  • 9% or greater: Poor diabetes control.

Levothyroxine Administration

• Levothyroxine: Used for thyroid hormone replacement.

• Should be taken on an empty stomach, typically 30 to 60 minutes before breakfast.

• Take as prescribed without altering timing, dose, or brand; treatment is typically lifelong.

Type 2 Diabetes Mellitus Normal Function Findings

• Focus on abnormalities associated with Type 2 Diabetes Mellitus (insulin resistance and decreased insulin production).

• Specific "normal function findings" are not detailed.

Diabetic Ketoacidosis (DKA) Complications

• DKA is characterized by metabolic acidosis, ketone accumulation, and severe hyperglycemia (>250 mg/dL).

• Complications/Manifestations include:

  • Polyuria, polydipsia, polyphagia, weight loss.

  • GI effects: Nausea, vomiting, abdominal pain.

  • Fruity Odor of Breath: Due to ketone bodies.

  • Kussmaul Respirations: Deep, rapid breathing to excrete carbon dioxide and acid.

  • Metabolic acidosis.

Thyroid Storm Manifestations

• Thyroid Storm (thyrotoxicosis) is a medical emergency.

• Manifestations include:

  • Hyperthermia

  • Hypertension

  • Delirium

  • Vomiting and abdominal pain

  • Tachydysrhythmias, chest pain, dyspnea, palpitations

Hyperthyroidism-Related Eye Complications

• Graves Disease: Eye complications include Exophthalmos (bulging eyes).

• Results from edema in the extraocular muscles.

• Causes blurred or double vision, eye fatigue, excessive tearing, bloodshot appearance.

• Eyelid Retraction (lag) can lead to an unblinking appearance.

Type 2 Diabetes Mellitus Education

• Education includes diet, exercise, and preventative foot care:

  • Diet: Carbohydrates should account for about 45% of total daily intake; restrict saturated and trans fats; consistency in meal times is critical.

  • Exercise: Engage in physical activity at least three times weekly (150 min/week), exercise only when glucose levels are between 80-250 mg/dL.

  • Foot Care: Inspect feet daily, wash with mild soap and warm water, avoid soaking; do not use commercial remedies for calluses or corns; wear clean, absorbent socks and well-fitting shoes.

Impacts of Hypothyroidism on Overall Health

• Hypothyroidism causes a decrease in metabolic rate, affecting body systems:

  • Cardiovascular: Bradycardia, hypotension, dysrhythmias, and risk of accelerated atherosclerosis.

  • Gastrointestinal: Decreased peristalsis, leading to constipation/paralytic ileus.

  • Integumentary: Dry, flaky skin; thinning hair; myxedema (swelling of face, tongue, hands, feet).

  • Neurological: Slow thought processes and speech.

  • Life-threatening complication: Myxedema coma (respiratory failure, hypotension, hypothermia).

Hyperosmolar Hyperglycemia State (HHS) Manifestations

• HHS is characterized by profound hyperglycemia (>600 mg/dL), severe dehydration, and absence of ketosis.

• Manifestations include:

  • Severe dehydration leading to polyuria, polydipsia, and orthostatic hypotension.

  • Mental status changes: Confusion, lethargy.

  • Seizures or myoclonic jerking related to blood osmolarity >350 mOsm/L.

  • Blood glucose exceeding 600 mg/dL.

  • Blood osmolarity greater than 320 mOsm/L.

Prioritizing Care for a Client Who Has Diabetes Complications

• Priority care focuses on managing acute life-threatening symptoms and preventing long-term complications:

  • Airway and Circulation (Acute Crisis like DKA/HHS): Maintain airway patency, establish IV access, initiate rapid fluid replacement (0.9% sodium chloride) for severe dehydration and hypovolemia.

  • Monitoring: Frequent monitoring of blood glucose, vital signs, and neurological status.

  • Chronic Complications (e.g., Neuropathy): Meticulous foot care to prevent deformities and ulcers; monitoring for tolerance to activity due to potential cardiac involvement.

Causes of Acquired Central Diabetes Insipidus (Neurogenic DI)

• Causes include:

  • Head injury

  • Tumor or lesion

  • Surgery or irradiation near/around the pituitary gland.

Client at High Risk for SIADH

• High-risk conditions stimulating hypothalamus to hypersecrete ADH include:

  • Malignant tumors

  • Increased intrathoracic pressure (e.g., positive pressure ventilation)

  • Head injury

  • Meningitis

  • Certain medications: barbiturates, anesthetics, chemotherapy agents, TCAs, SSRIs, opioids.

Teaching Clients Who Have HHS

• Management involves monitoring and prevention of severe hyperglycemia and dehydration:

  • Monitor blood glucose every 2 to 4 hours when ill.

  • Continue taking insulin or oral hypoglycemic agents.

  • Maintain hydration by consuming adequate fluids.

  • Test urine for ketones if blood sugar is 300 mg/dL or above.

  • Notify provider if illness lasts longer than 24 hours or if unable to tolerate food/fluids.

Priority Developments to Anticipate for Postoperative Pituitary Tumor Removal (Hypophysectomy)

• Urgent anticipated developments relate to fluid balance and intracranial leaks:

  • Diabetes Insipidus (DI): Monitor for excessive output exceeding intake.

  • CSF Leakage: Monitor nasal drainage; report clear, watery drainage or “halo sign”.

  • Airway Compromise: Encourage deep breathing, limit coughing/straining to prevent CSF leakage and increased ICP.

Priority Discharge Teaching for Clients Who Have DI

• Diabetes Insipidus (DI): Results from ADH deficiency leading to polyuria.

• Priority teaching includes:

  • Weigh daily.

  • Monitor fluid intake and output.

  • Monitor for dehydration signs (weight loss, confusion, dry, cracked lips).

  • Wear a medical alert wristband.

  • Teach lifelong self-administration of vasopressin if prescribed; monitor for signs of water intoxication (severe headache, confusion).

Causes of Hypothyroidism

• See topic 68.

Education on Prevention of UTIs

• See topic 69.

Continuous Ambulatory Peritoneal Dialysis (CAPD)

• CAPD requires performing exchanges 7 days per week lasting 4 to 8 hours.

• Clients can continue normal activities during CAPD.

• Dialysate is instilled, dwells for a prescribed time, and effluent containing waste flows out into a drainage bag.

Pathophysiology of Acute Kidney Injury (AKI)

• AKI: Sudden cessation of kidney function when blood flow significantly compromised.

• AKI can be categorized:

  • Prerenal: Resulting from volume depletion and prolonged reduction of blood flow (e.g., shock, hypovolemia).

  • Intrarenal: Direct kidney damage (e.g., nephrotoxins like antibiotics or contrast dye, physical injury).

  • Postrenal: Resulting from bilateral obstruction of structures leaving the kidney (e.g., stone, tumor, prostate hyperplasia).

Anatomy of Clients Who Have a Vagina and a UTI

• Female clients predisposed to UTIs due to short urethra and close proximity of urethra to rectum.

• Age-related decreased estrogen promotes atrophy of urethral opening toward rectum.

Causes of Polycystic Kidney Disease (PKD)

• PKD is a congenital disorder caused by a genetic mutation characterized by fluid-filled cysts in the nephrons that replace healthy kidney tissue.

Risk Factors for Renal Calculi (Kidney Stones)

• See topic 74.

Complications of Polycystic Kidney Disease (PKD) and BP

• Primary complications:

  • Hypertension: Caused by kidney ischemia from enlarging cysts.

  • Progressive Kidney Failure:

  • Controlling blood pressure is a nursing priority for clients with PKD.

Psychosocial Impact of Frequent UTIs

• The psychosocial impact of frequent urinary tract infections is not detailed in the sources.

Clinical Manifestations of Renal Calculi (Kidney Stones)

• Clinical manifestations include:

  • Severe pain (renal colic).

  • Flank pain (suggests calculi in kidney/ureter).

  • Pain radiating to abdomen, scrotum, testes, or vulva (suggests calculi in ureter/bladder).

  • Oliguria/Anuria: If urinary flow is obstructed (medical emergency).

  • Hematuria: Rusty or smoky-looking urine.

  • Associated symptoms: Nausea, vomiting, fever, diaphoresis.

Preventing Urinary Retention in Surgical Patients

• General strategies to prevent urinary retention in surgical patients are not detailed in the sources.

Clinical Manifestations of Renal Calculi (Kidney Stones)

• See topic 77.

Muscle Stretching

• Muscle stretching is encouraged for clients with Multiple Sclerosis but balanced to avoid overexertion.

• Complementary therapies like yoga or tai chi promote relaxation and alleviate muscle tension.

Causes of Osteoporosis

• See topic 81.

Postoperative Care Following Knee Replacement

• Postoperative care focuses on:

  • Positioning: Avoid placing pillows behind the knee, use one pillow under the calf and foot for slight knee extension.

  • Mobility: Assist with early ambulation (often on postoperative day one); limit kneeling and deep-knee bends indefinitely.

  • Monitoring: Monitor neurovascular status (movement, sensation, color, pulse, capillary refill) of the surgical extremity frequently.

  • Medications: Administer analgesics (opioids, NSAIDs) and anticoagulants (e.g., warfarin, enoxaparin) to prevent venous thromboembolism (VTE).

  • VTE Prevention: Encourage plantar flexion, dorsiflexion, and circumduction exercises.

Causes of Impaired Mobility

• Impaired mobility results from neurological and musculoskeletal issues:

  • Parkinson’s Disease (PD): Causes muscle rigidity, bradykinesia, postural instability due to decreased dopamine production.

  • Multiple Sclerosis (MS): Causes muscle spasticity and muscle weakness.

  • Osteoarthritis (OA): Causes pain when bearing weight, joint stiffness, joint destruction.

Diabetes Effects on Circulation

• Diabetes Mellitus contributes to cardiovascular disease and peripheral vascular disease.

• Diabetes causes diabetic neuropathy, damaging sensory nerve fibers, leading to complications like foot deformities and ulcers.

Mobility Complication Prevention

• Strategies to prevent mobility complications include:

  • Preventing VTE: Encourage early ambulation; exercises like plantar flexion and dorsiflexion; apply anti-embolic stockings/sequential compression devices.

  • Preventing Contractures: For knee/hip procedures, avoid prolonged elevation of the extremity on a pillow and position prone for 20-30 minutes daily.

  • General Immobility Complications: Turn client every 2 hours; use footboards and splints.

Causes of Knee Instability

• Specific causes of knee instability are not detailed in the sources.

Mental Status Changes After a Fall

• Changes like confusion, disorientation, lethargy, or difficulty arousing can indicate increased ICP due to traumatic brain injury.

Causes of Stress Fractures

• Fatigue (stress) fractures occur when excessive strain results from recreational and athletic activities.

Manifestations of Open Fractures

• An open (compound) fracture disrupts skin integrity, creating an open wound and tissue injury.

• Possible manifestation includes visible bone at the site.

Manifestations of Synovitis

• Synovitis (inflammation of synovium) can cause carpal tunnel syndrome; treatment may involve NSAIDs if linked to osteoarthritis.

Evaluation of Fluid Resuscitation

• Adequate fluid resuscitation (following major burn injury) is evaluated by monitoring urine output.

• Goal is to maintain urine output of 0.5 mL/kg/hr (~30 mL/hr for average client); if below this range, increase fluid replacement.

Burn Physiology

• A burn injury results in loss of temperature regulation, sweat/sebaceous gland function, and sensory function.

• Destroyed dermis prevents skin regrowth; metabolism increases to maintain body heat post-tissue damage.

Priority Care for Pressure Injuries

• General principles for managing existing pressure injuries detail not provided; frequent client turning is recommended to prevent breakdown.

Surgical Debridement

• Surgical Debridement: Removal of necrotic tissue layers until bleeding indicates viable tissue.

• In burn care, mechanical debridement uses scissors/forceps during hydrotherapy; indicated in chronic osteomyelitis if significant bone removal is necessary.

Inhalation Injury Potential

• High potential for inhalation injury occurs with burns in enclosed spaces.

• Critical findings for impending loss of airway: Hoarseness, brassy cough, drooling/difficulty swallowing, audible wheezing, crowing, stridor.

• Signs include singed nasal hair/eyebrows/eyelashes and sooty sputum.

Hyperbaric Oxygen Therapy

• Utilized in managing chronic cases of osteomyelitis to promote healing.

Identifying Skin Infections

• Skin infections identified by causative organism and appearance:

  • Bacterial (e.g., Cellulitis): Lesions can be pustules, papules, or nodules, erythematous, edematous, painful, and warm; may report fever, malaise, chills.

  • Viral (e.g., Herpes): Presents vesicular lesions progressing to pustules that ulcerate/crust; may report itching, pain, stinging.

  • Fungal (e.g., Candidiasis): May report itching/burning; oral candidiasis presents as white plaques on oral mucosa.

Pressure Injury Healing

• Detailed information on evaluation or healing process for pressure injuries is not provided.

Skin Infection Risk

• Skin infection risk factors include:

  • Immunosuppression from disease (e.g., HIV) or treatment (e.g., long-term glucocorticoids for Cushing’s syndrome).

  • Skin breaks from scratching in dermatitis increase bacterial infection risk.

  • Aseptic technique during wound care is essential for prevention.

Smoking's Impact on Wound Healing

• Specific physiological impact of smoking on wound healing is not detailed in the provided sources.