HESI STUDY GUIDE ACUTE CARE
NURSING
Acute Kidney Injury
Acute Pancreatitis - Care
1. Withhold food and fluid during acute period and maintain hydration with IV fluids
2. Administer TPN for severe nutritional depletion
3. Administer supplemental vitamins and minerals to increase caloric intake
4. NG tube to suction for patient with biliary obstruction, vomiting, or paralytic ileus
5. Administer opiates for pain
6. Administer H2-receptor antagonist or proton pump inhibitors as prescribed to decrease
hydrochloric acid production and prevent activation of pancreatic enzymes
7. Instruct client to avoid alcohol, caffeine, and fatty and spicy foods
8. Stress the importance of follow-up appointments
9. Instruct client to notify HCP if acute abdominal pain, jaundice, clay-colored stools, or
dark colored urine
10. Monitor for neuromuscular manifestations of hypocalcemia (tetany, muscle
twitching, grimacing, seizure, altered deep tendon reflexes and spasms)
11. Place patient in semi-Fowler’s position to decrease pressure on the diaphragm (sitting up
or leaning forward helps reduce pain)
12. Encourage the client to cough and deep breathe, and/or use incentive spirometry
13. Monitor for dysrhythmias related to electrolyte imbalance
Addison’s Disease
1. Autoimmune disorder commonly found in conjunction with other autoimmune endocrine
disorder, a primary disorder, hypofunction of the adrenal cortex
2. Sudden withdrawal from corticosteroids may precipitate symptoms of Addison’s
disease (patients should be cautioned against stopping steroids suddenly, they must be
tapered off slowly)
3. Characterized by lack of cortisol aldosterone, and androgens
4. Definitive diagnosis made using an ACTH stimulation test
5. If ACTH production by the anterior pituitary gland has failed, it is considered
secondary disease
6. Requires lifelong replacement of glucocorticoids and possibly mineralocorticoids if
significant hyposecretion occurs; the condition is fatal if left untreated
7. Patients taking exogenous corticosteroids must establish a plan with their HCPs for
increasing corticosteroids during times of stress
Addison’s Crisis
1. A life-threatening disorder caused by acute adrenal insufficiency
2. Precipitated by stress, infection, trauma, surgery, abrupt withdrawal from corticosteroid
use, or decreased salt intake
3. Can cause hyponatremia, hyperkalemia, hypoglycemia, and shock
1
,4. S/S – severe headache, severe abdominal pain, leg and lower back pain, generalized weakness,
irritability and confusion, severe hypotension, shock
5. Treatment - prepare to administer glucocorticoids IV; IV fluids to replace fluids and
restore electrolyte imbalance; following resolution of the crisis administer oral glucocorticoid
and mineralocorticoid; monitor vitals and urine output; monitor neurological status especially
irritability and confusion; monitor lab values especially Na, K, Glucose; protect patient for
infection; maintain bedrest and provide a quiet environment
AED Use
Allergic Rhinitis
ALS - priority finding
Aneurysm findings – action
Angina - exercise
1. Occurs when oxygen supply is insufficient to meet demand
2. Often precipitated by exercise
Angiogram- difficulty
swallowing
Antiviral – shingles
1. Caused by a reactivation of the varicella-zoster virus, can occur during any
immunocompromised state in a patient with history of chickenpox
2. Antivirals are often used to treat shingles
Assess 1st- appendicitis
1. Monitor for signs of peritonitis:
a. guarding of abdomen
b. fever and chills
c. pallor
d. progressive abdominal distention and pain
e. Restlessness
f. Tachycardia and tachypnea
Asthma acute findings
Symptoms of hypoxia
a. early – restlessness, anxiety, tachycardia, tachypnea, decreased oxygen saturation
b. late – bradycardia, extreme restlessness, severe dyspnea, cyanosis respiratory acidosis
Asthma – exercise and steroid inhaler
Encourage patient to have inhaler on hand and may need to use prior to exercise
Autonomic Dysreflexia
2
, 1. Generally occurs after a period of spinal shock is resolved and occurs with lesions or injuries
above T6 and in cervical lesions
2. Commonly caused by visceral distention from a distended bladder or impacted
rectum (constipation)
3. Neurological emergency that must be treated immediately to prevent a hypertensive stroke
4. Signs and Symptoms:
a. sudden onset of severe, throbbing headache
b. severe hypertension and bradycardia
c. flushing above the level of the injury
d. pale extremities below the level of the injury
e. nasal stuffiness
f. nausea
g. dilated pupils or blurred vision
h. sweating
I. piloerection (goose bumps)
j. restlessness and apprehension
BPH signs and symptoms
1. diminished size and force of urinary stream (early sign)
2. urinary urgency and frequency
3. nocturia
4. inability to start (hesitancy) or continue urine stream
5. feelings of incomplete bladder emptying
6. post-void dribbling from overflow incontinence (late sign)
7. urinary retention and bladder distention
8. hematuria
9. urinary stasis and UTIs
10. dysuria and bladder pain
Bariatric surgery – abdominal pain
Post-op abdominal pain, nausea, and vomiting may indicate a gastric leak
Bariatric surgery- postop diet
Bone pain management
Breast cancer detection
Breast engorgement relief
Bucks Traction
Nurses must be vigilant in assessing for subtle neurovascular changes in these patients (Turney,
Noble, & Kim, 2013). The “6 Ps” indicative of symptoms of neurovascular compromise
3
NURSING
Acute Kidney Injury
Acute Pancreatitis - Care
1. Withhold food and fluid during acute period and maintain hydration with IV fluids
2. Administer TPN for severe nutritional depletion
3. Administer supplemental vitamins and minerals to increase caloric intake
4. NG tube to suction for patient with biliary obstruction, vomiting, or paralytic ileus
5. Administer opiates for pain
6. Administer H2-receptor antagonist or proton pump inhibitors as prescribed to decrease
hydrochloric acid production and prevent activation of pancreatic enzymes
7. Instruct client to avoid alcohol, caffeine, and fatty and spicy foods
8. Stress the importance of follow-up appointments
9. Instruct client to notify HCP if acute abdominal pain, jaundice, clay-colored stools, or
dark colored urine
10. Monitor for neuromuscular manifestations of hypocalcemia (tetany, muscle
twitching, grimacing, seizure, altered deep tendon reflexes and spasms)
11. Place patient in semi-Fowler’s position to decrease pressure on the diaphragm (sitting up
or leaning forward helps reduce pain)
12. Encourage the client to cough and deep breathe, and/or use incentive spirometry
13. Monitor for dysrhythmias related to electrolyte imbalance
Addison’s Disease
1. Autoimmune disorder commonly found in conjunction with other autoimmune endocrine
disorder, a primary disorder, hypofunction of the adrenal cortex
2. Sudden withdrawal from corticosteroids may precipitate symptoms of Addison’s
disease (patients should be cautioned against stopping steroids suddenly, they must be
tapered off slowly)
3. Characterized by lack of cortisol aldosterone, and androgens
4. Definitive diagnosis made using an ACTH stimulation test
5. If ACTH production by the anterior pituitary gland has failed, it is considered
secondary disease
6. Requires lifelong replacement of glucocorticoids and possibly mineralocorticoids if
significant hyposecretion occurs; the condition is fatal if left untreated
7. Patients taking exogenous corticosteroids must establish a plan with their HCPs for
increasing corticosteroids during times of stress
Addison’s Crisis
1. A life-threatening disorder caused by acute adrenal insufficiency
2. Precipitated by stress, infection, trauma, surgery, abrupt withdrawal from corticosteroid
use, or decreased salt intake
3. Can cause hyponatremia, hyperkalemia, hypoglycemia, and shock
1
,4. S/S – severe headache, severe abdominal pain, leg and lower back pain, generalized weakness,
irritability and confusion, severe hypotension, shock
5. Treatment - prepare to administer glucocorticoids IV; IV fluids to replace fluids and
restore electrolyte imbalance; following resolution of the crisis administer oral glucocorticoid
and mineralocorticoid; monitor vitals and urine output; monitor neurological status especially
irritability and confusion; monitor lab values especially Na, K, Glucose; protect patient for
infection; maintain bedrest and provide a quiet environment
AED Use
Allergic Rhinitis
ALS - priority finding
Aneurysm findings – action
Angina - exercise
1. Occurs when oxygen supply is insufficient to meet demand
2. Often precipitated by exercise
Angiogram- difficulty
swallowing
Antiviral – shingles
1. Caused by a reactivation of the varicella-zoster virus, can occur during any
immunocompromised state in a patient with history of chickenpox
2. Antivirals are often used to treat shingles
Assess 1st- appendicitis
1. Monitor for signs of peritonitis:
a. guarding of abdomen
b. fever and chills
c. pallor
d. progressive abdominal distention and pain
e. Restlessness
f. Tachycardia and tachypnea
Asthma acute findings
Symptoms of hypoxia
a. early – restlessness, anxiety, tachycardia, tachypnea, decreased oxygen saturation
b. late – bradycardia, extreme restlessness, severe dyspnea, cyanosis respiratory acidosis
Asthma – exercise and steroid inhaler
Encourage patient to have inhaler on hand and may need to use prior to exercise
Autonomic Dysreflexia
2
, 1. Generally occurs after a period of spinal shock is resolved and occurs with lesions or injuries
above T6 and in cervical lesions
2. Commonly caused by visceral distention from a distended bladder or impacted
rectum (constipation)
3. Neurological emergency that must be treated immediately to prevent a hypertensive stroke
4. Signs and Symptoms:
a. sudden onset of severe, throbbing headache
b. severe hypertension and bradycardia
c. flushing above the level of the injury
d. pale extremities below the level of the injury
e. nasal stuffiness
f. nausea
g. dilated pupils or blurred vision
h. sweating
I. piloerection (goose bumps)
j. restlessness and apprehension
BPH signs and symptoms
1. diminished size and force of urinary stream (early sign)
2. urinary urgency and frequency
3. nocturia
4. inability to start (hesitancy) or continue urine stream
5. feelings of incomplete bladder emptying
6. post-void dribbling from overflow incontinence (late sign)
7. urinary retention and bladder distention
8. hematuria
9. urinary stasis and UTIs
10. dysuria and bladder pain
Bariatric surgery – abdominal pain
Post-op abdominal pain, nausea, and vomiting may indicate a gastric leak
Bariatric surgery- postop diet
Bone pain management
Breast cancer detection
Breast engorgement relief
Bucks Traction
Nurses must be vigilant in assessing for subtle neurovascular changes in these patients (Turney,
Noble, & Kim, 2013). The “6 Ps” indicative of symptoms of neurovascular compromise
3
