MED SURG FINAL REVIEW
WHAT IS THE FIRST AREA YOU ASSESS WHEN A PATIENT HAS An ULNAR OR TIBIA FX. -
NEUROVASCULAR STATUS- PEDAL PULSE AND TINGLING
NG TUBE USE- INTESTINAL OBSTRUCTION- (USED FOR DECOMPRESSION)
GASTRIC LAVAGE FOR GI BLEEDS- NEED LARGE BORE NG TUBE.
SCLERODERMA IMPACT ON BODY? Translates to “Hardening of the skin.” A GROUP OF DISEASES
THAT EFFECT THE BODY’S CONNECTIVE TISSUE, WHICH SUPPORTS THE SKIN AND INTERNAL
ORGANS (HEART, LUNGS, AND KIDNEYS). CAN DAMAGE BLOOD VESSELS. S/S arthralgia aka joint
pain, Raynaud’s syndrome, pitting edema in hands. Basically, hardening of skin on extremities or
internal organs- if the heart then pt has arrythmias, lungs=dyspnea, kidney=hypertension. Gi
dysfunction- acid reflux, difficulty swallowing/dysphagia.
TRACTION- WHEN CAN A NURSE REMOVE SKELATAL TRACTION
LIFE THREATENING
CPR
CARPAL TUNNEL COMPRESSION- OF THE MEDIAN NERVE. IN THE WRIST FROM SWOLLEN OR
THICKENED SYNOVIAN, CAUSING PAIN AND NUMBNESS.
HEALTH PROMOTION
TAKE FREQUENT BREAKS FROM REPETIVE MOTIONS
REST THE WRIST, FINGERS AND STRETCH THEM
PREVENT STRESS INJURIES
RISK FACTORS
METOBOLIC AND CONNECTIVE TISSUES DISEASE (DM- (REDUCED CIRCULATION)
RA)
REPETITIVE STRESS
REPETIVE SPORTS INJURIES
GROWTH OF LESIONS
HANDHELD DEVICES
FINDINGS
PAIN OFTEN WORSE AT NIGHT
PARATHESIS
PHALENS MANUEUVER (POSITIVE IN MOST PATIENTS WITH CARPAL TUNNEL) ASK CLIENT
TO PLACE THE BACK OF THEIR HANDS TOGETHER AND FLEX BOTH WRIST AT THE SAME
TIME.
TINEL’S SIGN: TAP LIGHTLY OVER THE MEDIAN NERVE AREA OF THE WRIST/ A POSITIVE
RESULTT IN THE MEDIAN NERVE DISTRIBUTION (PALMER SIDE THUMB, INDEX, MIDDLE
AND HALF RING FINGER).
NURSING CARE
MEDICATION THERAPY (NASIDS FOR RELIEFT OF PAIN AND INFLAMMATION,
CORTICOSTEROIDS INJECTIONS
, SPLINTS OR BRACES TO IMMOBOLIZE THE WRIST
LASER OR ULTRASOUND THERAPY
EXECRICISE/YOGA
SURGERY CAN RELIEFT THE PRESSURE BY DECOMPRESSING THE PRESSURE ON THE
NERVE.
POST SURGERY
ELEVATE HAND ABOVE HEART
MONITOR V/S
MONITORO NEUROVASCULAR STATUS
PAIN MEDS
ASSIST CLIENT WITH CARE
CLIENT EDUCATION
HAND MOVEMENT AND HEAVY LIFTING MAY BE RESTRICTED 4 TO 6 WEEKS
EXPECT WEAKNESS AND DISCOMFORT FOR WEEKS OR MONTHS
REPORT ANY CHANGES IN NEUROVACULAR STATUS INCLUDING INCREASE PAIN TO
SURGEON IMMEDIATELY
MUSCLOSKELETAL
OSTEOARTHRISTIS- PROGRESSIVE DEGENERATIVE DETERIORATION AND LOSS OF CARTILAGE I
ONE OR MORE JOINTS.
RISK FX.
AGING
FEMALE
METABOLIC DISEASE
OBESITY
SMOKING
REPETITIVE USE OR ABUSE OF JOINTS
SIGNS AND SYMTOMS
CHRONIC JOINT PAIN AND STIFFNESS
PAIN DIMINISHED AFTER REST AND WORSEN AFTER ACTIVITY
CREPTIUS
LIMITED MOVEMENT
HERBERDENS NODES (CLOSEST TO THE END OF FINGERS
BOUCHARDS NODES (MIDDLE JOINTS OF FINGERS AND TOES)
EXCESSIVE JOINT FLUID
SKELETAL MUSCLE ATROPHY FROM DISEASE
TREATMENT:
ASPIRIN/ NSAIDS-COUMADIN CONTRAINDICTED DUE TO INCREASE RISK OF BLEEDING
ASPIRIN TOXICITY S/S- TINITUS (RINGING/ BUSING IN THE EAR
NSAIDS
CORTICOSTEROIDS
TOPICAL ANALGESICS
, SUPPLEMENTS (GLUCOSAMINE, CHONDROITIN SULFATE/0
THERAPUETIC MEASURES
TOTAL JOINT ATHROPLASTY
TOTAL JOINT REPLACEMENT
CLIENT EDUCATION
USE. OF ASSISTIVE DEVICES AND SAFETY
PREVENT COMPLICATIONS
EXCERCISE PER TREATMENT PLAN
ANTHROPLASTY-SURGICAL REMOVAL OF A DISEASE JOINT DUE TO OSTEOARTHRITIS
OSTEONECROSIS, RHEUMATOID ARTHRITIS, TRAUMA, OR CONGENITAL ABNORMALIES AND
REPLACEMENT WITH PROSTHETICS OR ARTIFICIAL COMPONENTS MADE OF METAL AND OR
PLASTIC
PUT IN ORDER?
HEMI ARTHROPLASTY- HALF OF A JOINT REPLACEMENT. Used to treat Fractured Hip- replaces
half the Hip. Pillow in between legs for Abduction--keeping legs apart.
Monitor for infection, increase redness, swelling
ENDOCRINE SYSTEM
Posterior Pituitary ADH
DIABETES INSIPIDUS decrease ADH
S&S: anorexia. diluted urine, polydipsia, decrease bp, increase HCT, BUN, hypernatremia, at
risk for dehydration
NS care:
I&O, monitor for s/s of dehydration, instruct client avoid food or drink that promote diuresis
Tx: Desmopressin; take initial dose in the evening and report nocturia which
will require increase dose
SIADH: Increase ADH, caused by tumor in brain, cancer, medications,
injury, stroke, TB, hemorrhage.
S&S: FLUID VOLUME EXCESS, tachycardic, confusion secondary to hyponatremia
THYROID GLAND butterfly shape
Pituitary thyroid axis: regulate metabolism, regulate growth and reproduction, responds to
stress
TRH: injury to hypothalamus.
TSH: anterior pituitary gland, blood test determines how thyroid is
functioning
T3/t4: thyroid gland
WHAT IS THE FIRST AREA YOU ASSESS WHEN A PATIENT HAS An ULNAR OR TIBIA FX. -
NEUROVASCULAR STATUS- PEDAL PULSE AND TINGLING
NG TUBE USE- INTESTINAL OBSTRUCTION- (USED FOR DECOMPRESSION)
GASTRIC LAVAGE FOR GI BLEEDS- NEED LARGE BORE NG TUBE.
SCLERODERMA IMPACT ON BODY? Translates to “Hardening of the skin.” A GROUP OF DISEASES
THAT EFFECT THE BODY’S CONNECTIVE TISSUE, WHICH SUPPORTS THE SKIN AND INTERNAL
ORGANS (HEART, LUNGS, AND KIDNEYS). CAN DAMAGE BLOOD VESSELS. S/S arthralgia aka joint
pain, Raynaud’s syndrome, pitting edema in hands. Basically, hardening of skin on extremities or
internal organs- if the heart then pt has arrythmias, lungs=dyspnea, kidney=hypertension. Gi
dysfunction- acid reflux, difficulty swallowing/dysphagia.
TRACTION- WHEN CAN A NURSE REMOVE SKELATAL TRACTION
LIFE THREATENING
CPR
CARPAL TUNNEL COMPRESSION- OF THE MEDIAN NERVE. IN THE WRIST FROM SWOLLEN OR
THICKENED SYNOVIAN, CAUSING PAIN AND NUMBNESS.
HEALTH PROMOTION
TAKE FREQUENT BREAKS FROM REPETIVE MOTIONS
REST THE WRIST, FINGERS AND STRETCH THEM
PREVENT STRESS INJURIES
RISK FACTORS
METOBOLIC AND CONNECTIVE TISSUES DISEASE (DM- (REDUCED CIRCULATION)
RA)
REPETITIVE STRESS
REPETIVE SPORTS INJURIES
GROWTH OF LESIONS
HANDHELD DEVICES
FINDINGS
PAIN OFTEN WORSE AT NIGHT
PARATHESIS
PHALENS MANUEUVER (POSITIVE IN MOST PATIENTS WITH CARPAL TUNNEL) ASK CLIENT
TO PLACE THE BACK OF THEIR HANDS TOGETHER AND FLEX BOTH WRIST AT THE SAME
TIME.
TINEL’S SIGN: TAP LIGHTLY OVER THE MEDIAN NERVE AREA OF THE WRIST/ A POSITIVE
RESULTT IN THE MEDIAN NERVE DISTRIBUTION (PALMER SIDE THUMB, INDEX, MIDDLE
AND HALF RING FINGER).
NURSING CARE
MEDICATION THERAPY (NASIDS FOR RELIEFT OF PAIN AND INFLAMMATION,
CORTICOSTEROIDS INJECTIONS
, SPLINTS OR BRACES TO IMMOBOLIZE THE WRIST
LASER OR ULTRASOUND THERAPY
EXECRICISE/YOGA
SURGERY CAN RELIEFT THE PRESSURE BY DECOMPRESSING THE PRESSURE ON THE
NERVE.
POST SURGERY
ELEVATE HAND ABOVE HEART
MONITOR V/S
MONITORO NEUROVASCULAR STATUS
PAIN MEDS
ASSIST CLIENT WITH CARE
CLIENT EDUCATION
HAND MOVEMENT AND HEAVY LIFTING MAY BE RESTRICTED 4 TO 6 WEEKS
EXPECT WEAKNESS AND DISCOMFORT FOR WEEKS OR MONTHS
REPORT ANY CHANGES IN NEUROVACULAR STATUS INCLUDING INCREASE PAIN TO
SURGEON IMMEDIATELY
MUSCLOSKELETAL
OSTEOARTHRISTIS- PROGRESSIVE DEGENERATIVE DETERIORATION AND LOSS OF CARTILAGE I
ONE OR MORE JOINTS.
RISK FX.
AGING
FEMALE
METABOLIC DISEASE
OBESITY
SMOKING
REPETITIVE USE OR ABUSE OF JOINTS
SIGNS AND SYMTOMS
CHRONIC JOINT PAIN AND STIFFNESS
PAIN DIMINISHED AFTER REST AND WORSEN AFTER ACTIVITY
CREPTIUS
LIMITED MOVEMENT
HERBERDENS NODES (CLOSEST TO THE END OF FINGERS
BOUCHARDS NODES (MIDDLE JOINTS OF FINGERS AND TOES)
EXCESSIVE JOINT FLUID
SKELETAL MUSCLE ATROPHY FROM DISEASE
TREATMENT:
ASPIRIN/ NSAIDS-COUMADIN CONTRAINDICTED DUE TO INCREASE RISK OF BLEEDING
ASPIRIN TOXICITY S/S- TINITUS (RINGING/ BUSING IN THE EAR
NSAIDS
CORTICOSTEROIDS
TOPICAL ANALGESICS
, SUPPLEMENTS (GLUCOSAMINE, CHONDROITIN SULFATE/0
THERAPUETIC MEASURES
TOTAL JOINT ATHROPLASTY
TOTAL JOINT REPLACEMENT
CLIENT EDUCATION
USE. OF ASSISTIVE DEVICES AND SAFETY
PREVENT COMPLICATIONS
EXCERCISE PER TREATMENT PLAN
ANTHROPLASTY-SURGICAL REMOVAL OF A DISEASE JOINT DUE TO OSTEOARTHRITIS
OSTEONECROSIS, RHEUMATOID ARTHRITIS, TRAUMA, OR CONGENITAL ABNORMALIES AND
REPLACEMENT WITH PROSTHETICS OR ARTIFICIAL COMPONENTS MADE OF METAL AND OR
PLASTIC
PUT IN ORDER?
HEMI ARTHROPLASTY- HALF OF A JOINT REPLACEMENT. Used to treat Fractured Hip- replaces
half the Hip. Pillow in between legs for Abduction--keeping legs apart.
Monitor for infection, increase redness, swelling
ENDOCRINE SYSTEM
Posterior Pituitary ADH
DIABETES INSIPIDUS decrease ADH
S&S: anorexia. diluted urine, polydipsia, decrease bp, increase HCT, BUN, hypernatremia, at
risk for dehydration
NS care:
I&O, monitor for s/s of dehydration, instruct client avoid food or drink that promote diuresis
Tx: Desmopressin; take initial dose in the evening and report nocturia which
will require increase dose
SIADH: Increase ADH, caused by tumor in brain, cancer, medications,
injury, stroke, TB, hemorrhage.
S&S: FLUID VOLUME EXCESS, tachycardic, confusion secondary to hyponatremia
THYROID GLAND butterfly shape
Pituitary thyroid axis: regulate metabolism, regulate growth and reproduction, responds to
stress
TRH: injury to hypothalamus.
TSH: anterior pituitary gland, blood test determines how thyroid is
functioning
T3/t4: thyroid gland
