Med surg
Med surg ATI (study guide; latest Fall 2020, A+ help
TREATMENT
● Stop the infusion and remove the catheter.
● Elevate the extre mity.
● Encourage active range of motion.
● Apply a warm or cold compress depending on the solution infusing.
● Restart the infusion proximal to the site or in another e xtre mity.
Phlebitis or thrombophlebitis
Edema; throbbing, burning, or pain at the site;
increased skin temperature; erythema; a red line
up the arm with a palpable band at the vein site;
slowed rate of infusion TREATMENT
● Promptly discontinue the infusion and remove the catheter.
● Elevate the extre mity.
● Apply warm compresses three to four times/day.
● Restart the infusion in a different vein proximal to the site or in another e xtre mity.
● Obtain a specimen for culture at the site and prepare the catheter for culture if drainage is present.
• Pathophysiology - (2)
o Polycystic Kidney Disease, Acute Kidney Injury and Chronic Kidney Disease: Clinical Manifestations of
Nephrotic Syndrome (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 59)
AKI
● CARDIOVA SCULAR: fluid overload (dependent and generalized edema), dysrhythmia (hyperkalemia)
● RESPIRATORY: crackles, decreased o xygenation, shortness of breath
● RENAL: scant to normal or excessive urine output, depending on the phase; possible hematuria
● NEUROLOGICAL: lethargy, muscle twitching, seizures
● INTEGUMENTARY: dry skin and mucous membranes
CKD
• NEUROLOGIC: lethargy, decreased attention span, slurred speech, tremors or jerky movements,
ataxia, seizures, coma
• CARDIOVA SCULAR: fluid overload (jugular distention; sacrum, ocular, or peripheral edema), hypertension,
dysrhythmias, heart failure, orthostatic hypotension, peaked T wave on ECG (hyperkalemia)
• RESPIRATORY: uremic halitosis with deep sighing, yawning, shortness of breath, tachypnea,
hyperpnea, Kussmaul respirations, crackles, pleural frict ion rub, frothy pink sputum
• HEMATOLOGIC: anemia (pallor, weakness, dizziness), ecchymoses, petechiae, melena
• GA STROINTESTINAL: ulcers in mouth and throat, foul breath, blood in stools, vomiting
• MUSCULOSKELETAL: osteodystrophy (thin fragile bones)
• RENAL: urine contains protein, blood, particles; change in the amount, color, concentration
• SKIN: decreased skin turgor, yellow cast to skin, dry, pruritus, urea crystal on skin (uremic frost)
• REPRODUCTIVE: erectile dysfunction
o Parkinson’s Disease: Teaching About Pathophysiology (Active Learning Template - System Disorder, RM
AMS RN 10.0 Chp 7)
▪ Parkinson’s disease (PD) is a progressively debilitating disease that grossly affects motor function.
▪ Symptoms: tremor, muscle rig idity, bradykinesia (slow movement), and postural instability.
,Med surg
Med surg ATI (study guide; latest Fall 2020, A+ help
Treatment of PD focuses on increasing the amount of dopamine or decreasing the amount of
acetylcholine in a client’s brain
Health Promotion/ Disease Prevention - (1)
Heart Failure and Pulmonary Edema: Instructions for Home Care (Active Learning Template - System
Disorder, RM AMS RN 10.0 Chp 32)
Instruct the client on a low-sodium diet and flu id restriction
The client should measure weight daily at the same time. Notify the provider of a gain of more
than 2 lb in 1 day or 5 lb in 1 week
Instruct the client to report swelling of feet or ankles or any shortness of breath or angina
Maintain an e xerc ise routine to remain physically active, and consult with the provider before
starting any exe rcise regimen
Refrain from s moking
Health Screening - (1)
Middle and Inner Ear Disorders: Risk Factors for Hearing Loss (Active Learning Template - System
Disorder, RM AMS RN 10.0 Chp 13)
Middle ear disorders
● Recurrent colds and otitis media
● Enlarged adenoids
● Trauma
● Changes in air pressure (scuba diving, fly ing)
Inner ear disorders
● Viral or bacterial infection
● Damage due to ototoxic medications
Mobility/ Immobility - (1)
Mobility and Immobility: Complications of Immobility (Active Learning Template - Basic Concept, RM
FUND RN 9.0 Ch 40)
Temporary, such as following knee arthroplasty
Permanent, such as paraplegia
Sudden onset, such as a fractured arm and leg following a motor-vehicle crash
Slow onset, such as multiple sclerosis
Complications
Thrombophlebitis and deep-vein thrombosis
MANIFESTATIONS: Pain, edema, warmth, and erythema at the site
Nursing action:
Notify DR
Elevate leg
Give anticoag
pulmonary embolism
MANIFESTATIONS: Shortness of breath, chest pain, hemoptysis (coughing up
blood), decreased blood pressure, and rapid pulse
Nursing action:
Prepare to obtain blood gas analysis.
Pulse ox and give o xygen
Give anticoag or thrombolytic
Position in high fowler
, Med surg
Med surg ATI (study guide; latest Fall 2020, A+ help
• Nutrition and Oral Hydration - (1)
o Polycystic Kidney Disease, Acute Kidney Injury and Chronic Kidney Disease: Evaluating
Teaching About Nutrition (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp
59)
▪ Drink at least 2 L daily
▪ Stop smoking
▪ High-protein diet to replace the high rate of protein breakdown due to stress from
the illness. Possible total parenteral nutrition (TPN)
▪ Implement potassium, phosphate, sodium, and magnesium restrictions (depending
on stage of injury)
• Adverse Effec ts/Contraindications/Side Effects/Interactions - (1)
o Pulmonary Embolism: Planning Care for a Client Who Is Receiving Eno xaparin (Active Learning
Template
- Medication, RM AMS RN 10.0 Chp 24)
▪ Assess for contraindications (active bleeding, peptic ulcer disease, history of
stroke, recent trauma).
▪ Monitor bleeding times: Prothrombin t ime (PT) and international normalized rat io
(INR) for warfarin, partial thromboplastin time (a PTT) for heparin, and complete
blood count (CBC).
▪ Monitor for side effects of anticoagulants (e.g., thrombocytopenia, anemia, hemorrhage).
• Blood and Blood Products - (1)
o Blood and Blood Product Transfusions: Administering Packed RBCs to an Older Adult
Client (Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 40)
▪ No larger than a 19-gauge needle is used
▪ Assess kidney function, flu id status, and circulation prior to blood product
administration. Older adult patient are at an increased risk for fluid overload
▪ Use blood products that are less than 1 week old.
▪ Assess vital signs every 15 min throughout the transfusion for flu id overload
▪ Administer the blood transfusion over 2 to 4 hr for older adult clients.
▪ Without giving other IV fluid to prevent fluid overload
▪ Risk for HF and flu id overload= cardiac and renal dysfunction Pt
• Central Venous Access Devices - (1)
o Cardiovascular Diagnostic and Therapeutic Procedures: Teaching About Care of a
Peripherally Inserted Central Catheter (Active Learning Template - Nursing Skill, RM AMS
RN 10.0 Chp 27)
▪ Clean the insertion port with alcohol for 15 seconds and allowing it to dry completely prior
to
accessing it. Va lve disinfection caps which contain alcohol are available for single use.
▪ dressing changes, usually every 7 days and when indicated (wet, loose, soiled).
▪ Use transparent dressing to allow for visualization.
▪ Educate the client not to have venipuncture or blood pressure taken in arm with PICC line
▪ Advise the client not to immerse his arm in water. To shower, cover dressing site to
avoid water e xposure
▪ Flush with 5 mL heparin (10 units/mL) when the PICC is not actively in use.
▪ Flush w/ 10 cc 0.9% NS before, between, and after meds
▪ Flush w/ 20 cc 0.9% NS after blood draw
• Medication Administration - (1)
o Hypertension: Client Education About Beta Blockade Agents (Active Learning Template -
Medication, RM AMS RN 10.0 Chp 36)
▪ can cause fatigue, weakness, depression, and sexual dysfunction
▪ Stopping suddenly can cause rebound hypertension
▪ Teach the client manifestations of hypoglycemia that do not include tachycardia
Med surg ATI (study guide; latest Fall 2020, A+ help
TREATMENT
● Stop the infusion and remove the catheter.
● Elevate the extre mity.
● Encourage active range of motion.
● Apply a warm or cold compress depending on the solution infusing.
● Restart the infusion proximal to the site or in another e xtre mity.
Phlebitis or thrombophlebitis
Edema; throbbing, burning, or pain at the site;
increased skin temperature; erythema; a red line
up the arm with a palpable band at the vein site;
slowed rate of infusion TREATMENT
● Promptly discontinue the infusion and remove the catheter.
● Elevate the extre mity.
● Apply warm compresses three to four times/day.
● Restart the infusion in a different vein proximal to the site or in another e xtre mity.
● Obtain a specimen for culture at the site and prepare the catheter for culture if drainage is present.
• Pathophysiology - (2)
o Polycystic Kidney Disease, Acute Kidney Injury and Chronic Kidney Disease: Clinical Manifestations of
Nephrotic Syndrome (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 59)
AKI
● CARDIOVA SCULAR: fluid overload (dependent and generalized edema), dysrhythmia (hyperkalemia)
● RESPIRATORY: crackles, decreased o xygenation, shortness of breath
● RENAL: scant to normal or excessive urine output, depending on the phase; possible hematuria
● NEUROLOGICAL: lethargy, muscle twitching, seizures
● INTEGUMENTARY: dry skin and mucous membranes
CKD
• NEUROLOGIC: lethargy, decreased attention span, slurred speech, tremors or jerky movements,
ataxia, seizures, coma
• CARDIOVA SCULAR: fluid overload (jugular distention; sacrum, ocular, or peripheral edema), hypertension,
dysrhythmias, heart failure, orthostatic hypotension, peaked T wave on ECG (hyperkalemia)
• RESPIRATORY: uremic halitosis with deep sighing, yawning, shortness of breath, tachypnea,
hyperpnea, Kussmaul respirations, crackles, pleural frict ion rub, frothy pink sputum
• HEMATOLOGIC: anemia (pallor, weakness, dizziness), ecchymoses, petechiae, melena
• GA STROINTESTINAL: ulcers in mouth and throat, foul breath, blood in stools, vomiting
• MUSCULOSKELETAL: osteodystrophy (thin fragile bones)
• RENAL: urine contains protein, blood, particles; change in the amount, color, concentration
• SKIN: decreased skin turgor, yellow cast to skin, dry, pruritus, urea crystal on skin (uremic frost)
• REPRODUCTIVE: erectile dysfunction
o Parkinson’s Disease: Teaching About Pathophysiology (Active Learning Template - System Disorder, RM
AMS RN 10.0 Chp 7)
▪ Parkinson’s disease (PD) is a progressively debilitating disease that grossly affects motor function.
▪ Symptoms: tremor, muscle rig idity, bradykinesia (slow movement), and postural instability.
,Med surg
Med surg ATI (study guide; latest Fall 2020, A+ help
Treatment of PD focuses on increasing the amount of dopamine or decreasing the amount of
acetylcholine in a client’s brain
Health Promotion/ Disease Prevention - (1)
Heart Failure and Pulmonary Edema: Instructions for Home Care (Active Learning Template - System
Disorder, RM AMS RN 10.0 Chp 32)
Instruct the client on a low-sodium diet and flu id restriction
The client should measure weight daily at the same time. Notify the provider of a gain of more
than 2 lb in 1 day or 5 lb in 1 week
Instruct the client to report swelling of feet or ankles or any shortness of breath or angina
Maintain an e xerc ise routine to remain physically active, and consult with the provider before
starting any exe rcise regimen
Refrain from s moking
Health Screening - (1)
Middle and Inner Ear Disorders: Risk Factors for Hearing Loss (Active Learning Template - System
Disorder, RM AMS RN 10.0 Chp 13)
Middle ear disorders
● Recurrent colds and otitis media
● Enlarged adenoids
● Trauma
● Changes in air pressure (scuba diving, fly ing)
Inner ear disorders
● Viral or bacterial infection
● Damage due to ototoxic medications
Mobility/ Immobility - (1)
Mobility and Immobility: Complications of Immobility (Active Learning Template - Basic Concept, RM
FUND RN 9.0 Ch 40)
Temporary, such as following knee arthroplasty
Permanent, such as paraplegia
Sudden onset, such as a fractured arm and leg following a motor-vehicle crash
Slow onset, such as multiple sclerosis
Complications
Thrombophlebitis and deep-vein thrombosis
MANIFESTATIONS: Pain, edema, warmth, and erythema at the site
Nursing action:
Notify DR
Elevate leg
Give anticoag
pulmonary embolism
MANIFESTATIONS: Shortness of breath, chest pain, hemoptysis (coughing up
blood), decreased blood pressure, and rapid pulse
Nursing action:
Prepare to obtain blood gas analysis.
Pulse ox and give o xygen
Give anticoag or thrombolytic
Position in high fowler
, Med surg
Med surg ATI (study guide; latest Fall 2020, A+ help
• Nutrition and Oral Hydration - (1)
o Polycystic Kidney Disease, Acute Kidney Injury and Chronic Kidney Disease: Evaluating
Teaching About Nutrition (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp
59)
▪ Drink at least 2 L daily
▪ Stop smoking
▪ High-protein diet to replace the high rate of protein breakdown due to stress from
the illness. Possible total parenteral nutrition (TPN)
▪ Implement potassium, phosphate, sodium, and magnesium restrictions (depending
on stage of injury)
• Adverse Effec ts/Contraindications/Side Effects/Interactions - (1)
o Pulmonary Embolism: Planning Care for a Client Who Is Receiving Eno xaparin (Active Learning
Template
- Medication, RM AMS RN 10.0 Chp 24)
▪ Assess for contraindications (active bleeding, peptic ulcer disease, history of
stroke, recent trauma).
▪ Monitor bleeding times: Prothrombin t ime (PT) and international normalized rat io
(INR) for warfarin, partial thromboplastin time (a PTT) for heparin, and complete
blood count (CBC).
▪ Monitor for side effects of anticoagulants (e.g., thrombocytopenia, anemia, hemorrhage).
• Blood and Blood Products - (1)
o Blood and Blood Product Transfusions: Administering Packed RBCs to an Older Adult
Client (Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 40)
▪ No larger than a 19-gauge needle is used
▪ Assess kidney function, flu id status, and circulation prior to blood product
administration. Older adult patient are at an increased risk for fluid overload
▪ Use blood products that are less than 1 week old.
▪ Assess vital signs every 15 min throughout the transfusion for flu id overload
▪ Administer the blood transfusion over 2 to 4 hr for older adult clients.
▪ Without giving other IV fluid to prevent fluid overload
▪ Risk for HF and flu id overload= cardiac and renal dysfunction Pt
• Central Venous Access Devices - (1)
o Cardiovascular Diagnostic and Therapeutic Procedures: Teaching About Care of a
Peripherally Inserted Central Catheter (Active Learning Template - Nursing Skill, RM AMS
RN 10.0 Chp 27)
▪ Clean the insertion port with alcohol for 15 seconds and allowing it to dry completely prior
to
accessing it. Va lve disinfection caps which contain alcohol are available for single use.
▪ dressing changes, usually every 7 days and when indicated (wet, loose, soiled).
▪ Use transparent dressing to allow for visualization.
▪ Educate the client not to have venipuncture or blood pressure taken in arm with PICC line
▪ Advise the client not to immerse his arm in water. To shower, cover dressing site to
avoid water e xposure
▪ Flush with 5 mL heparin (10 units/mL) when the PICC is not actively in use.
▪ Flush w/ 10 cc 0.9% NS before, between, and after meds
▪ Flush w/ 20 cc 0.9% NS after blood draw
• Medication Administration - (1)
o Hypertension: Client Education About Beta Blockade Agents (Active Learning Template -
Medication, RM AMS RN 10.0 Chp 36)
▪ can cause fatigue, weakness, depression, and sexual dysfunction
▪ Stopping suddenly can cause rebound hypertension
▪ Teach the client manifestations of hypoglycemia that do not include tachycardia
