INTERMEDIATE MED SURG FINAL

1. Kidney assessment, costovertebral angle a. Costovertebral angle: landmark for locating kidneys. Formed by the rib cage and vertebral column b. Left kidney rarely palpable, right kidney lower pole is palpable c. Percussion: Tenderness and pain in the flank area (CVA) may indicate kidney infection or polycystic kidney disease d. Auscultation : Bell is used to auscultate over CVA and upper abdominal quadrants. Auscultate the abdominal aorta and renal arteries for a bruit. If present, it may indicate impaired blood flow to the kidney 2. Multiple sclerosis interventions a. b. Other therapies: i. Spasticity: dorsal-column electrical stimulation, neurectomy, rhizotomy ii. Tremors: thalamotomy or deep brain stimulation iii. Neurologic dysfunction: physical and speech therapies iv. Exercise decreases spasticity, increases coordination, and retrains unaffected muscles to substitute for impaired ones v. Water exercise is important, patient is able to have more control over the body c. During an acute exacerbation patient may be immobile and on bedrest i. Interventions include respiratory and urinary tract infection prevention ii. Pressure ulcer prevention d. Tell pt. to avoid fatigue, extremes of heat and cold, and exposure to infection e. Encourage early and vigorous treatment of infection f. Teach pt. to achieve good balance of exercise and rest g. Minimize caffeine, and eat nutritious meals (high in fiber may help with constipation) h. Bladder control is a major problem: Anticholinergics may help with spasticity, may need to teach patient self-catheterization Some Goals • Maintain or improve muscle strength and mobility • Use assistive devices for ambulation • Maintain urinary continence