Med Surg Exam 3 Study Guide

ITP: autoimmune disease that platelets (15,000) Treatment: • Corticosteroid (prednisone) • IV immunoglobin • Splenectomy is last resort Outcomes: • No evidence of bleeding or bruising • Maintain vascular and tissue integrity NI: • S/S OF BLEEDING = HUGE & look for all over body o S/s of hemorrhage • Monitor labs (PTT order) • Avoid IM injections: o Small gauge needle if injection is necessary o Pt. can end up with huge hematoma if given • Soft toothbrush, electric razor • Administer blood platelets & fresh frozen plasma • Avoid hard coughing & sneezing • Blow nose softly • Monitor pt. w/ NG tube b/c of risk of bleeding going into moist tissues – monitor procedure carefully • No high impact activities/sports • Avoid aspirin & blood thinners • Avoid strenuous BM (baring down a lot, GI issues, & coughing/sneezing hard) • No invasive products • Stay up to date w/ regular Dr. appointments Iron Deficiency Anemia: pt. will be pale and fatigued • Primary reason for development: blood loss & malnutrition • Pt. at risk: alcoholics & foliate deficient - anemia Treatment: • Eat iron rich foods (cause of anemia) • Take iron supplements • Blood transfusion (severe cases) Outcomes: • iron & symptoms Priorities: • Education • Relieve symptoms • Treatment • Treat underlying condition NI: • Place pt. on bed rest b/c of weakness & fatigue (severe anemia) o Risk for DVT & pneumonia w/ bed rest • Explain procedures & hematologic vocab • Give O2 if severe anemia • Educate pt. on iron rich food • Assess hemoglobin and RBC counts for response to therapy • Emphasize adherence with dietary and drug therapy • Teach pts. about side effects of iron supplements o Stool may be dark and tarry o Constipation o Heartburn • Teach pt. to balance rest and activity (#1 NI) • Monitor oxygen level while walking • Give O2 if SOB - NI • Monitor pt. very closely & never let pt. walk alone • Iron by IV (sometimes, only when pt. is in trouble) Bacterial Infection: Treatment: • Antibiotics Outcomes: • Treating infection = priority, if not treated renal damage & loss of renal function can occur Priorities: • FLUIDS - #1 NI o Conservative approach 1st: oral fluids then IV • Urine culture • Pt. is free of UTI s/s • Pain free urination • Normal WBC count NI: • Assess labs (urinalysis, bacteria count, & urine culture) to determine causative agent for most effective antibiotic • Encourage fluid intake • Encourage pt. to finish all prescribed antibiotics ( development of resistance) • Instruct pt. to void often (bacterial clearance facilitate bladder emptying) • Push fluid intake (promotes renal blood flow & flush bacteria from urinary tract) • Monitor s/s • Nutritional status: eating well to fight off infection • Pt. may/may not have Foley to monitor I&O o Look at color and smell of urine • Use clean hands & gloves w/ pt. • Teach pt. to wipe front to back • Tylenol for back pain • Elder pt. hospitalized w/ UTI, can’t fight it on own (stop drinking & eating from pain), leads to altered nutrition, dehydration & other issues Sickle Cell Crisis • #1 RF: common in African Americans (1 in 4 births are born w/ sickle cell trait) • Can cause death due to vascular occlusion (stroke, heart attack, liver & kidney damage) • No cure Treatment: • Hematopoietic stem cell transplant • F/E: HUGE • Anticoagulants • Transfusion therapy • Pain medications Outcomes: • Treat acute chest syndrome o Acute pulmonary complications that include pneumonia, tissue infarction and fat embolism • Watch anemia - monitor HGB & HCT • Alleviate pain • Appropriate INR – prophylaxis test Priorities: • #1 NI if pt. in pain: PAIN MANAGEMENT • #1 Priority Overall: OXYGENATION AND PERFUSION (ABC’s) o Cause excruciating pain when crescent blood cells get stuck o Pt. w/ sickle cell crisis & nothing more then that • Prophylaxis – prevent clotting NI: • Assess for s/s of hypoxia • Assist pt. w/ turning, coughing & deep breathing to prevent pneumonia • Assess for skin infection – SCD can damage spleen, which is organ that fights off infection • Evaluate for infection • Evaluate pts. tolerance to activity o Limit activities within pts. tolerance • Educate prevention sickle cell o Avoid high altitudes b/c lots of O2 required o Stay hydrated o Avoid folic acid • Pain management to promote comfort • Monitor O2 sat to prevent sever sickling • Administer fluids for F/E o  fluid = risk for crescent cells to stick together o Monitor pt. for fluid volume overload & dehydration o Push oral fluids • Teach pt. to cough and deep breathe • Administer O2 to pt. w/ painful deep breathing if needed (sometimes humidified O2) • Place pt. in semi fowlers position, legs extended b/c legs folded isn’t allowing crescent cells to move through body easily and sticking to body • Avoid over exertion • Administer analgesics (severe pain 20 out of 10) • Can get clotting disorder since crescent cells take over body • Rest very important – bed rest (bed pan or urinal for pt.) until crisis is over