Med_Surg Summary Notes.

Med_Surg Summary Notes. 1) Diabetes Insipidus – page  Caused by a deficiency of production of ADH or a decreased renal response to ADH.  Clinical Manifestations: Polydipsia and Polyuria.  Diagnostic Studies: Water deprivation test (pt deprived of water for 8-12 hrs and then given desmopressin acetate subcut or nasally), Measure level of ADH after an analog of ADH is given.  Types of Diabetic Insipidus: Central DI (results from an interference of ADH synthesis, transport, and release. Ex: brain tumor, head injury, brain surgery, CNS infection), Nephrogenic DI (results from inadequate renal response to ADH despite presence of adequate ADH. Ex: Drug therapy, renal damage, hereditary renal disease), Primary DI (Results from excessive water intake. Ex: Structural lesion in thirst center, psychological disorder).  Nursing Management: Early detection, Maintaining adequate hydration, and patient teaching for long-term management. 2) Healthcare associated pneumonia  Also known as nosocomial pneumonia, pneumonia in a non-intubated patient that begins 48 hours or longer after admission to hospital and was not present at the time of admission. Ventilatorassociated pneumonia, also a type of HAP, refers to pneumonia that occurs more than 48 hours after endotracheal intubation.  Treatment: Antibiotics that can be started as soon as sputum cultures identify the exact pathogen.  Risks: In treatment of pneumonia, risk of developing multidrug-resistant organisms. Limits the available antibiotics that can be used as treatment. 3) Diabetes Mellitus long term complications  Stroke  Hypertension  Dermopathy  Atherosclerosis  Nephropathy  Peripheral neuropathy  Neurogenic bladder  Retinopathy, Cataracts, Glaucoma, Blindness  Coronary Artery Disease  Gastroparesis  Islet Cell Loss  Erectile Dysfunction  Peripheral Vascular Atherosclerosis  Gangrene  Infections  Examinations performed Daily, Annually, or when you visit HCP: Funduscopic, Fundus photography, Urinalysis, Feet Examination, and Stress Tests. Page 2 of 38 4) Renal dosing/ issues with drugs – page 1020 Box 44-3 ANTIBIOTICS OTHER DRUGS OTHER AGENTS Amikacin Captopril Gold Amphotericin B Cimetidine Heavy Metals Bacitracin Cisplatin Cephalosporins Cocaine Gentamicin Cyclosporine Neomycin Ethylene Glycol Polymyxin B Heroin Streptomycin Lithium Sulfamidies Methotrexate Tobramycin Nitrosoureas Vancomycin NSAIDS Phenacetin Quinine Rifampin Salicylates 5) Spinal cord injury – page  Classification: (1) Mechanism of Injury, (2) Level of Injury, (3) Degree of Injury.  Clinical Manifestations: Motor and Sensory effects, Respiratory System (decrease in vital capacity volume), Cardiovascular System (bradycardia, peripheral vasodilation, hypotension), Urinary System (urinary dysfunction), Gastrointestinal System (incontinence, impaction, ileus, megacolon, decreased GI secretion) , Integumentary System (skin breakdown, pressure ulcers), Thermoregulation (Adjustment from body temp to room temp), Peripheral Vascular Problems (Pain, VTE, PE)  Emergency Management: Table 60-3 Ph. 1425  NURSING ASSESSMENT o Subjective Date: Health History o Objective Data: Poikilothermism (unable to regulate body heat) o Integumentary System: Warm dry skin below level of injury o Respiratory: Injury at C1-3-Apnea, Inability to cough. Injury at C4-Poor Cough, diaphragmatic breathing, hypoventilation. Injury at C5-T6- Decreased respiratory reserve. o Cardiovascular: Injury above T6-Bradycardia, hypertension, absence of vasomotor tone. o Gastrointestinal: Decreased or absent bowel sounds, abdominal distension, constipation, fecal incontinence, fecal impaction. o Urinary: Retention, flaccid bladder, Spasticity with reflex bladder emptying. o Reproductive: Priapism, altered sexual function o Neurologic: Complete-Areflexic, flaccid paralysis, hyperactive deep tendon reflexes, bilaterally positive Babinski test. Incomplete- Mixed loss of voluntary motor activity and sensation. o Musculoskeletal: Muscle atony, Contractures. o Pain: Neuropathic, musculoskeletal, and/or visceral. Page 3 of 38 6) Blood in stool  Melena = black, tarry stools (often foul smelling) caused by digestion of blood in the GI tract. Black appearance is from the presence of iron.  Occult bleeding = small amounts of blood in gastric secretions, vomitus, or stools not apparent by appearance. Detectable by guaiac test.  Could be indication of an upper GI bleed  Hemorrhoids are the most common reason for bleeding with defecation o Focus on pain control and promote wound healing o Sitz bath 1 to 2 days after surgery and continue for 1 to 2 weeks o Teach the pt importance of diet, care of the anal area, symptoms of bleeding complications, and avoidance of constipation and straining 7) CVA (focus on vision issues)  Cerebral vascular accident / Stroke  Treat as medical emergency  Know FAST (Facial drooping, Arm weakness, Speech difficulties, Time)  Sudden trouble seeing in one eye should be reported immediately for indication of a CVA  Women who experience migraine with aura are at an increased risk for stroke. 8) Acute kidney injury  Slight deterioration in function to severe impairment  Rise in serum creatinine and/or a reduction in urine output, and sometimes leads to development of azotemia (accumulation of nitrogenous waste products in the blood)  Hospitalized patients develop AKI at a high rate and have a high mortality rate  Common causes: o Prerenal: Hypovolemia, Decreased Cardiac Output, Decreased Peripheral Vascular Resistance, Decreased Renovascular Blood Flow o Intrarenal: Nephrotoxic injury, Interstitial Nephritis o Postrenal: BPH, bladder cancer, calculi formation, trauma  Clinical manifestations: o Urinary changes – oliguria o Hypovolemia o Metabolic Acidosis o Sodium balance o Potassium excess o Hematologic disorders o Waste product accumulation o Neurologic disorders  Diagnostic studies: o H&P o Identification of precipitating cause o Serum creatinine and BUN levels o Electrolytes o Urinalysis o Renal Ultrasound o Renal scan o CT scan  Primary treatment is to eliminate the cause, manage the signs and symptoms and prevent complications while the kidneys recover Page 4 of 38 9) Abscess  A swollen area within the body tissue, containing an accumulation of pus  The body’s immune system sends WBC to fight the infection  Painful, swollen lump that is filled with pus  S/S = chills, fever, pimples, redness, painful lump, pus, tenderness, swelling, swollen lymph nodes  Treatment includes draining the abscess and antibiotics  Types mentioned in MedSurg: Anorectal (p. 970), brain (p. 1338), lactational breast (p. 1207), lung (p. 512), peritonsillar (p. 484) 10) Amyotrophic Lateral Sclerosis (lung issues)  AKA Lou Gehrig’s Disease  A nervous system disease that weakens muscles and impacts physical function.  In this disease, nerve cells break down, which reduces functionality in the muscles they supply. The cause is unknown.  The main symptom is muscle weakness.  Medication and therapy can slow ALS and reduce discomfort, but there's no cure.  Muscular: muscle weakness, problems with coordination, stiff muscles, loss of muscle, muscle spasms, or overactive reflexes  Whole body: fatigue or feeling faint  Speech: difficulty speaking or vocal cord spasm  Also common: difficulty swallowing, drooling, lack of restraint, mild cognitive impairment, severe constipation, severe unintentional weight loss, shortness of breath, or difficulty raising the foot  Treatment includes: o Therapies o Supportive Care o Medications (glutamate blocker or muscle relaxant) o Surgery o Medical procedure 11) Neutropenic precautions  is a blood condition involving low levels of neutrophils, a type of white blood cell. Neutrophils fight infection by destroying harmful germs. Without enough neutrophils, you’re more likely to develop infections. Usually, neutropenia occurs after: chemotherapy, radiation therapy or taking certain medicines. Remember: Gown, Gloves, Mask to protect the patient from catching any foreign bodies that night cause an infection. If the patient leaves the room, they must have a mask on before leaving and it must remain on them at all times while they are outside the room. 12) Asthma (focus on exercise)  that is induced or exacerbated during physical exertion is called exercise induced asthma (EIA) or exercise induced bronchospasm (EIB). This typically occurs after vigorous exercise, not during it (jogging, aerobics, climbing stairs). Symptoms of EIA are pronounced during activities where there is exposure to cold, dry air. Like swimming in an indoor heated swimming pool is less likely to produce symptoms than downhill skiing. Airway obstruction may occur due to changes in the airway mucosa caused by hyperventilation during exercise, with either cooling or rewarming of air and capillary leakage in the airway wall. Characteristics would include: wheezing, cough, dyspnea and a tight chest. Page 5 of 38 13) Bronchoscopy and complications (perforation)  Bronchoscopy is a procedure in which the bronchi are visualized through a fiberoptic tube. It may be used for diagnostic purposes to obtain biopsy specimens and assess changes resulting from treatment. It is also used to remove mucus plugs or foreign bodies. Laser therapy, electrocautery, cryotherapy, and stents can be placed through a bronchoscope to achieve patency of an airway that has been completely or partially obstructed by tumors. It can be performed in an inpatient or outpatient procedure room or at the bedside. 14) Burns (focus on electrical)  Electrical burns are the result of intense heat generated from an electric current. The severity depends on the amount of voltage, tissue resistance, current pathways, surface area in contact with the current, and length of time that the current flow was sustained. Electrical burns put the patient at risk for dysrhythmias or cardiac arrest, severe metabolic acidosis, and myoglobinuria. Myoglobin