AdultMedSurgnotes- ATIMEDSURGSTUDY GUIDE

AdultMedSurgnotes- ATIMEDSURGSTUDY GUIDE


advancemedsurg(WestCoastUniversity)

AdultHealth/Med-Surg

Whenindoubt,thecorrectanswermaybethelowurineoutput(Urineoutputlessthan30mL/
hr)

Strongindicationofahematologicdisorder=Absenceofhaironthelegs
 Rationale:Thinningorabsenceofhairontheextremitiesindicatespoorarterial
circulationtothatarea

BrachytherapyTreatment
 Procedurethatinvolvesplacingradioactivematerialinsideofthebody
 Indication
o Commonlyusedtotreatprostatecancer
o Cervicalcancer
o Uterine(endometrial)cancer
o Brestcancer,lungcancer,eyecancer,andskincancer

 NursingConsideration
o Nurseneedstoeducatetheclientontheimportanceofremainingonbedrest
withlimitedmovementwhiletheradioactiveimplantisinplacetopreventdisl
odgment
o Nurseshouldwearaleadapronwhenprovidingdirectcaretoprovideprot
ectionfromradiationsourceandnotturntheirbacktowardtheclient
o Limiteachoftheclient’svisitorsto30minutesperday
o Instructvisitorstoremainatleast6feetfromclientreceivingradiationatallti
mes
IndicationofPancreatitis
 Increasedserumlipaselevel
o Rationale:duetothereleaseoflipaseintothepancreasandautodigestion
 IncreasedWBCcount(becauseoftheinflammatoryprocess)
 Decreasedalbuminlevel(duetotheinflammatoryprocess)
 Increaseinbloodglucoselevels(duetoadrop-ininsulinproduction)

PolycythemiaVera
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, typeofbloodcancerthatcausesbonemarrowtomaketoomanyredbloodcells.
 NursingInterventions
o Patientshouldelevatetheirlegswhensitting
 Rationale:toavoidvenouspoolingwithsubsequentclotformation
o Patientshoulddrinkatleast3Litersoffluidperdaytohelplowerbloodviscosity
o Patientshouldwearsupporthose/TEDhose/SCDwhenawake
o Patientshoulduseasofttoothbrushtocleantheirteeth(avoidflossingor
anythingthatincreasingtheriskforbleeding)




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, Pyelonephritis
 Abacterialinfectionofthekidneyandrenalpelvis
 Nursingconsideration
o Thenurseshouldinstructtheclientabouttheimportanceofwipingfromfrontto
backfollowingfecaleliminationtoavoidintroducingbacteriaintotheurinarytr
act

DumpingSyndromeinformation:PreventingDumpingSyndrome
 Eliminate/avoidsimplesugarsandsugaralcoholsfromtheclient’sdiettopreven
tdumpingsyndrome
o Sugar,honey,andsugaralcoholsincreasehypertonicityandpropelfoodthroug
htheintestinesfasterthanfoodwithoutsweeteners
 Theclientshouldingestproteinateverymealtoslowgastricemptying(preventing
dumpingsyndrome)
 TheclientshoulddrinkbeveragesbetweenmealsONLY(about1houraftereatingsolid
foods)
o Rationale:Mixingfoodandfluidspropelsthemixturethroughthe
gastrointestinaltractfasterthansolidfoodalone).

Electroencephalogram(EEG)
 NursingConsideration
o Pre-Operativecare
 Thoroughlyshampootheclient’shairpriortotheEEG
o Instructtheclienttobesleep-
deprivedpriortotheEEGtoincreasethelikelihoodofrecordingseizureactivity
o Instructclienttoliestillinrecliningchairorbedandtokeeptheireyesclosed(f
ortheinitialrecording)
o EEGtakes45minutesto2hours
o EEGdocumentsbrainactivity

HowtoAvoidSickleCellCrisis
 Avoidstrenuousphysicalactivitiesthatcauseoverexertion
 Drinking3to4litersoffluidperday
 Avoidtravelingtohighaltitudesandinairplanes(sincepassengercabinsarenon
-pressurized)
 Avoidrecreationalactivitiesthatrequirepersistentexposuretocoldweather

EKG/ECG/TelemetryReading
 AflattenedTwaveorthedevelopmentofUwavesisindicativeofHypokalemia
 ElevatedSTSegment=Hyperkalemia
 WidenQRS=Hyperkalemia
 ProlongedQTIntervals=Hypocalcemia
o ManifestationsofHypocalcemia




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,  Tingling&numbness
 Tetany
 Seizures
 ShortenQTintervals=Hypercalcemi
aDiabetesInsipidus
 Treatment
o Chlorpropamide
 Antidiabeticagentwithantidiureticeffects
o Vasopressin
 Anexogenousformofantidiuretichormone
o Desmopressin
 Syntheticformofantidiuretichormone

SIADH
 Treatment
o Tolvaptan
 Promotestheexcretionofwater,whichhelpscorrectthefluidimbalance
inclientswhohasSIADH
o Fluidrestriction
o Sodiumreplacementwithsmallamountsof0.9%sodiumchloride

BrainstemInjury
 Nursingconsideration
o Thenurseshouldmonitortherespiratoryeffortofaclientwhohasaninjurytoth
ebrainstem.
 Themedullainthebrainstemcontrolstherespiratorycenter

ExternalRadiationTherapy
 NursingConsideration
o Instructclienttoprotectareasofskinfromsunlightthatreceivedradiation
 Rationale:Thisistopreventskinirritationandsubsequentbreakdown
o Avoidheatexposuretotheradiatedarea
o Avoidmassagingtheareatopreventfrictiontotheradiatedskin
o Washingoffthemarkingsiscontraindicated

RadiationTherapyforCancer
 Nursingconsideration
o Keepalead-linedcontainerintheclient’sroom(aswellasforceps)
 Rationale:incaseofaccidentaldislodgementoftheimplant
o Restricteachvisitorto30minutesperday(tolimitexposuretoradiation)
o Nurseshouldkeepallsoiledlinensintheclient’sroomuntiltheclienthashadt
heradiationimplantremoved




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