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• Medical-Surgical Study Notes focus on Urinary Incontinence, Nephrolithiasis, Urinary Tract Infections, Glomerulonephritis, Interstitial Cystitis, Musculoskeletal Injuries, Fractures, Wound Care, GI Diagnostics and Disorders, Diabetes, and pertinent nursing considerations

Urinary Incontinence

• Involuntary leakage of urine
• Stress, Urge, Overflow, Functional, Reflex/Neurogenic, and Transient are the different types of incontinence

Stress Incontinence

• Loss of small amounts of urine due to increased abdominal pressure such as coughing, sneezing, heavy lifting, & exercise

Urge Incontinence

• Sudden urges to void due to BPH, obstruction, or UTI(overactive bladder)

Overflow Incontinence

• Urinary retention from bladder overdistension causes leakage because the bladder cannot empty completely

Functional Incontinence

• Loss of urine due to environmental barriers (immobility)

Reflex/Neurogenic Incontinence

• Involuntary loss of urine due to impaired nervous system function

Transient Incontinence

• Temporary situation-related incontinence

Urinary Incontinence: Lab Tests

• Urinalysis checks for UTI
• BUN & Creatinine assesses complications & hydration status
• Ultrasound identifies residual urine & bladder abnormalities
• Voiding Cystourethrography evaluates bladder shape, size, support, function, and obstruction

Urinary Incontinence: Medications

• Antibiotics used for UTI treatment/infection
• TCA & Anticholinergics used for urinary incontinence relief
• Oxybutynin, Dicyclomine are urinary antispasmodics
• Phenazopyridine is a bladder analgesic

Phenazopyridine

• Turns urine orange/red

Urinary Incontinence: Treatment

• Main components are bladder training, assessing bathroom needs every 1-2 hrs, restricting fluids and using post void residual(PVR) with bladder scan
• Foleys are not used
• Oxybutin is used

Nephrolithiasis (Kidney Stone Disease): Pathophysiology

• Supersaturated crystals precipitate & form stones
• Keeping urine diluted and free-flowing reduces risk

Nephrolithiasis (Kidney Stone Disease): Types of Stones

• Struvite is the most common in women; increased pH (common with UTIs)
• Calcium Oxalate: the most common and frequent in males; decreased pH
• Uric Acid is predominant in men; decreased pH (think GOUT)
• Cystine is Genetic; decreased pH

Nephrolithiasis (Kidney Stone Disease): Risk Factors

• Dehydration (higher risk in summer)
• Metabolism & Climate have impact
• Genetics (higher in whites, family history increases risk)

Nephrolithiasis (Kidney Stone Disease): Clinical Manifestations

• Renal colic: Sudden, acute renal pain
• Flank pain: Usually one-sided, moves as stone travels
• Other Symptoms: Nausea, vomiting, dysuria, fever, chills, cool/moist skin

Nephrolithiasis (Kidney Stone Disease): Diagnostic Tests

• Ultrasound detects all stone types
• Urinalysis determines stone type based on pH
• X-ray, IV Pyelogram, CT, MRI identify stones

Nephrolithiasis (Kidney Stone Disease): Stones on an X-Ray

• Cystine and uric acid calculi are not seen on X-rays

Nephrolithiasis (Kidney Stone Disease): Nutritional Therapy

• Obstructing Stone: Adequate fluids (avoid excessive intake due to risk of reflux & hydronephrosis)
• Non-Obstructing Stone: High fluid intake (~3L/day)
• Diet Modifications: Limit colas, coffee, black tea, and high-sodium foods

Nephrolithiasis (Kidney Stone Disease): Dietary Modifications

• Alkaline Stones (Calcium Oxalate, Struvite): Avoid oxalate-rich foods such as peanuts, almonds, chocolate, and spinach)
• Acidic Stones (Uric Acid, Cystine): Avoid purine-rich foods such as red meat, organ meats, sardines, and shellfish

Nephrolithiasis (Kidney Stone Disease): Treatment Options

• < 4mm stones: Increase fluid intake, ambulation, diet modification

• 7mm stones: Lithotripsy, open surgical stone removal

• Endourologic Procedures: Cystoscopy, cystolitholapaxy, shockwave lithotripsy (ESWL)
• Complications: Hemorrhage, retained stone fragments, obstruction, infection

Kidney Functions

• Acid/base balance
• Water balance regulation
• Erythropoiesis
• Toxin removal
• Blood pressure regulation
• Electrolyte balance
• D vitamin D activation

Urinary Tract Infection (UTI)

• Symptoms in Elderly: Confusion, altered LOC, incontinence
• Early signs include hypotension, hypoglycemia, dehydration
• Diagnostic Tests: Dipstick Test

UTI Dipstick Test

• Identifies nitrites (68-88% positive for UTI), WBCs, RBCs, and protein

UTI Special Considerations

• Pregnant Women: Immediate treatment needed (risk of preterm labor)

Pyelonephritis

• Inflammation of renal pelvis & kidney (often linked to CAUTIs)
• Colicky abdominal pain (starts/stops suddenly)
• CVA tenderness, flank pain, back pain
• Dysuria, Frequency, urgency to urinate, dark urine, hematuria, burning sensation, fever, nocturia

Pyelonephritis Management:

• Outpatient or short hospitalization
• NSAIDs/antipyretics (Caution: Nephrotoxic)
• Antibiotics
• Increase fluids (cranberry juice)
• Analgesics turns urine orange
• Diagnostic Tests with KUB X-ray Identifies kidney, ureter, bladder abnormalities

Gallium Scan

• Visualizes infection/inflammation

IV Pyelogram

• Detects calculi, structural, and vascular issues (check for shellfish allergy, increase fluids post-procedure)

Glomerulonephritis

• Inflammation of glomeruli and is NOT an infection
• Types include Acute and Chronic

Acute Glomerulonephritis

• Follows infection, sudden onset, reversible

Chronic Glomerulonephritis

• Leading cause of ESRD, slow progression (20-30 years), irreversible renal failure, anemia due to low erythropoietin

Glomerulonephritis Signs & Symptoms

• Full-body edema, SOB, weight gain (due to fluid retention)
• Tea-colored/frothy urine (proteinuria, hematuria)

Glomerulonephritis Management

• 95% recover or improve with acute management
• Symptomatic relief, conserve energy, REST
• Daily weight monitoring, fluid/Na/K+ restriction

Glomerulonephritis: Treatment

• Severe HTN is treated with antihypertensives + diuretics

Interstitial Cystitis

• Chronic bladder inflammation and has NO CURE
• Symptoms include Urgency, frequency, suprapubic pain as pain increases as bladder fills
• Voiding occurs up to 60x/day (including nocturia)
• Diagnosis with Negative Urine Culture & Sensitivity

Critical Nursing Considerations: Burn Injury & Hypovolemia

• Concerning BP < 90/40 mmHg

Critical Nursing Considerations: Fluid Balance

• Daily weight monitoring is most accurate

Critical Nursing Considerations: Frequent Watery Stools (Diarrhea)

• Check BP first

Critical Nursing Considerations: Flank Tenderness (Pyelonephritis)

• Strike flat hand over CVA

Critical Nursing Considerations: Post-Cystoscopy Instructions

• Expect blood-tinged urine

Critical Nursing Considerations: Phenazopyridine

• May change urine color

Critical Nursing Considerations: Kidney Stone Prevention

• Drink at least 3L fluids daily

Critical Nursing Considerations: Acute Pyelonephritis

• Report BP is < 90/48 mmHg

Critical Nursing Considerations: Extracorporeal Shockwave Lithotripsy

• Report decreased urine output

Critical Nursing Considerations: Urethral Catheter Care

• NEVER disconnect from drainage tube to obtain a specimen

Critical Nursing Considerations: Bladder Infection Red Flags

• Report left-sided flank pain

Critical Nursing Considerations: Uric Acid Stones

• Avoid high-purine foods such as liver and chicken

Medical-Surgical Week 3 Notes

• Musculoskeletal Injuries & Management focuses on Strains & Sprains, Dislocations & Subluxations, Fractures & Healing

Strains & Sprains Notes

• Strain: Excessive stretching of a muscle or tendon
• Management: RICE (Rest, Ice, Compression, Elevation), switch to heat after 24 hours
• Severe Strains may require surgical repair
• Sprain: Ligament injury due to twisting motion
• Symptoms include pain, swelling, decreased function, and bruising
• Treatment with Immobilization, possible surgery

Dislocations & Subluxations Notes

• Dislocation: Complete displacement of a joint
• Complications: Impaired perfusion leading to Avascular necrosis
• Subluxation: Partial displacement of a joint
• Immediate reduction (open or closed) is the treatment

Fractures & Healing Notes

• Complete fracture: Bone completely separated into two parts such as Oblique, Spiral, Transverse, Comminuted, Impacted, Displaced
• Incomplete: Bone partially broken (e.g., Greenstick, Stress)
• Open (Compound): Bone exposed through skin leading to a high infection risk
• Closed (Simple): Skin remains intact
• Pathological: Caused by disease e.g., osteoporosis, cancer

Fracture Healing Process:

• Hematoma Formation: Blood clot at injury site (within hours)
• Granulation Tissue: Hematoma converts to fibrous tissue (days-weeks)
• Callus Formation: Spongy bone formation (weeks-months)
• Ossification & Consolidation: Bone strengthening (months to years)
• Remodeling: Final reshaping (up to 4 years)

Fractures: Assessment & Management

• Assess Circulation: Cap refill, skin color/temp, and pedal pulses
• Assess Pain, swelling, deformity, tenderness, and impaired function
• Immobilization: Splinting above & below injury
• Reduction: Open (surgical) vs. Closed (manual)
• Fixation: Internal (plates/screws) vs. External (pins/rods)
• Nutrition: Increase fluids (2-3L/day) to prevent DVT

Casts Notes

• Plaster Cast takes 24-48 hours to dry and handle with palms
• Fiberglass dries within 20 minutes
• Monitor temperature, foul odor, and drainage
• Main complication is Compartment syndrome (pain, pallor, pulselessness, paresthesia, paralysis, and pressure)

Traction Notes

• Buck's Traction is used for lower extremity injuries
• Pin Care with monitor for excess drainage, redness, and swelling

Fracture-Specific Considerations: Hip Fractures

• Symptoms include severe pain, shortened extremity, inability to walk
• Assessment includes checking peripheral pulses, assess for leg shortening
• Post-Op: Keep leg in abduction (away from midline)

Pelvic Fractures

• Major Concern: Internal bleeding due to high vascularity
• Avoid Foley Catheter because it can cause perforation

Mandibular Fractures

• Aspiration Risk: Keep wire cutters at bedside

Spinal Fractures

• Paralysis Risk: Log-roll patient, use cervical collar

Complications of Fractures: Compartment Syndrome Notes

• Cause: Increased pressure in muscle compartments that leads to Ischemia
• Symptoms: 6 P's of Pain, Pallor, Pulselessness, Paresthesia, Paralysis, and Pressure
• Do NOT elevate or apply ice because vasoconstriction worsens the condition
• Treatment: Fasciotomy which is a surgical incision to relieve pressure

Fat Embolism Syndrome (FES):

• Cause: Fat from bone marrow enters bloodstream (common in long bone fractures)
• Symptoms: Petechiae rash (chest, neck, axillae, conjunctiva), dyspnea, confusion
• Treatment: Oxygen immediately

Osteomyelitis

• Cause: Bone infection (common in open fractures and diabetes)
• Treatment: IV antibiotics, possible amputation if resistant to treatment

Venous Thrombosis (DVT)

• Cause: Blood clot from immobilization
• Prevention: Fluids, movement, anticoagulants

Pressure Injuries

• Stage 1: Non-blanchable erythema, intact skin
• Stage 2: Partial-thickness skin loss (may appear as a blister)
• Stage 3: Full-thickness skin loss, adipose tissue visible
• Stage 4: Exposed bone, muscle, tendon, or ligament
• Stageable: Covered with slough (yellow tissue) or eschar (black tissue)

Pressure Injuries: Prevention

• Reposition every 2 hours and assess circulation (CMS check: Circulation, Movement, Sensation)

Wound Healing & Surgical Care: Wound Healing Types

• Primary Intention: Surgical closure
• Secondary Intention: Left open to heal from the inside out
• Delayed Primary (Tertiary): Initially left open, then closed later

Surgical Complications: Wound Healing

• Dehiscence happens when wound edges separate, but organs do not protrude and intervention is to provide a pillow for coughing support
• Evisceration is when the wound opens with organ protrusion and intervention is to cover with moist saline dressing and keep patient supine

Wound Healing Note

• Jackson-Pratt (JP) Drain is used to drain excess fluid from surgical wounds

Key Nursing Considerations for Fractures

• Always assess circulation distal to injury by checking cap refill and pulses

Key Nursing Considerations for Traction

• Weights must be free-hanging and NEVER placed on bed/floor

Key Nursing Considerations for Hip Surgery

• Maintain leg abduction to prevent dislocation

Key Nursing Considerations for Compartment Syndrome

• Do NOT elevate or ice because it worsens ischemia

Key Nursing Considerations for Fat Embolism

• First action is to give oxygen

Pressure Injuries: Prevention

• Rotate patients every 2 hours to prevent skin breakdown
• Evisceration: Cover organs with sterile saline gauze & keep patient supine

Week 2 Nutrition & Metabolism Notes

• Upper Gastrointestinal (GI) Diagnostics includes Esophagogastroduodenoscopy (EGD)

Esophagogastroduodenoscopy (EGD)

• Uses a flexible tube with a camera to examine the esophagus, stomach, and duodenum.
• Used for assessing GERD, ulcers, and tumors.
• Key Considerations: Verify gag reflex before oral fluids post-procedure to prevent aspiration.
• Biopsy: Can rule out Barrett's esophagus but is not a diagnostic test for GERD.

Esophageal pH Monitoring

• Most accurate method for diagnosing GERD.
• The catheter inserted through the nose measures pH levels over 24-48 hours.

Esophageal Manometry

• Measures lower esophageal sphincter (LES) pressure
• Assesses LES function in GERD and esophageal disorders

Barium Swallow

• Identifies structural abnormalities in the esophagus
• Result in white stool afterward

Gastroesophageal Reflux Disease (GERD)

• Main risk factors include family history, asthma, obesity, older age
• Smoking, alcohol, hiatal hernia are other risk factors
• Spicy, fatty foods, chocolate, and peppermint main foods to avoid
• Symptoms include flatulence, eructations (burping), and dyspepsia
• Heartburn worse when lying down
• Milk worsens symptoms for Gerd

Peptic Ulcer Disease (PUD): Causes

• H. Pylori infection
• NSAID or corticosteroid use
• Alcohol, smoking, severe stress, Crohn's disease

Peptic Ulcer Disease (PUD): Symptoms

• Dyspepsia, bloating, nausea
• Gastric Ulcers: Pain worsens during meals (daytime)
• Duodenal Ulcers: Pain worsens at night but relieved by food/antacids
• Severe Symptoms: Coffee-ground emesis, GI bleeding

Peptic Ulcer Disease (PUD): Treatment

• H. Pylori: 2 antibiotics (Metronidazole, Amoxicillin) + Proton Pump Inhibitor (PPI)
• Mucosal protectant: Sucralfate

Peptic Ulcer Disease (PUD)

• Aluminum Hydroxide (Antacid)
• Sucralfate (Mucosal protectant)
• Ranitidine (H2 Receptor Blocker)
• Pepto-Bismol (Bismuth)
• Omeprazole (PPI)
• Antibiotics: Metronidazole, Amoxicillin, and Tetracycline

Gastric Outlet Obstruction: Causes

• Acute gastritis with deep inflammation

Gastric Outlet Obstruction: Complications

• Vomiting leads to fluid & electrolyte depletion which then leads to metabolic alkalosis

Gastric Outlet Obstruction: Management

• Monitor fluids & electrolytes
• Insert Nasogastric Tube (NGT) to relieve vomiting and perform Supportive care IV fluids, and endoscopy as needed

Gastric Bleeding Anemia Causes

• Gastritis leading to bleeding & inflammation
• Interventions are IV fluids and blood products as needed
• Monitor CBC & clotting factors
• Perform NGT for gastric lavage to remove blood

Dumping Syndrome

• Rapid release of metabolic peptides after food intake
• Symptoms include fullness, weakness, dizziness, palpitations
• Also include sweating, abdominal cramping, and diarrhea
• Interventions are to avoid high-sugar meals, eat small, frequent meals, and lay down 30 minutes after eating

Pernicious Anemia

• Gastritis damages parietal cells which leads to impaired Vitamin B12 absorption
• Treatment is Monthly Vitamin B12 injections

Inflammatory Bowel Disease (IBD): Types

• Crohn's Disease: Patchy inflammation in the entire GI tract (most common in ileum & colon)
• Ulcerative Colitis: Continuous inflammation in colon & rectum

Inflammatory Bowel Disease (IBD): Symptoms

• Crohn's (RLQ pain): Diarrhea (5-6/day), weight loss, ulcers, fever
• Ulcerative Colitis (LLQ pain): Urgent BM (15-20/day), rectal bleeding, cramps

Inflammatory Bowel Disease (IBD): Treatment

• No cure, but surgery such as proctocolectomy improves quality of life
• Medications can include NSAIDs, antibiotics, corticosteroids, and immunosuppressants
• Diet modifications with: Low-fiber, lactose-free, high-calorie/protein, and hydration

Gastritis vs. Peptic Ulcer Disease (PUD): Condition

• Gastritis involves superficial stomach inflammation
• PUD in contrast involves deep mucosal erosion of the(stomach, duodenum, and esophagus)
• Acute Gastritis Symptoms include anorexia, nausea, and vomiting
• Additional symptoms are epigastric tenderness, fullness
• Also possible alcohol-induced hemorrhage

Diabetes Mellitus: Type 1 vs. Type 2

• Diabetes Type 1 is an autoimmune destruction of beta cells with rapid onset and weight loss as well as increased thirst and urination
• Diabetes Type 2 is insulin resistance with low insulin production with gradual onset and being obesity-related as well as slow wound healing and eye issues

Diabetes Mellitus: Diabetic Ketoacidosis (DKA)

• Symptoms are polyuria, polydipsia, and polyphagia
• Other symptoms include weight loss, nausea, vomiting, and fruity breath
• Kussmaul respirations, metabolic acidosis are possible symptoms
• DKA Treatment includes Hydration (IV fluids), IV Insulin drip, and monitor electrolytes & blood glucose

Treat Hypoglycemia

• Symptoms include sweating, tremors, confusion, seizures
• If conscious give 15g carb like juice, and/or soft drink, and/or candy
• If unconscious give IV glucagon and/or IV dextrose (50%)

Upper vs. Lower GI Bleeding

• Conditions in the Lower GI: Diverticulosis, hemorrhoids, and IBD
• Bleeding Type: Cause is the small intestine and requires Colonoscopy, steroids, and embolization
• Conditions in the Upper GI: Peptic ulcer, gastritis, and/or cancer
• The Bleeding Type is in the large intestine requires PPI therapy, endoscopic intervention

Nursing Considerations & Key Interventions: Gastric Lavage

• For active GI bleeding assess the presence of blood

Nursing Considerations & Key Interventions: Post-EGD

• Verify the gag reflex before oral intake

Nursing Considerations & Key Interventions: Gastric Outlet Obstruction

• NGT decompression given to relieve vomiting.

Nursing Considerations & Key Interventions: Dumping Syndrome

• Advise to lie down after meals to slow gastric emptying.

Nursing Considerations & Key Interventions: Pernicious Anemia

• Monthly Vitamin B12 injections needed

Nursing Considerations & Key Interventions: IBD Management

• Must rest the bowel, reduce inflammation, and maintain hydration.

Nursing Considerations & Key Interventions: Treating DKA

• Monitor ketones, blood glucose, & electrolytes.

Nursing Considerations & Key Interventions: Hypoglycemia

• If unconscious, administer IV glucagon or dextrose.