Medical Terminology

Terms to Know

• Cholesterolemia indicates abnormal cholesterol levels in the blood.
• Bruit is a swooshing sound heard over a fistula.
• FLACC scale is a pain assessment tool.
• Oliguria means low urine output.
• Malaise is fatigue.
• Ventricular septal defect (VSD) involves an opening in the septum separating the left and right ventricles.
• Effluent is wastewater discharged from healthcare facilities.
• Broviac central line is inserted into a large vein in the chest wall.
• Dialysate is a specialized fluid that removes waste products and excess fluid from the blood, consisting of purified water, electrolytes, and minerals.
• Kernicterus is a newborn condition marked by high bilirubin levels, potentially causing brain damage and severe jaundice if untreated.
• Orthotics are devices worn to relieve pain associated with foot and ankle conditions, such as shoe inserts and ankle braces.
• Hernia occurs when an organ or tissue pushes through a weak spot in surrounding muscle or tissue, causing a bulge or lump typically seen in the abdomen.
• Dehiscence is the separation of a surgical wound’s edges after closure.

Lab Values

Phosphorus

• Important for bone and kidney function and phosphorus levels.
• High levels may indicate CKD due to impaired phosphorus excretion.
• Low levels are not commonly significant.

Calcium

• Important for bone health, muscle function, and nerve signaling and calcium levels.
• High levels may indicate hyperparathyroidism, malignancies, or excessive vitamin D intake.
• Low levels may indicate CKD due to an inverse relationship with phosphorus or malnutrition/metabolic disorders.

Magnesium

• Impacts muscle and nerve function and magnesium levels.
• High levels may indicate CKD or magnesium supplement use.
• Low levels are rare, but can be seen in malabsorption, chronic diarrhea, or excessive losses.

Complete Metabolic Panel (CMP)

• CMP provides an overall view of metabolic and electrolyte balance.
• Electrolytes included in a CMP are calcium, sodium, potassium, bicarbonate, and chloride.

Alanine Transaminase (ALT) and Aspartate Aminotransferase (AST)

• Relate to liver function.
• High levels may indicate infection, inflammation, or damage.
• Generally considered normal, but may be low in end-stage liver disease/cirrhosis due to lack of liver cells.

White Blood Cells (WBC)

• Indicate immune response.
• High levels may indicate infection or inflammation.
• Low levels may indicate immunosuppression, chemotherapy, or bone marrow suppression.

Blood Urea Nitrogen (BUN)

• Relates to kidney function and hydration status.
• High levels may indicate AKI/CKD or high protein intake.
• Low levels may indicate malnutrition or liver disease.

Hemoglobin

• Represents the oxygen-carrying capacity of blood.
• High levels may indicate dehydration or polycythemia.
• Low levels may indicate AKI/CKD, anemia, or blood loss.

Hematocrit

• Represents the portion of red blood cells in blood.
• High levels may indicate dehydration or polycythemia.
• Low levels may indicate AKI/CKD.

Platelets

• Relate to clotting ability.
• High levels may indicate thrombocytosis (inflammation, malignancy).
• Low levels may indicate CKD (due to fluid imbalances) or thrombocytopenia (bleeding risk).

Creatinine

• Relates to kidney function.
• High levels may indicate CKD or AKI.
• Low levels may indicates low muscle mass or liver disease

Sodium

• Relates to fluid and electrolyte balance.
• High levels may indicate CKD, AKI, or dehydration.
• Low levels may indicate Overhydration or SIADH (syndrome of inappropriate antidiuretic hormone).

Potassium

• Crucial for heart and muscle function.
• High levels may indicate CKD, AKI, or acidosis.
• Low levels may indicate diuretic use, vomiting, or diarrhea.

Lactate

• Indicates tissue oxygenation and metabolism.
• High levels may indicate tissue hypoxia, metabolic acidosis, severe infection, or shock.
• Low levels may indicate metabolic disorders

Blood Glucose

• Relates to glucose levels, diabetes, and metabolic health.
• High levels may indicate stress response or corticosteroid use.
• Low levels may indicate hypoglycemia or excessive insulin administration.

Medications

Potassium Chloride

• Indications: Hypokalemia.
• Side Effects: Nausea, vomiting, diarrhea, abdominal pain, electrolyte imbalances, muscle weakness or twitching, arrhythmias.
• Nursing Considerations: Administer as prescribed, monitor potassium levels closely, administer oral KCL with sufficient water or food to avoid stomach irritation, never push, and always dilute when given through an IV pump.

Erythropoietin

• Indications: Stimulate RBC production in patients with anemia related to CKD or cancer treatments.
• Side Effects: Hypertension, headache, joint or muscle pain, flu-like symptoms, risk of blood clots.
• Nursing Considerations: Monitor BP, assess for hypersensitivity, educate patients about potential flu-like and the need to report adverse reactions ASAP.

Renvela (Sevelamer)

• Indications: Phosphate binder that reduces high blood phosphate levels in patients with CKD.
• Side Effects: Nausea, vomiting, diarrhea, stomach upset, constipation, difficulty swallowing tablets.
• Nursing Considerations: Administer with meals and water, monitor serum phosphatase levels regularly to adjust dosage, and encourage adherence to dietary restrictions related to phosphate intake.

Baclofen

• Indications: Relieves skeletal muscle spasms.
• Used to treat muscle spasticity related to spinal cord injury, multiple sclerosis, or cerebral palsy.
• Side Effects: Urinary retention/constipation, N/V, drowsiness/dizziness (weakness, fatigue).
• Nursing Considerations: Administer with food, encourage fluids and increased fiber in the diet, taper drug over 1-2 weeks to prevent withdrawal symptoms, and administer intrathecally for severe quadriplegic spasticity.

Botulinum Toxin A

• Indications: Muscle spasticity in cerebral palsy, blocks nerve activity in muscles, and reduces spasticity.
• Side Effects: Injection site reactions, muscle weakness or paralysis, flu-like symptoms.
• Nursing Considerations: Administer by trained professionals only and be vigilant for potential allergic reactions.

Diazepam

• Indications: Anxiety, skeletal muscle spasms, seizure disorders, acute alcohol withdrawal symptoms, and to induce anesthesia.
• Use with caution in the elderly and patients with respiratory and or liver impairments
• Side Effects: Cardiac arrest, respiratory depression/sedation, drowsiness/slurred speech, low BP, increased HR, OD/toxicity.
• Nursing Considerations: Assess the patient’s memory, monitor VS, monitor for drug tolerance and dependence and have IV flumazenil available.

Furosemide

• Indications: Edema (fluid retention).
• Used to treat conditions like HF, liver disease, or kidney disorders, pulmonary edema in HF, edema caused by renal, hepatic, or cardiac failure not affected by other diuretics, and hypertension not controlled by other diuretics.
• Side Effects: Ototoxicity, hyperglycemia, hypotension, hypokalemia, hyponatremia, and severe fluid loss (dehydration).
• Nursing Considerations: Monitor BG, serum electrolyte levels, and cardiac dysrhythmias.

Insulin

• Indications: Regulate blood sugar levels in patients with diabetes or given for hyperkalemia.
• Monitor for cardiac dysrhythmias.
• Side Effects: Hypoglycemia and injection site reactions.
• Nursing Considerations: Dose and timing of insulin administration are critical, ensure patients understand their insulin regimen, recognize symptoms of hypoglycemia and how to treat it, and monitor blood glucose level frequently.

Dextrose

• Indications: Treat hypoglycemia.
• Side Effects: High blood sugar, vein irritation, and inflammation at the injection site.
• Nursing Considerations: Monitor blood glucose and administer through a central line or large peripheral vein to prevent vein irritation.

Acetaminophen

• Indications: Relieve pain and reduce fever.
• Side Effects: Hepatotoxicity and hypertension.
• Nursing Considerations: Assess temperature and pain, note that acetylcysteine reduces liver injury and counteracts OD, and monitor BP as well as for S/S of OD.

Tacrolimus

• Indications: Prevent transplant rejection.
• Side Effects: Decreased urination, SOB, rash/itching/hives/edema, fatigue/weight gain, petechiae, seizures, vision changes, HA/confusion, and coma.
• Nursing Considerations: Monitor blood levels to maintain therapeutic drug levels and minimize toxicity, educate patients on the importance of medication adherence and the risk of infections, and closely monitor kidney function and BP.

Antimycobacterials - Isoniazid (INH) & Rifampin

• Isoniazid inhibits synthesis, disrupting mycobacterial cell wall integrity.
  • ADRs: peripheral neuropathy, hepatotoxicity, nausea, vomiting, rash, and vitamin B6 deficiency.
  • Interactions: avoid alcohol and antacids.
  • Nursing Implications: monitor liver function and administer vitamin B6.
  • Client Education: take on an empty stomach, complete the treatment, and report dysfunction or neuropathy.
• Rifampin inhibits bacterial RNA synthesis and is effective against Mycobacterium tuberculosis.
  • ADRs: orange-red discoloration of bodily fluids, hepatoxicity, GI distress, and DRESS syndrome.
  • Interactions: avoid alcohol and antacids.
  • Nursing Implications: monitor liver function and educate about harmless discoloration.
  • Client Education: take on an empty stomach, complete a full course, and report liver-related symptoms.

Antiparasitics - Metronidazole (Flagyl) & Chloroquine

• Metronidazole disrupts DNA synthesis in anaerobic bacteria and protozoa.
  • ADRs: nausea/vomiting, metallic taste, peripheral neuropathy, and disulfiram-like reaction.
  • Avoid alcohol
  • Monitor for peripheral neuropathy.
  • Client Education: Take full course, report GI/CNS symptoms, and avoid alcohol.
• Chloroquine inhibits parasite replication by interfering with heme metabolism.
  • ADRs: nausea/vomiting/diarrhea, retinopathy, and cardiac toxicity (QT prolongation).
  • Use caution with other QT-prolonging drugs.
  • Nursing Implications: visual changes and cardiac function.
  • Client Education: take with food or milk and schedule regular eye exams.

Antifungals - Ketoconazole & Amphotericin B

• Ketoconazole inhibits ergosterol synthesis, disrupting fungal cell membranes.
  • ADRs: nausea/vomiting, liver toxicity, rash, and dizziness.
  • Avoid alcohol, better absorbed with food and carbonated drinks
  • Report liver symptoms, take with food
• Amphotericin B binds to ergosterol, creating pores in fungal membranes.
  • ADRs: infusion-related reactions (fever, chills, headache) and nephrotoxicity.
  • Monitor for hypokalemia
  • Maintain hydration
  • Complete Treatment.

Antivirals - Acyclovir

• Acyclovir inhibits viral DNA polymerase.
  • ADRs: nausea/vomiting/diarrhea, headache, rash, fatigue, and topical application (burning/itching).
  • Nursing Implications: Monitor renal function.
  • Client Education: Wear gloves for topical application, report tremors and restlessness, and use sunglasses outdoors.

Module #5: Cerebral Palsy and Spina Bifida

Cerebral Palsy (CP)

• Non-progressive, permanent disorder affecting movement and posture due to brain damage.
• Cannot be diagnosed at birth.
• Causes:
  • Prenatal: brain abnormalities, infections, toxic exposure.
  • Perinatal: TBI, hypoxia, prolonged labor, fetal stroke, bradycardia.
  • Post-Natal: meningitis, hypoxia, seizures, kernicterus, multiple births, trauma.
  • Idiopathic: unknown.

Types of CP

• Spastic: Increased muscle tone and stiffness (80% of CP cases).
  • Cortex is affected.
  • Deep tendon reflexes, hypertonia, and tense/contracted muscles leading to flexion.
  • Can be diplegic, hemiplegic, or quadriplegic.
• Dyskinetic: Loss of voluntary muscle control.
  • Basal ganglia affected.
  • Caused by kernicterus.
  • Hearing loss, dysarthria, swallowing difficulties, and drooling.
  • Dystonic and athetoid movements.
• Ataxic: Poor balance (5% of CP cases).
  • Cerebellum Affected. Manifestations:
  • Lack of coordination + equilibrium.
  • Poor balance, clumsy appearance, fine motor skill impairment, wide-based gait, intention tremor, and challenges with quick or precise movements.

CP Prognosis

• Varies based on severity and comorbidities.
• Most individuals survive into adulthood.
• Respiratory disease is the most common cause of death.
• Early recognition improves outcomes.

CP Assessment

• Includes gross motor movement delays, abnormal motor performance, muscle tone alterations, abnormal postures, reflex abnormalities, and speech/hearing/vision/cognitive impairments.

CP Interventions

• Dental hygiene, G-tube feeds, frequent rest periods, safety precautions, multidisciplinary involvement, constipation management, and chronic respiratory infection management.
• Medications, including botulinum toxin A, baclofen, benzodiazepines, and miralax.

Spina Bifida

• Occulta: Mild, hidden form with a midline defect due to failure of the spine to close; covered by skin.
• Cystica: Open, visible midline defect.
  • Meningocele: External sac containing meninges and spinal fluid.
  • Myelomeningocele: External sac containing meninges, spinal fluid, and nerves.

Spina Bifida Cystica Assessment

• Neuro: reflexes, muscle tone, sensation
• GI: bowel control, diet
• GU: urinary continence, neuropathic bladder
• MS: paralysis, deformities of knees, hips, feet, spine, contractures

Spina Bifida Cystica Interventions

• Pre-Surgery: Maintain sac moisture and sterility, meticulous skin care, prone position with legs abducted, isolate, and initiate latex precautions.
• Post-Surgery: Assess surgical site and head circumference, monitor VS and neuro status, encourage parent/caregiver contact, position, and provide skin care.

Issues for Clients with Disabilities

• Poor communication, compromised care, negative attitudes, and fear about hospitalization.

Module #6: Antibiotics, Antivirals, Antiparasitics, Sepsis, Cellulitis

Cellulitis (Localized)

• Inflammation of subcutaneous tissues due to bacterial enzyme production.
• Primary or secondary complication
• Assessment: Hot, tender, erythematous with diffuse borders, chills, malaise, and fever.
• Interventions: Topical treatments, immobilization, and elevation. May use oral or IV antibiotics.

Sepsis

• Life-threatening condition involving organ dysfunction due to a dysregulated response to infection.
• Septic shock: Circulatory, cellular, and metabolic abnormalities causing hypotension.
• Gram-negative (e.coli) and Gram-positive (staph a) bacteria.

Sepsis Risk Factors

• Immunosuppression, use of antibiotics or corticosteroids, older age/infancy, invasive devices, long hospital stay, DM, and chronic kidney/liver disease.

Sepsis:Clinical Manifestations

• Confusion, unusual behavior, hypotension, tachypnea, and generally feeling unwell.
• Diagnosis: Blood cultures, serum lactate, CXR, and various tests.
• Management: Prevention, treatment of infection, rapid antibiotic therapy, tissue oxygenation, hemodynamic support, nutritional support, and support of failing organs.

Sepsis Complications

• Organisms enter the bloodstream triggering widespread inflammation, SIRS, MODS.

Module #7: AKI/CKD

Functions of the Renal System

• Renal blood flow: kidneys filter blood.
• Nephrons: tiny functional units; blood pushed into the glomerulus for filtration.
• Equilibration, waste removal as urine.
• Reabsorption: solutes return to the blood.
• Secretion: wastes from the blood into the filtrate.
• Water conservation: concentrates or dilutes urine.
• Regulates blood volume and BP.
• Secretes renin and erythropoietin.
• Regulates acid-base balance.
• Synthesizes calcitriol.

Etiology of AKI

• Prerenal: reduced kidney perfusion.
• Intrarenal: direct kidney damage.
• Postrenal: obstructed urine outflow.

Etiology of CKD

• Years of kidney injury and slow progression.
• Diabetic nephropathy, hypertensive disease, glomerulonephritis, and cystic kidney disease.

Phases of AKI

• Oliguric Phase:
  • Begins 1-7 days from initial cause; lasts 10-14 days.
  • Causes: Ischemia and Nephrotoxic Drugs.
  • Manifestations: Electrolyte imbalances, fluid overload, metabolic acidosis, and waste product accumulation.
• Diuretic Phase:
• Manifestations- increase in urine output.
• Recovery Phase:
  • Begins with GFR.
  • True recovery can take up to a year.

AKI Treatment

• Assessments: Fluid Volume, Is & Os restriction, Nutrition, Adequate protein.

CKD

• Can lead to high blood pressure, monitor renin.
• Can lead to low calcium levels, give a supplement
• Causes increase Urea build up in the body monitor for issues and give medications to manage related issues

Dialysis

• HD- Outpatient or in hospital

Role of Nurses Caring for those with different Dialysis Care

• Must consider: fluid intake, side effects

Module #8: Organ Transplant, End of Life

Hospice and Palliative Care

• Hospice: Provides compassion, concern, and support for those at the end of a terminal illness
• live comfortably
• Nursing role pain management
• Palliative: Prevent suffering

Ethical Legal Issues in End of Life

• Capacity ability ot consent or refuse
• Decsions must be made on wishes and value

Organ Donation

• Kidney most common
• Brain can not be transsplanted

AKI

• Prerenal: reduced kidney perfusion.
• Intrarenal: direct kidney damage.
• Postrenal: obstructed urine outflow.

Organ Donation Recipient

• Emotional Physical prep

Organ Transplant

• Can come with rejection and if so may need to be retreated.
• Must check patients levels.