Medical-Surgical Nursing Notes PDF

Medical-Surgical Week 4 Notes Urinary Incontinence → Involuntary leakage of urine Types of Incontinence: ​ Stress Incontinence: Loss of small amounts of urine due to increased abdominal pressure. ○​ Ex → coughing, sneezing, heavy lifting, & exercise ​ Urge Incontinence: Sudd...

Medical-Surgical Week 4 Notes Urinary Incontinence → Involuntary leakage of urine Types of Incontinence: ​ Stress Incontinence: Loss of small amounts of urine due to increased abdominal pressure. ○​ Ex → coughing, sneezing, heavy lifting, & exercise ​ Urge Incontinence: Sudden urges to void due to BPH, obstruction, or UTI(overactive bladder) ​ Overflow Incontinence: Due to urinary retention from bladder overdistension(overflow bladder, causes leakage bc it cant empty completely) ​ Functional Incontinence: Loss of urine due to environmental barriers (e.g., immobility). ​ Reflex/Neurogenic Incontinence: Involuntary loss of urine due to impaired nervous system function. ​ Transient Incontinence: Temporary situation-related 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. Medications: ​ UTI/Infection: Antibiotics ​ Urinary Incontinence Relief: TCA & Anticholinergics ​ Urinary Antispasmodics: Oxybutynin, Dicyclomine ​ Bladder Analgesic: Phenazopyridine (turns urine orange/red) Treatment: ​ Bladder training ​ Assess bathroom needs every 1-2 hrs ​ Restrict fluids ​ Post void residual(PVR) → bladder scan ​ No foley used incontinence  ​ Oxybutin for incontinence Nephrolithiasis (Kidney Stone Disease) Pathophysiology: ​ Supersaturated crystals precipitate & form stones. ​ Reduce risk by keeping urine diluted and free-flowing. Types of Stones: (1)​Struvite →Most common in women; increased pH (common with UTIs) (2)​Calcium Oxalate → Most common and more frequent in males; decreased pH (3)​Uric Acid → Predominant in men; decreased pH (think GOUT) (4)​Cystine → Genetic; decreased pH Risk Factors: ​ Dehydration (higher risk in summer) ​ Metabolism & Climate ​ Genetics (higher in whites, family history increases risk) 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 Diagnostic Tests: ​ Ultrasound: Detects all stone types ​ Urinalysis: Determines stone type based on pH ​ X-ray, IV Pyelogram, CT, MRI: Identify stones (except cystine & uric acid calculi not seen on X-ray) 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, high-sodium foods  ○​ Alkaline Stones (Calcium Oxalate, Struvite): Avoid oxalate-rich foods (e.g., peanuts, almonds, chocolate, spinach) ○​ Acidic Stones (Uric Acid, Cystine): Avoid purine-rich foods (e.g., red meat, organ meats, sardines, shellfish) 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 7 functions of the Kidneys 1.​ Acid/base balance 2.​ Water balance regulation 3.​ Erythropoiesis 4.​ Toxin removal 5.​ Blood pressure regulation 6.​ Electrolyte balance 7.​ D → vitamin D activation Urinary Tract Infection (UTI) Symptoms in Elderly: ​ Confusion, altered LOC, incontinence ​ Early signs: Hypotension, hypoglycemia, dehydration Diagnostic Tests: ​ Dipstick Test: Identifies nitrites (68-88% positive for UTI), WBCs, RBCs, protein Special Considerations: ​ Pregnant Women: Immediate treatment needed (risk of preterm labor) Pyelonephritis Definition: Inflammation of renal pelvis & kidney (often linked to CAUTIs) Findings(S/S):  ​ Colicky abdominal pain (starts/stops suddenly) ​ CVA tenderness, flank pain, back pain ​ Dysuria, freq. Urgency to urinate, dark urine, hematuria, burning sensation, fever, nocturia Management: ​ Outpatient or short hospitalization ​ NSAIDs/antipyretics (Caution: Nephrotoxic) ​ Antibiotics ​ Increase fluids (cranberry juice) ​ Analgesics → pyridium will turn urine orange Diagnostic Tests: ​ KUB X-ray: Identifies kidney, ureter, bladder abnormalities ​ Gallium Scan: Visualizes infection/inflammation ​ IV Pyelogram: Detects calculi, structural, vascular issues (check for shellfish allergy, increase fluids post-procedure) Glomerulonephritis Definition: Inflammation of glomeruli (NOT an infection) Types: ​ Acute: Follows infection, sudden onset, reversible ​ Chronic: Leading cause of ESRD, slow progression (20-30 years), irreversible renal failure, anemia due to low erythropoietin Signs & Symptoms: ​ Full-body edema, SOB, weight gain (due to fluid retention) ​ Tea-colored/frothy urine (proteinuria, hematuria) Management: ​ 95% recover or improve with acute management ​ Symptomatic relief, conserve energy, REST ​ Daily weight monitoring, fluid/Na/K+ restriction  ​ Severe HTN: Treat with antihypertensives + diuretics Interstitial Cystitis Definition: Chronic bladder inflammation (NO CURE) Symptoms: ​ Urgency, frequency, suprapubic pain ​ Pain increases as bladder fills ​ Voiding up to 60x/day (including nocturia) Diagnosis: ​ Negative Urine Culture & Sensitivity (not an infection) Critical Nursing Considerations ​ Burn Injury & Hypovolemia: BP < 90/40 mmHg is concerning. ​ Fluid Balance: Daily weight monitoring is most accurate. ​ Frequent Watery Stools (Diarrhea): Check BP first. ​ Flank Tenderness (Pyelonephritis): Strike flat hand over CVA. ​ Post-Cystoscopy Instructions: Expect blood-tinged urine. ​ Phenazopyridine Education: May change urine color. ​ Kidney Stone Prevention: Drink at least 3L fluids daily. ​ Acute Pyelonephritis: Report BP < 90/48 mmHg. ​ Extracorporeal Shockwave Lithotripsy: Report decreased urine output. ​ Urethral Catheter Care: NEVER disconnect from drainage tube to obtain specimen. ​ Bladder Infection Red Flags: Report left-sided flank pain. ​ Uric Acid Stones: Avoid high-purine foods (e.g., liver, chicken) Medical-Surgical Week 3 Notes Musculoskeletal Injuries & Management Strains & Sprains: ​ 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: Pain, swelling, decreased function, bruising ○​ Treatment: Immobilization, possible surgery Dislocations & Subluxations: ​ Dislocation: Complete displacement of a joint ○​ Complications: Impaired perfusion → Avascular necrosis ​ Subluxation: Partial displacement of a joint ○​ Treatment: Immediate reduction (open or closed) Fractures & Healing Fracture Types: ​ Complete: Bone completely separated into two parts ○​ Types: Oblique, Spiral, Transverse, Comminuted, Impacted, Displaced ​ Incomplete: Bone partially broken (e.g., Greenstick, Stress) ​ Open (Compound): Bone exposed through skin → High infection risk ​ Closed (Simple): Skin remains intact ​ Pathological: Caused by disease (e.g., osteoporosis, cancer) Fracture Healing Process: 1.​ Hematoma Formation: Blood clot at injury site (within hours) 2.​ Granulation Tissue: Hematoma converts to fibrous tissue (days-weeks) 3.​ Callus Formation: Spongy bone formation (weeks-months) 4.​ Ossification & Consolidation: Bone strengthening (months to years) 5.​ Remodeling: Final reshaping (up to 4 years) Assessment & Management: ​ Assess Circulation: Cap refill, skin color/temp, pedal pulses ​ Pain, swelling, deformity, tenderness, 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 & Traction Casts: ​ Plaster Cast: Takes 24-48 hours to dry, handle with palms ​ Fiberglass Cast: Dries within 20 minutes ​ Monitor: Temperature, foul odor, drainage ​ Complication: Compartment syndrome (pain, pallor, pulselessness, paresthesia, paralysis, pressure) Traction: ​ Buck’s Traction: Used for lower extremity injuries ​ Pin Care: Monitor for excess drainage, redness, swelling Fracture-Specific Considerations Hip Fractures: ​ Symptoms: Severe pain, shortened extremity, inability to walk ​ Assessment: Check 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: 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: ​ Cause: Increased pressure in muscle compartments → Ischemia ​ Symptoms: 6 P’s (Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Pressure) ​ DO NOT elevate or apply ice (vasoconstriction worsens condition) ​ Treatment: Fasciotomy (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, diabetes) ​ Treatment: IV antibiotics, possible amputation if resistant to treatment Venous Thrombosis (DVT): ​ Cause: Blood clot from immobilization ​ Prevention: Fluids, movement, anticoagulants Pressure Injuries Stages of Pressure Injuries: 1.​ Stage 1: Non-blanchable erythema, intact skin 2.​ Stage 2: Partial-thickness skin loss (may appear as a blister) 3.​ Stage 3: Full-thickness skin loss, adipose tissue visible 4.​ Stage 4: Exposed bone, muscle, tendon, or ligament 5.​ Unstageable: Covered with slough (yellow tissue) or eschar (black tissue) Prevention: ​ Reposition every 2 hours ​ 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: ​ Dehiscence: Wound edges separate, but organs do not protrude ○​ Intervention: Provide pillow for coughing support ​ Evisceration: Wound opens with organ protrusion ○​ Intervention: Cover with moist saline dressing, keep patient supine Wound Drains: ​ Jackson-Pratt (JP) Drain: Drains excess fluid from surgical wounds Key Nursing Considerations ​ Fractures: Always assess circulation distal to injury (cap refill, pulses) ​ Traction: Weights must be free-hanging, NEVER placed on bed/floor ​ Hip Surgery: Maintain leg abduction to prevent dislocation ​ Compartment Syndrome: Do NOT elevate or ice (worsens ischemia) ​ Fat Embolism: First action → Give oxygen  ​ Pressure Ulcers: 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 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. ​ A 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. ​ Note: May result in white stool afterward. Gastroesophageal Reflux Disease (GERD) Risk Factors:  ​ Family history, asthma, obesity, older age ​ Smoking, alcohol, hiatal hernia ​ Spicy, fatty foods, chocolate, peppermint Symptoms: ​ Flatulence, eructations (burping), dyspepsia ​ Heartburn (worse when lying down) ​ Milk worsens symptoms Peptic Ulcer Disease (PUD) Causes: ​ H. Pylori infection ​ NSAID or corticosteroid use ​ Alcohol, smoking, severe stress, Crohn’s disease 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 Treatment: ​ H. Pylori: 2 antibiotics (Metronidazole, Amoxicillin) + Proton Pump Inhibitor (PPI) ​ Mucosal protectant: Sucralfate Antacid Categories: 1.​ Aluminum Hydroxide (Antacid) 2.​ Sucralfate (Mucosal protectant) 3.​ Ranitidine (H2 Receptor Blocker) 4.​ Pepto-Bismol (Bismuth) 5.​ Omeprazole (PPI) 6.​ Antibiotics: Metronidazole, Amoxicillin, Tetracycline Gastric Outlet Obstruction Causes: ​ Acute gastritis with deep inflammation Complications: ​ Vomiting leads to fluid & electrolyte depletion → metabolic alkalosis Management: ​ Monitor fluids & electrolytes ​ Insert Nasogastric Tube (NGT) to relieve vomiting ​ Supportive care, IV fluids, endoscopy as needed Gastric Bleeding Anemia Causes: ​ Gastritis leading to bleeding & inflammation Interventions: ​ IV fluids, blood products as needed ​ Monitor CBC & clotting factors ​ NGT for gastric lavage to remove blood Dumping Syndrome Cause: Rapid release of metabolic peptides after food intake Symptoms: ​ Fullness, weakness, dizziness, palpitations ​ Sweating, abdominal cramping, diarrhea Interventions: ​ Avoid high-sugar meals ​ Eat small, frequent meals ​ Lie down 30 minutes after eating Pernicious Anemia Cause: ​ Gastritis damages parietal cells → impaired Vitamin B12 absorption Treatment: ​ Monthly Vitamin B12 injections Inflammatory Bowel Disease (IBD) Types: ​ Crohn’s Disease: Patchy inflammation in entire GI tract (most common in ileum & colon) ​ Ulcerative Colitis: Continuous inflammation in colon & rectum 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 Treatment: ​ No cure, but surgery (e.g., proctocolectomy) improves quality of life ​ Medications: NSAIDs, antibiotics, corticosteroids, immunosuppressants ​ Diet: Low-fiber, lactose-free, high-calorie/protein, hydration Gastritis vs. Peptic Ulcer Disease (PUD) Condition Description Gastritis Superficial stomach inflammation PUD Deep mucosal erosion (stomach, duodenum, esophagus) Acute Gastritis Symptoms:  ​ Anorexia, nausea, vomiting ​ Epigastric tenderness, fullness ​ Alcohol-induced hemorrhage Diabetes Mellitus Type 1 vs. Type 2: Type 1 Type 2 Autoimmune destruction of beta cells Insulin resistance + low insulin production Rapid onset, weight loss Gradual onset, obesity-related Increased thirst, urination Slow wound healing, eye issues Diabetic Ketoacidosis (DKA) Symptoms: ​ Polyuria, polydipsia, polyphagia ​ Weight loss, nausea, vomiting, fruity breath ​ Kussmaul respirations, metabolic acidosis DKA Treatment: ​ Hydration (IV fluids) ​ IV Insulin drip ​ Monitor electrolytes & blood glucose Hypoglycemia Symptoms & Treatment: ​ Sweating, tremors, confusion, seizures ​ Conscious: 15g carb (juice, soft drink, candy) ​ Unconscious: IV glucagon, IV dextrose (50%) Upper vs. Lower GI Bleeding Bleeding Type Cause Treatment Upper GI Peptic ulcer, gastritis, cancer PPI therapy, endoscopic intervention Lower GI Diverticulosis, hemorrhoids, IBD Colonoscopy, steroids, embolization Nursing Considerations & Key Interventions ​ Gastric Lavage: For active GI bleeding, assess presence of blood. ​ Post-EGD: Verify gag reflex before oral intake. ​ Gastric Outlet Obstruction: NGT decompression to relieve vomiting. ​ Dumping Syndrome: Lie down after meals to slow gastric emptying. ​ Pernicious Anemia: Monthly Vitamin B12 injections. ​ IBD Management: Rest bowel, reduce inflammation, maintain hydration. ​ DKA: Monitor ketones, blood glucose, & electrolytes. ​ Hypoglycemia: If unconscious, give IV glucagon or dextrose.