Med Surg 1 Final Review Notes PDF

Med Surg 1 Final Review 01 Week 1 Nursing Process; Perioperative Nursing Pre-Operative Phase Timin : Emer ent, Ur ent, Laboratory Assessment: Assessment: (HEAD TO TOE) Elective - Urinalysis - Cardiovascular: CAD, - Blood type and screen MI within 6 months - Dia nostic: Determine - CBC or hemo lobin level the cause and ori in be ore sur ery, an ina, and hematocrit - n o the disorder - Clottin studies (PT, INR, hypertension, - Curative: Resolves a aPTT) dysrhythmias problem or disease - Electrolyte levels - Respiratory: Chronic - Palliative: Relieves - Serum Creatine respiratory problems, symptoms but does not - Pre nancy test decreased oxy en delivery - Chest X-Ray - Renal/Urinary: Kidney cure the underlyin - ECG (Baseline) impairment disease - Neurolo ic: Baseline, LOC - Preventative: Reduces - Musculoskeletal: the risk o developin a Checklist: Nutritional status, condition - NPO - Witness the education malnutrition, obesity - Cosmetic: Alters the and witness the si ned - Herbal Supplements: physical appearance consent (we do not Ginsen , Gin er, Gink o educate, we just clari y - Psychosocial: Anxiety acts and dispel myths) - Baseline vitals - Identi y prescription and over the counter dru s - Identi y any cultural and ethnic actors that can affect the sur ery Intraoperative Phase General Re ional Roles o the Circulatin Nurse: Anesthesia: - Prepares the OR with necessary equipment Anesthesia: - Opens sterile supplies or sterile nurse - Depresses the - Reduction o CNS. Causes a - Visits the patient preoperatively; identiﬁes the patient, sensation in loss in sensation, veriﬁes the consent and answers patients questions certain parts o consciousness, - Per orms patient assessment reﬂexes, and the body (blocks - Observes procedure to maintain sterile ﬁeld memory the peripheral - Document operative record and nurses notes - Check or amily history nerves) - Counts the spon es, needles, and instruments when the o mali nant wound is be innin to close hyperthermia - Accompanies the patient to the recovery room to ive - Hypoventilation - Dysrhythmias Local report - Aspiration Anesthesia: - Delivered Mali nant Hyperthermia: Reaction to eneral topically and or Roles o the Scrub Nurse: anesthesia local inﬁltration - Per orms sur ical hand scrub - Acute, Li e - Patient remains - Dons the sterile own and loves threatenin conscious, able - Counts the spon es, needles, and instruments with the - Genetic to ollow circulatin nurse - Muscle Ri idity, instructions - Gowns and loves the sur eon Flushed, - The only - Assess with sur ical drapin o the client Abnormal anesthesia where - Hands the sur eon instruments, spon es, and other Heartbeat and the patient is supplies durin procedure Hi h Temp - Reversal A ent: able to drive - Identiﬁes and handles sur ical specimen correctly Dantrolene themselves back - Maintain the count o spon es, needles, and instruments home so that none will be misplaced or lost within the wounds PACU Recovery Room: - On oin evaluation and stabilization patients - To anticipate, prevent, and mana e the complications Postoperative - The Joint Commission NPSGs require the circulatin nurse and anesthesia providers to ive the PACU nurses verbal hand off reports - Decreased Peristalsis - NG tube is inserted durin sur ery to help decompress GI Phase (this should be drained every 8 hours) - Prevent cardiovascular complications: - VTE (Venous Thromboembolism) - Le Exercises - Mobility - Pneumatic compression devices Trans er rom PACU to the UNIT - ABC - Patient must have no excessive - Protect the airway, positionin bleedin or draina e - Shallow breathin , decreased, incentive spirometer - No si ns o respiratory depression - Bleedin , wound mana ement - O2 above 90% - Educate on preventin respiratory complications: - Pain is acceptable - Breathin exercises - Pt is awake/ baseline - Incentive Spirometer - Minimal nausea or vomitin - Cou h and Splintin Atelectasis: Collapse o alveoli (the air sacs in the lun s) - Absent breath sounds bilaterally - Labored breathin (tachypnea) 02 Week 2 Nutrition; Metabolism Upper GI Diagnostic Tests Esopha o astroduodenoscopy: (EGD) - Esopha eal linin red VERY IMPORTANT Veri yin the a reﬂex be ore ivin oral ﬂuids Biopsy: - Rules out Barrett's esopha us (not a dia nostic test to GERD) Esopha eal pH monitorin : - Most accurate method o dia nosin GERD Catheter is placed throu h the nose and pH readin s are taken to ood, position and activity or 24-48 hours Esopha eal Manometry: - Measures the pressure o the lower esopha eal sphincter Barium Swallow: - Identiﬁes, structural abnormality which could contribute to or cause GERD Complications Gastric Bleeding Gastric Outlet Dehydration Anemia Obstruction Causes: Causes: Causes: - Due to astritis that extends into - Caused by acute astritis with deep the stomach muscle tissue inﬂammation that extends - Loss o ﬂuid due to into stomach muscle vomitin and diarrhea Nursin Interventions: - Monitor IV ﬂuids Nursin Interventions: - Provide ﬂuid replacement and - Monitor ﬂuid and electrolyte because continuous vomitin results Nursin interventions: blood products - Monitor I&O in loss o chloride - Monitor CBC and clottin actors - Can cause metabolic alkalosis, ﬂuid - Insert NGT or astric lava e and electrolyte depletion - Provide IV ﬂuids i (obtain an x-ray) - Monitor I&O needed - Monitor NG tube or absence or - Prepare NGT to empty stomach presence o blood contents - Monitor electrolytes - Prepare or dia nostic endoscopy - Report Vomitin , bloatin and nausea Pernicious Anemia Dumping Syndrome Causes: Causes: - Rapid release o metabolic - Gastritis dama es peptides a ter eatin ood bolus parietal cells Nursin Interventions: - S/SX: Fullness, weakness, Nursin Interventions: dizziness, palpitations, sweatin , abdominal crampin , diarrhea - Monthly vitamin B12 - S/SX resolve a ter a bowel injections movement - Late mani estations can occur 10 mins to 3 hours a ter eatin Inﬂammatory Bowel Disease (IBS) IBS: Intestinal disorder which causes abdominal pain, as, diarrhea, and constipation (Part o the Lower GI) Patient Teachin : - Avoid dairy, e s, wheat products, alcohol, and caffeine - Increase ﬁber intake 30-40 rams per day; increase ﬂuid intake 2-3 liters per day - Keep dairy o ood intake and bowel patterns Medications: - Alosetron: For IBS with diarrhea (Side Effect: Constipation) - Lubiprostone: For IBS with constipation (Side Effect: Diarrhea) Ulcerative Colitis UC: Inﬂammation o the colon which causes continuous lesions Symptoms: LLQ (Lower Le t Quadrant) pain, ever, 15-20 liquid stools/day, abdominal distention and pain, mucous/ blood/ pus in the stool Labs & Risk Nursing Care & Factors Medications Diet Medications: Labs: - 5 aminosalicylic acid Nursin Care: - Monitor or si ns o - Decreased Hb and (Sul asalazine) peritonitis (nausea, Hct vomitin , boardlike - Decreased Albumin - Corticosteroids abdomen, rebound - Increased ESR, CRP, tenderness, ever) (Prednisone) - Monitor intake and output WBC (RISK FOR HYPOKALEMIA) - Immunosuppressants Diet: Risk Factors: (Cyclosporine) - NPO durin exacerbations - Genetics - Eat oods hi h in protein and low in calories - Caucasians - Antidiarrheal - Low in Fiber - Jewish Decent (Loperamide) - Avoid caffeine and alcohol - Stress - Eat small requent meals - Autoimmune Disorders Crohn's Disease CD: Inﬂammation and ulceration o small intestine, causin sporadic lesions RISK FOR FISTULAS Symptoms: RLQ (Ri ht Lower Quadrant), pain, ever, 5 loose stools/day, mucus/pus in stools, abdominal distension and pain, steatorrhea Risk Nursing Labs Medications Factors Care - Decreased - Genetics - 5 aminosalicylic - Monitor or acid si ns o Hct and H b - Caucasians (Sul asalazine) peritonitis - Decreased - Jewish - Corticosteroids (nausea, vomitin , Albumin Decent (Prednisone) boardlike - Increased - Stress - Immunosuppress abdomen, ESR, CRP, - Autoimmun rebound ants tenderness, WBC e Disorders (Cyclosporine) ever, - Antidiarrheal tachycardia) (Loperamide) - Monitor intake and output, risk or hypokalemia Differences Between CD and UC Crohn's Disease Ulcerative Colitis - Affects entire GI tract - Affects colon and rectum - May affect other body - Pro ressive rom systems rectum and cecum - Especially skin and - Poor absorption o nutrients lymphatic systems - Edema and lesions o - Thickenin and scarrin nutrients - 5-6 stools/ day - Edema, lesions and ulcers - Pus/ Mucus - 10 -20 stools a day - Blood and mucus GERD (aka Heartburn) Risk Factors Symptoms Medications - Obesity - Dyspepsia (indi estion) - Antacids (takes 1- 3 - Smokin - Throat irritation, bitter hours a ter eatin , 1 - Alcohol Use taste hour be ore/a ter meds) - Older a e - Burnin pain in - H2 receptor anta onists - Pre nancy esopha us (Ranitidine) - Hiatal Hernia - Pain worsens while layin - Proton Pump Inhibitors - Supine position down and improves when (Pantoprazole) - Diet hi h in atty/ ried/ sittin upri ht - Prokinetics spicy ood - Caffeine - Chronic cou h (Metoclopramide: - Citrus ruits Accelerates astric emptyin ) Surgery Patient Diagnostic Stretta: Uses radio requency ener y, applied by an endoscope to decrease ba us nerve activity. Education - Upper Endoscopy and EKG to rule cardiac Causes LES muscle to contract source or chest pain - Avoid atty/ ried/ spicy and pH testin or and ti hten. oods emesis - Eat smaller meals Fundoplications: Fundus stomach - Remain upri ht a ter meals is wrapped around and behind - Avoid ti ht ﬁtted clothin the esopha us throu h a - Lose Wei ht laparoscopy to create a physical - Elevate the HOB 6-8 inches barrier with blocks Peptic Ulcer Disease (PUD) PUD: Erosion in the stomach, esopha us, and duodenum mucosa Gastric Ulcer & Diagnosis, Medications Risk Factors & S/S Duodenal Ulcer & Complications Risk Factors: Gastric Ulcer: Dia nosis: - Pain 30-60 mins a ter meal, - Esopha o astroduodenoscopy - H. Pylori In ection (EGD) - NSAID use worse in the DAY, worse - Urea Breath Testin - Stress with eatin Medications: - MULTIPLE antibiotics to prevent resistance (Metronidazole, Si ns and Symptoms: Amoxicillin, Clarithromycin, - Nausea Duodenal Ulcer: Tetracycline) - Pain 1.5- 3 hours a ter - H2 receptor anta onists - Vomitin (Ranitidine) - Heartburn meal, worse at NIGHT, - PPI (Pantoprazole) - Bloatin better with eatin or - Antacids (Take 1-3 hours a ter antacids meals, 1 hour apart rom other - Bloody emesis or stool meds) - Pain - Mucosal Protectant (Sucral ate, iven 1 hour be ore meals and at bedtime) Complications: - Per oration (severe epi astric pain, birdlike abdomen, rebound tenderness, hypotension, tachycardia) Erosive/ Non Erosive and Gastritis Prevention Risk Factors Acute/ Chronic Erosive: caused by NSAIDS, alcohol or recent - Stress mana ement - Exposure to other with H. Pylori radiation - Family history o astritis - Diet Non-erosive: caused by H. Pylori - Decrease or eliminate alcohol - Prolon ed used o NSAIDS and Acute: - Vitamin B12 injections or steroids - Sudden onset, short duration, can pernicious anemia - Old A e result in GI bleed - Follow mediation re imen - Radiation - Can be caused by in estion o an - Avoid oods and bevera es that - Smokin irritant (acid or alkali poisonin ) cause irritation - Caffeine - Can result in the development o - Excessive Stress an renous tissue or per oration - Report constipation, nausea, vomitin , or blood stool - Bacterial In ection Chronic: - Stop smokin - Autoimmune Disease - Can be related autoimmune disease - Watch out or GI bleed - Exposure to contaminated ood such as pernicious anemia and H. indications or water Pylori - Excessive alcohol Lab Tests/ Diagnostic Tests Interventions Physical Assessment CBC: checks anemia - Dyspepsia - Female: Hb less than 12 and Rbc - Monitor I&O - General Abdominal discom ort less than 4.2 - Administer IV ﬂuids as - Indi estion - Male: H b less than 14 and Rbc - Headache prescribed less than 4.7 - Hiccupin - Blood and stool antibody/ anti en test or - Monitor electrolytes - Reduced appetite and wei ht presence o H. Pylori - Teach patient to avoid loss alcohol, caffeine and other - Abdominal bloatin or Upper Endoscopy: oods that cause astric distention - Small tube inserted throu h mouth, stomach, and duodenum irritation - Hematemesis - NPO 6-8 hours a ter - Stress mana ement - Positive occult blood - Watch out or per oration - Monitor GI bleed - Anorexia - Throat will be sore a ter - Monitor Anemia - Pernicious anemia - Rapid onset o astritis Upper GI Bleed Signs and Symptoms Complications - Coffee round emesis - Dehydration - Black, tarry stools - Electrolyte Imbalance (melena) - Hypovolemia - Decreased O2 and BP - Anemia - Tachycardia - Fati ue Drug Therapy Proton Pump Antacids H2 Blockers Inhibitors - Neutralizes - Decreased acid acid in the production - Decreased acid stomach release Mucosal Prostaglandins Protectant - Protects the stomach - Decreased acid Production Diabetes Mellitus There are three types o diabetes mellitus 1. Type 1: (insulin dependent) - Autoimmune disease - Caused by the destruction o insulin producin cells - Sudden - Thin 2. Type 2: (non insulin dependent) - Caused by the response to insulin (Insulin Resistance) - Associated with bein overwei ht and underactive - Gradual - O ten obese 3. Gestational Diabetes - Can affect any pre nant woman - Can lead to dan erously lar e babies, which can complicate delivery Diabetes Mellitus 2 Risk Factors of Expected Type 2 Health Promotion Lab Tests Findings Metabolic Syndrome Diabetic Fastin Blood Glucose - Hyper lycemia - Abdominal - Not ood or drink Screenin or 8 hours - Polyuria obesity, insulin resistance, - Screenin - Polydipsia sedentary patients at Dia nostic criteria - Polypha ia include 2 ﬁndin s on li estyle, risk separate days at least (Kussmaul's hypertension - BMI o more respirations) one o the ollowin : Hyperlipidemia than 25 and - Blood lucose - Associated Risk reater than 200 o a e reater m /dl cardiovascular than 45 child - - Fastin blood disease is overwei ht lucose reater - Insulin than 126 m /dl resistance - 2 hour lucose - HGB-A1C is than 200 m oral - Pancreatitis, Cushin screenin o lucose tolerance Syndrome choice test - A1c reater than A e 6.5% Hyperglycemia Hypoglycemia Si ns o Hyper lycemia: - Avoid excess insulin, - Hot dry skin and ruity exercise and alcohol breath consumption on an empty stomach - Encoura e oral ﬂuid - Decrease ood intake or intake delay in ood absorption - 4- 60z o ruit juice or - Restrict exercise when re ular so t drinks, blood lucose is lucose tablets reater than 250 n /dL - 6- 10 candies or 1 tsp o - Test urine or ketones honey and recheck BG in 15 mins - I unconscious and unable to swallow, administer luca on IM - Administer 50% dextrose i IV is available DKA vs. HHS DKA HHS - Caused by a pro ound - Hyperosmolar deﬁciency o insulin Hyper lycemic - I not treated it can turn Nonketotic Syndrome into hypokalemia - Most common in Type 2 - Mostly in type 1 DM - Blood su ars rise - Presents earlier - Very thirsty - Less neurolo ical - The body tries to symptoms excrete there ore you will urinate a lot Precipitatin Factors: Warnin Si ns: - Illness - In ection - Blood Su ar over - Inadequate insulin 600m /dl dosa e - Dry, parched mouth - Lack o Education, - Extreme thirst understandin o - Hi h Fever resource and ne lect - Weakness on one side Insulin Rapid Acting Short Acting Intermediate Acting Long acting - Most rapid Re ular Insulin Insulin Isophane Insulin Glar ine onset o action (Humulin R; Novolin R) Suspension (also (Lantus) (5 to 15 minutes) called NPH) - Short duration - Onset: 30 to 60 - cloudy - Patient must eat minutes appearance - Clear, a meal a ter - The only insulin - Slower in onset colorless injection product that and more solution Insulin Lispro can be iven by prolon ed in - Usually (Humalo ) IV bolus, IV duration than Insulin Aspart in usion, or endo enous dosed once (Novalo ) even IM insulin daily Insulin Glulisine - Peak: 2 to 3 - Onset: 1 to 2 - Re erred to (Apidra) hours hours as basal - May be iven - Duration: 5 to 7 - Peak: 4 to 12 insulin subcutaneously hours hours or via - Duration: 18 to - Onset: 1 hour continuous 24 hours - Peak: none subcutaneous - Duration: 24 in usion pump hours (but not IV) 03 Week 3 Mobility; Tissue Integrity Soft Tissue Injury Strains Sprains Disclocations - Excessive stretchin o - An excessive Dislocation a muscle or tendon - complete stretchin o a displacement or - Mana ement involves li ament usually separation o the cold and heat caused by twistin articulation sur aces applications, exercise motion o the joint with activity limitations, anti-limitations, anti- - History is usually Subluxation inﬂammatory o a twistin , - partial or incomplete medications, and wrenchin , or displacement o the muscle relaxants joint sur ace twistin motion Treatment - Sur ical repair may be - Pain and swellin - prompt attention due required or a severe - Cast or sur ery to vascular strain (ruptured muscle may required compromise or tendon) RICE: REST, ICE, COMPRESSION, ELEVATION Fractures Types of Fracture - A break in the continuity o the bone Complete :The bone is completely separated by a break which is caused by the trauma, into two parts twistin because o the muscle Incomplete: A partial break in the bone spasm or the indirect loss o levera e, or bone decalciﬁcation and Open Compound: The bone is exposed to air throu h a break in the skin, and so t tissue injury and in ection disease that result in osteopenia are common - Hi hest incidence in 15-24 year old Closed or Simple: Skin over the ractured area remains males intact Complications Mani estations : - Impaired unction Compartment Syndrome - De ormity - Avascular Necrosis - Swellin Fat Embolism - Muscle - Pulmonary Emboli spasm - Tenderness In ection and Osteomyelitis - Pain Venous Thrombosis - Impaired Delayed Union and Nonunion sensation Reduction Closed Open Reduction Reduction - Involves a sur ical - Per ormed by manual intervention usually combined with internal manipulation ﬁxation (ORIF) - May be treated with - May be per ormed internal ﬁxation devices under local or - The client may be eneral anesthesia placed in traction or a cast ollowin the procedure - Reduction: - A cast may be applied - Patients with ORIF are ollowin reduction at risk or complication Restorin the o immobility bone to - Check the color, skin, proper temperature, and sensation o the ali nment affected extremity Fixation Internal Fixation External Fixation - Followin an open - External ﬁxation is reeducation utilized with multiple - Involves the removal o pins applied throu h dama ed bone and the bone replacement with a - Provides more reedom prosthesis o movement than - Provides immediate traction bone stren th - Risk o in ection is associated with procedure Casts - Cast: Ri id device that immobilizes the affected Cast Care Interventions body part while allowin other body parts to move - Educate with wet cast - Cast materials: plaster, ﬁber lass, polyester- cotton - Apply ice directly over the racture - Types o casts or various or 24 hours at - Keep the cast and parts o the body: arm, le , intervals (off/on) extremity elevated brace, body - No sharp objects - Allow a wet cast 24-48 hours to dry into the casy (synthetic casts dry 20 mins) Nursing Care - Prevent skin irritation, clean - Handle a wet cast - Monitor the client's areas with warm with the palms o the temperature washcloth hand until dry - Monitor or the presence o a - Attend to - Turn the extremity oul odor unless complaint o pain - Monitor draina e contraindicated, so - Don’t circle the area o - Neuro-checks are that all the sides o draina e a must the cast will dry - Check the patient’s capillary - Isometric reﬁll at the end o the cast exercises Traction Traction Care - Traction: The Nursing - Maintain exertion o a pullin orce applied in two Responsibilities correct balance directions to reduce and immobilize a - Assess or between complications o racture traction pull - Provides proper other or ans and counter bone ali nment and - Educate/ traction orce reduces muscle encoura e mobility - Care o wei hts spasms - Pain mana ement - Maintain ali nment - Skin inspection - Check Equipment - Ropes are at the - Pin care center o the wheel - Avoid manipulation - Assessment o rooves o pins neurovascular - Wei hts are equal on - Maintain counter status both sides and ree traction han in - Skin care - Ropes are secured - Toiletin between pins and wei hts Bucks Skin Pelvic Skin Traction Traction - A boot appliance is applied to attach the - Also known as balanced traction - Wei ht is attached to a pulley’ allow the suspension traction wei hts to han reely over the ed e o the - Used to relieve low back, hip, or bed le pain and to reduce muscle - Not more than 5 pounds o wei ht should spasm be applies - Elevate ood o the bed to provide traction - Apply traction snu ly over the - Patient should be turned every 2 hours hip and pelvis and iliac crest - Pillows to keep heels off o the bed and attach to the wei hts - Lotion and powder are not used on the - Patients position is important skin due to skin breakdown - I patient complains o muscle spasms reali n the patient ﬁrst - Monitor peripheral pulse - I this does not work you - Check temperature o skin can request or a muscle - Wei hts should han reely relaxant - Nurses aren't allowed to adjust - The last result is opioids wei hts unless emer ency Infection and Osteomyelitis - Can be caused by the interruption o the inte rity o the skin - Severe in ection o the bone, bone marrow, and surroundin so t tissue Types: - Indirect (20%) - Risk actors are adults older a e, debilitation, hemodialysis, sickle cell disease, and IV dru use - Direct (80%) - It can occur with an open wound Assessment - Fever, pain, erythema in the area surroundin the racture, tachycardia, elevated WBC count - Difficult to move or bare wei ht Implementation - A ressive IV antibiotic - PT/OT Compartment Syndrome - Increased pressure 7 Ps of Circulation & within one or more compartments causin Treatment compromise o Paresthesia- Tin lin , burnin numbness circulation Pain- Out o proportion, unresponsive to - Leads to decreased medication Pressure- Taut skin, cast ﬁst to ti ht per usion and tissue Pallor- Pale, white, ray, dusky anorexia Pulselessness- Weakened or lost Poikilothermia- Cool skin temp Paralysis- Weakness or loss o motor activity - Noti y physician Immediately - Bivalvin : to split (a cast) alon one - Do not elevate or two sides (to relieve pressure) - No cold compress - Fasciotomy: A procedure in which the ascia is cut to relieve pressure in the muscle compartment Fat Embolism Assessment Diagnosis Implementation - An - Early si n - No speciﬁc - Noti y the embolism is laboratory physician ori inatin tests immediately con usion - Fat cells in - Treat in the bone - Restlessne blood, urine, Symptoms marrow ss or sputum that occurs - Decrease o Respiratory (O2 or - Tachycard a ter a PaO2 to less Mechanical racture ia, than 60 Ventilation) - Lon bone tachypnea mmH or ﬂat bone , and - Decreased Cardiac (IV ﬂuids, ractures hypotensi platelet pulmonary are at the on count and vasodilators, reatest - Dyspnea hematocrit peripheral risk - ECG may vasoconstrictors, - Petechial show ST and inotropic - Usually rash over se ment dru s) occurs the upper and T wave within 48 chan es Medication: No chest, hours - Chest x-ray research neck and ollowin may show supportin the use the injury axillae bilateral o steroids, pulmonary heparin, or dextran inﬁltrates Pulmonary Embolism Assessment - Restlessness and apprehension, dyspnea, diaphoresis, arterial blood as chan es - An early si n is SOB Implementation - Noti y the physician i si ns o emboli are present - Prepare to administer anticoa ulant therapy (Thrombosis) Pressure Ulcers - Occurs because o the ischemia to the tissue bed rom collapsed blood vessels Risk Factors - Immobility, moisture, obesity, nutrition, sheer, riction, disease, contractures, increased body temp, impaired circulation, incontinence, low diastolic pressure, mental deterioration, pain, prolon ed sur ery Sites - Heels, sacrum, scapula, hips, elbows, ears Inﬂuenced by - Intensity, time, tissue tolerance Braden scale - Sensory perception, moisture, activity, mobility, nutrition, and riction/ shear 04 Week 4 Elimination Incontinence Stress Urge Overﬂow - Loss o small amounts - Inability to stop the - Due to urinary o urine due to ﬂow lon enou h to retention rom increased abdominal pressure without reach the bladder bladder contraction bathroom due to overdistention - Associated with bladder irritation, - Characterized by lau hin , sneezin , or UTI or overactive requent loss o li tin bladder small amounts o - Can occur a ter childbirth and males urine due to a ter prostatectomy obstruction Reﬂex Functional Transient - Involuntary loss o urine - Loss urine due to - Reversible without warnin due to actors that inter ere impaired unctionin incontinence due with respondin to to inﬂammation, nervous system - Usually due to spinal the need to urinate UTI, disease, or cord dys unction, stoke, (co nitive, mobility, meds MS or spinal cord and environmental lesions barriers) Renal Calculi Urinary Clinical Diagnostic Treatment Tract Calculi Manifestations Studies - Nephrolithia Renal Colic Ultrasound Stones o 4mm or less sis: kidney - Flank area, Urinalysis - May take weeks stone - Checks pH (type - Hydrate back, or lower o stone) disease - Ambulate abdomen pain. - Urine osmolarity, - Modi y diet - More - Ureter speciﬁc ravity requent in (check hydration whites than stretches; Lithotripsy, or open status) blacks, dilates and - Positive RBC- due sur ical stone removal: spasms - Stones more hispanics, to trauma - Nausea and than 7mm and asians - Positive WBC and bacteria (present - Lar e stones: - Summer vomitin , bacteriuria or dysuria, ever, i in ected) 24 hour urine symptomatic chills; moist X ray or IV pyelo ram in ection cool skin, pain CT or MRI o abdomen or - Impair renal moves pelvis: cysteine or uric unction acid calculi (not seen in - Cause persistent x-rays) pain, nausea, or Retrieval and analysis o paralytic ileus stones: important to Or i : determine problem - The patient contributin to stone cannot be ormation: Strain all treated medically urine or only has one kidney Renal Calculi Current approaches - Opioids: Morphine ﬁrst 24-36 hours or moderate to severe pain (Caution: REspiratory Issues) - Antidote: Narcan - NSAIDS- Ketorolac - Oxybutynin (Spasmolytic): Decreases pain by decreasin bladder spasm - Antibiotics Surgical Therapy Primary indications or sur ery: - Pain, in ection, and obstruction Type o sur ery depends on location o stone: Nephrolithotomy- kidney; Pyelolithotomy- renal pelvis; Ureterolithotomy- ureter; Cystotomy- bladder Post complication: Hemorrha e Endourologic Procedures Nutritional Therapy - Cystoscopy: remove stone in bladder - Adequate ﬂuids to avoid dehydration (don’t - Cystolitholapaxy: lar e stones broken up orce ﬂuids) with lithotrite (stone crusher) - Hi h intake to produce 2.5 L urine/day - Cystoscopic lithotripsy: ultrasonic waves - Low Sodium Diet break stones - Dietary restrictions accordin to type o Complications: Hemorrha e, retained stone ra ments stone (COLLECT FRAGMENTS FOR LAB), in ection Extracorporeal Complications of Kidney Shockwave Stones Lithotripsy - Use sound, laser or Urosepsis: shock wave to ra ment - Occurs with struvite stones when UTI spread to stones bloodstream - Obtain consent - ABX prophylactic - Flat position - Monitor C and S - Apply topical anesthesia Obstruction: - Watch out or hematuria - Calculus can block outﬂow - Bruises at site is normal - Can cause hydroureter Hydronephrosis: and expected - Enlar ed kidney due to block - Prepare client or removal UTI In ection o the Risk Factors: Risk Factors or Female: Risk Factor or urinary tract - Immunosuppress - Short urethra Elderly- ed - Wet bathin suit - Increased risk Upper UTI: - DM - Intercourse o bacteremia - Kidney disorders - Pre nancy - Incomplete Glomerulonephritis, - Obesity - Poor ﬁttin bladder Pyelonephritis emptyin due - Bein Female diaphra m - HIV in ection - Synthetic to BPH Lower UTI: - Pre nancy underwear - Bladder Urethritis, Cystitis, - Menopause - Decreased prolapse in Interstitial Cystitis - Poor Hy iene estro en in emale - Bubble Baths elderly - Fecal - Delay o incontinence urination Types o Stone Calcium Oxalate Struvite Uric Acid Cystine Stones pH ACIDIC ALKALINE ACIDIC ACIDIC Diet Spinach, Black tea, Dairy products, red or - Or an meats, poultry, Limit animal protein Rhubarb, cocoa, beets, or an, meats, and whole ﬁsh, ravies, red wine, intake pecans, strawberries, rains and sardines peanuts, okra, - Lemon or oran e juice chocolate, wheat erm, can be consumed to lime peel, swiss chard alkalize the urine - Limit sodium intake Medications Thiazides, Diuretics, No typical meds Allopurinol, Potassium AMPG, Captopril orthophosphates or sodium citrate or sodium bicarb UTI Signs and Symptoms Diagnostic Test Plan of Care Medications - A lot o UTI are Dipstick Dia nostic Assessment: - Fluoroquinolones asymptomatic - Dia nosis or an - H and P , Nitro urantoin, - Fati ue and in ection - Urinalysis- clean Trimethoprim, or Anorexia - Identiﬁes and catch Sul onamide - Dysuria presence o - Urine C & S - Hesitancy nitrates - Ima in Fluoroquinolones: - Hematuria Microscopic Urinalysis - Increased - Chills - WBC: + indicates Mana ement: sunburn - Flank pain- pyuria - Patient teachin - Take with ull pyelonephritis Urine C and S via catch - Increase ﬂuids lass o water - Nocturia technique ir throu h - Check or aller y - Nocturia emesis oley catheter Dru Therapy: - Observe or 15-20 - Urinary retention - Done or - Anti un al mins (do not - Post void dribblin persistent UTI or Fluconazole leave or dele ate) a ter dipstick test - Antibiotics: Elderly Mani estations: and WBC are + Ciproﬂoxacin - Check or sul a - Con usion/ Altered Visualization status causes achilles meds or sul a LOC - Looks or reasons tendon rupture aller y - Incontinence or UTI and can - Anorexia dia nose other Discom ort: Phenazopyridine: - Nocturia tumors or - Warm sitz bath bladder anal esic or - Dysuria obstruction 2-3/ per day UTI pain - Urosepsis- SexuallyTransmitted - Does not treat hypotension, in ection testin PREGNANT WOMEN in ection tachycardia, - Check or STDS NEED TO BE TREATED - TURNS URINE tachypnea like chlamydia ASAP ORANGE Pyelonephritis NOTE: THE PRESENCE OF Expected PYELONEPHRITIS INCREASES RISK OF PRETERM LABOR IN Acute or Chronic Complications PREGNANT WOMEN Acute: Findings - Septic Shock - In ection and - Active bacterial - CKD - Colicky inﬂammation o the in ection occurrin - Hypertension abdominal kidney pelvis, calyces more in emale 20- 30 pain - Dehydration and medulla or renal years old - Nausea, parenchyma Can cause: Vomitin - Usually rom ascendin in ection - Interstitial inﬂammation Management - Malaise ati ue - E.Coli is most common - Tubular cell necrosis - Burnin - Abscess ormation Mild Symptoms: ur ency and - NSAIDS or antipyretic requency - Temporarily altered Risk Factors dru s - CVA kidney unction tenderness - Outpatient - Nocturia Chronic: mana ement - HTN - Male above 65 due to - Follow up C and S - Result o repeated - Tachypnea prostatitis and BPH - Dru therapy in ection - Tachycardia - Chronic kidney stones - Cause pro ressive - Fever, chills - Spinal cord injury due to Severe Symptoms: - Flank and increased reﬂux inﬂammation or scarrin - Hospitalization back pain - Pre nancy - Results in thickenin o - Increased ﬂuids - Tumors o bladder calyces and post - NSAIDS - DM, HTN, chronic cystitis inﬂammatory ﬁbrosis - Antipyretics - Alkaline urine - Incomplete bladder - Follow up C and S emptyin - 6 week ABX course Glomerulonephritis Risk factors - - - Inﬂammation o the lomeruli Affects BOTH kidneys Chronic develops over 20-30 years Acute: - Goodpasture syndrome - Scleroderma Expected Findings: Acute Patient Centered Care - Lupus - Viral - Anorexia - FOCUS: symptomatic relie - In ective endocarditis - Nausea - Conserve ener y - Poststreptococcal - Body edema - Daily wei ht check lomerulonephritis - Dysuria - Monitor BP.HR, and ﬂuids - Immuno lobulin A - Oli uria - NA and Fluid restriction (edema) - Fati ue - Severe HTN Chronic: - S3 - Protein restriction - Diabetic neuropathy - Crackles - Low protein, low sodium - Focal se mental SOB: due to ﬂuid buildup in lun s - ABX: i streptococcal in ection is lomerulosclerosis Wei ht Gain: due to kidney present - HTN compromise - Steroids and cytotoxic dru s: LOW Tea colored (Reddish or color - Teach relaxation colored urine): presence o protein - Vancomycin and streptomycin may Older adults: Con used contraindicated in patients with Lab tests decreased renal unction Urinalysis - Syndrome o permanent and pro ressive renal ﬁbrosis GFR: decreased Throat Cultures Chronic - Can pro ress to ESRD - Symptom development is slow 24 Hour Urine collection Glomerulonephritis - Decreased RBC production BUN and Crea - S/S: proteinuria, hematuria and uremia Interstitial Kidney Disease Interstitial Signs, Symptoms and Interprofessional Cystitis Diagnostic Tests Care - Chronic pain ul - Pain and bothersome - No sin le treatment to inﬂammatory disease o lower urinary tract relieve symptoms the bladder symptoms - S/S: ur ency, - Patient can void as o ten Therapy: requency, and as 60 times per day - Nutritional therapy: No pain in the bladder includin at ni ht caffeine, alcohol, citrus - Pain: Suprapubic re ion products, carbonated and or pelvis can involve perineal drinks, chocolate, vine ar, - Re ers to urinary pain that re ion, rectum, anus curries, hot peppers, ood cannot be attributed to - Made worse by bladder that pH like cranberries other causes such as UTI ﬁllin postponed urination - Sur ery or stones physical exertions and - Stress mana ement - More common in women pressure a ainst the - TCA- Amitriptyline than men suprapubic area, ood or - Pelvic physical therapy emotional stress and bladder hypo NEGATIVE URINE CULTURE IS - Voidin relieves some pain distention therapy EXPECTED SINCE THIS DISEASE - Can have periods o HAD NOT INFECTION exacerbation and remission 05 Week 5 Oxygenation Abg Interpretation Acidosis Normal Alkalosis pH 7.45 CO2 >45 35-45 Immunodeﬁciencies level o consciousness chemical (nonin ectious) > Chemotherapy/ radiation - Depressed cou h or a reﬂex pneumonitis results in recipients - Difficulty swallowin possible bacterial in ection > Immunosuppression therapy; lon - Insertion o naso astric term corticosteroid therapy tubes with or without tube in 24 to 72 hours - Caused by bacteria, virus, or eedin microor anisms that do not normally cause disease - Acute In ection o the lun parenchyma - Si niﬁcant morbidity and mortality - Pneumonia and lower tract in ections > 4th leadin cause o death Pneumonia S/S Assessment Findings Complications - Cou h: productive or - Fine or coarse crackles over - Multidru resistant (MDR) affected re ion patho ens- major problem in nonproductive treatment - With consolidation - Green, yellow, or rust - Risk Factors: - Bronchial breath - Advanced a e colored sputum sounds - Immunosuppression - Fever, chills - E ophony - History o antibiotic use - Dyspnea, tachypnea - Increased remitus - Prolon ed mechanical - Pleuritic chest pain - With pleura, effusion ventilation - Antibiotic susceptibility tests - Older or debilitated - Dullness to - Increase mortality rom patient: con usion or percussion over pneumonia stupor affected area Complications Diagnostic Tests Treatment - Atelectasis - History and physical Gram ne ative and ram positive or anisms - Pleurisy examination - Antibiotic o choice macrolides - Pleural Effusion- liquid - Chest x ray (CXR) - Should see improvement in 3 to 5 in pleural space - Thoracentesis and or day or need to reevaluate - Antibiotics: IV, proceed to oral - Bacteremia- bacterial bronchoscopy when stable; at least 5 days; in ection in the blood - Pulse oximetry a ebrile 48 to 72 hours - Pneumothorax- lun - Arterial Blood Gases Pneumococcal vaccine - Used to prevent S. pneumoniae collapse - Sputum ram stain, in ection - ARF culture and sensitivity Nutrition - Sepsis/Septic Shock - Blood cultures - Hydration, small requent, hi h calorie meals - CBC with differential Tuberculosis - In ectious disease - Leadin cause o death in HIV and AIDS - Occurs in poor, underserved and minorities - RISK FACTORS: lon term acilities, shelters, hospitals, IV injectin dru users, overcrowded livin conditions, decreased sanitation, immunosuppression, poor nutrition, recent travel to area where TB is endemic Patho - M. tuberculosis is a ram positive, aerobic, acid- ast bacillus - Spread rom person to person by airborne droplet when breathin , talkin , si nin , sneezin , and cou hin - TB is not hi hly in ectious - Requires close contact or requent prolon ed exposure - Once inhaled a Ghon lesion or ocus happens (calciﬁed TB ranuloma)- hallmark o primary TB in ection (de ense mechanisms to wall o the microor anisms) - Most immunocompetent adults can kill the microor anism - It is an opportunistic in ection - From lun s it spread via lymph node to other or ans Tuberculosis Screening Latent TB Active Infection S/S - Client in hi h risk areas - A state o persistent - In ants, children, adolescents with latent should be screened immune response to TB have symptoms yearly stimulation by - Active in ection in in ants: Persistent - Household members Mycobacterium cou h, wei ht loss, low rade ever not just amily should be tuberculosis anti ens screened without evidence o Active in ection in Adults: - Screen immi rants and clinically mani ested - Fati ue people outside the US active TB - Cou h more than 3 weeks - Diminished appetite - They are in ected with - Wei ht loss Epidemiology the TB bacteria but do not have si ns o - - Hemoptysis Ni ht sweats active TB disease and - Chills - Asians, hispanics, and do not eel ill - Enlar ed lymph nodes blacks - 66% rom orei n born people - Forei n born MDRTB increased rom 31% to 90% Tuberculosis Assessment Purpose LTBI TB Disease History and Physical Exam Checks or active Has no symptoms - Bad cou h more than 3 weeks TB i patient is - Pain in chest asymptomatic - Cou hin up blood or sputum - Weakness or atiu e - Wei ht loss, no appetite Tuberculin Skin Test Check or in ection - Chills (does not - Fever distin uish active - Sweatin at ni ht or latent) Does not eel sick Usually eels sick Quanti eron TB Gold or T Spot Indirect dia nostic TB Test test or active and latent TB Cannot spread TB bacteria to others May spread TB bacteria to others Chest X-Ray Used to determine active TB with presence o Usually has a skin test or blood test Usually has a skin test or blood test inﬁltrates (No result showin TB in ection lon er used alone) Has normal chest x ray and ne ative May have an abnormal chest x ray or Bacteriolo ical studies, sputum Culture is old sputum smear positive sputum smear or culture smear or acid ast bacilli standard sputum culture 3 consecutive positives within Needs treatment or latent TB to 8-24 hour intervals prevent active TB Needs treatment or active TB disease Tuberculosis Diagnostic Test Quant Gold TB Skin Testin (Mantoux Test): - Release assays - Uses puriﬁed protein derivative - Standard method to screen or TB - Detect INF- Y release rom T cells - 0.1 PPD transdermal on ventral sur ace o - EX: Quanti eron TB test and T orearm spot TB test - Read 48-72 hours later - Positive: induration (not redness) means - FAst result in hours patient has been exposed to TB and not - 1 patient visit developed antibodies - No reader bias - 2 step testin - I initial test is positive, additional screenin - No booster phenomenon needed - Not affected by BCG - I ﬁrst is ne ative then second is done 1-3 vaccinations (Calmette- Guerin) weeks later Pulmonary Embolism 06 Week 6 Perfusion Cardiac Terminology Preload: Volume o blood received by the heart Increased hypovolemia, re ur itation o cardiac valves, heart ailure A ter load: Pressure or resistance the heart has to overcome to eject blood Increased in hypertension and vasoconstriction Increased a terload= increased cardiac workload Ejection Fraction: 50-70% Cardiac Output Formula: HRxSV=CO The amount o blood pumped into the vascular system in one minute Mean Arterial Pressure: SBP+2(DBP)/3 The “constant” pressure within the arterial system Cardiac Labs LDH(bad cholesterol) = low LDL is a decreased risk o cardiac disease (the hi her the risk) HDH (happy cholesterol) = we want it to be hi h D-Dimer = elevated means there is a clot somewhere in the body BNP = the hi her the worse the heart ailure is Troponin Myoglobin Creatine Kinase - Protein ound in - Related when - Protein is related when the heart cardiac and heart brain or muscle becomes skeletal muscles skeletal muscle dama ed - Not speciﬁc to becomes - Best indicator or cardiac dama ed dia nosin MI (heart - Help ul rulin out - CK-MB ound in attack) acute MI cardiac muscle Cardiac Procedures & Surgeries Stress Transesophageal Echocardiogram Echocardiogram Echocardiogram (TEE) - Records: sound - Combination o - Immediately done waves, direction o exercise test and be ore sur ery ﬂow, measures echocardio ram - Clear ima es o valve - Patient is on heart size, wall motion, valve abnormalities, treadmill or abnormalities, con enital. Heart exercise bicycle endocarditis de ects, wall ve etation, and motion, EF and possible source o heart unction thrombi without inter erence rom lun s or chest ribs - NPO Coronary Angiogram/ Coronary Artery Angioplasty Bypass(CABG) - An io ram= Dia nostic - An ioplasty= Procedure - Open Heart Sur ery - Radial or Femoral - Treat CAD and MI Approach - Nursin - DX and Treat CAD and Considerations: MI - ICU 24- 48 hours - Nursin Considerations: - Monitor B/P ﬂuid - Lay Flat or 4 hours and electrolytes - Assess distal blood - Early Ambulation ﬂow is key - Complication - Complication - Bleedin , Clot - Bleedin , ormation at Anemia, DVT site, DVT EKG Interpretation Sinus Rhythms Normal Sinus Sinus Atrial Fibrillation Sinus Bradycardia Tachycardia - Rate: - Rate: Less than 60 - Rate: 100- 160 beats per minute - Rate: Atrial 350 to 600 beats per beats per minute - Rhythm: Re ular minute 60-100 Ventricular 120 to 200 beats per - Rhythm: Re ular - P Waves: Uni orm in beats per - P Waves: Uni orm in minute appearance, upri ht, appearance, upri ht, normal - Rhythm: Irre ular minute normal shape, one shape, one precedin each - P Waves: Not Visible - Rhythm: precedin each QRS - PR Interval: Not measurable (no P QRS complex Re ular complex - PR interval: Normal waves) - P waves: - PR interval: Normal - QRS: Normal - QRS: Normal Causes: - QRS interval: Normal Uni orm in - Causes: Causes: - MI, CAD, HTN, Heart Failure, appearan Va al stimulation - Physiolo ical Stress Heart Sur ery, Valvular disease, ce, - Medication toxicity - Psycholo ical stress COPD - Metabolic demand S/S: upri ht; - Medications - Asymptomatic S/S: normal - Syncope S/S: - Fati ue - Fati ue - SOB, Palpation, Syncope, HA - SOB shape, one - Anxiety - Dizzy Treatment: precedin - Li htheaded - Dizziness - Address the underlyin cause each QRS - Con usion - Hypotension - Medication: Adenosine Treatment: complex Treatment: - Address the underlyin (Patient will be awake: Have Stable: - PR Interval: cause EKG, 3 lead monitor, and - O2 Normal - Medication: Atropine deﬁbrillator) - CA Channel and beta blockers - Percutaneous pacin - Anticoa ulants - QRS: - Cardioversion - Antiarrhythmics: Amioderone Complications: Normal - Low cardiac output Complications: Unstable: - Decrease per usion - Low cardiac output & - O2 Decrease per usion - Synchronized cardioversion Shocking Stable Unstable Cardioversion: Deﬁbrillation: - Synchronized shock - Asynchronized shock - Shock delivered durin - Hi her ener y used the R wave o the QRS - Patient is unstable complex low ener y used - Examples: - Patient needs a QRS a - Pulseless ventricular complex tachycardia or - Patient is stable ventricular - Examples: ﬁbrillation - Atrial Fibrillation RAAS System Coronary Artery Disease (CAD) - Dama e o the coronary arteries due to arteriosclerosis - Partial obstruction= ischemia (an inal pain) - Complete obstruction= MI (myocardial) S/S: - Asymptomatic - An ina (Chest pain) - SOB - Claudication DX: EKG Lipid levels Cardiac Cath Meds: ASA Antihyperlipidemic TX: Percutaneous coronary intervention (PIC): Non sur ical procedure used to treat narrow coronary arteries o the heart ound in coronary artery disease Education: Diet modiﬁcation (Cardiac Diet) Nursin Interventions: Monitor cholesterol, HTN, DM MI, Thrombus Hypertension HTN: Types HTN: Mana ement Hypertensive Crisis Primary/ Essential/ Idiopathic Non Pharmacolo ical Hypertensive emer ency - Onset course to a ew days - No deﬁnitive cause - Avoid risk actors - Blood pressure reater than 220/140 - Not curable - Heart Healthy diet - Tar et or an dama e - Usually caused by an alerted Medication: - Intracranial hemorrha e RAAS - Diuretics (-ide) - MI Secondary hypertension - ACE Inhibitors- (hypertensive - Renal Failure med) blood pressure med(-pril)- - Heart Failure - caused by another medical TX: condition No Salt substitutes - Lower BP with IV antihypertensives - ARBS (An iotensin receptor - Sodium Nitroprusside HTN Dia nosis: blockers)(-sartan) - Maintain Airway - BP more than 140/90 - Beta blocker- Decrease the heart - Monitor BP every 5 mins - 2x in 2 weeks, separate - Elevate Head o Bed rate(-lol) readin s - Strict I&O - Calcium channel blockers- Block HTN: S/S the absorption and excretion o - Look out or intense headache pain - Silent killer calcium or repolarization and Hypertensive Ur ency - Fati ue depolarization - Onset days to a ew weeks - Dizziness HTN: Complications - Blood pressure reater than 180/120 - Palpation - No tar et or an dama e - Stroke - Could be due to not takin meds when - An ina - Vision loss needed - Occipital HA - Heart Failure TX: - CP - Heart Attack - Oral antihypertensive medications - Visual Chan es - Kidney Disease/ Failure (catopril) - Sexual Dys unction - I patient does not - Epistaxis (nose bleeds) respond iv sodium Nitroprusside Angina Pectoris - Chest pain associated with An ina Pectoris: Types ischemia (inadequate blood supply Stable An ina: - Predictable to an or an or part o the body - Pain brou ht on by exertion especially the heart muscles) - Narrowed coronary artery Patho: - Pain is relieved by rust or nitro lycerin - Cardiac Muscle deprived o O2 - Normal EKG - Increased workload o the heart Unstable An ina: Causes: - Dan erous - Medical Emer ency - Times o hi h 02 demand - Pain without exertion - Exercise - Precursor to an MI - Stress - EKG: inverted T wave or ST depression S/S: An ina Treatment: - CP - Rest - Medications - Fati ue - Nitrates - Anxiety - Calcium Channel Blockers - Pallor - Beta Blockers - Diaphoresis - Anti platelet - Anticoa ulation Nitroglycerin Use: An ina Prevent Attacks Given PO, sublin ual, transdermal, IV Action: Vasodilators Decrease vascular resistance Decrease cardiac workload Decrease oxy en consumption Side effects: Most common side effect is a headache (HA) Hypotension Flushin Contraindicated: Phosphodiesterase inhibitors Head Trauma Severe anemia Acute Attack: Sublin ual or NAsal spray What is the dosin ? (1 pill every 5 mins (3 max), i the chest pain does not o away a ter the ﬁrst 5 mins call 911) Prevention: Patch/ ointment (wear loves) Extended release Myocardial Infarction (MI) - Complete blocka e in one or more arteries S/S: Risk Factors: o the heart - Ti htness - Pain radiatin rom back, neck, CAD (coronary NSTEMI jaw/tooth, shoulder, and arm artery disease) - Patient is stable - Partial Blocka e - Crushin chest pain Hi h Cholesterol - Le t arm pain - EKG: ST depression - SOB Hi h Blood Pressure - Troponin elevated - Sweaty (diaphoresis) Family History TX: - Pale Hi h stress level - Anti thrombolytics Women S/S: - Asymptomatic Smokin - Sur ery percutaneous coronary intervention, CABG - Fati ue - Shoulder discom ort - Heartburn STEMI Unstable Total Blocka e MONA DX: EKG: ST Elevation (In arct) Morphine - Increased Troponin (Blood Oxy en Troponin, elevated Test) + St Elevation= Acute MI Nitro lycerin TX: Aspirin TX: - Cardiac Cath (rapidly, move ast) Prevention: - IV med - The will eel the need to poop (DO Stop smokin - Thrombolytics= clot busters NOT LET THEM POOP) —> can send Diet Chan es (-teplase, -ase) them into ventricular tachycardia Exercise - low sodium, Antihypertensives low cholesterol, - The only way to know between an NSTEMI Cholesterol & “Statin” Dru s low caffeine and STEMI is by EKG PVD vs PAD Peripheral Venous Peripheral Arterial Disease Disease - Pain: Yes (Dull, Constant, Achy, Pain) - Pain: Yes, (Sharp pain/ Worse @ ni ht, - Pulse: Yes ( May not be palpable due to intermittent claudication) edema) - Pulse: Yes, (Very poor or even absent) - Edema: Yes ( Blood is poolin in the le ) - Temp: Warm le s - Edema: No, (No blood in extremities) - Color: Brown/Yellow (Stasis Dermatitis) - Temp: Cool, no blood= cool le - Wounds: Venous stasis ulcers, irre ular - Color: Pale, dry, scaly, thin skin, due to shaped wounds, shallow lack o nutrients (decrease O2) - Gan rene: No, TOO MUCH BLOOD! - Wounds: Re ular shape, red sores, (Gan rene is insufficient blood) round appearance, “punched out” - Positionin : Elevate the veins (BAD: Dan le, - Gan rene: Yes, tissue death caused by stand, sit, or lon ) Treatment:

Med Surg 1 Final Review Notes PDF

Document Details

Tags

Related

Summary

Full Transcript

Upgrade to continue