NCM 112 Medical Surgical Nursing Midterm

NCM 112 MEDICAL SURGICAL IN NURSING Infectious and Inflammatory Disorders o S. Pneumoniae - most common Infectious Disorder of Adults bacterial that is common in people...

NCM 112 MEDICAL SURGICAL IN NURSING Infectious and Inflammatory Disorders o S. Pneumoniae - most common Infectious Disorder of Adults bacterial that is common in people younger than 6o years old without comorbidity and those 6o years old with comorbidity. Gram positive Pneumonia, Tuberculosis that resides in URI and causes Ebola disseminated invasive infections MERS CoV pneumonia and other lower H1N1 (Swine Flu) respiratory tract infections, and Hepatitis other upper respiratory tract Guillain-Barre Syndrome infections such as otitis media and Sexually Transmitted Diseases rhinosinusitis. Gastro-intestinal System o H. influenzae - causes a type of o Inflammatory Bowel Disease- CAP that frequently affects older Crohn's and Ulcerative Colitis, adults and those with comorbid Appendicitis Peritonitis illness (COPD, alcoholism, o Pancreatitis diabetes) o Cholecystitis o Mycoplasma Pneumonia is caused Allergy (Hypersensitivity) by M. Pneumoniae - spread by Lupus Erythematous infected respiratory droplets person Rheumatoid Arthritis to person contact. Patients can be Transplant Rejection treated for mycoplasma antibodies. o Viruses - most common cause of pneumonia in infants and children. PNEUMONIA 2. Health Care- Associated Pneumonia o MDROs - causative pathogens because of prior contact with the healthcare environment. Is an inflammation of the lung o Identifying this type of pneumonia parenchyma in areas such as emergency dept. Cause by microorganisms that causes lung o HCAP is difficult to treat, initial parenchyma inflammation: antibiotic treatment must not be o bacteria delayed. o mycobacteria 3. Hospital-Acquired Pneumonia - develops o fungi 48 hours or more after hospitalization and does not o Virus appear to be incubating at the time of admission. Pneumonitis: more general term that (Nosocomial) describes an inflammatory process in the o HAP is associated with a high lung tissue that may predispose or place the mortality rate, in part because of patient at risk for microbial invasion. the virulence of the organism, the resistance to the antibiotic, and the CLASSIFICATION OF PNEUMONIA patient’s underlying conditions. o The usual presentation of HAP is a new pulmonary infiltrate on chest 1. Community Acquired Pneumonia - most x-ray combined with evidence of common infectious disease that occurs either infection such as fever, respiratory in the community setting or within the first symptoms, purulent sputum or 48 hours after hospitalization or leukocytosis. institutionalization. Factors that predispose patients to HAP: NCM 112 MEDICAL SURGICAL IN NURSING Comorbid conditions (severe acute or PATHOPHYSIOLOGY chronic) Supine positioning Aspiration a. Aspiration of flora (oropharynx) Coma b. Blood-borne organisms enter the Malnutrition pulmonary circulation and are trapped in the Prolonged hospitalization Hypotension Metabolic disorders infection Common organisms responsible for HAP: Enterobacter species Escherichia coli H. influenzae Klebsiella pneumoniae Pseudomonas aeruginosa Acinetobacter species Methicillin-sensitive or methicillin-resistant Staphylococcus Aureus S. Pneumoniae Pseudomonal Pneumonia - occur in patients who are debilitated, those with altered mental status and those with prolonged mental status and those with prolonged intubation or with tracheostomy. Staphylococcal Pneumonia - can occur through inhalation of the organism or spread through the hematogenous route. 4. Ventilator-Associated Pneumonia 5. Pneumonia in the Immunocompromised Host o Causes: ▪ Use of corticosteroids/immunosu ppressive agents ▪ Chemotherapy ▪ Nutritional depletion ▪ Use of broad spectrum antimicrobial agents ▪ AIDS ▪ Genetic immune disorders ▪ Long-term advanced life support technology (Mechanical ventilation) 6. Aspiration Pneumonia - pulmonary consequences resulting from entry of endogenous or exogenous substances into the lower airway. NCM 112 MEDICAL SURGICAL IN NURSING pulmonary capillary bed RISK FACTORS 1. Conditions that produce mucus or bronchial obstruction and interfere with normal lung drainage (CA, COPD) 2. Immunocompromised patient 3. Smoking 4. Prolonged immobility 5. Depressed cough reflex 6. NPO status, placement of NGT 7. Supine positioning 8. Antibiotic therapy 9. Alcohol intoxication 10. General anesthesia, sedative 11. Advanced age 12. Transmissions of organisms from health providers REMEMBER! Patient with Pneumonia high fever and chills (39-40 degrees Celcius) Patient with PTB low grade fever afternoon fever NCM 112 MEDICAL SURGICAL IN NURSING 4. Supplemental oxygenation Note: Antibiotics - ineffective in viral URT. PULMONARY TUBERCULOSIS PTB – is an infectious disease that primarily affects the lung parenchyma. it may be transmitted to other parts of the body(meninges, kidneys, bones and lymph Clinical Manifestations (Pneumococcal): nodes). Infectious Agent 1. Sudden onset of chills and rapidly rising of fever (38.5-40.5 C) 2. Pleuritic chest pain aggravated by deep M. tuberculosis. It is an acid-fast aerobic breathing and coughing. rod that grows slowly and sensitive to heat 3. Tachypnea and ultraviolet light. 4. Respiratory distress ( shortness of breath and use of accessory muscles). Transmission and Risk Factors 5. Orthopnea (shortness of breath when reclining or in the supine position). 6. Appetite is poor 7. Diaphoretic and tires easily. Spreads from person to person by airborne 8. Rusty, blood-tinged sputum -streptococcal transmission. pneumonia. An infected person releases droplet through: a. Talking b. Coughing Assessment and Diagnostic Findings c. Sneezing d. Laughing e. Singing 1. History of a recent respiratory tract infection. 2. Physical Examination rales crackles 3. Chest x-ray 4. Blood culture 5. Sputum examination Prevention Pathophysiology Pneumococcal vaccination Medical Management 1. Antibiotics - for bacterial pneumonia 2. Adequate rest 3. Hydration NCM 112 MEDICAL SURGICAL IN NURSING Mantoux method – used to determine whether a person has been infected with the TB bacillus. Standardized, intracutaneous injection procedure Procedure: o Tubercle bacillus is injected intradermal layer of the inner aspect of the forearm (4 inches below the elbow). o 0.1 ml of PPD is injected creating an elevation in the skin (6-10 mm diameter) The test result is read 48-72 hours after injection. Result: o Reaction of 0-4 mm – not significant o 5mm or greater – significant and a person is at risk Medical Management Note: 6-12 months treatment of anti-TB agents Clinical Manifestation Consider the drug resistance for effective 1. Low grade fever therapy: 2. Cough – non productive, or o Multi drug resistance (MDR TB) – mucopurulent sputum resistance to 2 agents (Isoniazid a. Hemoptysis – coughing out of blood and Rifampicin) 3. Night sweats o Extensively drug resistance (XDR 4. Fatigue TB) – resistance to isoniazid and 5. Weight loss rifampicin in addition to any fluoroquinolone. Four first line medications: Assessment and Diagnostic Findings: 1. Isoniazid 2. Rifampicin 3. Pyrazinamide 4. ethambutol 1. Positive skin test 2. Blood test Phases of Recommended Treatment 3. Sputum culture for acid fast bacilli 4. Complete history 5. Physical examination 6. Tuberculin skin test Initial phase (isoniazid, rifampicin, 7. ChestX-ray pyrazinamide, ethambutol plus vitamin B6 - 8. Drug Susceptibility Testing 50 mgs) Note: chest x-ray reveals lesions in the upper lobes. o Should be taken once a day and oral for 8 weeks Tuberculin Skin Test Continuation phase (isoniazid, rifampicin) Lasts for an additional 4 or 7 months. NCM 112 MEDICAL SURGICAL IN NURSING Note: a. Small frequent meals 4 months used - for large majority of b. Liquid nutrition patients 7 months - for patients with cavity 4. Preventing transmission of Tuberculosis pulmonary TB whose sputum culture after Infection initial 2 months of treatment is still positive. a. Mouth care 2-3 weeks of continuous medication therapy b. Covering the mouth and nose when – non infectious coughing and sneezing, proper disposal of tissues and Isoniazid – used as prophylaxis (prevention hand hygiene. of illness) c. Reporting to health department NOTE: Nursing Management If you can’t manage the PTB it will transferred to your body: 1. Promoting airway clearance 1. Meninges a. Increase fluid intake – promotes systemic 2. Kidney hydration and effective expectorant. 3. Lymph nodes b. Postural drainage – allows the force of gravity to assist in the removal of bronchial TYPES OF TUBERCULOSIS secretions MEDICATIONS: 2. Promoting adherence to treatment regimen – most effective means of preventing transmission a. Take the medications in an empty stomach 1. Rifampicin or 1 hour before meals – food interferes with o Oral: 600mg daily medication absorption. o Adverse Effect: b. Patients taking isoniazid should avoid foods ▪ Hepatitis and flu like that contain tyramine and histamine (tuna, aged syndrome fever cheese, red wine, soy sauce, yeast extracts). ▪ It colors body fluids ▪ Result to: Headache, (Orange-red) - sweat, flushing, hypotension, urine, saliva, tears and lightheadedness, cerebrospinal fluid palpitations and o Nursing Management: diaphoresis ▪ Do not missed/skipped c. Avoidance of alcohol – hepatotoxic effects doses because flu like d. Liver enzymes, BUN and liver and kidney syndrome fever may function should be monitored. occur e. Sputum culture results are monitored for ▪ Contact lenses can be AFB discolored (should not f. Monitor VS be worn!) Rifampicin 2. Isonaizid discolor contact lenses o Oral: 300mg daily o Adverse Effect: peripheral Alter metabolism of other medications (beta neuritis blockers, oral anticoagulants, digoxin, o Nursing Indications corticosteroids, oral hypoglycemic drugs, ▪ Administer vitamin B6 contraceptives, theophylline) ▪ Monitor liver function 3. Pyrazinamide Other side effects of anti TB drugs: o Oral: 1-2g daily a. Hepatitis o Adverse effect: b. Neurologic changes (hearing loss, neuritis) ▪ Hepatotoxicity c. Rash ▪ Increase uric acid/Hyperurecemia 3. Promoting Activity and Adequate nutrition NCM 112 MEDICAL SURGICAL IN NURSING 1. human-to-human transmission via direct oNursing Implications contact (through broken skin or mucous ▪ Monitor uric acid level membranes) with: ▪ Monitor liver enzymes a. blood or body fluids of a person who is sick (because of with or has died from Ebola; and hepatotoxicity) b. objects that have been contaminated with 4. Ethambutol body fluids ( blood, feces, vomit) o Oral: 800-1000mg daily 2. Close contact with patients. o Adverse effect: optic neuritis 3. Burial ceremonies that involve direct o Nursing Implication: monitor contact with the body of the deceased. the red-green color 4. People remain infectious as long as their discrimination in peripheral blood contains the virus. vision and visual acuity. Note: Pregnant women who get acute Ebola and Diagnosis: Deficient knowledge and information recover from the disease may still carry the virus in related of taking medication. breast milk, or in pregnancy related fluids and tissues. Symptoms EBOLA VIRUS Ebola virus disease (EVD or Ebola) o known as Ebola hemorrhage. o Rare and deadly disease caused by fever infection with one of the Ebola fatigue virus strains. muscle pain Headache Characteristics sore throat vomiting Diarrhea People get infected with Ebola by touching. internal and external bleeding Infected animals when preparing, cooking or eating them. Incubation Period Body fluids of an infected person such as 20-21 days saliva, urine, feces or semen. Things that have the body fluids of an Note: infected person like clothes or sheets. A person with Ebola can only spread the disease o Ebola enters the body through cuts once they have symptoms and as long as their body in the skin or when touching one’s contains the virus, even after they have died. eyes, nose or mouth. Transmission After recovering from Ebola Host – fruit bats of the Pteropodidae family After recovering from Ebola, some people may have Introduce into human through close contact symptoms for two years or longer. with: Symptoms are: o blood feeling tired o secretions headache o organ or other fluids of infected muscle and joint pain animals ( bat, chimpanzees, eye pain and vision problems gorillas, monkeys, forest antelope) weight gain found ill or dead in the rainforest. belly pain and loss of appetite hair loss and skin problems NCM 112 MEDICAL SURGICAL IN NURSING trouble sleeping safe burial practices memory loss hearing loss Note: depression and anxiety. Health-care workers caring for patients with suspected or confirmed Ebola virus should apply Diagnosis extra infection control measures to prevent contact with the patient’s blood and body fluids and contaminated surfaces or materials such as clothing and bedding antibody-capture enzyme-linked immunosorbent assay (ELISA) WHO Management antigen-capture detection tests serum neutralization test reverse transcriptase polymerase chain reaction (RT-PCR) assay Rehydration and the treatment of electron microscopy symptoms improves survival virus isolation by cell culture WHO has made strong recommendations for the use of two monoclonal antibody treatments in treating EBOLA: Treatments (Supportive) o mAbu4 (Ansuvimab; Ebanga) o REGN-EB3 (Inmazeb) oral or intravenous fluids blood transfusions medicines for other infections the person may have, such as malaria medicines for pain, nausea, vomiting and diarrhea Risk Reductions: reducing the risk of wildlife-to-human MERS-COV transmission MERS - is a viral respiratory disease caused reducing the risk of human-to-human by Middle East respiratory syndrome transmission coronavirus (MERS-CoV) that was first outbreak containment measures, including identified in Saudi Arabia in 2012.) and safe and dignified burial of the dead Coronavirus disease-2019 (COVID-19). reducing the risk of possible sexual transmission Causative Agent reducing the risk of transmission from pregnancy related fluids and tissue Standard precautions for Health Workers: Middle East Respiratory Syndrome CoronaVirus (zoonotic virus) Mode of Transmission Hand hygiene Respiratory hygiene Direct or Indirect contact with camels, bats, use of personal protective equipment (to goats, cow block splashes or other contact with infected materials), safe injection practices Incubation Period NCM 112 MEDICAL SURGICAL IN NURSING 14 days Signs and Symptoms Fever Cough Shortness of breath Pneumonia (common but not always present) GI(diarrhea) Nausea and vomiting Kidney failure Laboratory and Diagnostic Examination H1N1 (SWINE FLU) Polymerase Chain Reaction Testing (PCR- Signs RT)-with presence of antibodies in blood 10 days after onset symptoms Fever, but not always. Treatment Aching muscles. Chills and sweats. Cough. Supportive Sore throat. Runny or stuffy nose. Prevention and Control Watery, red eyes and eye pain Headache Tiredness/weakness Diarrhea Avoid contact with animals or sick animals Feeling sick to the stomach, vomiting – Hand washing before and after touching common in children (Influenza A virus) animals Avoid consumption of raw or undercooked Flu symptoms develop about 1 to 4 days after you're animal products (high risk) exposed to the virus. Note: seek immediate attention if an acute respiratory For emergency in adult the sign and symptoms illness with fever appears 14 days after returning are: from travel. Troubled in breathing or shortness of breath. Chest pain Signs of dehydration such as not urinating Ongoing dizziness. Seizures. Worsening of existing medical conditions. Severe weakness or muscle pain. Emergency symptoms in children can include: NCM 112 MEDICAL SURGICAL IN NURSING Trouble breathing. alcohol-based hand sanitizer that has at least Pale, gray or blue-colored skin, lips or nail 60% alcohol. beds depending on skin color. Cover your coughs and sneezes Chest pain. Avoid touching your face, eyes, nose and Dehydration. mouth. Severe muscle pain. Clean and disinfect surfaces regularly. Seizures. Avoid people who are sick or have Worsening of existing medical conditions. symptoms of flu. Causes Cells are infected that line the nose, throat and lungs air in droplets ( talking, coughing, sneezing, breathing) Touching a contaminated surface and then touching your eyes, nose or mouth. You can't catch swine flu from eating pork. Risk Factors and Prevention HEPATITIS Age – below 2 years old and 65 years old Living or working condition Viral Hepatitis Weakened immune system Systemic, viral infection in which necrosis Chronic illness and inflammation of liver cells produce a Race – American Indians/Alaska Native characteristic cluster of clinical, biochemical Aspirin use – below 19 years old and cellular changes. Pregnancy Obesity TYPES Prevention: Seasonal Flu Vaccination Hepatitis A Complications Hepatitis B Hepatitis C Hepatitis D Worsening of chronic conditions - such as Hepatitis E heart disease and asthma. Pneumonia. Mode of Transmission Neurological symptoms, ranging from fecal and oral route confusion to seizures. Bronchitis and respiratory failure Phases of Infectious Hepatitis Muscle tenderness. Bacterial infections. Viral replication phase Measures to prevent and limit the spreading of o asymptomatic flu: o laboratories – reveal markers of hepatitis Preicteric phase –prodromal phase Wash your hands soften for at-least 20 o anorexia, nausea, vomiting, fatigue, seconds by using soap and watercourses pruritus Icteric phase NCM 112 MEDICAL SURGICAL IN NURSING o jaundice and dark urine HAV antigen – found in the stool 7-10 days Convalescent Phase before the illness o sign and symptoms resolve and HAV antibodies – found in serum laboratory values return to normal Prevention Scrupulous hand washing. HEPATITIS A VIRUS Safe water supplies. Formerly called infectious Hepatitis Proper control of sewage disposal. HAV vaccine Transmission Fecal-oral route by ingestion of food or Medical management liquids infected with the virus Bed rest Nutritious diet – frequent small feedings, IV Characteristics fluids with glucose Prevalent countries with overcrowding and mm poor sanitation. Found in the stool of infected patients Nursing Management before the onset of symptoms. Diet, rest and follow-up of blood work Acquire through poor hygiene, hand to Avoidance of alcohol mouth contact or other close contact. Sanitation and hygiene measures. An infected food handler can spread the disease. People can contract hepatitis by consuming water or shellfish from sewage- contaminated waters. Transmitted during sexual activity – oral- anal contact or anal intercourse. with multiple sex partners. Incubation Period 2-3 weeks (mean 4 weeks) HEPATITIS B VIRUS It is transmitted primarily through blood. HBV found – blood, saliva, semen, and Clinical Manifestations vaginal secretions. Anicteric (without jaundice)-symptomless Transmitted through mucous membranes Mild flu-like URTI (low grade fever) and breaks in the skin. Anorexia – early symptom Transferred from carrier mothers to their o due to release of a toxin by the infants via umbilical vein and during close damage liver contact. (Book: The infection is not Jaundice and dark urine transmitted via umbilical vein but from the Indigestion – epigastric distress, nausea, mother at the time of birth and close contact heartburn flatulence afterward) Strong aversion to the taste of cigarettes Risk Factors Exposure to blood, blood products or other Diagnostic Findings body fluids Liver and spleen- moderately enlarged Hemodialysis IV injection/drug use NCM 112 MEDICAL SURGICAL IN NURSING Gay men and bisexual activity Mother to child transmission Hepatitis D Virus Multiple sexual partners Receipt of blood or blood products History of sexually transmitted infection Common in IV injection, hemodialysis, Tattooing blood transfusions. Mode of transmission – sexual contact with hepatitis B and D Clinical Manifestation Hepatitis E Virus Arthralgia and rashes Loss of appetite dyspepsia Transmitted by the fecal-oral route through Abdominal pain contaminated water in poor sanitation. Generalized aching Malaise and weakness Jaundice may or may not be evident Guillain-Barre Syndrome (GBS) Light colored colored stools and dark urine Idiopathic Polyneuritis Liver maybe tender and enlarged and spleen is enlarged Autoimmune attack on the peripheral nerve myelin resulting in acute, rapid segmental demyelination of Preventing Transmission peripheral nerves and some cranial nerves producing Screening of blood donors ascending weakness with dyskinesia, hyporeflexia Use of disposable syringes, needles and and paresthesias. lancets. Gloves are worn when handling all blood Antecedent – viral infection (Epstein-Barr Virus) and body fluids Subtypes Active Immunization: HBV Weakness in lower extremities which Hepatitis B vaccine progresses upward and respiratory failure (potential)- most common Passive Immunity: Hepatitis B Immune Globulin Motor with no sensation provides passive immunity to HBV Descending GBS – affects the head and neck indicated for people exposed to HBV who muscles have never had Hepatitis B and have never received hepatitis B vaccine. Pathophysiology Medical Management GBS – result of a cell – mediated, humoral immune Goal-minimize infectivity and liver attack on peripheral inflammation nerve myelin proteins that causes Inflammatory 1. Alpha-interferon Demyelination. 2. Bed rest 3. Activities are restricted until hepatic enlargement and liver enzymes have decreased. 4. Adequate nutrition a. Proteins - not restricted Hepatitis C Virus Common in Blood transfusion and sexual contact and other parenteral means. NCM 112 MEDICAL SURGICAL IN NURSING 4. Sensory symptoms – paresthesias of the hands and feet and pain – due to demyelination of sensory fibers. 5. Cranial nerve demyelination 6. Optic nerve demyelination – blindness 7. Bulbar muscle weakness – demyelination of the glossopharyngeal and vagus nerves resulting in the inability to swallow or clear secretions. 8. Vagus nerve demyelination resulting in autonomic dysfunction (tachycardia, bradycardia, hypertension and orthostatic hypotension) Note: GBS does not affect cognitive function or LOC Assessment and Diagnostic Findings 1. Symmetric weakness 2. Diminished reflexes 3. Upward progression of motor weakness 4. Elevated protein levels – detected in CSF Note: history of a viral illness (few weeks previously)- suggest diagnosis Medical Management Respiratory therapy/mechanical ventilation Goal Preventing the complications of immobility. o Use of anticoagulant o Compression boots – prevent venous thromboembolism (VTE)and DVT. Therapeutic plasma exchange and IVIG – affect the peripheral nerve myelin antibody level. Continuous ECG monitoring Alpha adrenergic blocking agents – treat Clinical Manifestation tachycardia and hypertension IV fluid administration – to treat hypotension 1. Muscle weakness and diminished reflexes of the lower extremities. Complications 2. Hyporeflexia and weakness may progress to Respiratory failure tetraplegia. Cardiac failure 3. Neuromuscular respiratory failure – Cardiac arrhythmias demyelination of the nerves that innervate the diaphragm and intercostal muscles. NCM 112 MEDICAL SURGICAL IN NURSING Nursing Process antifungal – miconazole, nystatin Nursing Diagnosis: o Inserted into the vagina with an Impaired breathing associated with rapidly applicator during bedtime. progressive weakness and impending Oral medication – fluconazole respiratory failure. Vaginal creams Impaired mobility associated with paralysis. Impaired nutritional intake associated with B. Trichomonas inability to swallow. Flagellated protozoan – called as trich Vaginal ph – Impaired verbal communication associated greater than 4.5 with cranial nerve dysfunction. Anxiety associated with loss of control and Medical management: paralysis Metronidazole o Abstain from alcohol during Planning and Goals: treatment Maintaining Respiratory Function o Abstain from sexual activity for 7- o Incentive spirometry 10 days after treatment o Chest physiotherapy o Suctioning Enhancing Physical Mobility Passive and active range of motion Anti-coagulant Anti-embolism stockings Adequate hydration Providing Adequate Nutrition C. Genital Warts Paralytic ileus – due to insufficient Causative Agent: parasympathetic activity. Human Papilloma Virus with 100 types o IVF and parenteral nutrition o Gastrostomy tube Mode of transmission: Direct contact with infected skin mucous Improving Communication membranes, childbirth Use with picture cards/eye blink system Incubation Period: Decreasing Anxiety 2-3 months, range 1-20 months Period of Communicability: as long as lesions Sexually Transmitted Diseases persist (STD’s) Common types of STD or STI’s Sign and Symptoms: A. Candidiasis Circumscribed lesions in cervix, vulva, anus, penis, vagina, oropharynx (vary in sizes) Fungal or yeast infection caused by Candida Albicans Pathophysiology Clinical Manifestations: pruritus, irritation Discharges – watery or thick, white, cottage cheese-like appearance. Medical Management: NCM 112 MEDICAL SURGICAL IN NURSING Laboratory/Diagnostic Examination: Period of Communicability: Visualization of lesion during and up to 7 weeks after primary Excision and histological exam of lesion lesions appear Risk Factors: Pathophysiology: young, sexually active Multiple sex partners Sex with a partner who has had multiple partners Medical Management: External genital warts – topical application of trichloroacetic acid Electrocautery Condom Removal of warts by freezing with liquid Clinical Manifestations: nitrogen itching, pain, redness, edematous in the infected area Note: o macules and papules then progress transmission can occur during skin-skin to vesicles and ulcers but may contact spread to surrounding tissues or disseminated in the body. o Labia- primary site (female) Prevention: o Glans penis, foreskin, penile shaft HPV vaccine for individuals 11-12 years old (male)-site and safe sexual practice Influenza like symptoms – 3-4 days after the lesions appear 3. Inguinal lymphadenopathy Elevated temperature, malaise, headache, myalgia, dysuria Medical management/Treatment: No cure for genital herpes infection Antiviral agents - acyclovir Antispasmodic Saline compress Prevention: Safe sexual practices CS delivery if lesions are present during late pregnancy D.Herpes Virus Type 2 Infection (Herpes Genitalis) Causative Agent: Herpes simplex virus Mode of Transmission: direct contact with infected skin and mucous membranes, childbirth Nursing Process: Incubation Period: 2-12 days Assessment: NCM 112 MEDICAL SURGICAL IN NURSING o Health history o Pelvic examination F. Syphilis Diagnosis: o Acute pain associated with the Causative Agent: genital lesions Treponema Pallidum o Risk for infection o Anxiety associated with worry about the diagnosis Mode of Transmission: Nursing Interventions: Sexual Contact o Relieving pain o Preventing infection and its spread Incubation Period: 10-90 days (proper hand washing) - Relieve anxiety] Four different stages: Note: People are very contagious in the first and E. Chlamydia second stages and can easily pass Causative Agent: the infection to their sex partners. o Chlamydia trachomatis Types and sign and symptoms: primary- chance that appears within 3 Mode of transmission: weeks at area of contact. o Sexual contact or contact with secondary – condylomata, sore throat, exudates from mucous membranes, mucous patches of the mouth and childbirth Incubation Period: 7-14 maculopapular rash. days Tertiary – gamma formation, cardiovascular and nervous system involvement. Sign and symptoms: Diagnostic Examination: o Urethritis with purulent discharge Dark Field illumination test from anterior urethra (males) venereal disease research laboratory o Mucopurulent cervicitis often (VDRL) test asymptomatic (females) – lead to Fluorescent treponemal antibody test endometritis, salpingitis and pelvic peritonitis Treatment: Penicillin Tetracycline Diagnostic Examination: Erythromycin o Culture and Nucleic acid amplification test (NAAT) of urine Prevention and Control: or swab samples. Practice monogamy Treatment: Sex education o Doxycycline, Azithromycin (single dose G. Human Immunodeficiency Virus/Acquired ImmunoDeficiency Syndrome Nursing Management: Causative Agent: HIV 1 and 2 o Use of condom and spermicide o Educational counseling Mode of Transmission: Sexual contact Blood transfusion Prevention and Control: Contaminated syringes, needles, nipper, o Safe sexual practices blades o Test pregnant women NCM 112 MEDICAL SURGICAL IN NURSING Direct contact of open wounds/mucous Diagnostic Examination: membranes with contaminated blood, body Enzyme Linked Immunosorbent Assay fluids, semen, and vaginal discharges (ELISA)- presumptive test Western blot – confirmatory test Incubation Period: Treatment: Varies from 3-6 months to many years (8-10 Antiretroviral drug – suppress the virus years) Prevention and Control: Sign and Symptoms: 1. Blood and blood products a. Screen blood donors b. Observe universal precaution c. Refrain from using contaminated needles 1. Clinical stage 1 – persistent generalized and syringes lymphadenopathy 2. Sexual transmission a. Abstain from promiscuous sexual contact b. Be faithful to your partner and practice monogamous sexual contact. Follow correct and consistent use of condoms. 2. Clinical stage 2 weight loss of 10% of body weight Truvada. Unexplained chronic diarrhea for 1 month Inflammatory Disorders (All Unexplained prolonged fever for Body Systems) >1 month Oral candidiasis Gastro-intestinal System Oral hairy leukoplaki PTB within the past year Inflammatory Bowel Disease – IBD Severe bacterial infections 4. Clinical stage 4 Group of chronic disorders (Crohn's disease Pneumocystic carinii pneumonia and ulcerative colitis that result in Toxoplasmosis of brain inflammation or ulceration (both) of the Herpes simplex virus infection bowel. Kaposi's sarcoma Extra pulmonary tuberculosis Predisposing factors: Lymphoma Family history Acquired immunodeficiency Caucasian syndrome – most advanced stages Living in northern climate of HIV infection. Living in urban areas Occurrence of any more than 20 opportunistic Causes: infections or HIV-related cancers (WHO, 2018) Genetic NCM 112 MEDICAL SURGICAL IN NURSING Altered immune response Altered response to gut microorganisms Crohn’s Disease (Regional Enteritis) Sub acute and chronic inflammation of the GIT wall that extends through all layers (distal ileum and ascending colon). Pathophysiology Assessment and Diagnostic Findings: CT scan – bowel wall thickening and mesenteric edema, obstruction, abscess and fistulas MRI CBC Hgb – decreased WBC – elevated ESR – elevated Albumin and protein levels – decreased Complications: Intestinal obstruction/stricture formation Perianal disease Clinical Manifestations: Fluid and electrolyte imbalance Diarrhea Malnutrition from malabsorption Right lower quadrant abdominal pain unrelieved by defecation Fistula and abscess formation o Enterocutaneous fistula – Crampy abdominal pain occur after meals common type of small bowel Abdominal tenderness and spasm fistula Weight loss, malnutrition, anemia and o Note: patients with Crohn’s disease dehydration are risk of colon cancer Weeping, edematous intestine Intra-abdominal and anal abscess Fever and leukocytosis Steatorrhea (excess fat in the feces) and anorexia - chronic symptoms Arthritis Skin lesions (erythema nodosum) Uveitis Oral ulcers Ulcerative Colitis NCM 112 MEDICAL SURGICAL IN NURSING Chronic ulcerative and inflammatory disease Electrolyte imbalance of the mucosal and sub mucosal layers of the C-reactive protein - elevated colon and rectum. Elevated antineutrophil cytoplasmic antibody levels Characteristics: remission and exacerbation Complications: Abdominal cramps and bloody or purulent Toxic megacolon diarrhea Perforation Bleeding Pathophysiology Risk: Osteoporotic fracture Colon cancer Management of Inflammatory Bowel Disease: 1. Pharmacologic Therapy a. Aminosalicylates (Sulfasalazine) ▪ Adverse effects: Clinical Manifestations: Headaches Remission and exacerbation Nausea Diarrhea with passage of mucus, pus, or Diarrhea blood b. Antibiotics (Metronidazole, Left lower quadrant pain Ciprofloxaxcin) Intermittent tenesmus b. Corticosteroids Bleeding (mild or severe) b. Immunomodulators (Azathioprine) Pallor, anemia and fatigue ▪ Adverse effects: Anorexia, weight loss Depress bone Fever marrow (monitor Vomiting for neutropenia) Dehydration b. Anti-tumor necrosis factor Cramping and passage of six or more liquid medications (Infliximab) stools each day Nutritional Therapy A. Oral fluids and IV therapy Hypoalbuminemia B. low residue, high calorie diet with Electrolyte imbalance supplemental vitamin therapy and iron replacement Skin lesion (erythema nodosum) C. Calcium and vitamin D – prevent osteopenia Uveitis D. Nutritional therapy Arthritis E. Cold foods and smoking – avoided F. Probiotic supplements – indicated for Assessment and Diagnostic Findings: ulcerative colitis Abdominal X-ray Colonoscopy – definite screening test Surgical Management: Biopsies A. Proctocolectomy and total Colectomy with CT scan Ileostomy MRI B. Restorative Proctocolectomy with Ileal Ultrasound Pouch Anal Anastomosis Stool - + for blood C. Continent Ileostomy Low hematocrit and hemoglobin Elevated WBC Nursing Process: Low albumin NCM 112 MEDICAL SURGICAL IN NURSING 1. Diarrhea associated with the inflammatory process Note: Ruptured appendix – pain is consistent 2. Acute pain associated with anorexia, nausea and diarrhea Result to: 3. Impaired nutritional status associated with A. Peritonitis dietary restrictions, nauseas and B. abdominal distention - due to paralytic ileus. malabsorption Assessment and Diagnostic Findings: 1. WBC – Neutrophilia Nursing Interventions: 2. C-reactive proteins – within the 12 hours 1. Maintaining Normal Elimination Patterns 3. CT scan/UTZ 2. Relieving pain 3. Maintaining fluid intake Complications: 4. Maintaining optimal Nutrition 1. gangrene/perforation of the appendix – lead to 5. Promoting rest peritonitis, abscess formation 6. Reducing anxiety - Perforation occurs within 6 hours to 24 hours after 7. Reducing anxiety the onset of pain 8. Enhancing coping measures 9. Preventing Skin Break down Medical Management: Appendicitis and Peritonitis Immediate surgery (appendectomy) Antibiotics IV fluids Appendicitis – is an inflammation of the appendix and filled with pus. Nursing Management Goals: Relieve pain Preventing fluid volume deficit Reduce anxiety Preventing or treating surgical site infection Preventing atelectasis Maintaining skin integrity Attaining optimal nutrition Nursing management: Clinical Manifestations: 1. Before surgery: 1. Vague umbilical pain (visceral – dull and a. IV infusion poorly localized) progresses to right lower b. Promote adequate renal quadrant function 2. Anorexia and nausea c. Antibiotic 3. Low grade fever d. Analgesics 4. Localized tenderness – elicited at Mc Burney’s point Note: Enema is contraindicated – lead to perforation 5. Rebound tenderness 2. After surgery: 6. Rovsing’s sign – palpating the left lower a. High fowler position – reduces tension on quadrant causes pain in the right lower the incision and abdominal organ –reducing pain. quadrant Promotes thoracic expansion – preventing 7. Constipation atelectasis 3. Incentive spirometer (morphine) Note: Laxatives and cathartic is contraindicated when 4. IVF there is fever, nausea and 5. Oral fluid and food – when bowel sound return abdominal pain. 6. Urine output  NCM 112 MEDICAL SURGICAL IN NURSING 7. Ambulation the day of surgery – reduce the risk of 5. Abdominal X-ray – show free air and fluid and atelectasis and venous distended bowel loops. thromboembolism 6. Abdominal UTZ – abscess formation 8. Heavy lifting is avoided 9. Normal activity resumed within 2-4 weeks. Medical Management: Peritonitis 1. Fluid, colloid and electrolyte replacement Peritonitis –inflammation of the peritoneum 2. Isotonic solution administration – for hypovolemia Causes: 3. Analgesia 1. Bacterial infection or secondary to fungal or 4. Antiemetic mycobacterial infection (E. Coli, Pseudomonas, 5. Intestinal intubation and suction – relieve Streptococcus, Klebsiella) abdominal distention 2. External sources ( abdominal surgery or trauma or 6. Oxygen therapy- for respiratory distress inflammation that extends from an 7. Antibiotic therapy – broad spectrum organ outside the peritoneal area) antibiotic Nursing Management: Types: 1. Intensive care – for septic shock patient 1. Primary – spontaneous bacterial peritonitis 2. Prepare patient for emergency surgery 2. Secondary – due to perforation of abdominal organs causing spillage that infects the serous peritoneum ( perforated appendix, peptic ulcer, diverticulitis Clinical Manifestations: 1. Pain is diffuse then constant, localized and intense. 2. Abdomen is tender and distended, rigid. 3. Rebound tenderness 4. Anorexia, nausea, vomiting 5. Peristalsis diminished resulting in paralytic ileus 6. Increased in body temperature and pulse rate 7. Hypotension, oliguria and anuria Note: Sign and symptoms will mirror of sepsis and Pancreatitis septic shock Pancreatitis – inflammation of the pancreas Assessment and Diagnostic Findings: 1. WBC – elevated Pancreatitis duct temporary obstructed – 2. Hgb/HCt – low hypersecretion of the exocrine enzymes of the 3. ABG – reveals dehydration and acidosis pancreas – enzymes enter the bile duct (activated) 4. Electrolytes – altered in sodium, potassium and together with the bile – reflux into the pancreatic duct chloride – pancreatitis NCM 112 MEDICAL SURGICAL IN NURSING Division of disorder: 2. Amylase and lipase elevated within 24 hours Acute Pancreatitis 3. WBC elevated Hypocalcaemia 4. Transient hyperglycemia and glycosuria Causes: Serum bilirubin elevated Cholelithiasis 5. UTZ, CT scans and MRI Alcohol abuse Medical Management: Types 1. Pain Management 1. Interstitial edematous pancreatitis – lack of a. Opioid – Morphine pancreatic with diffuse enlargement of the b. NSAIDs – avoided (risk for bleeding) gland due to inflammation and edema. 2. Intensive Care 2. Necrotizing pancreatitis – tissue necrosis in a. Correction of fluid and blood loss and low the pancreatic parenchyma albumin Insulin – in case of hyperglycemia 3. Respiratory Care a. ABG monitoring Pathophysiology b. Use of humidified oxygen 4. Biliary Drainage 5. Surgical Intervention 6. NPO – inhibit stimulation of the pancreas a. Enteral feedings – recommended 7. NGT – relieve nausea, vomiting, abdominal distention and paralytic ileus 8. Proton-pump inhibitor Chronic Pancreatitis inflammatory disorder characterized by progressive destruction of the pancreas Clinical manifestations: Severe abdominal pain and tenderness Causes: (midepigastrium)– due to irritation and 1. Alcohol consumption edema of inflamed pancreas. 2. Malnutrition o occur 24-48 hours after a very 3. Smoking heavy meal or alcohol ingestion. - can’t be relieved by antacids Clinical Manifestations: o abdominal distention, palpable 1. Recurring attacks of severe upper abdominal mass, decreased peristalsis and back pain accompanied by vomiting. o vomiting (bile stained) 2. Weight loss o rigid or boardlike abdomen – 3. Proteins and fats – impaired peritonitis 4. Stools contain high fat content – steatorrhea o ecchymosis (flank or around the umbilicus) – severe pancreatitis Assessment and Diagnostic Findings: o fever, jaundice 1. CT scan o mental confusion and agitation 2. ERCP o hypotension, tachycardia, cyanosis, cold clammy skin - respiratory distress and hypoxia Medical Management: o myocardial depression, Goal: hypocalcemia, hyperglycemmia 1. Prevent and manage the acute attacks o DIC 2. Relieve pain and discomfort 3. Manage the exocrine and endocrine insufficiency Assessment and Diagnostic Findings: 1. History of upper abdominal pain Nonsurgical management: NCM 112 MEDICAL SURGICAL IN NURSING 1. Non opioid drug Acalculous cholecystitis – inflammation of 2. Implementation of the WHO’s three-step gallbladder in the absence of obstruction by ladder of treatment of chronic pain: the gallstones. a. Initiating monotherapy o Causes: b. Peripheral acting and centrally acting ▪ alteration in fluids and medications electrolytes and in Surgical Management: regional flow in the Pancreaticojejunostomy visceral circulation. ▪ bile stasis – increased viscosity of the bile. Cholethiasis Calculi or gallstones form in the gallbladder from the solid constituents of bile. Common: 1. Women 2. Older forty years 3. Multiparous 4. Obesity 5. Oral contraceptives Cholecystitis Pathophysiology Cholecystitis-inflammation of the gallbladder Sign and symptoms: 1. Pain 2. tenderness and rigidity of the upper right abdomen radiating to the midsternal area or right shoulder 3. nausea and vomiting Note: Empyema – gallbladder filled with purulent fluid Clinical Manifestations: 1. Pain and biliary colic Causes: a. Fever Calculous cholecystitis – 90% causes of b. Palpable mass cholecystitis c. Biliary colic with excruciating upper right o Pathophysiology abdominal pain radiating to the back or right shoulder. d. Nausea and vomiting ▪ Note: Morphine Sulfate should be avoided – causes spasm of the sphincter of Oddi. e. abscess, necrosis perforation, peritonitis 2. Jaundice – due to obstruction of bile duct 3. Changes in urine and stool color – due to excretion of the bile pigments 4. Vitamin deficiency a. interferes with absorption of fat-soluble vitamins (A, D, E, K) – due to obstruction of bile flow. NCM 112 MEDICAL SURGICAL IN NURSING a. Bleeding Assessment and Diagnostic Findings: b. Tenderness and rigidity of the abdomen 1. Abdominal X-ray c. Change in color of stools 2. UTZ d. Anorexia, vomiting, pain, abdominal 3. Oral Cholecystography distension and fever 4. ERCP (Endoscopic retrograde cholangiopancreatography) Nursing Process: Medical Management: 1. Nursing Diagnosis Goal: reduce the incidence of acute episodes of pain. a. Acute pain and discomfort associated with 1. Cholecystectomy surgical incision 2. Nutritional and Supportive Therapy b. Impaired gas exchange associated with high a. Rest abdominal surgical incision b. IVF 2. Nursing Interventions: c. NGT suction a. Placed in low Fowler's position d. Analgesia b. IVF e. Antibiotic c. NGT suctioning f. Low fat liquids (high in protein and CHO in d. Relieve pain skim milk) ▪ Splint the affected site and g. Eggs, pork, fried foods, cheese, rich take shallow breathing dressings, gas forming vegetable, alcohol – avoided (use pillow or abdominal 3. Pharmacologic Therapy binder) a. Ursodeoxycholic acid and chenodeoxycholic – dissolve small radiolucent stones. 4. Surgical Management: a. Laparoscopic cholecystectomy – small incision or puncture made through the abdominal wall to the umbilicus. b. Cholecystectomy – removal of the gallbladder through abdominal incision. 5. Improve respiratory status a. Take breathing and coughing exercises Cystitis every hour – expand; the lungs and prevent atelectasis Cystitis - is inflammation of the bladder, usually b. Use of incentive spirometer caused by a bladder infection. It is a type of urinary c. Early ambulation – prevent DVT tract infection (UTI), particularly in women. ▪ Note: elderly, obesity and with pre-existing UTI – caused by pathogenic microorganisms in the pulmonary disease – prone urinary tract. to pulmonary complication. 6. Maintaining skin integrity and promoting Catheter-associated UTI – hospital acquired UTI. biliary drainage a. Observed for infection, leakage of bile into Lower UTI peritoneal cavity, obstruction of bile drainage. b. Jaundice Types: c. Note and report right upper quadrant 1. Cystitis – (bladder) abdominal pain, nausea, vomiting bile drainage, clay- 2. Prostatitis – (prostate gland) colored stools and change in VS. 3. Urethritis – (urethra) 7. Improve nutritional status a. Diet – low in fat and high CHO and protein Pathophysiology 8. Monitoring and managing potential complications such as: NCM 112 MEDICAL SURGICAL IN NURSING a. Antispasmodic/analgesic drug b. Heat to the perineum c. Drink plenty of fluids d. Urinary irritants should be avoided (coffee, tea, colas, citrus) e. Frequent voiding (every 2-3 hours). 2. Monitoring and managing potential complications Note: gram-negative sepsis – most Causes: common complication Bacterial invasion of the urinary tract Monitor VS and LOC Reflux – obstruction to free-flowing urine Antibiotic o urethrovescial reflux - reflux of Increased fluid intake urine from urethra into the bladder Urolithiasis o vesicoureteral reflux – backflow of stones (calculi) in the urinary tract and urine from the bladder into one or kidney. both ureters. concentrations of substances (calcium oxalate, calcium phosphate and uric acid) Routes (3 ways) Contributing factors: 1. Transurethral route (ascending infection) – 1. Infection most common (fecal contamination) 2. Urinary stasis 2. Bloodstream (hematogenous spread) 3. Immobility 3. Fistula from the intestine (direct extension) 4. Alter calcium metabolism or increased Clinical Manifestations: calcium formation of stones 1. Burning on urination 2. Urinary frequency Causes: 3. Urgency 1. Renal tubular acidosis 4. Nocturia 2. Excessive intake of vit. D 5. Incontinence 3. Excessive intake of milk and alkali 6. Suprapubic or pelvic pain 7. Hematuria 8. back pain Clinical Manifestations: 1. Infection (fever, chills and urinary frequency) Assessment and Diagnostic Findings: 2. Excruciating pain and discomfort 1. Urine cultures 3. Intense, deep ache and tenderness in the cost 2. Cellular studies vertebral region (stones in renal pelvis) a. Hematuria 4. Hematuria b. Pyuria 5. Nausea and vomiting c. X-rays/CT scan 6. Ureteral colic 7. Oxalate stones Medical Management: Assessment and Diagnostic Findings: Antibacterial agent (Anti-infectives – 1. CT scan cephalosporin, levofloxacin) 2. Blood chemistries test (calcium, uric acid, creatinine, sodium pH) Pathophysiology Nursing Diagnosis: Acute pain associated with infection within the urinary tract Nursing Interventions: 1. Relieve pain Interventional Procedures: NCM 112 MEDICAL SURGICAL IN NURSING 1. Ureteroscopy Headache 2. Electrohydraulic lithotripsy Vomiting 3. Surgical management – nephrolithotomy Intense tenderness of the uterus or cervix Medical Management: Complications: 1. Opioid analgesics 1. Peritonitis 2. NSAIDs 2. Abscess strictures 3. Increased fluid intake 3. Fallopian tube obstruction resulting to: 4. Limit oxalate intake (spinach, chocolate, a. Ectopic pregnancy peanuts) b. sterility Inflammatory Disorders (All c. Adhesions Body Systems) Medical Management: Reproduction 1. Broad spectrum antibiotic (ceftriaxone, doxycycline, metronidazole) Pelvic Inflammatory Disease Nursing Management: 1. VS and MIO 2. MIO Is an inflammatory condition of the pelvic 3. Record the characteristics and amount of cavity that may begin with cervicitis and vaginal discharge uterus (endometritis), fallopian tubes 4. Analgesics (salpingitis), ovaries (oophoritis), pelvic 5. Infection control practices- meticulous hand peritoneum, or pelvic vascular system. washing Causes: 1. Virus 2. Fungus 3. Parasite Gonorrheal/chlamydial organisms – common causes Pathophysiology Clinical Manifestations: Vaginal discharge Dyspareunia Dysuria Pelvic or lower abdominal pain Tenderness that occurs after menses and postcoital bleeding Fever General malaise Benign Prostatic Hypertrophy/Hyperplasia Anorexia (BPH) Nausea NCM 112 MEDICAL SURGICAL IN NURSING noncancerous enlargement or hypertrophy of 5. Urethrocystoscopy the prostate common diseases in aging men (over 40 Medical Management: years old) Cystostomy – incision in the bladder Pharmacologic Therapy: Pathophysiology Alpha adrenergic blockers (alfuzosin, terazosin) relax the smooth muscle of the bladder neck and prostate. Side effects: Dizziness Headache Asthenia/fatigue Orthostatic hypotension Rhinitis Sexual dysfunction 5-alpha-reductase inhibitors (finasteride) [prevent the conversion of testosterone to DHT and decrease the prostate size. Side effects: o Decreased libido o Ejaculatory/erectiledysfunction o Gynecomastia Risk factors: o Flushing 1. Smoking 2. Heavy alcohol consumption Surgical Management: 3. Obesity 4. Reduced activity level Transurethral resection of the prostate (TURP) 5. Hypertension 6. Heart disease 7. Western diet ( high in animal fat and CHON and refined CHO) Clinical Manifestations: 1. Urinary frequency, urgency 2. Nocturia, hesitancy in starting urination 3. Decreased and intermittent force of stream 4. Sensation of incomplete bladder emptying 5. Abdominal straining with urination 6. Decrease in the volume and force of the urinary stream 7. Recurrent UTI 8. Azotemia – due to chronic urinary retention and large residual volumes Assessment and Diagnostic Findings: 1. Voiding diary 2. Urinalysis 3. PSA level 4. UTZ NCM 112 MEDICAL SURGICAL IN NURSING 11. Spasticity 12. Cognitive and psychosocial problem Inflammatory Disorders (All (decreased concentration, memory loss) Body Systems) 13. Ataxia and tremors – involvement in cerebellum or basal ganglia Immunologic Disorder 14. Emotional lability and euphoria 15. Bladder, bowel and sexual dysfunction Multiple Sclerosis Note: exacerbations and remissions are Multiple Sclerosis – immune – mediated, characteristics of MS progressive demyelinating disease of the CNS Assessment and Diagnostic Findings: Demyelination – destruction of myelin – MRI – plaques in the CNS fatty and protein material that surrounds nerve fibers in the brain and spinal cord Medical Management: resulting in impaired transmission of nerve Goal: impulses. 1. delay the progression of the disease 2. Manage chronic symptoms Causes: 3. Treat acute exacerbations Autoimmune a. Pharmacologic Therapy Interferon beta-1a and interferon beta-1b – SC every other day o Side effects: flu-like Risk factors: symptoms, increased liver 1. Genetic function test, leukopenia, 2. Virus depression 3. Environmental – obesity, lack of vitamin D IV methylprednisolone – treat exposure, high salt diet in teenage years. acute exacerbations Pathophysiology Symptom Management Baclofen – gamma-aminobutyric acid agonist (treat spasticity) Benzodiazepines – treat spasticity and convulsion Beta adrenergic blockers (propanolol) Anti-cholinergic agent – bladder and bowel problems Increased fluid intake Nursing Process: 1. Nursing Diagnosis a. Impaired mobility associated with weakness, Clinical Manifestations: muscle paresis, spasticity, increased weight gain 1. Fatigue 2. Nursing Interventions: 2. Depression a. Promoting physical mobility - exercise 3. Weakness b. Nutrition 4. Numbness c. Preventing falls 5. Difficulty incoordination d. Managing fatigue 6. Loss of balance e. Strengthening coping mechanisms 7. Spasticity f. Monitoring and managing potential 8. Pain complications - suicide 9. Visual disturbances (blurring of vision, diplopia, total blindness) 10. Sensory manifestations (paresthesias, dysesthesias, proprioception loss) NCM 112 MEDICAL SURGICAL IN NURSING History of gestational diabetes Family history of diabetes- most common Obesity Impaired glucose tolerance Physical inactivity HPN Type 1 Diabetes Type 1 Diabetes - destruction of the pancreatic beta cells Factors that contribute to beta cells destruction: 1. Genetic predisposition