Medical-Surgical Notes PDF

**DEFINITION OF TERMS :** **Antibody:** a protein substance developed by the body in response to and interacting with a specific antigen **Antigen:** substance that induces the production of antibodies **Apoptosis:** programmed cell death that results from the digestion of deoxyribonucleic acid b...

**DEFINITION OF TERMS :** **Antibody:** a protein substance developed by the body in response to and interacting with a specific antigen **Antigen:** substance that induces the production of antibodies **Apoptosis:** programmed cell death that results from the digestion of deoxyribonucleic acid by end nucleases **B cells:** cells that are important for producing a humoral immune response **Cellular immune response**: the immune system's third line of defense involving the attack of pathogens by T cells **Cytotoxic T cells:** lymphocytes that lyse cells infected with virus; also play a role in graft rejection. **Humoral immune response:** the immune system's second line of defense; often termed the antibody response **Immune response:** the coordinated response of the components of the immune system to a foreign agent or organism **Immune system:** the collection of organs, cells, tissues, and molecules that mediate the immune response **Immunity:** the body's specific protective response to a foreign agent or organism; resistance to disease, specifically infectious diseases **Interferons:** proteins formed when cells are exposed to viral or foreign agents; capable of activating other components of the immune system **Memory cells**: cells that are responsible for recognizing antigens from previous exposure and mounting an immune response **Natural killer (NK) cells:** lymphocytes that defend against microorganisms and malignant cells **Opsonization:** the coating of antigen--antibody molecules with a sticky substance to facilitate phagocytosis **Phagocytic cells:** cells that engulf, ingest, and destroy foreign bodies or toxins **Immunity** is the body's specific protective response to a foreign agent or organism. The **immune system** functions as the body's defense mechanism against invasion and allows a rapid response to foreign substances in a specific manner. **There are two general types of immunity:** Natural (innate) and Acquired (adaptive). **Natural immunity or nonspecific immunity** is present at birth. **Acquired or specific immunity** develops after birth. Each type of immunity has a distinct role in defending the body against harmful invaders, but the various components are usually interdependent **There are two general types/arms of immunity:** **INNATE and ADAPTIVE** **Innate -- external and internal defense** **EXTERNAL** Epidermis (made up of epithelia) Sebaceous oil glands ph Sweat Hair Mucous Cilia Gastric secretions **INTERNAL** CELLS CHEMICALS PHYSIOLOGICAL RESPONSES I. PHAGOCYTES A. Neutrophils -- wbc's (NLMEB) -- targets and engulfs the pathogen B. Macrophages -- they pull of parts of the pathogen \- wandering and **fixed** \- **histiocytes** **-Kupffer cells** **-alveolar cells** **-microglia** C. NK CELLS -- target and destroy \- releases perforins and granzymes **CHEMICAL :** 30 compliment proteins A. Cytokines -- interlukins (bcells) and interferons (tcells) **PHYSIOLOGIC :** 1. Inflammation -- damage that occurs to vascularized tissue - Vascular dilation - Increases vascular permeability - Signs of inflammation redness, heat, pain, swelling - Pyrogens stimulates heat - Benefits of fever: - a.) increases immune cell function - b.) decreases pathogen the ability to divide   **RHEUMATOID ARTHRITIS** Rheumatoid arthritis is a **chronic, systemic, autoimmune, inflammatory** disorder that can affect more than just your joints. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the **[lining of your joints,]** causing a painful swelling that can eventually result in bone erosion and joint deformity. 1. Antigen triggers the immune response 2. IgG forms the antibodies (RF) 3. Overtime, that inflammation causes tissue destruction, edema and the development of a spongey tissue called pannus 4. Decreased function and movement of the joint 5. Granulation tissue pull the joints, it would lead to deformities 6. Possible complications (rheumatoid vasculitis and ankylosis) Hands Ankles Elbows Feet Knees Shoulders Wrist Hips Symmetrical **RISK FACTORS :** Hereditary Females Ages 30-50s **Certain Triggers :** Smoking Viruses and Bacteria **Signs and symptoms of rheumatoid arthritis may include**: Joint pain/swelling/redness Fatigue Morning stiffness lasts \>30 mins Symptoms are symmetrical (left and right side are equally affected) Joint deformity/disability/deformities Anemia **DX :** **Blood tests -- RF (** check for antibodies) **ESR** /**CRP** **Synovial Fluid Aspiration** **X-ray to monitor progression of the deformity** **TREATMENT :** 1. Education, Joint Mobility, ROM (PT/OT) 2. Nutrition/ Weight Management **MEDICATION :** 1**. NSAIDs**. Nonsteroidal anti-inflammatory drugs can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription. Side effects may include stomach irritation. **2. Steroids.** Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage. **NURSING CARE :** 1. Education 2. Assess mental status 3. Check for signs of infection 4. Up to date on Vaccines 5. Emotional Support -- manage pain **SYSTEMIC LUPUS ERYTHEMATOSUS** - Is a chronic inflammatory disorder of the connective tissue and it causes widespread inflammation and tissue damage. - Is an autoimmune disorder which results in the production of antinuclear antibodies, or ANA. And this results in inflammation and damage to many organs in the body, including the skin, lungs, kidneys and the heart. And just like any other autoimmune diseases, lupus is characterized by periods of exacerbations and remissions   **HYPOTHYROIDISM**  **CAUSES :** **1.Primary Hypothyroidism** -- leading cause is Hashimoto's Disease, Iodine Deficiency, Pituitary Tumor, Anti Thyroid D **2. Secondary Hypothyroidism** **3. Tertiary Hypothyroidism** Hypothalamus releases Thyrotrophin releasing hormone (TRH) Stimulates the Ant. Pituitary Gland to release Thyroid Stimulating hormone, (TSH) which stimulates the thyroid gland To release T3 and T4 **FUNCTION OF T3 AND T4** Burns calories How fast your cells are replaced and Digestion Stimulates the SNS Temperature Regulation Regulates you Heart Rate and Blood Pressure **SIGNS AND SYMPTOMS :** HYPOTENSION BRADYCARDIA LETHARGY COLD INTOLERANCE CONSTIPATION WEIGHT GAIN **LAB RESULTS :** -Lab results will depend upon the underlying cause. Primary -- Low T3 and T4, elevated TSH Secondary and Tertiary -- Low T3, T4 and TSH **TREATMENT : Thyroid Replacement** 'Synthroid' Levothyroxine Liothyronine **NURSING INTERVENTIONS :** Frequent rest periods Low calorie and high fiber Provide blankets **Patient Education :** 1. Don't stop meds abruptly 2. Best to take meds in the morning without food 3. Don't take meds within 4 hours of taking a GI med severe, life-threatening hypothyroidism leading to decreased mental status and symptoms related to slowing of functions in multiple organs. **SIGNS AND SYMPTOMS :** Hypoxia Decreased cardiac output Decreased LOC Bradycardia Hypotension and Hypothermia **NURSING PRIORITIES :** Maintain a patent airway Monitor patient's cardiac rhythm Administer large doses of thyroid meds as ordered Warm the patient **Human immunodeficiency virus (HIV)** is the virus that causes acquired immunodeficiency syndrome (AIDS). When a person becomes infected with HIV, the virus attacks and weakens the immune system. As the immune system weakens, the person is at risk for getting life-threatening infections and cancers. What are the seven stages of the HIV life cycle? The seven stages of the HIV life cycle are: 1) [binding](https://clinicalinfo.hiv.gov/en/glossary/binding) -- co receptors 2) [fusion](https://clinicalinfo.hiv.gov/en/glossary/fusion) 3) [reverse transcription](https://clinicalinfo.hiv.gov/en/glossary/reverse-transcription), 4) [integration](https://clinicalinfo.hiv.gov/en/glossary/integration), 5) [replication](https://clinicalinfo.hiv.gov/en/glossary/replication), 6) [assembly](https://clinicalinfo.hiv.gov/en/glossary/assembly), 7) [budding](https://clinicalinfo.hiv.gov/en/glossary/budding). **Causes** The virus is spread (transmitted) person-to-person through certain body fluids: Blood Semen Rectal fluids Vaginal fluids Breast milk HIV can be spread if these fluids come in contact with: - **Mucous membranes** (inside of the mouth, penis, vagina, rectum) - **Damaged tissue** (tissue that has been cut or scraped) - **The blood stream by injection** - **Casual contact,** such as hugging or closed-mouth kissing - **Mosquitoes or pets** - **Participating in sports** - **Touching items** that were touched by a person infected with the virus - **Eating food** handled by a person with HIV **Risk factors for getting HIV include:** - Having unprotected anal or vaginal sex. Receptive anal sex is the riskiest. Having multiple partners also increases the risk. Using a new condom correctly every time you have sex greatly helps lower this risk. - Using drugs and sharing needles or syringes. - Having a sexual partner with HIV who is not taking HIV medicines or who has a detectable viral load. - Having a sexually-transmitted disease (STD). - **Symptoms** - Symptoms related to acute HIV infection (when a person is first infected) can be similar to the flu or other viral illnesses. They include: - Fever and muscle pains - Headache - Sore throat - Night sweats - Mouth sores, including yeast infection (thrush) - Swollen lymph glands - Diarrhea - Bacteria - Viruses - Fungi - Protozoa    Nurse's Role : 1. Screening 2. Education 3. Monitoring - Sexual behavior - Drug Use  **Glomerulonephritis** \- is a kind of kidney disease. It involves damage to your glomeruli. **FUNCTION OF GLOMERULI** Glomeruli are tiny filtering units made of capillaries (tiny blood vessels) in your kidneys. You have almost a million of them. Their job is to remove waste and extra fluid from your blood. If something damages them, they can't do their job. This means your kidneys may not work as well **DIAGNOSTICS :** 1\. ASO Titer - [**2.** **Urine test**](https://my.clevelandclinic.org/health/diagnostics/17893-urinalysis)**:** This test will determine if you have protein or blood in your urine [**3. Blood test:** ]This test will measure the level of [creatinine](https://my.clevelandclinic.org/health/diagnostics/16380-creatinine-clearance-test) (a waste product your kidneys filter) in a sample of your blood [4. **Imaging tests:**] such as [ultrasound](https://my.clevelandclinic.org/health/diagnostics/4995-ultrasound), [X-ray](https://my.clevelandclinic.org/health/diagnostics/21818-x-ray) or [CT scan](https://my.clevelandclinic.org/health/diagnostics/4808-ct-computed-tomography-scan). **NURSING INTERVENTIONS :** 1. Monitor fluid status very closely (may be prescribed diuretics) 2. Monitor for edema, lung sounds, blood pressure 3. Urine output 4. Monitor Daily weight 5. Education **TREATMENT :** SWELLING -- DIURETICS HYPERTENSION -- ANTIHYPERTENSIVES ANTIBIOTICS DIALYSIS  **LIVER** \- Located in the RUQ just below the diaphragm \- Made up of lobes called the lobules, which are the functional unit of the liver and contain hepatocytes. **It receives blood supply from 2 sources :** 1. Hepatic Artery 2. Hepatic Portal Vein **FUNCTIONS OF THE LIVER :** 1. Filters 2. Clotting 3. Breaks down substances : Ammonia RBC Produces Bile **HEPATITIS A** -- acute infection, fecal-oral route **HEPATITIS B** -- acute and chronic (blood, body fluids, perinatal) **HEPATITIS C** -- acute and chronic (blood, body fluids, perinatal) **HEPATITIS D** -- same as Hep B and C, but it needs HBV **HEPATITIS E** -- acute infection, fecal-oral route STRUCTURES : **HEPATITIS A** -- acute infection, fecal-oral route **HEPATITIS B** -- acute and chronic (blood, body fluids, perinatal) **HEPATITIS C** -- acute and chronic (blood, body fluids, perinatal) **HEPATITIS D** -- same as Hep B and C, but it needs HBV **HEPATITIS E** -- acute infection, fecal-oral route ***[Signs and symptoms :]*** Fever Fatigue Muscle aches Diarrhea Nausea and Vomiting **Other ways to reduce your risk of HBV include:** - Know the HBV status of any sexual partner. Don\'t engage in unprotected sex unless you\'re absolutely certain your partner isn\'t infected with HBV or any other sexually transmitted infection. - Use a new latex or polyurethane condom every time you have sex if you don\'t know the health status of your partner. Remember that although condoms can reduce your risk of contracting HBV, they don\'t eliminate the risk. - Don\'t use illegal drugs. Never share needles. **Diagnosis** - **Blood tests.** Blood tests can detect signs of the hepatitis virus in your body ALT -- alanine transaminase 7-56 U/L AST -- aspartate transaminase 10-40 U/L Bilirubin levels - \ 1. **Keep them comfortable, keep the environment cool and quiet** 2. **Monitor Weight** 3. **Educate them on their medications** 4. **Monitor them for "THYROID STORM"**  **Hyperthyroidism Teaching Tips** - If the patient has exophthalmos or another ophthalmopathy, suggest sunglasses or eye patches to protect his eyes from light. - Moisten the conjunctivae often with artificial tears. Warn the patient with severe lid retraction to avoid sudden physical movements that might cause the lid to slip behind the eyeball. - Elevate the head of the bed to reduce periorbital edema. - Stress the importance of regular medical follow-up after discharge because hypothyroidism may develop from 2 to 4 weeks postoperatively. - Drug therapy require careful monitoring and comprehensive patient teaching.