Med Surg Final .pdf

Musculoskeletal Changes due to aging Bone changes; potential safety risk Cartilage degeneration can lead to osteoarthritis Muscle tissue atrophy (elderly do not have muscle they once had) Kyphosis Hunchback Natural type of aging Scoliosis Sideways cure of...

Musculoskeletal Changes due to aging Bone changes; potential safety risk Cartilage degeneration can lead to osteoarthritis Muscle tissue atrophy (elderly do not have muscle they once had) Kyphosis Hunchback Natural type of aging Scoliosis Sideways cure of the spie Greater the cure = cardio/ resp. compromise Use NSAIDS for mild to moderate pain Thermal therapy can assist with spinal flexibility Physical therapy/ occupational therapy Cordosis Inward curve of lumbar spine Hepatitis Viral infection Clinical manifestation: Jaundice (on exam) Eat small frequent meals high calorie meals- LIMIT PROTEIN Rest after exercise Use nutritional support to get calories Take antiemetic to help decrease nausea  Standard universal precautions HEP A: oral/ fecal HAS VACCINE HEP B: blood/ bodily fluids HAS VACCINE Medication for HEP B: Tenofovir (on exam) Example: needles, mother to baby, blood transfusion HEP C: blood/ bodily fluids NO VACCINE Amputations Removal of a body part; trauma or elective Set time aside to listen to patient vent or talk; during which time you should asses pt for coping skills and support systems Educate about limb wrapping/ ROM exercises This is to help prevent contractures Educate client on community resources TX: Gabapentin for phantom pain Post- op: monitor pulse that is directly above amputation to check for circulation/ blood flow ORIF - Open reduction internal fixation Repair of fracture or broken bone Plates and screws are placed inside body to realign bones Cannot see hardware outside of body TO REALIGN BONE OREF - Open reduction external fixation Pins on inside of the body that are visible on the outside of the body Pins, framing, halo- type on outside  Nursing Intervention: pin care; clean around to ensure no infections Osteoporosis DEXA scan/ Bone mineral density scan 1st line tx: calcium and Vit D Clinical manifestation: pt reports loss of height, fear of falling, pain w/ activity that decreases with rest If pt is hospitalized from a fx and is dx with osteoporosis they must have home health Safety assessment for fall risks; rugs, chords, stairs, improper lighting Osteoarthritis Physical therapy Acetaminophen for pain May need a splint (depending on level) Colonoscopy education Procedure to look in colon NPO after midnight Strong laxatives are given prior to procedure Bowel Prep: NO BLOOD THINNERS IBS Interventions IBS C: constipation IBS D: diarrhea Best tx is loperamide IBS mixed: combo of both IBS unclassified  Help pt identify triggers Monitor for bowel obstructions Monitor for labs for electrolyte imbalances Monitor for dehydration/ fluid volume deficit Diverticulum Small pouch like protrusions in the colon Diverticulosis Pt will have diverticulum WITHOUT infection or inflammation Diverticulitis Pt hs diverticulum WITH infection Usually pts experience some kind of fever NG Tube Check placement Do not secure to bed linen; needs to be secured to pts gown so it goes wherever they turn Used to decompress the stomach Sometimes used for med administration MUST MONITOR PLACEMENT ESPECIALLY IF NOT BEING USED FOR FEEDINGS Post-op pt: no output for several hours must call doctor for x-ray to ensure tube is still in right place Carpal Tunnel Syndrome  Inflammation in nerves in wrist Caused by repetitive work/ usage Use Phalen’s Test to determine if it is carpal tunnel syndrome Clinical Mani: numbness and tingling during exam = carpal tunnel syndrome Skin traction Used to realign the bone and spasms No matter what type of traction (Skin or skeletal) that traction weight should always hang freely, no laying on floor at any time, not doing any good to keep realignment Weight and force (weight off the floor and hanging) Skeletal traction Usually used for femur or hip to keep bones realigned Crohn’s Disease Inflammatory condition that can occur anywhere in GI Tract Patchy inflammation areas Complication associated is small bowel obstruction Encourage eating items low in fiber and easier to absorb such as bagels or english muffins MADE FROM WHITE BREAD REMEMBER IT IS INFLAMMATORY Ulcerative Colitis Inflammatory condition occurs in colon and is continuous REMEMBER IT IS INFLAMMATORY Life threatening: peritonitis, fistulas, SBO  Electrolyte imbalance: Potassium Injury Site Some sort of traumatic injury Always assess below injury to ensure proper blood flow and pulse Bowel obstruction/ paralytic ileus Indication that either of these disorders are resolved? Paralytic ileus; absent or hypoactive bowel sounds can lead to SBO farting / shitting Flatus and bowel movement Complication: small bowel obstruction (Answer on exam is Hemoglobin) Colostomy Bag must be emptied when half full Stoma needs to be pink and moist Peptic ulcer disease (PUD) These pts can hemorrhage Replace blood and IV fluids Symptomatic: decrease BP and increase pain Large gauge IV (16 or 18) to give lots of fluids quickly Want to prevent hypovolemic shock Tx: IV isotonic fluids Osteomyelitis  Infection of the bone Complications: loss of appendage Monitor for parlor and paresthesias (pins and needles) Clinical manifestations: localized joint pain, lethargy, fever TX: is long term = 6-8 week antibiotic IV therapy through PICC line typically in rehab facility Muscular Dystrophy Multiple types Muscle biopsy= gold standard diagnostic Plan of care: steroids, ROM, fall precaution TX: Glucocorticoid therapy, speech, ROM GERD Reflux of acid into esophagus TX: omeprazole Heartburn and dysphagia Nissen Fundoplication: Surgery to correct GERD Fracture Compartment syndrome: build up of pressure MUST DRAIN FLUID 1st Check for swelling, pallor, tingling, edema, and numbness Dumping Syndrome Partially digested food enters small intestine rapidly from the stomach  Pt is experiencing this normally get dietary consult to help foods eat to prevent symptoms and decrease them Answer on exam: NEED DIETARY CONSULT Colon cancer High risk individuals need to be encouraged to eat diet high in veggies IE: cauliflower and broccoli Sprain Injury to ligament Tx: RICE Rest: up to 72 hours Ice: 15-20 min up to 3-5 times a day Compression: ace wrap Elevate: to decrease edema Assess CMS: C (pulse cap refill) M (wiggle toes) S (can you feel touch) Impaired mobility Pts who have this are at risk for: DVT, constipation, and development of pressure ulcers Pancreatitis Either acute or chronic Chronic: more related to alcohol Chronic pts must avoid: caffeine Acute: gallstones For acute pts; side lying for comfort, HOB 45 degrees, fetal position  Tx: NPO, allow gut to rest, pain meds, antacids Tx chronic; pancreatic enzymes (take whole DO NOT CRUSH) Educate w/ acute pts to deep breathe because it can be very painful Morphine for pain, especially acute Gastroenteritis Inflammation of stomach and intestines Monitor for signs of dehydration and electrolytes Clinical Mani: dry mucous membranes, decrease skin turgor, tenting skin, dry skin, pale hyperactive bowels Hepatic failure Toxins build up in liver Monitor for deteriorating Mental status changes: ammonia levels build up changes mental status (confusion) Can develop hepatic encephalopathy Lower GI bleed Active; pts will have bright red bloody stool Upper GI bleed Active; pts will have dark tarry stool Takes longer to get into stool Traumatic injury  If pts falls from ladder, roof or car accident WE MUST STABILIZE THE NECK THAT IS PRIORITY