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Med Surg Flashcards Cerebral Angiogram 1) Definition - Allows For Visualization of Cerebral Blood Vessels - Catheter is Placed Into an Artery (Femoral) and Threaded Up to the Blood Vessels in the Bran, Dye is Injected, X-Rays are...

Med Surg Flashcards Cerebral Angiogram 1) Definition - Allows For Visualization of Cerebral Blood Vessels - Catheter is Placed Into an Artery (Femoral) and Threaded Up to the Blood Vessels in the Bran, Dye is Injected, X-Rays are Taken 2) Pre Procedure - NPO 4-6 Hrs Prior to Procedure - Assess For Allergy to Iodine or Shellfish - Assess Kidney Function (BUN, Creatinine) To Determine if Kidneys Can Excrete Dye 3) Post Procedure - Check Insertion Site For Bleeding - Check Extremity Distal to Puncture Site Electroencephalography (EEG) 1) Definition - Analyzes Electrical Activity in the Brain - Used to Identify Seizure Activity, Sleep Disorders, Behavioral Changes - Small Electrodes Are Placed on the Scalp - Takes About an Hour 2) Preprocedure Pt Instructions - Wash Hair Prior to Procedure - Arrive Sleep Deprived (Increases Seizure Chance) - No NPO Needed - Avoid Stimulants, Sedatives 12-24 Hours Before Procedure - Inform Pt That Flashing Lights May be Used During Procedure, or Pt May be Instructed to Hyperventilate (To Increase Electrical Activity) Glasgow Coma Scale (GCS) 1) Definition - Score Between 3 & 15 - Between 3-8 = Severe Head Injury and/or Coma - Between 9-12 = Moderate Head Injury - Add Up Subscores 2) Eye Opening - 4: Spontaneously - 3: In Response to Voice - 2: In Response to Pain - 1: No Eye Opening 3) Verbal Response - 5: Coherent/Oriented - 4: Incoherent/Disoriented - 3: Inappropriate Words - 2: Sounds, No Words  - 1: No Vocalization 4) Motor Response - 6: Follows Commands - 5: Local Reaction to Pain - 4: General Withdrawal to Pain - 3: Decorticate Posture - 2: Decerebrate Posture - 1: No Motor Response Intracranial Pressure (ICP) Monitoring 1) ICP Monitoring - Device Inserted Into Cranial Cavity in the OR to Measure Pressure. Huge Risk of Infection 2) Indications - Pt Has GCS Score Less Than 8 (Or Coma) 3) Symptoms of Increased ICP - Irritability (Early Sign!), Restlessness, headache, Decreased LOC, Pupil Abnormalities, Abnormal Breathing (Cheyne Stokes), Abnormal Posturing 4) Normal ICP Range - 10-15 mmHg Lumbar Puncture 1) Definition - Cerebral Spinal Fluid (CSF) Sample is Taken From the Spinal Canal for Analysis 2) Indications - Used to Dx MS, Syphilis, Meningitis, Infection in CSF 3) Preprocedure - Have Pt Void, Position Pt in Cannonball Position on Their Side, or have Pt Stretch Over Table While Sitting 4) Post Procedure - Pt Should Lay Flat For Several Hours, If the Dura Puncture Site Does Not Heal, CSF May Leak, Resulting in Headache (Administer Pain Meds & Encourage Increased Fluid Intake), Epidural Blood Patch Can be Used to Seal Off the Hole Magnetic Resonance Imaging (MRI) 1) Assess For Allergy to Shellfish/Iodine if Contrast Will be Used 2) Asses for Hx of Claustrophobia 3) Have Pt Remove All Jewelry 4) Make Sure Pt Does Not Have Any Metal Implants (Pacemaker, Orthopedic Joints, Artificial Heart Valves, IUDs, Aneurysm Clips) 5) Earplugs Can be Provided, as MRIs are Loud Nociceptive vs. Neuropathic Pain 1) Nociceptive Pain - Damage/Inflammation of Tissues (Not Part of CNS) - Pain Described as: Throbbing, Aching, and is Usually Localized - Somatic: Bones/Joints, Muscle, Connective Tissue  - Visceral: Internal Organs - Cutaneous: Skin, Subcutaneous Tissue 2) Neuropathic Pain - Result of Damaged Nerves - Pain Described as: Shooting, Burning, “Pins & Needles” - Adjunct Meds Often Used: Antidepressants, Muscle Relaxants Component of Pain Assessment 1) Location of Pain 2) Quality of Pain (How it Feels to Pt, Burning, Aching) 3) Intensity of Pain (Rate on Scale From 0-10) 4) Timing (Onset, Duration, Frequency) 5) Setting (How it Affects Pt’s ADLs) 6) Associated Symptoms (Nausea, Fatigue) 7) Aggravating/Relieving Factors Non-Opioid vs. Opioid Analgesics 1) Non-Opioid - Use For Mild to Moderate Pain - Key Concerns: Acetaminophen Intake Should Not Exceed 4g/day - Monitor for Salicylism w/ Aspirin (Tinnitus, Vertigo) - Administer w/ Food to Prevent GI Upset - Long-Term NSAID Use Carries Risk of Bleeding 2) Opioid - Use for Moderate to Severe Pain - Key Side Effects Include: Constipation, Hypotension, Urinary Retention, n/v, Sedation, Respiratory Depression - Naloxone is Antidote - Administer Around the Clock (PRN) Meningitis 1) Definition - Inflammation of the Meninges (Membranes Around Brain & Spinal Cord) - Viral is Most Common (Resolves w/o Tx) - Bacterial Meningitis is Contagious, w/ a High Mortality Rate 2) Prevention - Immunizations Help Prevent Bacterial Meningitis - Hib Vaccine is Given to Infants - MCV4 Vaccine is Given to Students Living in Dorms 3) Symptoms - Headache, Nuchal (Neck) Rigidity, Photophobia, n/v, Positive Kernig’s & Brudzinski’s Signs, Fever, Altered LOC, Tachycardia, Seizures 4) Diagnosis - CSF Analysis, Bacterial Will Have Cloudy CSF, Decreased Glucose Content - Viral Will Have Clear CSF - Elevated WBC & Elevated Protein For Both Types of Meningitis 5) Nursing Care  - Droplet Precautions Until Antibiotics Are Administered for 24 Hours - Quiet Room, Low Light, HOB to 30 Degrees, Monitor For Increased ICP, Instruct Pt to Avoid Coughing/Sneezing, Implement Seizure Precautions 6) Meds - Antibiotics, Anticonvulsants (Phenytoin) Seizures 1) Definition - Uncontrolled Electrical Discharge of Neurons in the Brain - Epilepsy = Chronic Seizures (2 or More) 2) Risk Factors - Fever, Cerebral Edema, Infection, Toxin Exposure, Brain Tumor, Hypoxia, Alcohol/Drug Withdrawal, Fluid & Electrolyte Imbalance 3) Triggering Factors - Stress, Fatigue, Caffeine, Flashing Lights 4) Tonic Clonic - May be Preceded by Aura 3 Phases - 1) Tonic Episode: Stiffening of Muscles, Loss of Consciousness - 2) Clonic Episode: 1-2 Mins of Rhythmic Jerking of Extremities - 3) Postictal Phase: Confusion, Sleepiness 5) Absence - Loss of Consciousness For a Few Seconds - Key Features: Blank Stare, Eye Flutter, Lip Smacking, Picking @ Clothes 6) Myoclonic - Brief Stiffening of Extremities 7) Atonic - Loss of Muscle Tone, Results in Falling 8) Status Epilepticus - Repeated Seizure Activity Within 30 Minutes or a Single Seizure Lasting More Than 5 Minutes 9) Diagnosis - EEG To Identify Region of Seizure 10) Nursing Care - During Seizure: Turn Pt on Side, Loosen Restrictive Clothing, Do Not Insert Airway or Restrain Pt, Document Onset/Duration of Seizure - Post Seizure: Check Vitals, Neuro Check, Reorient Pt, Seizure Precautions, Determine Possible Trigger 11) Meds - Anti-Seizure Meds (Phenytoin) 12) Surgeries - Vagal Nerve Stimulator, Craniotomy to Remove Brain Tissue Causing Seizures Parkinson’s Disease 1) Cause - Degeneration of Substantia Nigra, Resulting in Not Enough Dopamine & Too Much Acetylcholine 2) S/S  - Tremors, Muscle Rigidity, Slow/Shuffling Gait, Bradykinesia (Slow Movement), Mask Like Affect, Drooling, Difficulty Swallowing 3) Nursing Care - Monitor Swallowing/Food Intake, Thicken Foods, Sit Pt Upright to Eat, Have Suction Available - Encourage ROM & Exercise, Assist w/ ADL’s 4) Meds - Levo/Dopa (Increases Dopamine Levels) - Benztropine (Decreases Acetylcholine Levels) Alzheimer’s Disease 1) Definition - Non-Reversible Dementia, Resulting in Memory Loss, Problems w/ Judgement & Changes in Personality 2) Stages - 1) No Impairment - 2) Forgetfulness, No Memory Problems - 3) Mild Cognitive Deficits, Short-Term Memory Loss Noticeable to Family - 4) Personality Changes, Obvious Memory Loss - 5) Assistance w/ ADLs Necessary - 6) Incontinence (Fecal/Urinary), Wandering - 7) Impaired Swallowing, Ataxia, No Ability to Speak 3) Nursing Care - Maintain Structured Environment - Provide Short Directions, & Repeat - Avoid Overstimulation - Use Single Day Calendar - Provide Frequent Reorientation - Maintain Toileting Schedule 4) Home Safety - Remove Scatter Rugs - Install Door Locks - Good Lighting (Especially Around Stairs) - Mark Step Edges w/ Tape - Remove Clutter 5) Meds - Donepezil (Prevents Breakdown of ACh, Improves Ability to Do ADLs) - Other Meds to Manage S/S (Anti-psychotics, Antidepressants, Anxiolytics) Multiple Sclerosis 1) Definition - Autoimmune Disorder Where Plaque Develops in White Matter of the CNS - Age of Onset is Typically 20-40 - More Common in Women - Characterized by Periods of Relapsing & Remitting 2) Triggers - Temperature Extremes, Stress/Injury, Pregnancy, Fatigue  3) S/S - Eye Problems (Diplopia/Nystagmus), Muscle Spasticity/Weakness, Bowel/ Bladder Dysfunction, Cognitive Changes, Ear Problems (Tinnitus/Hearing Issues), Dysphagia, Fatigue 4) Meds - Immunosuppressive Agents (Cyclosporine) - Prednisone - Muscle Relaxants (Dantrolene, Baclofen) Amyotrophic Lateral Sclerosis (ALS) 1) Definition - Degenerative Neurological Disorder of Upper & Lower Motor Neurons, Resulting in Progressive Paralysis - Eventually Causes Respiratory Paralysis Within 3-5 Years - Cognitive Function Not Impacted - No Cure 2) S/S - Muscle Weakness, Atrophy 3) Nursing Care - Maintain Patent Airway, Suction/Intubate as Needed - Monitor For Pneumonia & Respiratory Failure 4) Meds - Riluzole (Slows Deterioration of Motor Neurons, Extends Pt’s Life 2-3 Months) Myasthenia Gravis (MG) 1) Definition - Autoimmune Disorder That Causes Severe Muscle Weakness - Caused by Antibodies That Interfere w/ Ach At Neuromuscular Junctions (NMJ) - Characterized by Periods of Exacerbation & Remission - Associated w/ Thymus Hyperplasia 2) S/S - Muscle Weakness (Worse w/ Activity), Diplopia, Dysphagia, Impaired Respiration, Drooping Eyelids, Incontinence 3) Diagnosis - Administer Edrophonium (Increases Ach @ NMJ) If S/S Improve, it is MG, If Not, It is a Cholinergic Crisis (Give Atropine) 4) Nursing Care - Maintain Patent Airway (O2, Suction & Intubation Supplies @ Bedside) - Encourage Periods of Rest - Provide Small/Frequent & High Calorie Meals, Have Pts Sit Upright to Eat & Thicken Liquids - Administer Lubricating Eye Drops, Tape Eyes Shut at Night (To Prevent Cornea Damage) 5) Meds - Anticholinesterase Agents (Pyridostigmine or Neostigmine) - Immunosuppressants 6) Procedures/Surgeries  - Plasmapheresis: Removes Antibodies From Plasma - Thymectomy: Removal of Thymus Migraine Headaches 1) Risk Factors/Triggers - Allergies, Bright Light, Fatigue, Stress, Anxiety, Menstrual Cycle, Certain Foods (MSG, Tyramine, Nitrates) 2) S/S - Photophonia, n/v, Unilateral Pain (Usually Behind Eye or Ear) - Can Happen w/ or w/o Aura (Visual Disturbances, Numbness/Tingling) - Pain Persists for 4-72 Hours 3) Nursing Care - Provide Cool/Dark/Quiet Environment - Teach Pt to Avoid Triggers (Food/Stress) 4) Meds - NSAIDS (Mild) - Antiemetics (For n/v) - Sumatriptan or Ergotamine (Severe) Cluster Headaches 1) Symptoms - Severe, Unilateral, Non-Throbbing Pain Which Radiates to Forehead, Temple, Cheek - Lasts 30 min - 2 Hours, Usually Occurs Daily @ Same Time For 4-12 Weeks - More Frequent in Spring/Fall - More Common in Men Between 20-50 Years Old - Facial Sweating - Nasal Congestion 2) Meds - Sumatriptan, Ergotamine (Same as For Migraines) Macular Degeneration 1) Definition - Central Loss of Vision - Number 1 Cause of Vision Loss Over 60 - No Cure 2) S/S - Blurred Vision, Loss of Central Vision Cataracts 1) Definition - Opacity in Lens of an Eye, Impairing Vision 2) S/S - Decreased Visual Acuity, Progressive/Painless Loss of Vision, Diplopia, Halo Around Lights, Photosensitivity, Absent Red Reflex 3) Post Surgery Teaching  - Wear Sunglasses, Avoid Increasing IOP (Don’t Bend Over, Avoid Sneezing/ Coughing/Straining, Avoid Putting Head Back & Restrictive Clothing, Limit Housework & Rapid/Jerky Movements - Best Vision Occurs 4-6 Weeks After Surgery Glaucoma 1) Definition - Increase in IOP Due to Issue w/ Optic Nerve - Leading Cause of Blindness 2) Open Angle - Most Common - Aqueous Humor Outflow Decreased, Resulting in Gradual Increase in IOP - S/S: Mild Eye Pain, Loss of Peripheral Vision 3) Closed Angle - Less Common - Angle Between Iris & Sclera Closes Completely, Resulting in Sudden Increase in IOP - S/S: Severe Pain, Nausea 4) IOP - Normal Range 10-21 mmHg - Measure Using Tonometry - Measure Drainage Angle w/ Gonioscopy 5) Meds - Pilocarpine (Constricts Pupil) - Beta Blockers - Timolol (Reduces Aqueous Humor Production) - Mannitol (Osmotic Diuretic For Closed Angle Glaucoma, Quickly Reduces IOP) 6) Pt Teaching For Eye Drops - Administer 1 Drop in Each Eye Twice a Day - Wait 5-10 Mins Between Eye Drops - Do Not Touch Tip of Applicator to Eye - Place Pressure @ Lacrimal Duct (Puncta) After Installation 7) Post Surgery Teaching - Same As Cataract Surgery Meniere’s Disease 1) Definition - Inner Ear Disorder, Resulting in: Tinnitus, Unilateral Sensorineural Hearing Loss, Vertigo, Vomiting, Balance Issues 2) Risk Factors - Viral/Bacterial Infections, Ototoxic Meds 3) Otoscopic Exam - Pull Aurical Back & Up For Adults & Down & Back for Children < 3 - Tympanic Membrane Should be Pearly Gray & Intact - Light Reflex Should be at 5 o’clock For Right Ear & 7 o’clock For Left 4) Meds - Antihistamines, Anticholinergics, Antiemetics (Meclizine, Droperidol, Diphenhydramine, Scopolamine)  - Watch For s/s of Urinary Retention & Sedation 5) Pt Teaching - Avoid Caffeine & Alcohol - Rest in Quiet/Dark Place When Experiencing Severe Vertigo - Space Intake of Fluids Throughout Day, Decrease Salt Intake 6) Surgeries - Stapedectomy, Cochlear Implant, Labyrinthectomy Head Injury 1) First Priority - Stabilize Cervical Spine 2) Signs of Increased ICP - Irritability (Early Sign), Headache, Decreased LOC, Pupil Abnormalities, Abnormal Breathing (Cheyne Stokes), Abnormal Posturing, Cushing’s Triad (Severe HTN, Widening Pulse Pressure, Bradycardia) 3) Interventions to Decrease ICP - Reduce Hypercarbia (Hyperventilate Pts), Avoid Suctioning, Maintain HOB More Than 30 Degrees, Teach Pt to Avoid: Coughing, Blowing Nose, Extreme Neck Flexion/Extension, Restrictive Clothing 4) Meds - Mannitol: Osmotic Diuretic to Treat Cerebral Edema - Phenobarbital: Induces Coma, Decreases Metabolic Demands - Phenytoin: Prevents/Treats Seizures - Morphine: Treats Pain 5) Surgical Interventions - Craniotomy to Remove Nonviable Brain Tissue, Many Risks (Infection/Death) 6) Complications - Brain Herniation (Downward Shift of Brain Tissue r/t Cerebral Edema), S/S: Fixed Dilated Pupils, Decreased LOC, Abnormal Respirations & Posturing - Hematoma, Intracranial Hemorrhaging - SIADH Stroke/Cerebrovascular Accident (CVA) 1) Hemorrhagic - Ruptured Artery/Aneurysm 2) Thrombotic - Blood Clot in Cerebral Artery 3) Embolic - Blood Clot From Other Part of Body That Travels to Cerebral Artery 4) Key Risk Factors - Smoking, HTN, Diabetes, Afib, Hyperlipidemia 5) Overall s/s - Visual Disturbances, Dizziness, Slurred Speech, Weak Extremity 6) Left Hemisphere - Language Skills, Math Skills, Analytical Thinking  - S/S: Expressive Aphasia (Inability to Speak & Understand Language), Reading & Writing Difficulty, Right Sided Hemiparesis (Weakness) or Hemiplegia (Paralysis) 7) Right Hemisphere - Visual & Spatial Awareness - S/S: Overestimation of Abilities, Poor Judgement & Impulse Control, One Sided Neglect Syndrome (Ignore Left Side of Body), Left Sided Hemiparesis or Hemiplegia 8) Nursing Care - Monitor Pt’s BP: SBP >180 or DBP > 110 Can Indicate Ischemic Stroke - Assess Swallowing & Gag Reflex Before Allowing Pt to Eat, Thicken Liquids, Teach Pt to Swallow w/ head & Neck Forward - Reposition Pt Frequently to Protect From Pressure Injuries - Teach Pt to Use Scanning Technique (Turn Head From Direcion of Unaffected Side to Affected Side) For Homonymous Hemianopsia 9) Meds - Anticoagulants, Antiplatelets, Thrombolytic Meds (Give Within 4.5 Hours of Initial S/S) 10) Surgery - Carotid Artery Angioplasty w/ Stenting Spinal Cord Injury 1) Paraplegia - Injuries Below T1, Resulting in Paralysis/Paresis of Lower Extremities 2) Quadriplegia - Injuries in the Cervical Region, Resulting in Paralysis/Paresis of All 4 Extremities 3) Neurogenic Shock - Occurs After SCI For Several Days to Weeks, S/S: Hypotension, Dependent Edema, Temp Regulation Issues 4) Upper Motor Neuron Injuries (Above L1/L2) - Spastic Muscle Tone, Spastic Neurogenic Bladder 5) Lower Motor Neuron Injuries (Below L1/L2) - Flaccid Muscle Tone, Flaccid Neurogenic Bladder 6) Meds - Glucocorticoids (Reduces Spinal Cord Edema) - Vasopressors (Treats HTN During Neurogenic Shock) - Muscle Relaxers (Baclofen, Dantrolene) - Stool Softeners (In Addition to a Bowel/Bladder Schedule) 7) Autonomic Dysreflxia - For Injuries Above T6: Stimulation of Sympathetic Nervous System w/ Inadequate Response From Parasympathetic Nervous System - S/S: Extreme HTN, Severe Headache, Blurred Vision, Diaphoresis - Nursing Actions: Sit Pt Up, Notify Provider, Determine Cause (Distended Bladder, Fecal Impaction, Tight Clothing, Undiagnosed Injury), Treat Cause (Catheterize Pt, Remove Impaction, Remove Tight Clothing), Administer Antihypertensives Arterial Blood Gas (ABG) 1) Normal Ranges - pH: 7.35 - 7.45 - PaO2: 80 - 100 mmHg - PaCO2: 35 - 45 - HCO3: 21 - 28 mEq/L - SaO2 - 95 - 100% 2) ABG Procedure Key Points - Usually Performed by Respiratory Therapist - Perform Allen’s Test Prior to Puncture (Compress Ulnar & Radial Arteries Simultaneously) - Hold Direct Pressure Over Side For at Least 5 Mins (20 if Pt on Anticoagulants) Afterwards - If Air Embolism Suspected, Place Pt on Left Side in Trendelenburg Position Bronchoscopy 1) Definition - Allows for Visualization of Airway (Larynx, Trachea, Bronchi), Biopsies, Aspiration of Deep Sputum, or Excision of Lesions 2) Pre-Procedure - Pt NPO 4-8 Hours, Administer Prescribed Meds (Atropine, Antianxiety Meds, Viscous Lidocaine) 3) Post-Procedure - Ensure Pt’s LOC & Presence of Gag Reflex Before Allowing Pt ot Eat/Drink - Sore Throat, Dry Throat, & Small Amount of Blood-Tinged Sputum is Expected Thoracentesis 1) Definition - Surgical Perforation of Chest Wall & Pleural Space w/ Large-Bore Needle to Obtain Specimens, Inject Meds, or Remove Fluid/Air 2) S/S of Pleural Effusion - Chest Pain, SOB, Cough 3) Nursing Care - Have Pt Sit Upright, w/ Arms Supported on Pillows or Overbed Table - Pt Should Remain Totally Still - Amount of Fluid Removed Should Not Exceed 1L (To Prevent Cardiovascular Collapse) - After Procedure, Closely Monitor Resp Status 4) Complications - Mediastinal Shift, Bleeding, Infections, Pneumothorax (S/S: Deviated Trachea, Pain of Affected Side, Unequal Movement of Chest During Inhalation/Exhalation, Air Hunger, Tachycardia, Shallow Resps) Chest Tubes 1) Definition - Drains Fluid, Air, or Blood From Pleural Space  - Chest Tube Tip Positioned UP For Pneumothorax and DOWN for Hemothorax or Pleural Effusion 2) Drainage Collection Chamber - Chart Amount & Color of Drainage - Report Drainage >70 ml/hr to Provider 3) Water Seal Chamber - Add Sterile Fluid up to 2cm Line, Check Every 2 Hours - Chamber Must be Kept Upright & Below Chest Tube Insertion Site - Tidaling Expected - Lack of Tidaling = Lung Re-Expansion or Obstruction - Continuous Bubbling Indicates Air Leak 4) Suction Control Chamber - -20 cm H2O Common - Continuous Bubbling Expected 5) Nursing Care - Assess Chest Tube Insertion Site for Erythema, Pain, Crepitus - Position Pt in Semi/High Fowler’s Position - Obtain Chest X-Ray to Verify Tube Placement - Keep 2 Hemostats, Sterile Water, Occlusive Dressing At Bedside - Only Clamp When Ordered, Do Not Strip/Milk Tubing 6) Chest Tube Removal - Tell Pt to Take a Deep Breath, Exhale, & Bear Down (Or Take a Deep Breath & Hold it) During Removal - Apply Sterile Petroleum Jelly Gauze Dressing Over Chest Tube Site 7) Complications - If Drainage System Becomes Compromised, Place End of Tube Into Sterile Water (To Maintain Water Seal) - If Chest Tube is Accidentally Removed, Apply Dry Sterile Gauze over Area - Taped Only on THREE Sides 8) Tension Pneumothorax - Can Result From Kink in Tubing or Obstruction - S/S: Tracheal Deviation, Absent Breath Sounds on Affected Side, Respiratory Distress, Asymmetry of Chest Oxygen Delivery 1) Nasal Cannula - 1-6L/Min - Use Humidification For Flow Rate Over 4L/Min 2) Simple Face Mask - 5-8L/Min 3) Partial Rebreather Mask - 6-11L/Min - Adjust O2 Flow to Keep Reservoir Bag From Deflating 4) Nonrebreather Mask - 10-15L/Min - Keep Reservoir Bag ⅔ Full - Assess Valve, Flap Hourly  5) Venturi Mask - 4-10L/Min - Most Precise O2 Delivery 6) Aerosol Mask/Face Tent - Good for Pts w/ Facial Trauma or Burns; Provides High Humidification 7) S/S of Hypoxia - Early: Restlessness/Irritability, Tachypnea, Tachycardia, Pale Skin, HTN, Nasal Flaring, Use of Accessory Muscles, Adventitious Lung Sounds - Late: Confusion, Cyanosis, Bradypnea, Bradycardia, Hypotension, Dysrhythmias 8) S/S of O2 Tox - Non-Productive Cough, Substernal Pain, Nasal Congestion, n/v, Fatigue, Headache, Sore Throat 9) Avoiding Combustion - Post “No Smoking” Signs, Avoid Synthetic or Wool Fabrics, Do Not Use Flammable Materials (Alcohol, Acetone) Mechanical Ventilation 1) Low Pressure Alarm - Disconnection, Cuff Leak, or Tube Displacement 2) High Pressure Alarm - Excess Secretions, Pt Biting Tube, Kinks in Tubing, Coughing, Pulmonary Edema, Bronchospasm, Pneumothorax 3) Nursing Care - Suction Oral & Tracheal Secretions - Reposition ET Tube Every 24 Hours, Monitor For Skin Breakdown - Provide Frequent Oral Care - Have Manual Resuscitation Bag & Reintubation Equipment at Bedside - After Extubation: Encourage Coughing, Deep Breathing, Use of Incentive Spirometer, Frequent Position Changes (To Mobilize Secretions) Pneumonia 1) S/S - Fever, SOB, Chest Pain, Cough, Dyspnea, Confusion (Very Common in Older Pts), Crackles/Wheezes 2) Lab Tests - Obtain Sputum Sample BEFORE Starting Antibiotic Therapy 3) Diagnosis - Chest X-Ray (Shows Consolidation) 4) Nursing Care - Position Pt in High-Fowler’s, Administer O2 as Prescribed - Encourage Coughing, Deep Breathing, Use of an Incentive Spirometer, Increased Fluid Intake 5) Meds - Antibiotics, Bronchodilators (Albuterol), Anti-Inflammatories (Glucocorticoids) Asthma 1) Definition  - Chronic Inflammatory Disorder of the Airway, Intermittent & Reversible 2) S/S -Wheezing, Coughing, Prolonged Exhalation, Low SaO2, Barrel Chest, Use of Accessory Muscles 3) Diagnosis - Pulmonary Function Tests (FVC, FEV1) 4) Meds - Bronchodilators (Short-Acting: Albuterol, Long-Acting: Salmeterol), Anticholinergic Meds (Ipratropium), Anti-Inflammatory Meds (Corticosteroids) 5) Status Asthmaticus - Airway Obstruction Unresponsive to Topical Treatment - Administer O2, Bronchodilators, Epinephrine - Prepare for Emergency Intubation Chronic Obstructive Pulmonary Disease (COPD) 1) Definition - Emphysema (Loss of Lung Elasticity & Hyperinflation of Lung Tissue) - Chronic Bronchitis (Inflammation of Bronchi) - Irreversible, Smoking is Primary Factor 2) S/S - Dyspnea Upon Exertion, Crackles/Wheezes, Barrel Chest, Use of Accessory Muscles, Clubbing, Hyperresonance (Due to Trapped Air), Decreased SaO2 Levels, Rapid & Shallow Respirations 3) Labs - Increased Hct (Due to Low O2 Levels) PaO2 < 80mmHg, PaCO2 > 45mmHg, Respiratory Acidosis COPD 1) Nursing Care - Position Pt in High Fowler’s - Encourage Coughing, Deep Breathing, Use of Incentive Spirometer - Ensure Proper Nutrition (Increased Calories & Protein) - Teach Breathing Techniques - Abdominal Breathing: Take Breaths From the Diaphragm, Lie on Back w/ Knees Bent - Pursed Lip Breathing: Breathe in Through Nose & Out Through Mouth 2) Meds - Bronchodilators, Anti-Inflammatories, Mucolytic Agents (Acetylcysteine, Guaifenesin) 3) Complications - Right-Sided Heart Failure S/S: Dependent Edema, Distended Neck Veins, Enlarged Liver Tuberculosis (TB) 1) Definition - Infectious Disease in Lungs Caused by Mycobacterium Tuberculosis 2) S/S  - Cough Lasting > 3 Weeks, Night Sweats, Purulent/Bloody Sputum, Lethargy, Weight Loss 3) Diagnosis - Quantiferon Gold (Blood Test) - Mantoux Test (Skin Test): Read Within 48-72 Hours - Induration 10mm = Positive Result (5mm For Immunocompromised Pts), Those Who have Had the BCG Vaccine May Get a False Positive Result - Chest X-Ray: To Visualize Active Lesions in Lungs - Acid-Base Bacilli Culture: Use 3 Early Morning Sputum Samples 4) Nursing Care - Place Pt on Airborne Precautions in a Negative Air Flow Room - Wear N95 Mask in Pt’s Room, Have Pt Wear Surgical mask if They Need to Leave Room - Screen Family Members for TB - Teach Pt That Sputum Samples Will be Needed Every 2-4 Weeks - Pts are Not Infectious After 3 Sputum Cultures 5) Meds - Up to 4 Antibiotics are Required For 6-12 Months of Treatment, Including: Isoniazid, Rifampin, Pyrazinamide, Ethambutol Pulmonary Embolism (PE) 1) Definition - Life-Threatening Blockage in Pulmonary Vasculature, Most Commonly Caused by a DVT 2) Risk Factors - Immobility, Oral Contraceptives, Smoking, Obesity, Surgery, AFIB, Long-Bone Fractures (Fat Emboli) 3) S/S - Anxiety (Feeling of Impending Doom), Pain on Inspiration, Dyspnea, Pleural Friction Rub, Tachycardia, Hypotension, Tachypnea, Petechiae, Diaphoresis 4) Diagnosis - CT Scan, Labs: Elevated D-Dimer Indicates Presence of Clot 5) Meds - Anticoagulants (Heparin/Enoxaparin, Warfarin), Thrombolytic Therapy (Alteplase, Streptokinase) 6) Surgical Interventions - Embolectomy (Removal of Clot), Vena Cava Filter (Prevents New Emboli From Entering Pulmonary Vasculature) 7) Nursing Care - Place Pt in High-Fowler's Position, Administer O2 8) Pt Teaching For Anticoagulants - Frequent Blood Draws Required to Monitor PT/INR Levels (Therapeutic Level 2-3) - Maintain Consistent Intake of Vitamin K While on Warfarin - Encourage Smoking Cessation, Increased Mobility, Compression Stockings - Reduce Risk of Bleeding (No ASA, Use Electric Shavers, Soft Toothbrushes, Avoid Blowing Nose) Respiratory Emergencies 1) Pneumothorax - Lung Collapse Due to Air in the Pleural Space - Key Symptom: Hyperresonance w/ Percussion 2) Tension Pneumothorax - Air Enters Pleural Space During Inspiration, but Cannot Exit During Expiration - Key Symptom: Tracheal Deviation 3) Hemothorax - Blood Accumulates in Pleural Space - Key Symptom: Dull Percussion 4) Flail Chest - Chest Wall Expansion Limited Due to Multiple Fractured Ribs - Key Symptom: Paradoxical Chest Wall Movement 5) Common S/S of ALL - Respiratory Distress, Reduced/Absent Breath Sounds on Affected Side 6) Treatment - O2, Meds (Benzodiazepines For Anxiety, Opioids For Pain), Chest Tube (For Pneumothorax & Hemothorax) Cardiac Enzymes 1) Definition - Released in Bloodstream in Response to Ischemia in Heart Muscle - Troponin is Most Specific 2) CK-MB - More Specific to Heart Than CK - Should be 0% Elevated For 2-3 Days 3) Troponin T - Should be Less Than 0.1 ng/L - Elevated for 10-14 Days 4) Troponin I - Should be Less Than 0.03 ng/L - Elevated for -10 Days 5) Myoglobin - Can be Elevated Due to Heart Damage OR Skeletal Muscle Damage - Should be < 90 mcg/L - Elevated for 24 Hours Cholesterol Levels 1) Total Cholesterol - < 200mg/dL 2) HDL (H = Happy) - > 55 mg/dL (Women) - > 45mg/dL (Men) 3) LDL (L = Lousy) - < 130 mg/dL 4) Triglycerides  - Between 35-135 mg/dL (Women) - Between 40-160 mg/dL (Men) Hemodynamic Monitoring 1) Central Venous Pressure (CVP) - 2-6 mmHg 2) Pulmonary Artery Wedge Pressure (PAWP) - 6-15 mmHg 3) Cardiac Output (CO) - 3-6 L/min 4) Nursing Care During Arterial Line Insertion - Level Transducer w/ Phlebostatic Axis (4th Intercostal Space, Midaxillary Line), Zero System, Confirm Placement w/ X-Ray Coronary Angiogram 1) Cardiac Cath - Invasive Procedure Used to Determine if Pt has Coronary Artery Blockages or Narrowing - Catheter Inserted Into Femoral Artery & Threaded Up to Heart 2) Pre-Procedure - NPO 8 Hours Prior to Procedure - Assess For Allergy to Iodine or Shellfish - Assess Kidney Function (BUN, Creatinine) to Determine if Kidneys can Excrete the Dye 3) Post Procedure - Check Insertion Site for Bleeding, Check Distal Extremity to Puncture Site (Pulses, Cap Refill, Temp, Color) - Take VS Every 15 Mins x 4, Every 30 min x 2, Every Hour x 4 - Pt Lies Flat in Bed For 4-6 Hours After Procedure Cardiac Tamponade 1) Definition - Accumulation of Fluid in the Pericardial Sac 2) S/S - Hypotension, Muffled Heart Sounds, Distended Jugular Veins, Paradoxical Pulse (Variance of 10 mmHg or More in SBP Between Inspiration & Expiration) 3) Diagnosis - Chest X-Ray, Echocardiogram 4) Treatment - Pericardiocentesis (Removal of Fluid From Pericardial Sac) Peripherally Inserted Central Catheter (PICC Line) 1) Definition - Used for Long-Term Administration of IV Antibiotics, TPN, Chemotherapy - Tip Positioned in Lower ⅓ of Superior Vena Cava - Can Stay in Place for Up to 12 Months 2) Nursing Care of PICC  - Assess Site Every 8 Hour - Use 10ml (or Larger) Syringe to Flush Line - Flush w/ 10ml of 0.9% NaCl Before, Between, and After Meds - Blood Draws: Withdrawal 10ml Blood & Discard, Withdrawal 10 ml Blood for Sample; Flush w/ 20ml NaCl (Or Per Facility Policy) - No BP on Arm w/ PICC Line 3) Implanted Port - For Long-Term (> 1 Yr) Vascular Access, Common w/ Chemotherapy - Access w/ Non-Coring (Huber) Needle IV Complications 1) Phlebitis - S/S: Erythema, Pain, Warmth, Edema, Indurated or Cordlike Veins, Red Streak - Care: Discontinue IV, Warm Compress 2) Infiltration - S/S: Edema, Coolness, Taut Skin - Care: Discontinue IV, Cool Compress, Elevation 3) Air Embolism - S/S: SOB - Care: Place in Trendelenburg on Left Side, Give O2, Notify Provider Dysrhythmias 1) Bradycardia (HR Less Than 60) - If Symptomatic, Administer Atropine, Electrical Intervention: Pacemaker 2) AFIB, SVT, V-TACH w/ Pulse - Administer Anti-Arrhythmic Medication (Ex. Amiodarone, Adenosine, Verapamil) - Electrical Intervention: Cardioversion 3) Nursing Care for Cardioversion - Pt Must be on Anticoagulation For 4-6 Weeks Before Cardioversion - Staff Needs to Stand Clear of Pt When Shock is Delivered - After Procedure: Assess Airway, Monitor VS, Obtain EKG - Monitor for S/S of Dislodged Clot (PE, Stroke, MI) 4) Ventricular Tachycardia w/o Pulse, VFIB - Administer Antiarrhythmic Med (Ex. Amiodarone, Lidocaine, Epinephrine) - Electrical Intervention: Defibrillation Pacemakers 1) Definition - Provides Electrical Stimulation of Heart When Natural Pacemaker in Heart Doesn’t Maintain Proper Rhythm - Programmed to Pace Atrial (A), Ventricular (V) or Both Chambers (AV) 2) Modes - Asynchronous: Fires at Constant Rate Regardless of Heart’s Electrical Activity - Synchronous: Fires Only When Heart’s Intrinsic Rate Falls Below a Certain Rate 3) Indications - Symptomatic Bradycardia, Heart Block, Sick Sinus Syndrome 4) Nursing Care/Pt Teaching  - Provide Sling & Instruct Pt to Minimize Shoulder Movement - Assess for Hiccups, Which May Indicate Pacemaker is Pacing the Diaphragm - Instruct Pt to: Carry Pacemaker ID Card, Take Pulse Daily, Avoid Contact Sports & Heavy Lifting for 2 Months - Pacemaker Will Set Off Airport Security Detectors - MRIs are Contraindicated - OK to Use Garage Door Openers & Microwave Percutaneous Coronary Intervention (PCI) 1) Definition - Procedure to Open Coronary Arteries - Performed Within 3 hours of Onset of MI S/S - Three Types: Atherectomy (Removal of Plaque in Vessel), Placement of Stents, PTCA (Inflating a Balloon to Widen the Arterial Lumen) 2) Nursing Care - Same as Coronary Angiogram 3) Complications - Artery Dissection (Monitor for Hypotension & Tachycardia) - Cardiac Tamponade - Bleeding/Hematoma at Insertion Site - Embolism - Retroperitoneal Bleeding (Monitor For Flank Pain & Hypotension) - Restenosis of Vessel (Monitor for Chest Pain, Assess EKG) Coronary Artery Bypass Graft (CABG) 1) Definition - Surgery to Bypass One or More Coronary Arteries Due to Blockages and/or Persistent Ischemia - Saphenous Vein Often Used - Pt’s Core Temp Lowered to Decrease Metabolic (And O2) Demand During Procedure 2) Key Nursing Care - Monitor BP: HTN Can Cause Bleeding From Grafts, Hypotension Can Cause Collapse of Graft - Monitor Chest Tube: Over 150ml/hr Can Indicate Hemorrhage - Notify Provider 3) Pt Teaching - Treat Angina w/ Sublingual Nitro, Quit Smoking, Consume Heart Healthy Diet, Participate in Cardiac Rehab Program Peripheral Bypass Graft 1) Definition - Surgery to Restore Blood Flow to Extremity Due to Peripheral Artery Disease (PAD) 2) Nursing Care - Obtain Consent, Pt NPO For 8 Hours Before Procedure - Closely Monitor Peripheral Pulses, Cap Refill, Skin Color, Skin Temp  - Pt Should Maintain Bedrest for 18-24 Hours After Surgery, w/ Legs Straight - Pt Should Avoid Sitting for Long Periods of Time or Crossing Legs - Apply Antiembolic Stockings - Monitor for S/S of Compartment Syndrome (Worsening Pain, Swelling, Taut Skin) - Fasciotomy Used to Relieve Compartment Syndrome Angina 1) Stable Angina - Occurs w/ Exercise, Relieved by Rest (or Nitro) 2) Unstable Angina - Occurs w/ Exercise or at Rest. Increases in Duration, Occurrence, or Severity Over Time 3) Variant Angina - Related to Coronary Artery Spasm, Occurs During Rest 4) Angina vs. MI - Pain Unrelieved by Rest or Nitro & Lasts More Than 30 Mins is Indicative of an MI (vs. Angina). MIs (Unlike Angina) Often Have Other Symptoms, Such as: Nausea, Epigastric Discomfort, Diaphoresis, Dyspnea Myocardial Infarction (MI) 1) Risk Factors - Male Gender, Post-Menopausal Women, HTN, Smoking, Hyperlipidemia, Diabetes, Stress, Inactivity 2) S/S - Anxiety, Chest Pain, Nausea, Diaphoresis, Cold/Clammy Skin, Pallor, Tachycardia 3) Labs - Elevated Cardiac Enzymes (CK-MB, Troponin I, Troponin T, Myoglobin) 4) EKG Changes - ST Depression/Elevation, T Wave Inversion, Abnormal Q Wave 5) Meds - Nitro, Analgesics, Beta Blockers, Thrombolytic Meds, Antiplatelet Meds, Anticoagulants 6) Complications - Heart Failure, Cardiogenic Shock (S/S: Tachycardia, Hypotension, Decreased Urinary Output, Altered LOC, Respiratory, Decreased Peripheral Pulses, Chest Pain) Heart Failure 1) Definition - Heart Muscle Doesn’t Pump Effectively, Resulting in Decreased Cardiac Output - Left Sided: Results in Pulmonary Congestion (Pulmonary Edema), Key S/S: Dyspnea, Crackles, Orthopnea, Fatigue, Pink/Frothy Sputum - Right Sided: Results in Systemic Congestion, Key S/S: JVD, Peripheral Edema, Ascites, Hepatomegaly 2) Labs - hBNP Elevated (>100 pg/ml)  3) Diagnosis - Hemodynamic Monitoring: Increased CVP, PAWP, Decreased CO - Echocardiogram: Reduced Ejection Fraction (Normal: Left 55-70%, Right 45-60%) 4) Nursing Care - Monitor Daily Weight, I&Os - Position Pt in High-Fowler’s - Administer O2 - Restricted Fluid & Sodium Intake 5) Medications For HF - Diuretics - Afterload-reducing Meds (ACE Inhibitors, Angiotensin II Receptor Blockers, Calcium Channel Blockers) - Inotropic Agents (Digoxin) - Beta Blockers - Vasodilators (Nitro) - Human B-Type Natriuretic Peptides (hBNP) - Anticoagulants Valvular Heart Disease 1) 2 Types - Stenosis: Narrowed Opening - Insufficiency: Regurgitation of Blood 2) Key Risk Factors - HTN, Rheumatic Fever/Disease r/t Streptococcal Infections, Infective Endocarditis r/t streptococcal Infections, Older Age (Causes Fibrotic Thickening) 3) Symptoms - Murmurs, Extra Heart Sounds, Arrhythmias, Dyspnea w/Mitral Stenosis or Insufficiency 4) Diagnosis - Chest X-Ray, EKG, Echocardiogram 5) Meds for Valvular Disease - Diuretics - Afterload Reducing Meds (ACE Inhibitors, Angiotensin II Receptor Blockers, Beta Blockers, Calcium Channel Blockers) - Inotropic Agents (Digoxin) - Anticoagulants 6) Surgical Interventions - Percutaneous Balloon Valvuloplasty - Opens Valves that have Stenosis - Valve Repair or Replace w/ Prosthetic Valve 7) Pt Teaching - Prophylactic Antibiotics Need to be Taken Before Dental Work, Surgery, or Other Invasive Procedures Inflammatory Heart Disorders 1) Pericarditis  - Inflammation of Pericardium - Key Symptoms: Chest Pain (Relieved by Sitting Up & Leaning Forward), Friction Rub, SOB 2) Rheumatic Endocarditis - Infection of Endocardium Due to Upper Respiratory Infection From Group A Beta- Hemolytic Streptococcal Bacteria, Causes Lesions to Form on Heart - Key Symptoms: Murmur, Fever, Chest Pain, Joint Pain, Rash, SOB, Friction Rub, Tachycardia 3) Infective Endocarditis - Infection of Endocardium Due to Streptococcus Bacteria. Common w/ IV Drug Users - Key Symptoms: Fever, Flu Like Symptoms, Murmur, Petechiae, Red Streaks Under Nailbeds (Splinter Hemorrhages) 4) Lab Tests - Increased WBC, Positive Blood Culture, Elevated ESR & CRP (Due to Inflammation), Throat Culture Positive for Streptococcal Infection 5) Meds - Antibiotics (For Infection), NSAIDs (For Fever, Inflammation), Prednisone (For Inflammation) 6) Complications - Cardiac Tamponade Peripheral Artery Disease (PAD) 1) Definition - Inadequate Blood Flow to Lower Extremities Due to Atherosclerosis 2) Risk Factors - HTN, Diabetes, Smoking, Obesity, Hyperlipidemia 3) S/S - Pain in Legs During Exercise (Relieved by Placing Legs in Dependent Position - Ie. Dangling them) - Decreased Cap Refill of Toes - Decreased Pedal Pulses - Lack of hair on Calves - Thick Toenails - Pallor w/ Elevation, Dependent Rubor - Ulcers/Gangrene on Toes 4) Pt Teaching - Walk Until Point of Pain, Stop & Rest, Then Walk a Little More - Avoid Crossing Legs & Restrictive Garments - Maintain Warm Environment, Wear Insulated Socks - Avoid Cold, Stress, Caffeine, Nicotine - Which Can Lead to Vasoconstriction 5) Meds - Antiplatelets (ASA, Clopidogrel), to Reduce Viscosity, Statins 6) Surgeries - Angioplasty (Balloon, Stent), Peripheral Bypass Graft 7) Complications  - Graft Occlusion (Reduced Pedal Pulses, Increased Pallor, Pain, Cold), Compartment Syndrome (Numbness, Pain w/ Passive Movement, Edema) Peripheral Venous Disorder 1) Definition - Issue w/ Adequate Blood Return from the Extremities 3 Kinds: - 1) Venous Thromboembolism (VTE): Blood Clot - 2) Venous Insufficiency: Caused by Incompetent Valves in the Deeper Veins, This Can Lead to Swelling, Venous Ulcers & Cellulitis - 3) Varicose Veins: Enlarged Superficial Veins Venous Thromboembolism 1) Risk Factors - Virchow’s Triad (Impaired Blood Flow, Hypercoagulability, Endothelial Injury), Hip & Knee Replacement Surgery, Heart Failure, Immobility, Pregnancy, Oral Contraceptives 2) Symptoms - Calf/Groin Pain, Edema in Extremity, Warmth/Hardness Over Blood Vessel, SOB (PE) 3) Diagnosis - Positive D-Dimer, Venous Duplex Ultrasonography 4) Nursing Care - Elevation of Extremity (No Pillow or Knee Gatch Under Knees), Warm/Moist Compression Stockings, Watch for S/S of Pulmonary Embolism (PE) 5) Meds - Anticoagulants, Thrombolytics Venous Insufficiency 1) Risk Factors - Sitting/Standing in One Place for a Long Time, Obesity, Pregnancy 2) S/S - Aching Pain & Feeling of Heaviness in Legs, Brown Discoloration of Legs (Stasis Dermatitis), BLE Edema, Venous Stasis Ulcers (Usually Around Ankles) 3) Nursing Care - Elevate Legs, Avoid Crossing Legs or Restrictive Clothing, Compression Stockings (Apply in Morning When Swelling is Reduced) Varicose Veins 1) Risk Factors - Female, Jobs That Require Prolonged Standing, Pregnancy, Obesity, Family History 2) S/S - Distended/Tortuous Veins Just Below the Skin Surface, Aching, Pruritus 3) Therapeutic Procedures - Sclerotherapy (Chemical Solution is Injected Into Varicose Vein to Close it Off - Vein-Stripping, Laser Treatment, Radio Frequency Hypertension  1) 2 Types - Primary: No Known Cause - Secondary: Caused by Disease or Meds 2) Risk Factors - Primary: Family History, Excess Sodium Intake, Inactivity, Obesity, Smoking, Stress, Hyperlipidemia, Race (African American) - Secondary: Kidney Disease, Cushing’s Syndrome, Pheochromocytoma 3) S/S - Headache, Dizziness, Visual Disturbances, OR Pt’s may not have Any S/S 4) BP Levels - PreHTN: SBP 1202-139; DBP 80-89 - Stage I: SBP 140-159; DBP 90-99 - Stage II: SBP Over 160; DBP Over 100 - HTN Crisis: SBP Over 240; DBP Over 120 5) Meds - Diuretics, Calcium Channel Blockers, ACE Inhibitors, Angiotensin II Receptor Antagonists, Aldosterone Receptor Antagonists, Beta Blockers 6) Pt Teaching - Take BP Regularly, Limit Alcohol Intake, DASH Diet (High Fruits, Veggies, Low- Fat Dairy; Low in Salt), Reduce Weight, Reduce Stress, Stop Smoking 7) Complications - HTN Crisis (S/S: Severe Headache, Blurred Vision) Types of Hemodynamic Shock 1) Cardiogenic - Cardiac Pump Failure Due to Heart Failure, MI, or Dysrhythmias 2) Hypovolemic - Blood Loss Due to Trauma, Surgery, Burns or Fluid Loss Due to GI Losses, Diuresis 3) Obstructive - Blockage of Great Vessels (Ex. PE, Tension Pneumothorax, Cardiac Tamponade) 4) Distributive - Extreme Vasodilation, 3 Kinds: - 1) Septic: Endotoxins in Bloodstream From Infection (Most Commonly Gram Negative Bacteria) - 2) Neurogenic: Loss of Sympathetic Tone Due to Trauma or Spinal Block - 3) Anaphylactic: Antigen-Antibody Reaction Due to Exposure to Allergens 5) S/S - Hypoxia, Tachypnea, Hypotension, Tachycardia, Weak Pulse, Decreased Urine Output, Wheezing, Angioedema, Rash w/ Anaphylactic Shock 6) Labs - Increased Serum Lactic Acid, Abnormal ABGs, Increased Cardiac Enzymes w/ Cardiogenic Shock, Decreased Hgb/Hct w/Hypovolemic Shock, Positive Cultures w/Septic Shock 7) Nursing Care - Administer O2, Prepare for Intubation, Place Pt Flat w/ Legs Elevated For Hypotension  8) Meds - Dobutamine, Vasopressin, Epinephrine, Colloids for Hypovolemic Shock (Replace Volume First), Antibiotics for Septic Shock 9) Complications - MODS, DIC Aneurysms 1) Definition - Widening or Ballooning in the Wall of A Blood Vessel 2) AAA - Flank/Back Pain, Pulsating Abdomen Mass 3) Aortic Dissection - Feeling of “Ripping” or “Stabbing” in Abdomen or Back - S/S of Hypovolemic Shock (Hypotension, Tachycardia, Decreased Pulses, n/v, Diaphoresis) 4) Thoracic Aortic Aneurysm - Severe Back Pain, SOB, Difficulty Swallowing, Cough 5) Nursing Care - Reduce SBP to 100-120 mmHg, Administer AntiHTNs, Monitor VS, Cardiac Rhythm, ABGs, Urine Output (Report Output Less Than 30ml/hr) Expected Lab Values 1) RBC - 4-6 Million/uL (Approx) 2) WBC - 5,000 - 10,000 /mm^3 3) Platelets (PLT) - 150,000 - 400,000 mm^3 4) Hgb - 12 - 18 g/dL (Approx) 5) Hct - 37 - 52% (About 3x the Hgb) 6) PT - 11 - 12.5 Seconds 7) aPTT - 30 - 40 Seconds (Therapeutic Range is 1.5 - 2.5 Times This Amount While on Heparin) 8) INR - 0.8 - 1.1 (Therapeutic Range is 2 - 3 While on Warfarin) Blood Transfusions 1) Type A - Can Recieve Types A & O 2) Type B - Can Recieve Types B & O 3) Type AB - Can Recieve Types A, B, AB, & O  4) Type O - Can Receive Type O 5) Rh Compatibility - If a Rh-Negative Person Receives Rh-Positive Blood, it Will Cause Hemolysis 6) Blood Transfusions - Use 20 Gauge or Bigger IV Catheter - Confirm Pt ID, Blood Compatibility, & Expiration Time w/ Another RN - Prime Administration Set w/ 0.9% NaCl ONLY Blood Transfusion Reactions 1) Nursing Care - Stop Transfusion, Infuse 0.9% NaCl Through Separate Line, Send Blood Bag to Lab 2) Acute Hemolytic - Low Back Pain, Fever/Chills, Tachycardia, Hypotension, Tachypnea 3) Febrile - Fever/Chills, Hypotension, Tachycardia - Administer Antipyretics 4) Mild Allergic - Itching, Flushing, Hives (Urticaria) - Administer Diphenhydramine 5) Anaphylactic - Wheezing, Dyspnea, Cyanosis, Hypotension 6) Circulatory Overload - Dyspnea, Tachycardia, Tachypnea, Crackles, HTN, JVD - Slow Infusion Rate, Administer Diuretics Causes of Anemia 1) Blood Loss - Trauma, GI Bleed, Menorrhea 2) Sickle Cell Anemia - Defective Hgb, Malformed RBCs 3) Iron Deficient Anemia - Most Common Type of Anemia in Children & Pregnant Women - Provide Iron Supplements: Ferrous Sulfate, Iron Dextran 4) Pernicious Anemia - Lack of Intrinsic Factor in Gastric Mucosa, Which Prevents Absorption of B12 - Administer Cyanocobalamin (B12) Parenterally or Intranasally 5) Folic Acid Deficiency - Provide Folic Acid Orally or Parenterally - Note: Large Doses of Folic Acid Can Mask B12 Deficiency 6) Bone Marrow Suppression Coagulation Disorders 1) ITP - Autoimmune Disorder, Where Lifespan of PLTs is Decreased, Increasing Risk of Hemorrhage  2) DIC - Clotting Factors Are Depleted Through Formation of Thousands of Micro-Clots in the Body - These Clots Cause Ischemia, & Lack of Clotting Factors Cause Increased Bleeding 3) S/S -Bleeding From Gums/Nose, Oozing/Trickling of Blood From Incisions, Petechiae, Tachycardia, Hypotension 4) Nursing Care - Administer Blood, PLTs, Clotting Factors - Administer O2, Fluid Volume Replacement - Implement Bleeding Precautions, Injury Prevention 5) Meds - ITP: Corticosteroids, Immunosuppressants - DIC: Anticoagulants (Heparin) Fluid Volume Deficit 1) Causes - GI Losses, Diuretics, Hemorrhage, Diaphoresis, Diabetes Insipidus, Kidney Disease, Hyperventilation 2) S/S - Tachycardia, Tachypnea, Hypotension, Weak Pulse, Fatigue, Weakness, Thirst, Dry Mucous Membranes, GI Upset, Oliguria, Decreased Skin Turgor, Decreased Cap Refill, Diaphoresis, Flattened Neck Veins 3) Labs - Increased Hct, Serum Osmolarity, Urine Specific Gravity, BUN, Serum Na 4) Nursing Care - Fluid Replacement, Monitor Weight & I&O’s, Notify Provider For Urine Output < 30ml/hr, Implement Fall Precautions 5) Complications - Hypovolemic Shock, Administer O2, Colloids, Crystalloids, Vasoconstrictors Fluid Volume Excess 1) Causes - Heart Failure, Steroid Use, Kidney Dysfunction, Cirrhosis, Burns, Excess Na Intake 2) Symptoms - Tachycardia, Tachypnea, HTN, Bounding Pulses, Weight Gain, Edema, Ascites, Dyspnea, Crackles, Distended Neck Veins 3) Labs - Decreased Hct & Hgb, Serum Osmolarity, Urine Osmolarity, Urine Specific Gravity, BUN 4) Nursing Care - Place Pt in Semi or High Fowler’s Position, Monitor Weight Daily, Monitor I&O’s, Limit Fluid & Na Intake, Administer Diuretics & O2 as Ordered 5) Complications  - Pulmonary Edema Sodium 1) Function - Maintains Fluid Balance in Body, Nerve & Muscle Function 2) Hyponatremia - Causes: GI Losses, Diuretics, Kidney Disease, Skin Losses, SIADH, Hyperglycemia, Heart Failure - Symptoms: Tachycardia, Hypotension, Confusion (Common in Elderly), Fatigue, n/v, Headache - Care: Administer Isotonic (0.9% NaCl), Increase Na Intake. For Acute Hyponatremia, Administer Hypertonic (3% NaCl) IV Fluids SLOWLY 3) Hypernatremia - Causes: Water Deprivation, Excess Na Intake, Kidney Failure, Cushing’s Syndrome, Diabetes Insipidus, Burns, Excess Sweating - Symptoms: Tachycardia, Muscle Twitching/Weakness, GI Upset - Care: Administer Isotonic (0.9% NaCl) or Hypotonic (0.45% NaCl) IV Fluids, Decrease Na Intake, Increase Water Intake Potassium 1) Function - Maintains ICF (Intracellular Fluid Balance), Nerve Function, Regulates Muscle & Heart Contractions 2) Hypokalemia - Causes: GI Losses, Diuretics, Skin Losses, Metabolic Alkalosis - Symptoms: Dysrhythmias, Muscle Weakness & Cramps, Constipation, Hypotension, Weak Pulse - Care: Increase Foods High in K, Administer Supplements (PO, IV), Cardiac Monitoring 3) Hyperkalemia - Causes: Uncontrolled Diabetes (DKA), Metabolic Acidosis, Salt Substitutes, Kidney Failure, K-Sparing Diuretics (Spironolactone) - Symptoms: Dysrhythmias, Muscle Weakness, Numbness/Tingling, Diarrhea - Care: Limit Foods High in K, Administer Loop Diuretics, Na Polystyrene Sulfonate (Kayexalate), Insulin (w/ Dextrose) Calcium 1) Function - Bone/Teeth Formation, Nerve & Muscle Function, Clotting 2) Hypocalcemia - Causes: Vitamin D Deficiency, Hypoparathyroidism, Hyperphosphatemia, Pancreatitis - Symptoms: Positive Chvostek’s & Trousseau’s Signs, Muscle Spasms, Numbness/Tingling in Lips/Fingers, GI Upset, Hypotension, Decreased HR - Care: Increase Foods High in Ca, Provide Supplements 3) Hypercalcemia  - Causes: Hyperparathyroidism, Long-Term Steroid Use, Bone Cancer - Symptoms: Constipation, Decreased DTRs, Kidney Stones, Lethargy Magnesium 1) Function - Nerve & Muscle Function, Bone Formation - Critical For Many Biochemical Reactions in Body 2) Hypomagnesemia - Causes: GI Losses, Diuretics, Malnutrition, Alcohol Abuse - Symptoms: Hyperactive DTRs, Tetany, Seizures, Constipation - Care: Increase Foods High in Mg, Provide Supplements (Oral Mg Can Cause Diarrhea) 3) Hypermagnesemia - Causes: Kidney Disease, Laxatives Containing Mg - Symptoms: Hypotension, Muscle Weakness, Lethargy, Resp & Cardiac Arrest Acid Base Balance 1) Chemical/Protein Binders - First Line of Defense, Bind or Release H+ Ions to Quickly Change pH 2) Respiratory Buffers - Second Line of Defense, Chemoreceptors Sense Change in CO2, Send Signal to Brain to Adjust Respirations - Increased CO2 Results in Increased Rate & Depth of Respirations (Reduces the # of H+ Ions) - Decreased CO2 Results in Decreased Rate & Depth of Respirations (Increases # of H+ Ions) 3) Renal Buffers - Third Line of Defense, Slower to Respond, but has Longest Duration - Kidneys Reabsorb & Produce More Bicarbonate in Response to High Levels of H+ Ions - Kidneys Excrete More Bicarbonate in Response to Low Levels of H+ Ions Acid Base Imbalances 1) Respiratory Acidosis - Causes: Respiratory Depression, Inadequate Chest Expansion, Airway Obstruction, PE, Pulmonary Edema - Labs: pH < 7.35 & PaCO2 > 45 - Symptoms: Tachycardia, Tachypnea, Shallow Breathing, Pale/Cyanotic Skin, Confusion - Care: Administer O2, Bronchodilators 2) Respiratory Alkalosis - Causes: Hyperventilation (r/t Fear, Anxiety, Salicylate Toxicity) - Labs: pH > 7.45 & PaCO2 < 35 - Symptoms: Tachypnea, Deep & Rapid Breathing, Anxiety, Chest Pain, Dysrhythmias - Care: Reduce Anxiety 3) Metabolic Acidosis  - Causes: DKA, Kidney Failure, Diarrhea, Pancreas/Liver Failure - Labs: pH < 7.35, HCO3 < 22 - Symptoms: Bradycardia, Hypotension, Weak Pulses, Dysrhythmias, Kussmaul Respirations (Deep,Rapid Breathing), Warm/Flushed Skin - Care: Administer Insulin for DKA, Na Bicarb 4) Metabolic Alkalosis - Causes: Antacid Overdose, GI Losses (Vomiting, NG Suction) - Labs: pH > 7.45, HCO3 > 26 - Symptoms: Tachycardia, Dysrhythmias, Muscle Weakness - Care: Administer Antiemetics for Vomiting Expected Ranges of Liver Values 1) AST - 0 - 35 Units/L 2) ALT - 4- 36 Units/L 3) Amylase - 30 - 220 IU/L 4) Lipase - < 160 units/L 5) Bilirubin - < 1.0 mg/dL 6) Albumin - 3.5 - 5.0 g/dL 7) Ammonia - 10 - 80 mcg/dL Endoscopy Procedures 1) Colonoscopy - Allows Visualization of Anus, Rectum, Sigmoid, Descending, Transverse, & Ascending Colon - Done After Moderate Sedation - Bowel Prep: Polyethylene Glycol, Clear Liquid Diet, NPO After Midnight 2) EGD - Allows Visualization of Esophagus, Stomach, & Duodenum - Done Under Moderate Sedation - Prep: NPO 6-8 Hours Before Procedure 3) Sigmoidoscopy - Allows Visualization of Anus, Rectum, & Sigmoid Colon - No Anesthesia Required - Bowel Prep: Polyethylene Glycol, Clear Liquid Diet, NPO After Midnight GI Series 1) Definition - Identifies GI Abnormalities (Ulcers, Tumors, Obstructions) - Pt Drink Barium, X-Rays Taken as Barium Moves Through GI Tract  - Prep: Clear Liquid Diet, NPO After Midnight, No Smoking or Chewing Gum - Pt Teaching: Increase Fluid Intake to Flush Out Barium, Stools Will Be White for 24-72 Hours After Procedure Until Barium is Cleared Total Parenteral Nutrition (TPN) 1) Indications - Malabsorption, Hypermetabolic State, Chronic Malnutrition, Prolonged NPO 2) Administration - Through Central Line (Ex. PICC Line) 3) Nursing Care - Gradually Increase/Decrease Flow Rate - Change Tubing & Bag Every 24 Hours - Use Micron Filter on Tubing - Monitor I&Os, Daily Weights Electrolyte Levels, Blood Glucose (Every 4-6 Hours For First 24 Hours) - If Next TPN Bag is Unavailable, Administer 10% Dextrose in Water Until Arrives - Do Not Use TPN Line For Other Fluids or Meds - Monitor Central Line Insertion Site for S/S of Infection (Erythema, Pain, Exudate) Paracentesis 1) Definition - Insertion of Needle Through Abdominal Wall to Remove Fluid From Peritoneal Cavity 2) Indications - Ascites (Usually r/t Cirrosis) w/ Respiratory Distress 3) Nursing Care - Have Pt Sign Consent Form, Void Before Procedure - Take VS, Weight, Abdominal Girth Circumference Before & After Procedure - Monitor for Hypovolemia (Peritoneal Fluid Removed is High in Protein, Causing Fluid Shift) - Administer Albumin as Prescribed Bariatric Surgery 1) Indications - Morbid Obesity 2) Nursing Care - Eat Only Nutrient Dense Foods, Avoid Milk, Sweets, High Sugar Foods - Eat 6 Small Meals a Day (Vs. Larger Meals) - Allow for 30-60 Minutes to Eat. Chew Foods Thoroughly & Slowly - Do Not Consume Liquids w/ Meals, Restrict Fluids to 30ml at a Time - Watch For S/S of Dumping Syndrome: Abdominal Cramps, Nausea, Diarrhea, Diaphoresis, Tachycardia, Hypotension Nasogastric (NG) Tubes 1) Indications  - Intestinal Obstruction (S/S: Vomiting, Abnormal Bowel Sounds, Abdominal Pain & Distension) 2) Nursing Care - Assess Bowel Sounds, Abdominal Girth - Monitor NG Tube for Displacement - Assess Nasal Mucosa for Breakdown, Provide Oral Care - Monitor I&Os, Electrolytes - Encourage Ambulation to Increase Peristalsis Ostomies 1) Definition - Performed When Part of the Bowel Must be Removed Due to Disease/Injury - Ileostomy: Creates an Opening into the Ileum - Colostomy: Creates an Opening into the Large Intestine 2) Nursing Care - Inspect Stoma: Should be Pink & Moist - Pale Pink or Blue/Purple Indicates Ischemia - Empty Ostomy Bag When it is ¼ - ½ Full - Pt Can Use Breath Mint in Pouch to Decrease Odor - Cut Opening in Skin Barrier Less Than ⅛ Inch Larger Than Stoma (No Bigger) Gastroesophageal Reflux Disease (GERD) 1) Definition - Gastric Contents (Including Enzymes) Backflow Into Esophagus Causing Pain & Mucosal Damage (Esophagitis, Barrett’s Epithelium) 2) Risk Factors - Obesity, Smoking, Alcohol Use, Older Age, Pregnancy, Ascites, Hiatal Hernia, Supine Position, Diet High in Fatty/Fried/Spicy Foods, Caffeine, Citrus 3) S/S - Dyspepsia (Indigestion) - Throat Irritation, Bitter Taste - Burning Pain in Esophagus, Pain Worsens When Laying Down, Improves w/ Sitting Upright - Chronic Cough 4) Meds - Antacids (Take 1-3 Hours After Eating, 1 Hr Before/After Meds) - H2 Receptor Antagonists (Ex. Ranitidine) - Proton Pump Inhibitors (Ex. Pantoprazole) - Prokinetics (Ex. Metoclopramide: Accelerates Gastric Emptying, Watch for S/S of EPS) 5) Surgery - Fundoplication (Fundus of Stomach is Wrapped Around Esophagus) 6) Pt Education - Avoid Fatty/Fried/Spicy Foods - Eat Smaller Meals - Remain Upright After Meals - Avoid Tight-Fitting Clothing  - Lose Weight - Elevate HOB 6-8” w/ Blocks Esophageal Varices 1) Definition - Swollen/Fragile Blood Vessels in Esophagus That Can Hemorrhage (Life- Threatening) 2) Risk Factors - Portal HTN (Increased BP in Veins From Intestines to Liver) Due to Cirrhosis, Hepatitis 3) S/S - Elevated Liver Enzymes (AST, ALT) With Bleeding: Hypotension, Tachycardia, Decreased Hct/Hgb 4) Meds - Nonselective Beta Blockers (Ex. Propranolol), Vasoconstrictors (Ex. Vasopressin) 5) Procedures - Sclerotherapy, Variceal Band Ligation, Transjugular Shunt, Esophagogastric Balloon Tamponade (Compresses Blood Vesselsin Esophagus & Stomach) Bypass Peptic Ulcer Disease (PUD) 1) Definition - Erosion in the Stomach, Esophagus or Duodenum Mucosa 2) Risk Factors - H. Pylori Infection, NSAID Use, Stress 3) S/S - N/V, Heartburn, Bloating, Bloody Emesis or Stools, Pain - Gastric Ulcer: Pain 30-60 Min After Meal, Worse in DAY, Worse w/ Eating - Duodenal Ulcer: Pain 1.5 - 3 Hours After Meal, Worse in NIGHT, Better w/ Eating or Antacids 4) Diagnosis - Esophagogastroduodenoscopy (EGD) 5) Meds - MULTIPLE Antibiotics to Prevent Resistance (Metronidazole, Amoxicillin, Clarithromycin, Tetracycline) - H2 Receptor Antagonist (Ex. Ranitidine) - PPI (Ex. Pantoprazole) - Antacids (Take 1-3 Hours After Meals, 1 Hour Apart From Other Meds) - Mucosal Protectant (Ex. Sucralfate, Given 1 Hour Before Meals and at Bedtime) 6) Pt Teaching - Avoid Acid-Producing Foods (Milk, Caffeine, Spicy Foods), Avoid NSAIDs 7) Complications - Perforation (Resulting in Hemorrhaging) Symptoms Include Severe Epigastric Pain, Rigid/Board-Like Abdomen, Rebound Tenderness, Hypotension, Tachycardia Irritable Bowel Syndrome 1) Definition - An Intestinal Disorder Causing Abdomen Pain, Gas, Diarrhea, & Constipation 2) Pt Teaching - Avoid Dairy, Eggs, Wheat Products, Alcohol, Caffeine - Increase Fiber intake (30-40 g/day) and Fluid Intake (2-3L/Day) - Keep Diary of Food Intake & Bowel Patterns 3) Meds - Alosetron: For IBS w/ Diarrhea (Side Effect:Constipation) - Lubiprostone: For IBS w/ Constipation (Side Effect: Diarrhea) Intestinal Obstruction 1) Mechanical Obstruction Causes - Adhesions From Surgery (Most Common), Tumors, Diverticulosis, Fecal Impactions 2) Non-Mechanical Obstruction (Ie Paralytic Ileus) Causes - Neurogenic Disorder, Vascular Disorder, Electrolyte Imbalance, Inflammation 3) S/S - Both: Abdominal Distention, Obstipation, Abdominal Pain, High Pitched Bowel Sounds Above Obstruction, Hypoactive Bowel Sounds Below Obstruction - Small Bowel: Projectile Vomiting w/Fecal Odor, Severe F&E Imbalances, Metabolic Alkalosis - Large Bowel: Diarrhea or Ribbon-Like Stools Around Impaction 4) Nursing Care - NPO, Place NG Tube, Administer IV Fluids & Electrolytes 5) Surgery - Colon Resection, Colostomy, Lysis of Adhesions Inflammatory Bowel Disease 1) Ulcerative Colitis - Inflammation of the Colon, Causing Continuous Lesions - S/S: LLQ Pain, Fever, 15-20 Liquid Stools/Day, Abdominal Distention & Pain, Mucous/Blood/Pus in Stools 2) Crohn’s Disease - Inflammation & Ulceration of the Small Intestine, Causing Sporadic Lesions, Risk of Fistulas - S/S: RLQ Pain, Fever, 5 Loose Stools/Day, Mucus/Pus in Stools, Abdominal Distention & Pain, Steatorrhea 3) Diverticulitis - Inflammation of the Diverticula (Small Pouches in the Colon) - Can Perforate & Cause Peritonitis - S/S: LLQ Pain, n/v, Fever, Chills Ulcerative Colitis & Crohn’s Disease 1) Labs - Decreased Hct/Hgb & Albumin - Increased ESR, CRP, WBC  2) Risk Factors - Genetics, Caucasions, Jewish Descent, Stress, Autoimmune Disorders 3) Meds - 5-Aminosalicylic Acid (Ex. Sulfasalazine), Corticosteroids (Ex. Prednisone), Immunosuppressants (Ex. Cyclosporine), Antidiarrheals (Ex. Loperamide) 4) Nursing Care - Monitor for S/S of Peritonitis (N/V, Rigid/Boardlike Abdomen, Rebound Tenderness, Fever, Tachycardia) - Monitor I&Os, Electrolytes (Risk for Hypokalemia) - Diet: NPO During Exacerbations, Ongoing, Eat Foods High in Protein & Calories, Low in Fiber, Avoid Caffeine, Alcohol. Eat Small, Frequent Meals Diverticulitis 1) Labs - Decreased Hct/Hgb, Increased WBC 2) Meds - Antibiotics (Ex. Metronidazole), Analgesics 3) Nursing Care - Diet: NPO or Clear Liquid Diet During Exacerbations, then Progress to Low-Fiber Diet, Avoid Seeds, Nuts, Popcorn - Monitor S/S of Peritonitis (N/V, Rigid/Boardlike Abdomen, Rebound Tenderness, Fever, Tachycardia) Cholecystitis 1) Definition - Inflammation of the Gallbladder, Usually Caused by Cholelithiasis (Gallstones), Gallstones Block the Cystic or Common Bile Ducts & Cause Bile to Back Up Into Gallbladder 2) Risk Factors - Female, High Fat Diet, Obesity, Genetics, Older Age 3) S/S - RUQ Pain (Possible Radiation to Right Shoulder), Pain & N/V w/ Ingestion of High-Fat Food, Jaundice, Clay-Colored Stools, Steatorrhea, Dark Urine, Pruritus, Dyspepsia, Gas 4) Labs - Increased WBC, Bilirubin (If Bile Duct is Blocked), Amylase & Lipase (If Pancreas is Involved), AST & ALT (If Common Bile Duct is Blocked) 5) Interventions - Lithotripsy (to Break up Gallstones), Cholecystectomy (Removal of Gallbladder) Cholecystectomy 1) Definition - Removal of Gallbladder, If Done Laparoscopic Approach, Shoulder Pain is Expected (Encourage Ambulation to Reduce Free Air Pain), If Done via Open Approach, T-Tube May be Placed in Bile Duct - Nursing Care of T-Tube: Record Drainage (1,000ml/day Needs to be Reported), Empty Drainage Bag Every 8 Hours, Clamp Bag Every 8 Hours, Clamp Tube for 1-2  Hours to Assess for Tolerance to Eating Prior to Removal, After Removal, Stools Should Return to Brown Color in About 1 Week 2) Pt Teaching - Low Fat Diet, Avoid Gas-Causing Foods, Lose Weight 3) Complications - Pancreatitis, Peritonitis r/t Rupture of Gallbladder Pancreatitis 1) Definition - Autodigestion of the Pancreas by Pancreatic Digestive Enzymes That Are Prematurely Activated Before Reaching the Intestines 2) Risk Factors - Bile Tract Disease, Alcohol Abuse, GI Surgery, Trauma, Med Tox 3) S/S - Severe LUQ or Epigastric Pain (Radiating to the Back or Left Shoulder) n/v, Turner’s Sign (Ecchymoses on Flanks), Cullen’s Sign (Blue/Grey Discoloration Around Umbilicus), Jaundice, Ascites, Tetany 4) Labs - Increased Amylase, Lipase, WBC, Bilirubin, Glucose - Decreased Ca, Mg, PLTs 5) Nursing Care - NPO, NG Tube, Antiemetics, Insulin, IV Fluids & Electrolytes, Opioid Analgesics Pancreatic Enzymes (Pancrelipase) w/ Meals/Snacks, Progress to Bland/Low- Fat Diet 6) Pt Teaching - No Alcohol Consumption, Encourage Alcoholics Anonymous (AA), No Smoking, Reduce Stress 7) Complications - Chronic Pancreatitis, Pancreatic Pseudocyst, Type I Diabetes Hepatitis 1) Routes of Transmission - Hep A: Fecal/Oral - Hep B: Blood/Body Fluids - Hep C: Blood/Body Fluids 2) Risk Factors - IV Drug Use, Body Piercing, Tattoos, Unprotected Sex, Travel to Underdeveloped Countries, Crowded Living Environments 3) S/S - Flu-Like S/S, Fever, Jaundice, Dark-Colored Urine, Clay-Colored Stools 4) Labs - Increased ALT, AST, Bilirubin Cirrhosis 1) Definition - Normal Liver Tissue is Replaced w/ Fibrotic Scar Tissue - Postnecrotic: Due to Viral Hepatitis, Toxins, or Meds - Laennec’s: Due to Chronic Alcoholism - Biliary: Due to Chronic Biliary Obstruction 2) S/S - Jaundice, Ascites, Petechiae, Spider Angiomas, Palmar Erythema, Pruritis (Itching), Confusion, Confusion, Fatigue, GI Bleeding, Asterixis, Fetor Hepaticus (Fruity Breath), Peripheral Edema 3) Labs - Increased ALT, AST, Bilirubin, Ammonia Levels - Decreased Serum Protein, Albumin, RBC, Hgb, Hct, PLTs 4) Diagnosis - Liver Biopsy (Most Definitive), Ultrasound, CT, MRI 5) Nursing Care - Strict I&Os, Restrict Fluids & Na as Ordered - Elevate HOB to Help w/Breathing - Diet: High Carb, Moderate Fat, High Protein, Low Na Diet, Vitamin/Mineral Supplements, Several Small Meals vs. Fewer Big Meals - Measure Abdominal Girth Daily (Over Largest Part) - Wash Skin w/Cold Water & Apply Lotion to Reduce Itching - Encourage Alcohol Recovery Program 6) Meds - Lactulose to Remove Excess Ammonia Through Stool (Monitor for Hypokalemia), Diuretics 7) Procedures - Paracentesis: Void Before Procedure, Supine Position w/HOB Elevated, Assess Extracted Fluid (Color, Amount) - Liver Transplant 8) Complications - Encephalopathy (Reduce Ammonia Levels w/ Lactulose) - Esophageal Varices Renal System Expected Values 1) Creatinine - 0.6-1.2 mg/dL, Elevated Levels Indicate Kidney Disease (More Definitive than BUN) 2) BUN (Blood Urea Nitrogen) - 10-20 mg/dL, Elevated Levels May Indicate Kidney Disease or Dehydration 3) Urinalysis - Specific Gravity Should be Between 1.01-1.025. No Glucose, Protein, Ketones, Leukocyte Esterase, or Nitrates Should be Found in Urine 4) Cystography/Urography - Check for Allergies to Iodine & Shellfish, NPO After Midnight, Bowel Preparation Night Before Procedure, Encourage Increased Fluid Intake After Procedure,  - Pink Tinged Urine Expected, - Monitor for s/s of Infection: Cloudy or Foul Smelling Urine, Urinary Urgency, UA Positive for Leukoesterase, Nitrates Hemodialysis 1) Definition - Eliminates Excess Fluid, Electrolytes, and Waste Products From the Body. - Used in Pts with acute or Chronic Kidney Disease. - Usually Done 3 Times a Week 2) Preprocedure - Ensure Pt Vascular Access (Check for Bruit, Thrill, Distal Pulses) - Assess Vitals, Lab Values & Weights 3) Intra Procedure - Monitor for Hypotension, Cramping, n/v, Bleeding - Administer Anticoagulants to Prevent Clots as Ordered (Administer Protamine Sulfate to Reverse Heparin if Ordered) 4) Postprocedure - Decreased BP & Lab Values Expected - Compare Weight to Before Procedure to Estimated Fluid Removed (1L Fluid = 1 Kg) 5) Pt Teaching - Increase Protein Intake After Dialysis, as Protein is Lost w/ Each Exchange - Avoid Carrying Items w/ Arm w/ Access Site - Don’t Sleep on Arm w/ Access Site - Perform Hand Exercises to Mature Fistula 6) Complications - Disequilibrium Syndrome (S/S: n/v, Decreased LOC, Seizures) Due to Increased ICP - Slow Dialysis Exchange Rate - Hypotension: Administer IV Fluids or Colloids as Ordered - Slow Exchange Rate, Lower HOB Peritoneal Dialysis 1) Definition - Installation & Dwelling of Hypertonic Dialysate Solution in the Peritoneal Cavity to Remove Waste Products - Alternative to Hemodialysis For: Older Adults, Intolerance to Anticoagulants, Vascular Access Difficulties 2) Preprocedure - Assess Weight, Warm Dialysate Solution, Use Sterile Technique When Accessing Catheter Insertion Site 3) Intra Procedure - Compare Inflow vs. Outflow of Dialysate - Keep Outflow Lower Than Pt’s Abdomen - Monitor Color of Outflow - Should be Clear, Light Yellow, - Bloody, Cloudy Outflow Indicates Possible Infection 4) Complications  - Peritonitis (s/s: Fever, Purulent Drainage, Erythema, Swelling, Discolored Dialysate) - Protein Loss (Increase Protein in Diet) - Hyperglycemia (Administer Insulin as Needed) - Poor Inflow/Outflow (Check for Kinks in Tubing, Address Constipation, Reposition Pt, Milk Tubing to Break up Clots) Kidney Transplant 1) Preprocedure - Provide Immunosuppressant Therapy as Ordered 2) Postprocedure - Monitor Urine Output - Report Urine Output < 30 ml/hr - Perform Bladder Irrigation as Ordered - Monitor for Infection (s/s: Fever, Erythema, Incisional Drainage) - Monitor for Organ Rejection (s/s: Fever, HTN, Pain at Site) Types: - Hyperacute (Within 48 Hours of Surgery) - Acute (Within 1 Week - 2 Years) - Chronic (Occurs Gradually) 3) Pt Teaching - Low-Fat, High-Fiber, High Protein, Low Sodium Diet, Avoid Contact Sports Glomerulonephritis 1) Definition - Immune Complex Disease Resulting in Inflammation of Glomerular Capillaries 2) Risk Factors - Streptococcal Infection, Lupus, HTN, Diabetes 3) S/S - Decreased Urine Output, Fluid Volume Excess (Edema, Weight Gain, Dyspnea, HTN) 4) Labs - Throat Culture Positive for Strep - Positive ASO (Antistreptolysin Titer) - Decreased GFR (Obtained Through 24 Hour Urine Collection to Determine Creatinine Clearance) - UA: Increased Urine Specific Gravity, Proteinuria - Elevated WBC, ESR 5) Nursing Care - Monitor Weight (Report Weight Gain of 2 lbs in 24 Hr or 5 lbs in 1 Week) - Monitor I&Os, Labs, Restrict Fluids, Sodium, Protein - Administer Antibiotics for Strep Infection - Administer Diuretics, Corticosteroids 6) Procedure - Plasmapheresis (To Filter Antibody Complexes Out of Blood) Acute Kidney Injury 1) 3 Types  - Prerenal AKI: Due to Decreased Blood Flow to Kidneys (Shock, Sepsis, Hypovolemia, Renal Vascular Obstruction) - Intrarenal AKI: Direct Damage to Kidneys (Physical Trauma, Hypoxic Injury, Chemical Injury due to Toxins or Meds) - Postrenal AKI: Due to Obstruction Leaving the Kidneys (Stone, Tumor, BPH) 2) AKI Phases (4) - Onset: Onset to Development of Oliguria (Hours-Days) - Oliguria: Urine Output is 100-400 ml/24 Hours (1-3 Weeks) - Diuresis: Start of Kidney Recovery, Large Amount of Urine Expected (2-6 Weeks) - Recovery: Continues Until Complete Recovery (Up to 1 Year) 3) Diet - Restrict Potassium, Phosphate, Magnesium Intake, Increase Protein Intake Chronic Kidney Disease 1) Definition - Gradual, Irreversible Loss of Kidney Function 2) Risk Factors - Aging, Dehydration, AKI, Diabetes, HTN, Chronic Glomerulonephritis, Meds (Gentamicin, NSAIDs), Autoimmune Diseases 3) Stages - Stage 1: GFR > 90 ml/min - Stage 2: GFR 60-89 ml/min - Stage 3: GFR 30-59 ml/min - Stage 4: GFR 15-29 ml/min - Stage 5: GFR < 15 ml/min 4) Signs/Symptoms - Mostly Result of Fluid Volume Overload (JVD, HTN, Dyspnea, Tachypnea, Crackles, Peripheral Edema, Lethargy, Tremors, n/v, Pruritis, Uremic Frost 5) Labs - Elevated BUN & Creatinine - Decreased Sodium, Calcium - Increased Potassium, Phosphorus, Magnesium - Decreased Hgb & Hct - UA: Hematuria, Proteinuria 6) Nursing Care - Weigh Pt Daily ( 1Kg Weight Gain = 1L Fluid Retained) - Diet: High Carbs, Moderate Fat, Restrict Na, K, Ph, & Mg - Protect Skin from Breakdown - Prepare Pt for Hemodialysis - Promote Frequent Rest Periods 7) Meds - Digoxin, Na Polystyrene (To Reduce Serum K), Erythropoietin (To Increase RBC Production), Furosemide, Avoid NSAIDs, Contrast Dye, & Mg Containing Antacids Urinary Tract Infection (UTI) 1) Definition  - Infection in Lower Urinary Tract, Usually Caused by E. Coli 2) Risk Factors - Female Gender (Short Urethra, Close Proximity to Rectum), Menopause, Sexual Intercourse, Pregnancy, Synthetic Underwear, Wet Bathing Suits, Frequent Baths, Urinary Catheters, Stool Incontinence, Diabetes, Incomplete Bladder Emptying 3) S/S - Abdominal Pain, Dysuria (Urinary Frequency/Urgency), Fever, n/v, Hematuria, Pyuria, Cloudy/Foul-Smelling Urine, Confusion (In Older Adults) 4) UA - Presence of Bacteria, WBC, Positive Leukocyte Esterase & Nitrates 5) Meds - Antibiotics (Fluroquinolones, Nitrofurantoin, Trimethoprim, Sulfonamides), Phenazopyridine (Bladder Analgesic - Warn Pt in Will Turn Their Urine Orange) 6) Complications - Urosepsis (S/S: Hypotension, Tachycardia, Tachypnea, Fever) 7) Prevention - Drink More Than 3L Daily - Maintain Good Body Hygiene - Empty Bladder Regularly (Every 3-4 Hrs) - Urinate Before & After Intercourse - Drink Cranberry Juice - Women: Wipe Front to Back, Avoid Bubble Baths & Perfume Containing Feminine Products, Avoid Sitting in Wet Bathing Suits, Avoid Pantyhose or Tight Clothing Pyelonephritis 1) Definition - Kidney Infection, Usually Caused by E. Coli, Starts in Lower Urinary Tract & Moves up to Kidney 2) Risk Factors - BPH, Kidney Stones, Pregnancy, Increased Urine pH, Incomplete Bladder Emptying, Chronic Disease 3) S/S - Costovertebral Tenderness, Fever, Flank/Back Pain, n/v, Tachycardia, Tachypnea, HTN, Chills 4) Labs - UA Positive for Leukocyte Esterase, Nitrates, WBCs, Bacteria - Elevated Creatinine, BUN - Elevated ESR, C-Reactive Protein 5) Meds - Antibiotics, Opioid Analgesics 6) Complications - Septic Shock (S/S: Hypotension, Tachycardia,Fever, CKD, HTN) Urolithiasis 1) Definition  - Presence of Stones (Calculi) In Urinary Tract, Composed of Ca Phosphate, Ca Oxalate, or Uric Acid 2) Risk Factors - Male Gender, Damage to Urinary Tract Lining, High Acidity or Alkalinity of Urine, Urinary Retention, Dehydration 3) S/S - Severe Pain (Flank Pain, Possibly Radiating to Abdomen), Dysuria, Fever, Diaphoresis, n/v, Pallor, Tachycardia, Tachypnea, Oliguria, Hematuria 4) Nursing Care - Monitor I&Os, Strain all Urine (& Save Stone for Lab Analysis), Increase Fluids to 3L/Day, Encourage Ambulation 5) Meds - Opioid Analgesics or NSAIDs, Antispasmodic Drugs (Oxybutynin) 6) Procedures - Lithotripsy (Uses Laser or Shock-Wave Energy to Break up Stones, Done Under Moderate Sedation), Strain Urine Following Procedure, Hematuria, Bruising at Lithotripsy Site is Expected - Stenting - Ureterolithotomy (Extract Stone) 7) Education - Increase Fluid Intake (2-3L/Day) - For Ca Phosphate Stones, Limit Intake of Animal Protein & Na - For Oxalate Stones, Limit Foods High in Oxalates: Spinach, Rhubarb, Strawberries, Beets, Chocolate, Nuts, Tea - For Uric Acid Stones, Limit Foods High in Purines (Meat, Whole Grains, Legumes) Reproductive System Female Diagnostic Procedures 1) Pap Smear - Tests for Cancerous Cells in the Cervix - Recommended Every 3 Years Starting at Age 21 2) Mammogram - Tests for Breast Cancer - Recommended Annually Starting at age 40 - Avoid Use of Deodorant, Lotion, Powders in Axillary Region Prior to Exam Menstrual Disorders 1) Menorrhea - Excess Menstrual Bleeding (Amount/Duration) 2) Amenorrhea - Absence of Menses, Can be due to Low Body Fat % or Anorexia 3) PMS - Hormonal Imbalance Before Period - S/S: Irritability, Depression, Breast Tenderness, Bloating, Headache 4) Endometriosis  - Overgrowth of Endometrial Tissue Outside the Uterus, Common Cause of Infertility Menopause 1) Definition - Cessation of Menses (No Periods in 12 Months) 2) S/S - Hot Flashes, Decreased Vaginal Secretions, Mood Swings, Decreased Bone Density 3) Meds - Hormone Therapy (HT) - Oral, Transdermal, or Intravaginal, Prevents Hot Flashes, Reduces Vaginal Tissue Atrophy, & Decreases Risk of Bone Fractures - Taking HT Increases Risk of Embolic Events (DVT, MI, Stroke) & Breast Cx 4) Teaching - Quit Smoking Immediately - Avoid Knee-High Stockings & Other Restrictive Socks/Clothing - Avoid Sitting for Prolonged Periods of Time, Move & Stretch Legs Regularly - Monitor DVT (S/S: Unilateral Leg Pain, Edema, Warmth, Erythema), or MI Cystocele/Rectocele 1) Definition - Cystocele is Protrusion of Bladder Through Anterior Vaginal Wall - Rectocele is Protrusion of Rectum Through Posterior Vaginal Wall 2) Risk Factors - Obesity, Older Age, Chronic Constipation, Family History, Forceps Delivery 3) Treatment - Vaginal Pessary (Device Used to Provide Support & Block Protrusion of Other Organs) - Kegel Exercises (Contraction of Vaginal & Rectal Muscles) - Surgical Repair Fibrocystic Breast Condition 1) Definition - Noncancerous Condition Causing Development of Fibrotic Connective Tissue & Cysts in the Breasts 2) S/S - Breast Pain, Rubber-Like Lumps, Particularly in Upper/Outer Quadrant of Breasts 3) Diagnosis - Breast Ultrasound Male Diagnostic Procedures 1) PSA - Measures Amount of Protein Produced by the Prostate Gland in the Bloodstream - Increased Amount of PSA can Indicate Presence of Prostate Cx or BPH - Do NOT do DRE Prior to Drawing Blood for a PSA  - Recommended Annually for Med Over 50, African-American Men & Men w/ Family Hx Should Start Screening Order - PSA Over 4ng/ml Requires Further Evaluation 2) DRE - Palpation of the Prostate Gland Through the Rectal Wall, Provider Inserts Finger Into Anus - Abnormal Findings: Enlarged or Hard Prostate, Irregular Shapes or Lumps Benign Prostatic Hyperplasia 1) Definition - Enlargement of the Prostate Gland That Impairs Urine Outflow From Bladder, Resulting in Urinary Retention, This Results in Increased Risk of Infection & Reflux to the Kidneys 2) S/S - Urinary Frequency, Urgency, Retention, Hesitancy, Incontinence, Post-void dribbling, Reduced Urinary Stream Force, Hematuria, Nocutira, Frequent UTIs 3) Labs - Elevated PSA, Increased WBC w/UTI, Increased Creatinine/BUN w/ Kidney Involvement 4) Meds - Androgen Inhibitor (Finasteride), Peripherally Acting Antiadrenergic (Tamsulosin) 5) Procedures - Prostatic Stent: Keeps Urethra Patent - Transurethral Resection of the Prostate (TURP) Surgery TURP Surgery 1) Nursing Care - Pt Will Have Indwelling 3 Way Catheter - Perform Continuous Bladder Irrigation (CBI) w/ NS or Prescribed Solution, Goal is to keep Irrigation Outflow Light Pink - Increase CBI Rate if Irrigation Outflow is Bright Red, Ketchup-Appearing, or Contains Clots - If Catheter Becomes Obstructed (S/S: Bladder Spasms, Reduced Outflow): Turn off CBI, Irrigate w/50ml Using Large Piston Syringe - Expected: Pt Will Have a Continuous Need to Urinate 2) Meds - Analgesics - Antispasmodics (To Prevent Bladder Spasms) - Antibiotics (Prophylactic) - Stool Softeners (To Prevent Straining) 3) Pt Teaching - Drink 12 (or More) 8 oz Glasses of Water Per Day - Avoid Caffeine or Alcohol (Bladder Stimulants) - If Urine is Bloody, Stop Activity, Rest, & Increase Fluid Intake Musculoskeletal System Diagnostic Procedures  1) Arthroscopy - Allows Visualization of the Internal Structure of a Joint - Contraindicated if Pt has Infection or Cannot Bend at Least 40 Degrees 2) Nuclear Scan - Radioactive Material Injected Hours Before Scan - Repeat Scans at 24,48, 72 Hours - Bone Scan Detects Tumors, Fractures, Bone Disease - Gallium Scans More Sensitive Than Bone Scans 3) DXA - Used to Determine Bone Mass & Presence of Osteoporosis 4) Electromyography - Needles Placed into Muscle, and Electrical Activity Recorded During Muscle Contraction - Used to Diagnose Cause of Muscle Weakness Arthroplasty 1) Definition - Replacement of a Diseased Joint w/ a Prosthetic Joint - Used For Pts w/ Osteoarthritis, RA, Trauma, or Congenital Defects 2) S/S - Joint Pain, Crepitus, Swelling 3) Contraindications - Current/Recent Infection, Arterial Insufficiency to Affected Extremity 4) Pre-Op - Administer Epoetin Alpha to Increase Hgb, Autologous Blood Donation - Advise Pt to Scrub w/ Antiseptic Soap the Night Before & Morning of Surgery 5) Post Op Care - Initiate Continuous Passive Motion (CPM) Machine Immediately After Surgery (If Ordered) - DO NOT place Pillow Under Knee (or Use Knee Gatch), in Order to Prevent Flexion Contractures - Administer Analgesics, Antibiotics, Anticoagulants, Ice Therapy - Perform Neurovascular Checks Every 2-4 Hours - Pt Should NOT Kneel or Do Deep Knee Bends - Monitor for S/S of DVT (Unilateral Pain, Swelling, Erythema) or PE (Dyspnea, Chest Pain, Tachycardia) - Apply SCDs or Antiembolic Stockings - Encourage Early Ambulation, Foot Exercises - Place Abduction Device Between Legs, No Crossing of Legs - Do Not Allow Flexion of Hip Greater Than 90 Degrees - Externally Rotate Pt’s Toes (Do Not Allow Internal Rotation) - Monitor for Joint Dislocation: Onset of Severe Pain, Hearing a “Pop”, Shortened Affected Extremity, Internal Rotation of Affected Extremity - Use Elevated Toilet Seat, Avoid Low Chairs Amputation 1) Indications  - Trauma (Wrap Severed Extremity in Dry Sterile Gauze, Place in Sealed Plastic Bag, Submerge in Ice Water) - Infection - Peripheral Vascular Disease (S/S: Reduced Pulses, Cooler Temp, Gangrene, Cyanosis, Decreased Sensation) 2) Nursing Care - Treat Phantom Limb Pain (Common & Real) w/ Beta Blockers, Antiepileptics, Antispasmodics, Antidepressants - Position Stump in Dependent Position - Perform ROM Exercises - To Shrink Residual Limb (In Preparation of Prosthesis): Wrap Stum in Figure 8 Wrap - Avoid Elevating Stump for 24 Hours, Have Pt Lie Prone for 20-30 Mins Several times a Day Osteoporosis 1) Definition - Rate of Bone Resorption Exceeds Rate of Bone Formation, Resulting in Low Bone Density & Fragile Bones - Osteopenia is Precursor to Osteoporosis 2) Risk Factors - Females, Thin/Lean Body, Menopause, Insufficient Ca or Vitamin D Intake, Smoking, Alcohol Abuse, Excess Caffeine Intake, Lack of Physical Activity, Hyperparathyroidism, Long-Term Steroid Use, Long-Term Anticonvulsant Med Use 3) S/S - Back Pain, Fractures, Kyphosis, Reduced Height 4) Diagnosis - Dual x-ray Absorptiometry (DXA) 5) Meds - Calcitonin, Estrogen (Increased Risk of Breast Cx & DVT), Raloxifene, Alendronate (Remain Upright for 30 Mins After Taking) 6) Teaching - Get Sufficient Ca & Vitamin D, Moderate Sun Exposure Using Sunscreen, Weight Bearing Exercises, Home Safety Measures to Prevent Falls Fractures 1) Types - Closed (Simple): Does Not Break Skin Surface - Open (Compound): Breaks Skin Surface, Increased Infection Risk - Complete: Goes Through Entire Bone - Incomplete: Goes Part Way Through Bone - Comminuted: Bone Split in Multiple Pieces - Compression: One or More Bones in Spine Weaken & Collapse (Due to Loading Force) - Oblique: Occurs at an Oblique Angle - Spiral: Fracture From Twisting Motion (Sign of Abuse)  2) Risk Factors - Osteoporosis, Long-Term Steroid Use, Falls, Trauma, Bone Cx, Substance Abuse 3) S/S - Pain, Crepitus, Deformity in Extremity, Muscle Spasms, Edema, Ecchymosis 4) Nursing Care - Stabilize Affected Area, Elevate Affected Limb, Apply Ice, Perform Neurovascular Assessments Every Hour 5) Meds - Antibiotics (Prophylactic), Analgesics, Muscle Relaxants 6) Surgeries - External Fixation: Pins Attached to External Frame - Open Reduction & Internal Fixation (ORIF): Pins, Plates, Screws, Rods Used Internally 7) Neurovascular Assessment - Pain Level - Sensation (Numbness, Tingling, Lack of Sensation) - Skin Temperature - Capillary Refill (Should be Less Than 2 Secs) - Pulses - Movement Immobilization Devices 1) Casts - Handle Plaster Casts w/ Your Palms (Not Fingertips) & Wear Gloves Until Cast is Dry - Elevate Cast Above Level of Heart for 1st 24-48 Hours - Tell Pt Not to Place Objects Under Cast - Itching Can be Relieved by Blowing Cold Air From Hair Dryer Under Cast - Report to Provider: Hot Spots, Areas w/ Increased Drainage, Malodorous Areas 2) Traction a) Skin: Weights Attached to Pt’s Skin to Decrease Muscle Spasms & Immobilize the Extremity Before Surgery - Byrant Traction (For Hip Dysplasia in Children) - Buck’s Traction: (For Hip Fractures in Adults) b) Skeletal: Screws are Inserted into the Bone, Used for Long Bone Fractures c) Halo: Used for Cervical Bone Fractures - Make Sure Wrench to Release Rods is Attached to the Vest so CPR can be Performed 3) Nursing Care - Assess Neurovascular Status Every Hour for 1st 24 Hours, Then Every 4 Hours - Do Not Lift or Move Weights - Do Not Let Weights Rest on Floor (Make Sure they Are Hanging Freely) - Muscle Spasms are Expected and Should be Treated w/ Meds, Repositioning, Heat, or Massage, Report Unrelieved Muscle Spasms to Provider - For Halo Traction, Move Pt as a Unit & Do Not Apply Pressure to Rods 4) Pin Site Care - Monitor for S/S of Infection: Increased Drainage, Erythema, Loosening of Pins, Skin Tenting at Pin Site - Clean Pins Using a NEW Cotton Tip Swab for Each Pin - Do Not Remove Crusting at Pin Site Fracture Complications 1) Compartment Syndrome - Increased Pressure Within Muscle Compartment of Extremity Which Impairs Circulation - S/S: Intense Pain w/Passive Movement, Paresthesia (Early Sign), Paralysis (Late Sign), Pallor, Pulselessness (Late Sign), Hard/Swollen Muscles - Tx: Fasciotomy 2) Fat Embolism - Fat Globule From Bone Marrow Travels to Lungs, Impairing Respirations, Long Bone & Hip Fractures are Most Common - S/S: Dyspnea, Confusion (Early Sign), Tachypnea, Tachycardia, Petechiae on Upper Body (Late Sign) 3) Osteomyelitis - Bone Infection - S/S: Bone Pain, Erythema, Edema, Fever, Elevated WBC - Tx: Long-Term Antibiotic Therapy, Surgical Debridement of Bone, Hyperbaric O2 Therapy Osteoarthritis 1) Definition - Progressive Degeneration of Articular Cartilage in Joints 2) Risk Factors - Older Age, Women, Obesity, Smoking, Repetitive Stress on Joints 3) S/S - Joint Pain/Stiffness, Crepitus, Enlarged Joints, Herberden’s Nodes (Distal Interphalangeal Joints), Bouchard’s Nodes (Proximal Interphalangeal Joints) 4) Pt Care/Teaching - Apply Ice (Acute Inflammation) or Heat - Splinting and/or Use of Assistive Devices - Physical Therapy - TENS (Transcutaneous Electrical Nerve Stimulation) 5) Meds - Oral Analgesics (Acetaminophen, NSAIDs) - Topical Analgesics (Capsaicin): Wear Gloves When Applying, Do Not Apply on Areas w/ Broken Skin, Burning Sensation is Normal - Glucosamine: Increases Synovial Fluid Production & Helps Rebuild Cartilage - Injections: Glucocorticoids, Hyaluronic Acid 6) Surgery - Total Joint Arthroplasty Osteoarthritis vs. Rheumatoid Arthritis  1) Osteoarthritis