Final Flashcards
S/Sx of hypernatremia
thirst, swollen tongue, sticky mucosa, flushed skin, low-grade fever, edema, confusion, restlessness, weakness
(SALT- Skin flushed, Agitation, Low-grade fever, Thirst)
S/sx of hyponatremia
neurologic changes- lethargy, confusion, personality changes, seizures
S/sx of hyperkalemia
cardiac changes, dysrhythmias, muscle weakness, resp impairment, paresthesias, anxiety, and GI manifestations M-muscle weakness U-urine/oliguria R-respiratory distress D-decreased cardiac contract E-ekg changes R-reflexes/hyperreflexia
Tx for hyperkalemia
- limit K intake
- monitor ECG and use Ca gluconate for arrhythmias
- Kayexalate
- IV sodium bicarb
- reg insulin and hypertonic dextrose IV if met. acidosis
- albuterol
- dialysis
- diuretics to prevent pulm overload and excrete K
Hypophosphatemia lab value
serum phosphorus <2.0
Causes of hypophosphatemia
vit D deficiency, malabsorption syndromes, over-use of phosphate binding antacids, alcoholism
s/sx of hypophosphatemia
confusion, seizures, symptoms mimicking Guillian Barre, decreased oxygen capacity of RBC
tx for hypophosphatemia
high-phosphorus diet (beans, peas, eggs, chicken, fish, nuts, grains)
P.O. meds (Neutra Phos)
Normal osmolality of blood
275-295 mOsm/Kg
Labs and diagnostic testing for hypoparathyroidism
- Low serum Ca
- High phosphorus (PTH is overwhelmed due to hyperphosphatemia)
- Get hx (heredity and nutritional), duration, clinical s/sx, renal failure-PTH ineffective c renal failure, med analysis
- PTH immunoassay
- Vit D metabolites
- Transient (trauma, burns, meds, illness) vs. chronic
Labs and Diagnostic testing for hyperparathyroidism
-high PTH levels
-Hypercalcemia
alkaline phosphatase levels
Causes of Diabetes Insipidus
-A deficiency in the synthesis or release of ADH
or
-A decreased renal responsiveness to ADH
Treatment for Addison’s disease
- Administer cortisone, hydrocortisone, prednisone, or Cortef to replace cortisol
- Administer fludrocortisone to regulate Na and K balance from aldosterone insufficiency
- maintain fluid balance
how to administer hydrocortisone
with meals, milk, or antacids to avoid GI distress
Nursing interventions for Addison’s disease
- monitor F&E
- admin hormones
- weigh daily
- I&Os
- bone density test for osteoporosis due to decrease in mineralcorticoids
Pt teaching for Addison’s
- meds must be taken every day
- wear medic alert bracelet
- keep emergency supply of meds available
- Need for increased cortisol replacements during stress and illness and increased flurocortisone acetate during exercise and sweating*
Nursing interventions for Cushing’s
- daily weight and monitor fluid status
- I&Os (adequate hydration)
- monitor for glucose and acetone in urine
- allow adequate rest
- avoid trauma to skin (delayed wound healing)
- bone density scan to assess for osteoporosis bc corticosteroids can leech calcium from bone
- ongoing CV and musculoskeletal asmts
- suicide precautions
Pt teaching for Cushing’s
-maintain high calorie, high-calcium diet to aid in wound repair and replace Ca
What is Conn’s Syndrome?
aka Primary Aldosteronism
- Adrenal cortex is secreting excessive amounts of aldosterone
- This results in kidneys retaining Na and excreting K
S/Sx of Conn’s
- increased BP
- HA
- orthostatic hypotension
- muscle weakness and cramps (low K)
- fatigue
- temp paralysis
- constipation
- numbness, prickling, tingling
- polydipsia & polyuria
Interpreting test results for Conn’s
- low serum K
- 24 hr urine to monitor aldosterone, creatinine, and cortisol
- increased urinary aldosterone
- oral salt or saline loading test
- presence of adrenal tumor on CT
Tx for Conn’s
- Diuretcs (spironolactone for women and amiloride for men to increase K)
- Ca channel blockers (HTN)
- eplerenone (blocks effects of aldosterone)
NSG Dx for Conn’s
Risk for imbalanced fluid volume
Risk for activity intol
Impaired physical mobility
NSG for Conn’s
Monitor VS, restrict Na intake, I&Os, daily weights
Pt teaching: thirst, dry mucous membranes are caused by low sodium. Allow sips of water, ice chips
Nasal Polyps usually associated with:
Ashma, Hay fever, Sinus infection, Cystic Fibrosis <16yrs
Samter’s Triad
asthma, nasal polyps, aspirin intolerance
Teaching c nasal polyps
polyps can be recurring even after removal, may need to stay on steroid sprays for extended time to prevent recurrence
Causes of mucormycosis
weakened immune system, diabetes, DKA, kidney failure, organ transplant, chemo, Desferal tx for acute iron poisoning, exposure to construction, removal of nonsterile adhesive tape, tongue depressors as splints in neonates
Teaching for mucormycosis
- Seek health care immediately if facial swelling and a black discharge from nose occurs
- high-risk pts should avoid sugary foods, decaying plants, moldy bread, manure, and other sources of fungi
Clinical Manifestations of Vocal Cord Paralysis
- change in voice (croaky, rough, breathy, aphonic)
- SOB
- noisy breathing
- choking, coughing c eating/swallowing
- need for frequent breaths while speaking
- inability to speak loudly
- inability to “bear down”
Medical tx for vocal cord paralysis
For uncontrolled aspiration:
- permanent gastrostomy tube
- tracheostomy
- Semi-Laryngectomy
S/sx of Post-obstructive pulmonary edema (POPE)
frothy sputum and moist rales
Trach assessment
- auscultate lungs
- monitor 02
- assess for blood in the sputum*, sub-Q emphysema in the neck, resp distress, and tube patency
- monitor for POPE*
teaching for sarcoidosis
- limit Ca rich foods, vit D, & sunlight
- take prednisone
- seek medical care with increasing dyspnea, weight gain, more productive cough, or change in sputum from clear to yellowish-brown
Chronic Bronchitis
inflammation and increased mucous production in the trachea and bronchi with chronic productive cough
Emphysema
chronic inflammation reduces flexibility of walls of alveoli, resulting in over-distention of the alveolar walls. This causes air to be trapped in the lungs, impeding gas exchange
s/sx of pulmonary hypertension
Most common: exertional dyspnea fatigue and lethargy angina syncope Raynaud's edema
Less common:
cough, hemoptysis, hoarsness
Other s/sx of pulm htn (heart sounds mainly)
right ventricular heave, split heart sound, accentuated S2, ejection click, third heart sound, JVD, liver congestion, peripheral edema
Cor Pulmonale
failure of the right side of the heart due to pulmonary HTN
Functions of the Integumentary System
Protection Thermoregulation Tactile Stimulation Excretion Synthesis of Vit D Determines Identity Storage of blood and fats Reflection of emotion
contributing factors to diabetic wounds
neuropathy
macro/microvascular changes
slow, decreased immune response
Venous ulcers
- most occur on lower extremities
- margins not well defined
Arterial ulcers
- located on lower tibia area of leg
- cool to touch, discolored, hair loss
- “punched-out” appearance, well-defined margin
Adjunctive Wound Healing Treatments
- Negative pressure therapy
- Skin and tissue grafts or flaps
- Whirlpool therapy
- Hyperbaric oxygen therapy
- Electrical stimulation
- Normothermia
- Pressure reduction and relief
First degree burn
- Partial-thickness
- involve only superficial dermis
- heal spontaneously
Second degree burn
- Partial-thickness
- involve deep dermis
- may require a prolonged period to heal
Third degree burn
- Full-thickness
- All skin layers
Emergency/Resuscitative Period: Burns (when it is and goals)
-From time of injury to 2-3 days
-emergency care: Stop the burning process
Goals:
-maintain airway and oxygen
-correct fluid imbalance
-conserve body heat
-prevent wound infection
-relieve pain
-emotional support
Emergency/Resuscitative Period of Burns includes:
- assessments (esp resp and CV)
- saline soaks, keep warm
- prepare catheters, tubes
- protect against infection
- baseline studies, measurements
- fluid resuscitation (after airway stabilization)
- pain mgmt
Acute Phase of Burns (when it is and goals)
-From hemodynamic stability to wound closure Goals: -wound cleansing and healing -pain relief -preserve body heat -prevent infection -promote nutrition -splint, position, and exercise affected joints
Acute phase of burns includes:
- wound debridement
- escharotomies
- topical meds, dressings
- surgeries (wound excision, closures, grafts)
- promote and maintain normal mobility
- nutrition
Rehabilitative Phase of Burns (when it is and goals)
starts when wound <20% open (2wks-yrs after injury) Goals: -physical therapy -reconstruction -psychological prep -pain mgmt -nutrition
Rehabilitative Phase Includes:
- scar contracture formation
- functional and cosmetic reconstruction
- psychological, occupational recovery
Contraction prevention for burn scars
- Exercise, stretching, scar massage
- use pressure dressing 23 hours/day (decreases hypertrophic scar formation and increases wound pliability)
Rebound tenderness is often a sign of?
Peritonitis
Iliopsoas sign
indicates an inflammation of the psoas muscle
Obturator sign
indicates inflammation along the obturator internus muscle
-Positive tests can be related to appendicitis, diverticulitis, PID
Murphy’s sign
positive with inflammation of the gallbladder
Ulcerative Colitis
- affects colon and rectum
- affects only mucosal and submucosal layers
- bloody stools
Crohn’s Disease
- inflammation can occur in any part of the GI tract
- involves ALL layers of intestinal wall
- results in obstruction, abscess, and fistula formation
S/Sx of intestinal obstruction
abdominal swelling, pain, N/V/D, constipation
Complications of Gastric Surgery
Dumping Syndrome -undigested contents of stomach move too rapidly into SI -nervous system symptoms -secondary hypoglycemia Vitamin/Mineral Insufficiencies -pernicious anemia
S/sx of Prodromal Phase of Hepatitis
Vague, flu-like symptoms
- anorexia, N/V, fatigue
- myalgia, arthralgia
- mild abdominal pain
- fever <103
- increased AST, ALT, ALP
S/Sx of Icteric Phase of Hepatitis
- Begins with the onset of jaundice
- worsening of prodromal sx
- dark urine (increased bili)
- clay-colored stools
- increased serum bili
S/Sx of Convalescent Phase of Hepatitis
- Begins after 2-3 weeks of acute illness
- Symptoms subside, appetite and energy increase
- jaundice and abdominal pain disappear
- duration of illness varies c different types of hep
Early s/sx of Cirrhosis of Liver
- Fatigue
- significant change in weight
- GI sx
- abdominal pain and liver tenderness
- pruritis
Late s/sx of Cirrhosis
- jaundice and icterus
- clay-colored stools
- tea-colored urine
- dry skin, rashes, petechiae, ecchymosis
- warm, bright red palms
- spider angiomas
- peripheral dependent edema of extremities and sacrum
preparation for liver biopsy
- informed consent
- assess PT, aPTT, INR, and platelet counts
- NPO 6-8 hrs
- placed in supine or left lateral
post liver biopsy
- position on right side for 1-2 hrs
- monitor for bleeding, pneumothorax, infection
s/sx of hepatic encephalopathy
- asterixis (tremor of hand when wrist is extended)
- agitation
- combativeness
- confusion
- exaggerated reflexes (DTRs)
(AACCE)
tx for hepatic encephalopathy
lactulose- reduces ammonia
neomycin-sterilizes bowel
oxazepam-tx agitation
NSG for hepatic encephalopathy
- Mini Mental Stat Exam
- **PROTEIN RESTRICTED diet
- monitor DTRs
s/sx of Acute Pancreatitis
- sudden, severe epigastric pain radiating to back
- N/V
- abd distention, decreased bowel sounds, rigidity
- elevated amylase and lipase
- hypocalcemia
- Grey Turner’s and Cullen’s
- hyperglycemia
S/sx of Chronic Pancreatitis
- recurrent epigastric and LUQ pain (less severe than acute)
- tender abdomen, mild muscle guarding over pancreas
- anorexia
- N/V
- flatulence
- constipation
- steatorrhea (excess fat in stool)
Med mgmt of acute pancreatitis
- tx focused on resting pancreas
- NPO
- NG tube
- bed rest
- lg amt of IV fluids
- clear liquid diet when bowel sounds return
- slow transition to low-fat diet
- pain mgmt c narcotics
Med mgmt for chronic pancreatitis
- supplementation c pancreatic enzymes (always give with food!!)
- narcotics NOT used due to addiction risk
- lifelong lifestyle changes (no alcohol, low-fat diet)
gerontologic considerations for musculoskeletal
- decreased flexibility
- decreased Ca absorption
- decreased ROM d/t thinning cartilage
- decreased muscle mass
Grade 1 open fracture
- Inside-out fracture
- wound bed clean, <1cm
- minimal soft tissue injury and comminution (crushing, shattering)
Grade 2 open fracture
- soft tissue wound >1cm
- moderate contamination, comminution
Grade 3 A open fracture
wound <10cm, crushed tissue, contamination
Grade 3 B open fracture
wound >10cm, crushed tissue, contamination, regional or free flap
Grade 3 C open fracture
major vascular injury, limb salvage
patho behind osteoarthritis
- bony formations on weight-bearing joints
- decrease in collagen synthesis, increase in collagen breakdown
- asymmetrical joint cartilage loss
clinical manifestations of osteoarthritis
- morning stiffness
- pain with overuse of joint
- joint bone deformity
foods that are high in purine (gout pts cannot eat these)
mushrooms, sardines, asparagus, peas, beans, alcohol, gravy, animal broths
NSG dx for Osteoarthritis
Pain, chronic mobility: physical, impaired falls: risk for body image: disturbed readiness for enhanced self-care imbalanced nutrition: more than body requirements -powerlessness
what are usually the first s/sx of IICP?
sudden drowsiness and restlessness
other signs of IICP:
- decrease in motor function with presenting weakness in the extremities
- pathologic posturing (decorticate, decerebrate)
- Unusual headache and vomiting
- changes in vital signs that may indicate pressure on the brainstem or hypothalamus (Cushing’s triad- HTN, bradycardia, irreg respirations)
S/Es of Dilantin
gum hypertrophy, ataxia, diplopia, hirsutism
s/sx of autonomic hyperreflexia
- HTN
- headache, flushing, nausea
- blurred vision/restlessness
- bradycardia
Spinal Shock
- flaccid paralysis below level of injury followed by spastic reflexes
- loss of sensation
Neurogenic Shock
-loss of vasomotor and sympathetic nervous system tone Features: -Hypotension -Bradycardia -Poikilothermia
