med surg Flashcards
signs of increasing ICP
- Cushing Triad
- HTN,bradycardia, widening pulse pressure - Pailledema
- pressure agaisnt the the optic disc causing fleeting disturbances in vision, headache, and vomiting - Slurred speech
- Decoriticate/Decerebrate
how much water is retained per 1 kg gained
1 L
late signs of fluid volume deficit
- oliguria
- decreased CVP
- flat neck veins
where can you check for skin tenting
- forehead
2. sterum
what are the isotonic solutions
- NS
- LR
- D5W
pulmonary edema assessment
- cough
- dyspnea
- crackles
hypokalemia manifestation
- muscle weakness
- fatigue
- flat or inverted T wave
- Decreased bowel motility
- irritability/confusion
- Paresthesia
Hyperkalemia manifestations
- muscle twitching and paresthesia (early)
- asceding muscle weakness (late)
- peaked t waves and widening QRS
- increased motility
hyponatremia manifestations
- headache
- anorexia, n/v
- muscle cramps/ twitchig
- seizures
- lethargy
non pharmacological treatment for nausea
ginger tea
2.Irritable bowel syndrome diet
1.increase fiber (atleast 30 g)
Right sided stroke
- Visual spaital deficit
2. One sided neglect
metformin admin
take it once daily at night with your evening meal. GI tract moves slower during night therefore more medication gets absorbed.
s/s of hemolytic reaction
backpain and headache
what is the main adverse effect of suctioning
can cause a vasovagal attack. if this happens stop and oxygenate
bladder irrigation
- always use NS
- color of urine should slowly progress to an amber color.
- initial void may be uncomfortable, red and contain clots
- if urine isnt clear or there is still blood clots by day 4 call doctor
- if there is bright red blood with clots then increase the rate
- if cath becomes obstructed flush with a 50ml syringe
- *sodium can be absorbed through bladder irrigation
- tell patient not to push pee as it can cause muscle spasms that lead to more bleeding
Walker teaching
WWS walker weak leg strong leg 6-8 inches
crutches
- 6 inches lateral of each foot. Also 6 inches in front of each foot
- never bear weight on axilla
- elbows flexed at 30 degrees
client education- dumping syndrome
- lay down after meal as it will slow the movement of food within the intestine
- limit the amount of fluid ingested at one time. Dont drink fluid within 1 hour after a meal
- low to moderate carbs everything else high. Carbs move fast as they are easily digested
- avoid milk, sugars as they can cause diarrhea
- small frequent meals
- Pernicious anemia is common (take vit b12)
signs of pernicious anemia
- fatigue
- parasthsia
- depressed reflexes
- smooth red tongue
- SOB
what is pernicious anemia usually caused by
lack of intrinsic factor which is a protein secreted by the stomach which helps the ileum absorb B12
crohns disease signs/s
- diarrhea and colicky pain often right lower quadrant
- megaloblatic (pernicious) anemia
- UTI due to fistula
- high pitched bowel sounds with steatorrhea
crohns treatment
- fluids and bowel rest during acute attack
2. low fiber diet for long term treatment
Ulcerative colitis
- toxin megacolon is common (dilated colon which leads to no peristalsis leading to a giant poop forming that may require surgery to remove)
- seen in the descending colon and rectum
- common to see joint pain/arthritis
how do you treat ulcerative colitis
- low fiber or NPO for acute attacks
- sulfasalazine (anti-inflammatory for autoimmune type diseases)
- will cause yellowish orange discoloration of skin and urine
- photosensitivity so wear sun block
Interventions for ulcerative colitis
- NPO is priority (they will still have 20+ stools per day)
2. if only in rectum treat with sitz bath of witch hazel
ulcerative colitis teaching
- high protein and calorie with low fiber diet
- avoid caffeine and alochol and take multiviatmins that contain iron
- small frequent meals
Diverticulitis
- Usually in the sigmoid colon LLQ,
- put on high fiber high fluids diet to prevent attacks but during attack put on low fiber diet and probably NPO if severe
- encourage mild exercise like walking to decrease constipation but no strenous exercise
where to not put heat therapy
- do not put over areas that have metal devices such as pacemakers to avoid deep tissues burns
- do not put on the abdomen of a pregnant women
- bony prominences are more sensitive to heat application
- do not put under an immobile client
cholecystitis
- RUQ pain radiating to right shoulder
- Pain with deep inspiration during rigt subcostal palpation
- jaundice, decreased calcium levels, steatorrhea, dark urine, pruritus
- low fat diet, avoiding gas forming foods, and small meals are better tolerated
what is nephrotic syndrome
- decreased blood albumin -> edema
- hyperlipidemia (low albumin causes the liver to synthesis lipoproteins)
- proteinuria
- hypercoagulabity (due to loss of antithrombin 3 in urine)
what is nephritic syndrome
characterized by
- blood in urine (especially RBC casts with dysmorphic RBCs)
- Oliguria in the presence of HTN (this is due to destruction of the epithelial barrier which allows for blood in the urine and at the same time proliferation of mesangial cells which decreases perfusion to the kidneys. This decrease leads to activation of RAAS leading to HTN.)
acute glomerulonephritis
- It is an immune complex disease that causes inflammation of the glomerular apparatus. Usually following a streptococcal infection
- ask about recent sore throat. - Main signs are edema, HTN, oliguria
- Diet: fluid restricted to urine output + 500 mL
- low sodium, low protein and low potassium. If azotemia is present restrict protein intake
how to avoid hyperuricemia
- avoid red meat and seafood
- avoid beans and legumes
- dark greenies, cauliflower, mushrooms
- limit alcohol
- low fat dairy
Peritoneal dialysis interventions
- cloudy dialyisate
- abdominal cramping
- cleaning
This procedure is a sterile one
- call doctor
- slow infusion
- H2O2 and NS
when is kayexalate contraindicated
paralytic ileus
AV shunt interventions
- assess for thrill (palpated) and bruit (heard)
2. Take BP on opposite arm
Ostomy care
- never let bag get more then 1/2 full
- SHOULD BE pink/red and moist
- normal post op output is less then 1000 ml/day
- the higher up in the intestine the more liquid and more acidic the output will be
- Foods that cause odor: fish, eggs, asparagus, garlic, beans, dark green leafies
- foods that cause gas: dark green leafies, carbonated drinks, dairy, corn
- Yogurt can reduce gas
- clients with ilesotomys should avoid fiber for the first 2 months and drink plenty of fluid.
- Do not put anything into the bag for odor such as mint
autonomic dysreflexia
- occurs with above T6 spinal cord injuries but in rare cases can happen as low as T10
- HTN, bradycardia, super headache, diaphoresis, pallor below level of injury and flushing above, blurred vision, nausea
- sit the client up
- most common cause is distended bladder, can also be caused by fecal impaction, cold stress, or tight clothing
Flaccid neurogenic bladder
caused by lower motor neuron injuries
1.Credes method where you apply downward pressure on the bladder to manually express urine
Spastic neurogenic bladder
Upper motor neuron injuries.
1.tugg on pubic hair or put on condom cath. (bladder will randomly empty itself) Females will require an indwelling cath
2.upper motor neuron injuries are associated with
cervical spinal injuries
Leukotrine modifiers prototypes
- Montelukast (singulair)
- Zileuton (zyflo)
- Zafirlukast (accolate)
Everything about the leukotrine modifiers
- they supress inflammation, bronchoconstriction, edema, and mucus production
- used for long term therapy of asthma of children 15 and older.
- prevention of exercise induced asthma
Gentamicin
- can cause ototoxicity
- tinnitus, headache, dizziness, vertigo - nephrotoxicity
- monitor for azotemia, and I&O
all nephrotoxic meds
- Ace inhibitors
- Amphoteracin B
- Cisplatin
- Cyclosporins
- NSAIDS
Epogen
- how do we know its working
- what can happen if dose is to high
- how is it given
- adverse effects
- nursing interventions
- HCT goes up
- if HCT rises to fast it could raise BP leading to seizures or HTNive crisis
- subQ
- HTN, or cardiovascular events when Hgb increases more then 1 g in 2 weeks
- baseline BP
- need adequate iron, folic acid, and B12 to work
- Hgb and HCT needs to monitored twice a week.
- what is anemia
- what is the main issue in anemia
- s/s
- drugs
- considerations
- low RBCs, Hgb or both
- decreased O2
- fatigue, pallor, SOB, dizziness
- Epogen, ferrous sulfate
- you dont want Hgb to rise more then 1 gram/dL in 2 weeks
iron supplements teaching
- stool will be black
- take with vitamin C on empty stomach
- increase fiber intake
foods high in iron
- red meat
- egg yolks
- dark leafies
- dried fruits
- Beans/lentils
what does B12 do
converts folic acid to its active form.
Magnesium
- signs of toxicity
- the antidote
a CNS depressant that can lead to decreased respirations, DTR, and bradycardia, and hypotension.
2.Calcium gluconate
Dopamine
- whats it do
- what should you worry about
- what is the antidote
- vasoconstrictor
- extravastion
- Regitine
which dieseases are airborne
- TB
- measeles
- varicella
major side effect of antipsychotics
agranulocytosis
what can cause potassium to shift into the cell
- alkalosis
- insulin
- TPN
- water intoxication
which drug can fuck with captopril effects
aspirin and other NSAIDS
Murpheys sign
pain on inspiration during deep palpation of right subcostal area. Indicates cholecystitis
McBurneys point
right lower quadrant if their is tenderness here it indicates appendicitis
Rovsing sign
Perform rebound tenderness assessment on left lower quadrant. If their is pain in the right lower quadrant then it indicates appendicitis
mother tells nurse that she has found yellow exudate around penis post circumcision what should the nurse tell her
this is normal do not remove it and it will be gone within 3 days.
