Med Surg II - MASTER HESI Review Packet

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1) Diabetes Insipidus – page 1161-1162  Caused by a deficiency of production of ADH or a decreased renal response to ADH.  Clinical Manifestations: Polydipsia and Polyuria.  Diagnostic S... tudies: Water deprivation test (pt deprived of water for 8-12 hrs and then given desmopressin acetate subcut or nasally), Measure level of ADH after an analog of ADH is given.  Types of Diabetic Insipidus: Central DI (results from an interference of ADH synthesis, transport, and release. Ex: brain tumor, head injury, brain surgery, CNS infection), Nephrogenic DI (results from inadequate renal response to ADH despite presence of adequate ADH. Ex: Drug therapy, renal damage, hereditary renal disease), Primary DI (Results from excessive water intake. Ex: Structural lesion in thirst center, psychological disorder).  Nursing Management: Early detection, Maintaining adequate hydration, and patient teaching for long-term management. 2) Healthcare associated pneumonia  Also known as nosocomial pneumonia, pneumonia in a non-intubated patient that begins 48 hours or longer after admission to hospital and was not present at the time of admission. Ventilatorassociated pneumonia, also a type of HAP, refers to pneumonia that occurs more than 48 hours after endotracheal intubation.  Treatment: Antibiotics that can be started as soon as sputum cultures identify the exact pathogen.  Risks: In treatment of pneumonia, risk of developing multidrug-resistant organisms. Limits the available antibiotics that can be used as treatment. 3) Diabetes Mellitus long term complications  Stroke  Hypertension  Dermopathy  Atherosclerosis  Nephropathy  Peripheral neuropathy  Neurogenic bladder  Retinopathy, Cataracts, Glaucoma, Blindness  Coronary Artery Disease  Gastroparesis  Islet Cell Loss  Erectile Dysfunction  Peripheral Vascular Atherosclerosis  Gangrene  Infections  Examinations performed Daily, Annually, or when you visit HCP: Funduscopic, Fundus photography, Urinalysis, Feet Examination, and Stress Tests. CLAUSE STUVIA MED SURG II – MASTER HESI REVIEW Page 2 of 38 4) Renal dosing/ issues with drugs – page 1020 Box 44-3 ANTIBIOTICS OTHER DRUGS OTHER AGENTS Amikacin Captopril Gold Amphotericin B Cimetidine Heavy Metals Bacitracin Cisplatin Cephalosporins Cocaine Gentamicin Cyclosporine Neomycin Ethylene Glycol Polymyxin B Heroin Streptomycin Lithium Sulfamidies Methotrexate Tobramycin Nitrosoureas Vancomycin NSAIDS Phenacetin Quinine Rifampin Salicylates 5) Spinal cord injury – page 1419-1437  Classification: (1) Mechanism of Injury, (2) Level of Injury, (3) Degree of Injury.  Clinical Manifestations: Motor and Sensory effects, Respiratory System (decrease in vital capacity volume), Cardiovascular System (bradycardia, peripheral vasodilation, hypotension), Urinary System (urinary dysfunction), Gastrointestinal System (incontinence, impaction, ileus, megacolon, decreased GI secretion) , Integumentary System (skin breakdown, pressure ulcers), Thermoregulation (Adjustment from body temp to room temp), Peripheral Vascular Problems (Pain, VTE, PE)  Emergency Management: Table 60-3 Ph. 1425  NURSING ASSESSMENT o Subjective Date: Health History o Objective Data: Poikilothermism (unable to regulate body heat) o Integumentary System: Warm dry skin below level of injury o Respiratory: Injury at C1-3-Apnea, Inability to cough. Injury at C4-Poor Cough, diaphragmatic breathing, hypoventilation. Injury at C5-T6- Decreased respiratory reserve. o Cardiovascular: Injury above T6-Bradycardia, hypertension, absence of vasomotor tone. o Gastrointestinal: Decreased or absent bowel sounds, abdominal distension, constipation, fecal incontinence, fecal impaction. o Urinary: Retention, flaccid bladder, Spasticity with reflex bladder emptying. o Reproductive: Priapism, altered sexual function o Neurologic: Complete-Areflexic, flaccid paralysis, hyperactive deep tendon reflexes, bilaterally positive Babinski test. Incomplete- Mixed loss of voluntary motor activity and sensation. o Musculoskeletal: Muscle atony, Contractures. o Pain: Neuropathic, musculoskeletal, and/or visceral. MED SURG II – MASTER HESI REVIEW Page 3 of 38 6) Blood in stool  Melena = black, tarry stools (often foul smelling) caused by digestion of blood in the GI tract. Black appearance is from the presence of iron.  Occult bleeding = small amounts of blood in gastric secretions, vomitus, or stools not apparent by appearance. Detectable by guaiac test.  Could be indication of an upper GI bleed  Hemorrhoids are the most common reason for bleeding with defecation o Focus on pain control and promote wound healing o Sitz bath 1 to 2 days after surgery and continue for 1 to 2 weeks o Teach the pt importance of diet, care of the anal area, symptoms of bleeding complications, and avoidance of constipation and straining 7) CVA (focus on vision issues)  Cerebral vascular accident / Stroke  Treat as medical emergency  Know FAST (Facial drooping, Arm weakness, Speech difficulties, Time)  Sudden trouble seeing in one eye should be reported immediately for indication of a CVA  Women who experience migraine with aura are at an increased risk for stroke. 8) Acute kidney injury  Slight deterioration in function to severe impairment  Rise in serum creatinine and/or a reduction in urine output, and sometimes leads to development of azotemia (accumulation of nitrogenous waste products in the blood)  Hospitalized patients develop AKI at a high rate and have a high mortality rate  Common causes: o Prerenal: Hypovolemia, Decreased Cardiac Output, Decreased Peripheral Vascular Resistance, Decreased Renovascular Blood Flow o Intrarenal: Nephrotoxic injury, Interstitial Nephritis o Postrenal: BPH, bladder cancer, calculi formation, trauma  Clinical manifestations: o Urinary changes – oliguria o Hypovolemia o Metabolic Acidosis o Sodium balance o Potassium excess o Hematologic disorders o Waste product accumulation o Neurologic disorders  Diagnostic studies: o H&P o Identification of precipitating cause o Serum creatinine and BUN levels o Electrolytes o Urinalysis o Renal Ultrasound o Renal scan o CT scan  Primary treatment is to eliminate the cause, manage the signs and symptoms and prevent complications while the kidneys recover MED SURG II – MASTER HESI REVIEW Page 4 of 38 9) Abscess  A swollen area within the body tissue, containing an accumulation of pus  The body’s immune system sends WBC to fight the infection  Painful, swollen lump that is filled with pus  S/S = chills, fever, pimples, redness, painful lump, pus, tenderness, swelling, swollen lymph nodes  Treatment includes draining the abscess and antibiotics  Types mentioned in MedSurg: Anorectal (p. 970), brain (p. 1338), lactational breast (p. 1207), lung (p. 512), peritonsillar (p. 484) 10) Amyotrophic Lateral Sclerosis (lung issues)  AKA Lou Gehrig’s Disease  A nervous system disease that weakens muscles and impacts physical function.  In this disease, nerve cells break down, which reduces functionality in the muscles they supply. The cause is unknown.  The main symptom is muscle weakness.  Medication and therapy can slow ALS and reduce discomfort, but there's no cure.  Muscular: muscle weakness, problems with coordination, stiff muscles, loss of muscle, muscle spasms, or overactive reflexes  Whole body: fatigue or feeling faint  Speech: difficulty speaking or vocal cord spasm  Also common: difficulty swallowing, drooling, lack of restraint, mild cognitive impairment, severe constipation, severe unintentional weight loss, shortness of breath, or difficulty raising the foot  Treatment includes: o Therapies o Supportive Care o Medications (glutamate blocker or muscle relaxant) o Surgery o Medical procedure 11) Neutropenic precautions  is a blood condition involving low levels of neutrophils, a type of white blood cell. Neutrophils fight infection by destroying harmful germs. Without enough neutrophils, you’re more likely to develop infections. Usually, neutropenia occurs after: chemotherapy, radiation therapy or taking certain medicines. Remember: Gown, Gloves, Mask to protect the patient from catching any foreign bodies that night cause an infection. If the patient leaves the room, they must have a mask on before leaving and it must remain on them at all times while they are outside the room [Show More]

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