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MED SURG MIDTERM REVIEW
SODIUM 135-14 5
Hypernatremia >145 mEq/L causes: Diabetes insipidus s/s: thrist, confusion, seizures, GI upset,lethargy Tx: hypotonic IV fluids( 0.45 NaCI), Diuretics, sodium restrictions, increase water intake.
Hyponatremia <135 mEq/L causes: Inappropriate secretion of antidiuretic hormone (SIADH), Diuretics s/s: Confusion( common in elderly), seizures, fatigue, N/V, headache. tx: Hypertonic IV fluids( 2-3% NaCI), Increase sodium intake , fluid restriction. RESTRICT PATIENT’S WATER INTAKE
POTASSIUM 3.5-
Hyperkalemia >5 mEq/L causes:Diabetic Ketoacidosis, metabolic acidosis s/s: Muscle twitching/weakness, paresthesia( burning/prickling sensation),Dysrhythmias Tx: Furosemide, Insulin( with dextrose)
Hypokalemia <3.5 mEq/L Causes: Diuretics( furosemide), metabolic alkalosis s/s: muscle weakness, constipation/ileus, Dysrhythmias, weak pulse, abdominal pain tx: potassium supplements(PO,IV), Cardiac monitoring. NORMAL SINUS RHYTHM MEANS HYPOKALEMIA IS NOT PRESENT ANYMORE
CALCIUM
Hypercalcemia > 11 causes: hyperparathyroidism, prolonged immobility s/s: kidney stones tx: 0.9 NaCI, calcitonin
Hypocalcemia < causes: hypoparathyroidism, acute pancreatitis, vitamin D deficiency s/s: positive Chvostek’s and Trousseau’s signs, muscle spasm, tetany tx: calcium supplements RISK FOR SEIZURES
MAGNESIUM
Hypermagnesemia >2. causes: kidney disease s/s: Decreased Deep Tendon Reflexes, Respiratory Depression Tx: Furosemide( to lower Mg levels), calcium( to reverse cardiac effects)
Hypomagnesemia <1. causes: GI losses, alcohol abuse, malnutrition, diuretics s/s: Dysrhythmias( torsades de pointes), increase Deep Tendon Reflexes. tx: magnesium supplements (PO, IV)
ACID/BASE IMBALANCES
Metabolic Alkalosis : pH >7.45 HCO3> 26 causes: antacid overdose, loss of body acids( vomiting, NG tube suctioning, diuretics) s/s: tachycardia, lethargy Tx: address underlying cause
Metabolic Acidosis: pH< 7.35 HCO< causes: Diabetic ketoacidosis, kidney failure s/s:Kussmaul respirations tx: sodium bicarbonate
Respiratory Alkalosis: pH> 7.45 PaCO2 < causes: Hyperventilation s/s: shortness of breath, dizziness, chest pain tx: address underlying cause
HEART FAILURE
heart muscle does not pump enough blood to meet the body’s needs.
S/S:
LEFT-SIDED HF:PULMONARY CONGESTION)
Pulmonary edema dyspnea crackles in the lungs “Rales that don't clear with cough” fatigue pink/frothy sputum” Blood tinged”
RIGHT-SIDED HF: SYSTEMIC CONGESTION)
peripheral edema weight gain=water gain ascites( fluid in abdomen) jugular vein distention hepatomegaly( big liver)
LEFT=LUNGS RIGHT=REST OF THE BODY
lab: ELEVATED BNP ( B -type natriuretic peptides) <100 pg/mL = NO HF >400 pg/mL= HF
TX/MEDS:
- Diuretics(Furosemide)
- Digoxin :cardiac Glycoside treat heart conditions , HF & Atrial Fibrillation ● check apical pulse for a full min ● hold med if the heart rate is < 60 ● monitor electrolytes levels: low potassium( hypokalemia) increase risk of digoxin toxicity ● monitor digoxin levels during therapy( therapeutic range= 0.5- ng/mL )
NC ● monitor daily weight
● monitor intake & output ● sit patient upright( high fowler) ● administer oxygen ● restrict fluid & sodium intake as ordered ● monitor for complications ( pulmonary edema)
ANGINA
chest pain due to ischemic heart disease
Stable angina : occurs with exercise, relieved by rest or nitroglycerin
Unstable angina: occurs with exercise or at rest. chest pain increase in duration, frequency, or severity over time
Variant( prinzmetal's) angina : related to coronary artery spasm, occurs during rest
ANGINA vs MI: chest pain unrelived by rest or nitroglycerin, lasting > 30 min is indicative of a MI. MI’s also have other s/s: shortness of breath, N/V, diaphoresis.
CHEST PAIN CAN BE CRUSHING, SUBSTERNAL, SQUEEZING AND
RADIATE TO SHOULDERS ARMS AND JAW
TX/MEDS: Nitroglycerin
nitroglycerin instructions :for chest pain, stop activity and rest. take up to 3 tablets. place 1st under tongue, wait 5 min.if no relief, call 911. take 2nd, wait 5 min. if no relief, take 3rd.
Lifestyle changes : heart healthy diet, lose weight, decrease stress, smoking cessation
Primary : most common, idiopathic
Secondary: Disease or medication causes High B/P
R/F:
Primary: family history, high sodium intake, obesity, smoking, stress hyperlipidemia & african american ethnicity.
PT: DASH diet ( increase fruits, veggies, whole grains, low-fat dairy; low salt & fat), weight reduction, stress reduction, smoking cessation , limit consumption. take B/P regularly at home
THROMBOSIS thrombus(blood clot) forms in a deep vein in an extremity( usually in the lower leg)
DEEP VEIN THROMBOSIS PREVENTION: ➔ early & frequent ambulation ➔ compression stocking(TED hose) ➔ Sequential compression device(SCD) ➔ Prophylactic meds( Heparin, enoxaparin)
S/S : calf/thigh pain edema erythema
NC: ● Elevate extremity( No pillow or knee gatch under knee) ● warm/moist compresses ● DO NOT massage limb ● apply compression stockings ● monitor s/s of pulmonary embolism(PE): shortness of breath, chest pain
PERIPHERAL ARTERIAL DISEASE (PAD)
Inadequate blood flow to the lower extremities/ ischemia and necrosis of the extremities
ARTS
A bsent pulses (cool, shiny, no hair)
R ound, Red sores
T oes & feet pale or black “eschar”
S harp calf pain(intermittent claudication)
GRANGENE!! TX/PT
● D A ngle Arteries (dependent position) ● perform daily activities with moisturizer ● Walk until the point of pain, stop and rest, then walk a little more ● Avoid crossing legs and restrictive clothing ● Maintain a warm environment, wear socks ● Avoid cold, stress, caffeine, nicotine (which causes vasoconstriction)
Meds: Antiplatelets,vasodilators
PERIPHERAL VEIN DISEASE (PVD)
Deoxygenated blood can't get back to the heart. Pooling of oxygenated blood in extremities
VEINY
V ery pulses- WARM LEGS
E dema (blood pooling)
I rregular shape sores(ulcerations)
CIRRHOSIS
Extensive degeneration, destruction & fibrosis ( scarring) of the liver.
S/S:
Fatigue itchy skin N/V easy bruising & bleeding swelling in legs (Edema) spider angioma( spider-like blood vessels) Ascites jaundice(yellowing of the skin & eyes) abdominal pain
TX/MEDS:
Osmotic laxative for hepatic encephalopathy:
Lactulose :removes excess ammonia to prevent confusion and liver related brain issues (hepatic encephalopathy)
Paracentesis: remove fluid from the abdomen (ascites). Empty bladder to avoid puncturing it during the procedure)
** **monitor for diarrhea****
NC:
➢ monitor I&Os, restrict fluid and sodium as ordered ➢ measure abdominal girth daily ➢ monitor for complications( encephalopathy)
CHOLECYSTITIS(CHRONIC)
inflammation of the gallbladder S/S: RUQ PAIN( may radiate to the right shoulder) N/V fever abdominal tenderness
PT:
➢ LOW FAT diet: No fatty, greasy or fried food.
PEPTIC ULCER DISEASE( PUD)
Erosion in the mucosa of the stomach, esophagus or duodenum.
caused by H. pylori infection
Gastric ulcer: stomach lining
➢ over 50 yrs old. ➢ pain immediately or soon after meal ➢ worse with eating & daytime. ➢ greater risk of malignancy ( cancerous) ➢ weight loss ➢ hematemesis(bloody, coffee-ground emesis)
Duodenal ulce r: first part of the small intestine(duodenum)
➢ 25-50 yrs. ➢ pain 2-3 hrs after meal ➢ better with eating & worse at night ➢ lower risk of malignancy ➢ weight gain ➢ melena( bloody stools)
Tx/ meds:
Proton Pump Inhibitors( PPIs):
➔ omeprazole (PRAZOLE): reduce stomach acid production
Mucosal protectant:
➔ Sucralfate(carafate): adheres to ulcer, protecting from gastric acid **** Best taken on empty stomach, 1 hr before meal****
Antibiotics( for H. pylori infections):
Can be given with H2 Receptors & Mucosal Protectants
➔ Clarithromycin
Histamine2 receptor antagonists ➔ Cimetidine(DINE): a h2 blocker that decrease stomach acid
PANCREATITIS
sudden inflammation of the pancreas, usually caused by gallstones or alcohol abuse.( autodigestion)
S/S: severe LUQ or epigastric pain( radiating to the back or left shoulder)
Tx:
NPO, Iv fluids & pain control
Meds:
pancreatic enzymes( with meals/snacks)
CHOLELITHIASIS( GALLSTONES)
Stones in the gallbladder
Biliary Colic: This occurs when a gallstone temporarily blocks the bile duct , causing severe, cramping pain in the upper right abdomen
S/S:
RUQ PAIN( MAY RADIATE TO THE RIGHT SHOULDER) N/V fever & chills ( if infection is present) Jaundice( yellow of the skin or eyes)
DIET:
LOW FAT DIET: NO FATTY, GREASY OR FRIED FOODS
tx:
cholecystectomy(surgical removal of the gallbladder)
APPENDICITIS
inflammation of the appendix
S/S:
RLQ PAIN ( Mcburney’s point)
rebound tenderness
Tx: NPO, iv fluids, antibiotics.
surgery : laparoscopic or open appendectomy( removal of the appendix)
complications: perforation( sudden relief of pain may indicate rupture of the appendix, which is an emergency)
URINARY TRACT INFECTIONS ( UTIs)
S/S:
painful urination frequent urge to urine cloudy urine confusion( in older adults)
PREVENTION: drink 3L of fluid per day empty bladder regularly avoid constipation urinate after intercourse cranberry products may reduce risk of UTIs Females should wipe front to back & wear cotton underwear. Avoid bubble baths, sitting in wet bathing suits and wearing tight clothing Uncircumcised males should clean under foreskin
URINARY INCONTINENCE
Stress Incontinence: Occurs during sneezing, coughing, laughing or lifting.
Urge Incontinence: sudden intense urge to urinate followed by involuntary urination
Tx: bladder training, pelvic floor exercise(Kegels), meds or surgery.
URINARY CATHETERS
insertion of a catheter to drain urine from bladder, commonly used in surgery or for patients with urinary retention
Oliguric: urine output <400 mL/day. last 10-14 days
Diuretic: urine output 4-5 L/ day. last 1-3 weeks
recovery: takes up to 12 months
PRERENAL AKI: low blood flow to kidney due to shock, sepsis, hypovolemia
INTRARENAL AKI: direct damage to the kidneys(trauma, hypoxic injury)
POSTRENAL AKI: mechanical obstruction to urine outflow ( stones, tumor, BPH)
Dx: non contrast CT, renal ultrasound, kidney biopsy
GI BLEEDING
Common cause: PUD, VARICES CANCER
S/S: hematemesis( vomiting blood), melena(black tarry stools)
REQUIRES URGENT MEDICAL ATTENTION
DIAGNOSTIC TESTING/LABS
MMR: magnetic resonance imaging for diagnosing soft tissue conditions
COLONOSCOPY: visualization of the colon for screening colorectal cancer, polyps.
ERCP( ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY): used to examine the liver, gallbladder, bile ducts and pancreas , especially in the biliary area( gallstones, bile duct obstruction)
ENDOSCOPIES: visual examination of the upper digestive tract( esophagus stomach)
ABDOMINAL PARACENTESIS FOR CIRRHOSIS :remove fluid from the abdomen (ascites). Empty bladder to avoid puncturing it during the procedure)
FECAL OCCULT BLOOD TEST( FOBT) : used to screen for hidden blood in the stools, which may indicate GI bleeding, colon cancer
POST OP CARE AND ASSESSMENT
After surgeries like colectomy (removal of part or all of the colon) or laparoscopic cholecystectomy (removal of the gallbladder using small incisions),
The focus is on managing pain, monitoring for signs of infection, and ensuring early ambulation (walking).
Pain Management: Control pain with medications (e.g., opioids, NSAIDs) and non-pharmacological methods (e.g., deep breathing exercises, heat/cold therapy).
Early walking : Encouraged post-surgery to prevent complications such as deep vein thrombosis (DVT), atelectasis (collapsed lung), and promote bowel motility.
