Fat Embolism- Fatty globules may diffuse from bone marrow and occulde small vessels.
Clinical Manifestation- Chest pain, dyspnea, white sputum, fever, hypoxia, tachycardia, and petechiae.
Patient teaching regarding Barrett esophagus:
A pre-cancerous condition that must be assessed q6-12 months to rule out cancer
Criteria for selecting bariatric surgery pt.:
Number of co-morbidities
BMI > 30 or 100 lbs overweight
Only after other methods of weight loss have been tried and failed
Life Style change 6 small meals, 600-800 calories a day, lots of fluids to prevent dehydration, and vitamin and mineral suppliments.
Complications of gastrectomy:
Vit. and mineral deficiencies
Rapid stomach emptying into duodenum
Complication of gastric bowel surgery
Caused when high sugar liquids are ingested
Diverticulitis= Is pockets in the signoid colon wall.
Medical management of diverticulitis:
High fiber diet Low fat,
Stool characteristics of Ulcerative Colitis:
Watery with blood and mucus
Pt./family teaching for Ulcerative Colitis:
Diet: bland, high protein, high calories, high vit. Low residue
Avoid caffeine, alcohol, and smoking
Avoid skin breakdown by cleaning the tushy after each poop session
Inflammatory Bowel Disease
Nutritional therapy for Inflammatory Bowel Disease (IBD):
What are some complications to a laparoscopic Cholecystectomy?
Bile duct injuries
Diabetes Sick day Rule
Sick-day rules related to diabetes mellitus:
Monitor blood glucose q3-4hrs
Continue medications as usual
Diet of easily digested foods and liquids
Call provider is blood glucose higher than 300 or unable to retain fluids
DM Type 2 Medications
-Sulfonylureas: stimulates beta cells to secrete insulin
-Biguanides: increase body tissue sensitivity to insulin, Inhibit production of glucose by liver
- Thiazolidinedilones: sensitize body tissue to insulin
Adrenal Cortex Produces What?
What 3 steroids does the adrenal cortex produce?
Diabetes Rule of Thumb
Cool and Clamy= Give some candy.
Hot and Dry= Sugar to High, give insuline.
Lipodystrophy (from insulin injection):
Tough, lumpy areas of fat (Rotate injection sites to avoid)
Insuline=key to get glucose into cells.
Storage- keep out of direct sun light, store at room temperature less than 30 days. Refridgerate up opened vials.
Self Injection- 500-1000 unit syringe, inject equal amount of air of insuline to be given, alcohol wipe area, give shot at 90 degrees angle bunck skin between fingers in back of arm, thigh, or abdomen, and rotate injection sites.
TYPE 1 DM
Destruction of the beta cells of the pancreas possibly from infection/environment that triggers
MANAGEMENT- Primary tx is insuline, diet, and regular exercise.
BS criteria for DX: Fasting Gl 126 +, or casual Gl of 200 +.
Thyroid Storm= To low of a level of thyroid hormones T3, TSH, TRH, and T4.
Clinical Manifestations- Cardiac dyrithmias, neural imparements, and fever.
Foods that contain Iodine- Salt, dairy products, sea food, eggs, and breads.
Definition: A lesion in the lining mucosa of the digestive tract, usually caused by pepsin and stomach acid, or
Clinical manifestations of a peptic ulcer:
Dull gnawing pain in mid-epigastric region Pain relieved/reduced from eating
Medications to combat H. Pylori:
Protein Pump Inhibitors
Baruim Swallow- Patient is asked to drind a barium liquid and baking soda crystals to detect through x-ray and abnormalaties in upper GI system.
Such As: tumors, ulcers, hernias, pouches, strictures, and swallowing problems.
Insulin Given IV is?
Regular/ Humalog R
Esophageal Problems=cancer, tumor, swallowing problems, and etc.
Complications-Dysphagia, malnurtition, dehydration, aspiration proplems, and can get aspiration pneumonia.
Characteristics of Grave's Disease:
Dry itchy skin
Complications of thyroidectomy:
Parathyroid damage (hypo-function=low calcium)
NPH insulin onset, peak, duration:
NPH insulin onset, peak, duration:
Sulfonylureas (1st and 2nd generation)
Stimulates beta cells to secrete insuline
* (Amaryl) glimepiride
* (Glucotrol) glipizide
* (Micronase) glyburide
Only cure is surgical removal
HOB 30 degrees
Report new floaters and flashers to Dr
Conjunctivitis= Pink Eye, and eye infection.
Can easily spread from one eye to another (very contagious)
Abnormality of inner ear which leads to hearing loss and vertigo
What is best position for Orthopnea?= Can't breath laying down, must sit up to breath well.
Upright sitting position slightly leaning forward
Respiratory and Metabolic acidosis and alkalosis
What is the normal range for blood pH?
What is the normal range for CO2 in the blood?
Normal range for bi-carb (HCO3) ion the blood
CO2 is respiratory.
BiCarb is metabolic.
Dizziness and Vertigo
Sensation the individual is moving rather than the environment. Increased risk for falls.
Sensation of movement of environment, episodic, worsens with movement. Increased risk for falls.
AtelectasisClosure or collapse of alveoli.
First line measure to prevent/treat atelectasis Incentive Spirometer.
Retinal Detachment= Separation of the retinal pigment epithelium.
S/S: Shadows, bright flashing lights, Curtin of light.
DX: Visual acuity test, fundus exam.
Chemical burn to Eyes
Chemicla Burns to eyes= Immediately Irragate eyes for 10 minutes. Then seek medical help, eye exam, and etc.
Abnormally high levels of nitrogen-containing compounds in urine
Blindness in one half of the visual field of one or both eyes
Management- Approach on side of good vision, explain to patient to look in sweep room to see everything.
Eairly S/S: HTN, Severe HA, Change in LOC, and Vomiting.
What is the primary focus of assessment for ischemic and hemorrhagic stroke?
Cardiac and respiratory function
During a hemorrhagic stroke why should nurse raise HOB?
Decrease intracranial pressure in subarachnoid space
How is hemorrhagic stroke diagnosed? CT scan
Dilantin for long-term tx. of seizure?
What is a side effect of Dilantin for long-term tx. of seizure?
Provide really good oral care
Theraputic level:10-20 mcg
Thrombolytics (TPA)=Tissue Plasminagin Activator
tPA in tx of stroke
Continuous monitoring of cardiac after admission of tPA
Must be given within 3 hrs of stroke
Not for hemorrhagic strokes
Risks for using thrombolic agent
Bleeding Contraindicated of already on anticoagulants
Risk Factors For Stroke
Non-modifiable risk for stroke:
Over 55 yrs old, Male, and Black
Modifiable risk for stroke:
Hypertension is primary risk factor
Numbness, weakness, facial droop, confusion, Change in LOC, trouble speaking, HA, visual disturbances, dizziness, difficulty walking, & loss of balance or coordination.
Myasthenia Gravis- Autoimmune
Clinical manifestation of Myasthenia Gravis (MG)
Generalized weakness of muscles in extremities and intercostal muscles Motor disease only
*Do not have sensory or coordination deficits
*Very high risk for aspiration
Mesitinon Main medication used for Myasthenia Gravis (MG)
Start with this Rx first as others have more side effects
Must be taken on time or weakness sets in quickly
MYASTHENIA GRAVIS- Test to r/o
Tensilon (eproponium chloride) given IV to see if muscle strength increases after 0 - 40 seconds.
If not have MG you will get muscle twitches in < then 5 minutes.
Tensilon side effects are bradycardia, have Atropein to counter -act it.
Auto immune DI9SEASE THAT ATTACKS MYELINSHEATH.
MULTIPLE SCLEROSIS- Pathophysiology
Brain and spinal canal are effected. The immune system destroys the myelin sheath, plaques develop and slows transmission of impulses.
MULTIPLE SCLEROSIS- Clinical Manifestations
Numbness, weakness, loss of coordination, fatigue, dizziness, blurred vision and diplopia (double vision)
MULTIPLE SCLEROSIS- Patient Teaching
Avoid triggers, heat sun and stress.
Others: Exercise and rest, assistive devices, Rest in cool environment, bladder and bowel training.
Total knee Replacement
Total Knee Replacement= Replace knee with a man made one.
Assessment needed before DC= Prophylactic antibiotic, antithrombolitic, and 5 P's.
5 P's of Circulatory Checks
Hypoxia, or O2 lack there of chronic.
What does finger clubbing indicate?
Chronic hypoxic conditions
No urine output or less that 100 ml in 24 hr.
Very little urine output (30 mL/hr) or 400 in 24 hr.
Sleep Apnea= Periods of decreased to absent respirations while sleeping. Causes: Obesity, enlarged uvula, or partially blocked airway.
S/S: Fatigue, not rested after awakening, frequent HA, history of snoring.
Cheyne-Stokes= Abnormal breating pattern by progressive deeper breathing, faster breathing, followed by a gradual decrease apnea.
Patterns repeats from 30 sec.- 2 min.
Airway obstruction caused by either constriction, bronchospasm, or inflammation.
Hypoxia= Dificiency in the amount of O2 reaching the tissues.
S/S:Poor coordination, rapid breathing, poor judgment, cyanosis, lethargy, HA, Air hunger, dizziness, euphoria, tingling, and visual impairment.
Heart Failure- L/R
Left-sided S/S: Crackles in the lungs, and pink frothy sputum, Dyspnea, Decrease O2 sats, HTN, Tachycardia, tachypnea Right-sided: S/S: Jugular vein distention/ and edema
Pediculosis Capitis- Head Lice
Pediculosis Corporis- Body Lice
Pediculosis Pubis- Crabs Pubic lice
Lice TX: Shampoo and topical cream used to paralyze and kill lice. Use 1 time every 7-10 days, may take 2 treatments. Comb out lice with fine tooth comb and dont share hats, combs, or etc..
Aspiration= Food, fluid, or other substance goes in lungs.
High Risk Patients: Stroke, MS, ALS, MG, etc.
Helps to open up lungs and prevent atelectasis.
Use 10 x every hr while awake.
Mechanical Ventilation- Artifical way to make a person breathe mechanically.
Communication: Hand writing, Shake head yes or no, one way valve to speak through, or mouth words.
Breath Sounds- Crackles, ronchi, and wheeze.
Crackles= high pitched heard on inipiration, sounds like plasitc paper crinkled.
Ronchi= Loud, low coarse sounding, sounds like a snore.
Wheeze= musical whistling sound during inspiration or expiration.
Smoking= damages respiratory track, and number 1 cause of lung cancer.
What is the definitive test for Tuberculosis?
PPD (purified protein derivative)
Tx: Antituberculosos agents for 9-12 months.
Drugs to TX:
INH prophylaxis for those at risk.
INH, Rifampin, Ethambutol, Pyrazinamide.
Read PPB test 48-72 hr after, 7-10 mm is positive reaction.
MONA treatment MI
M= Morphine; decrease pain, anxiety, workload on heart
O= Oxygen; increased O2 will decrease workload on heart
N= Nitrates; relieve angina pain
CAD- Coronary Artery Disease
CAD- when blood frow to heart is reduced or stopped deprivig the heart of O2.
Fibrous plaque associated with Coronary Artery Disease
Progressive change in the arterial wall Normally endothelium cells repair themselves, but with CAD endothelium cells slow repair allows LDL to thicken arterial wall.
Used to DX: CAD, assess coronary artery patency, determine extent of atherosclerosis, and revascularization (Stent).
What causes Angina?
Pain caused by insufficient coronary blood flow; atherosclerosis AND increased demand for O2