Med SURG 2 Final HESI review 2020 | Med SURG 2 Final HESI review

Med SURG 2 Final HESI review 2020 Med surg 1 review/Med surg 2 review: Renal assessment Bun 8 – 25 Creatinine 0.6 – 1.3 Uric acid 2.5 – 8 Potassium 3.5 - 5 GFR 125/min (60 is good for kidney pt) Specific gravity – 1.003 – 1.02 AST: 0 – 35 ALT: 10 – 35 Albumin: 3.5 – 5.5 (same as potassium) Bilirubin: 0.1 – 1.2 mg/dl Amylase: 25-150 Lipase: 10 – 140 Thyroid • Hypothyroid- high TSH (trying to stimulate thyroid to work), low T3 and T4 o Everything slows down (bowel movements), hair falls out, dry skin, fat, fatigue, Puffy face o Give synthroid in morning before meals (at same time) o Myxedema (opposite of thyroid storm) – decrease mental status, hypothermia, slowing of organ function o After a thyroidectomy, a client is at risk for developing hypocalcemia.  Trousseau sign (carpal spasm w BP cuff) • Hyperthyroid- TSH is low (thyroid already working too much) o Thyroid storm, inc BP, diarrhea, weight loss, exopthalamous, heat intolerance, nausea o Thryorid storm - fever, hyperreflexia, abdominal pain, diarrhea, dehydration rapidly progressing to coma, severe tachycardia, extreme vasodilation  Radioactive iodine- stay away from pregnant people and chidren for 24 hours  Thyroidectomy- watch for hypothyroid, HOB raised (incision), watch for blood. Watch for thyroid storm.  Graves disease is the result of increased thyroid, not parathyroid, activity. • Hyperparthyroidism o calcium = too high  bone pain (kidney stones, concentration problems) o Elevated serum calcium levels produce osmotic diuresis and thus polyuria.  This diuresis leads to dehydration (weight loss rather than weight gain).  Calcium is being pulled from the bones  aka excess bone reabsorption  bone pain • Hypoparathyroidism (hypo  LOW calcium) o Parathyroid removed- calcium will drop (brittle nails, cataracts, dry skin) Pituitary Gland • Impaired Posterior pituitary gland  ADH & oxytocin • Impaired Anterior pituitary gland  G, LH and FSH SIADH - edema, fluid volume overload, • give diuretics, replace fluids (keep a balance so not dehydrated) • doctors restrict fluids, not nurses • SS: 1. High urine osmolality 2. Low serum osmolality 3. Hypotonicity of body fluids 4. Continued release of antidiuretic hormone 5. hyponatremia Diabetes Insipidis – not enough ADH; pee a lot; super thristy • s/s- low specific gravity of urine, dehydration • Treatment: desmopressin • give them an antidiuretic  increase urine concentration Type 1 Diabetes – no insulin production • keytones in urine, Dx very young • Insulin aspart is a very rapidly acting insulin, with an onset of 5 to 15 minutes. Insulin aspart should be administered when the client's tray is available Type 2 diabetes- not enough insulin production • HHNS o The primary goal of treatment in hyperglycemic hyperosmolar state (HHS) is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency. Intravenous fluid replacement is similar to that administered in diabetic ketoacidosis (DKA) and begins with IV infusion of normal saline o Insulin stimulates cellular uptake of glucose and also stimulates the sodium/potassium pump, leading to the influx of potassium into cells. The resulting hypokalemia is offset by parenteral administration of potassium o Potassium moves from the extracellular  intracellular (not lost in urine) o Type 2 cardiac catherization for percutaneous coronary  contrast used  watch creatinine and BUN!!! • D5W administration – watch potassium (3.5 – 5) • Gabapentin  an antiepileptic drug, but it is also used to treat diabetic neuropathy Hypoglycemia • Shakiness. Palpitations, lightheaded (tremors, irritability, nervousness) HANGRY • Treatment: simple sugar (such as two packets of sugar), followed by a complex carbohydrate (such as a slice of bread), and finally a protein (such as milk); o the simple sugar elevates the blood glucose level rapidly; o the complex carbohydrates and protein produce a more sustained response. Hyperglycemia • polyuria, blurred vision, kussmal Cardiac Hypertension • Hypertensive crisis  180 syst (if over 200 = emergency) • Complications of HTN o Kidney damage, heart attack, CVA’s • D.I.U.R.E.T.I.C.S o Beta-blockers  slows vitals! Don’t give to bradycardia pts or asthma o Calcium-channel  decreases contractility o ACE  cough • HTN  high stress increases, smoking increases, hyperlipidemia, African americans, Diabetes • Lifestyle changes first o Diet- low sodium, DASH diet o Exercise( 30min/5days a week), stop smoking o Beta blockers (drops BP and pulse so check), calcium channel blockers, ACE inhibitors Left sided heart failure – backs into lungs, dyspnes, edema (pulmonary), crackles, O2 sat decreases Right-sided heart failure – backs into body, JVD, asites, peripheral edema, weight gain (2lb per day is red flag!!) • #1 treatment = digoxin (increases contractibility of heart) level = 0.5 – 2 o late sign of toxicity = halo o hold if potassium is low! (or HR 60) Call doctor before calling doctor Cardiac tamponade • Fluid around the the heart (sac)  muffled heart sounds • lean forward  relieves pain • will have to use needle to draw out fluid (watch for shock) • paradoxal pulses Heart failure • Contractility problem  Systolic cant pump • Assessment findings: o Decrease cardiac output o Left  crackles, pulm edema o Right  peripheral edema, JVD o Digoxin, Beta-Blockers  Hold Digoxin if pulse 60 and potassium is low  Toxicity:  early  N/V  Late  halos o ACE  watch for hyperkalemia and kidney damage • Low sodium diet, reduce stress, exercise • Causes Pooling  watch for clots Heart failure meds: • Treatment with beta blocker medication  initiated at very low doses and PT should be monitored carefully because of the risk of fluid retention and worsening of the heart failure symptoms which decrease over time. o A diuretic may be needed to help maintain fluid and sodium balance until tolerance is acquired. • atropine  cholinergic agent; for bradycardia because it increases the heart rate • Coughing is a common side effect of ACE inhibitors and is not an indication to discontinue the medication. o Antihypertensive medications should not be stopped abruptly because rebound hypertension may occur Acute coronary syndrome (heart attack) • SS: chest pain radiating to left arm • The chest pain protocol indicates the client should receive O2, THEN nitroglycerine sublingual, THEN 12 lead ekg Myocardial infarction (blood clot  less blood to heart muscle) • Causes: o Crushing chest pain, SOB o Women feel: chocking or pain in jaw o V-Fib o Cardiogenic shock  D/c tissue perfusion (Left heart doesn’t pump) • Treat: o MONA (O2 first)  Morphine  d/c stress on heart & less O2 needed o 12 lead EKG • Interventions: o Fibrolytics  end in ACE o Heparin • Dx: o ST  elevated o Troponin  increases o CKMB Coronary artery disease - - - - - - - Continued