2 & Comprehensive Rationales. Med Surg 1A Topics 1. Cushing’s Syndrome (2 questions) → hypersecretion

Kaplan→ Med Surg 1, 2 & Comprehensive Rationales Med Surg 1A Topics 1. Cushing’s Syndrome (2 questions) → hypersecretion of ACTH (hormone that allows body to react to stress) ○ ● Signs & Symptoms → fatigue, muscle weakness, weight gain, thinning extremities, thin & fragile skin, moon face & ruddy complexion, hirsutism, truncal obesity, broad purple striae, bruising, impaired wound healing, increased blood pressure & sodium, hypokalemia, hyperglycemia, buffalo hump, DM ● Treatment → restore hormone balance by radiation, drug therapy or adrenalectomy (removal of one or both adrenal glands) ● Nursing Considerations → Frequently monitor VS (especially BP), monitor labs for electrolyte changes, monitor daily weight, check for signs of infection, perform passive range of motion for those that have osteoporosis or are bedridden ○ Post-surgery nursing considerations → encourage coughing & deep breathing, monitor for shock & HTN, administer cortisone as ordered ○ Diet → High in protein & potassium, but low in carbs & sodium, high calcium + vit. D 2. Hepatitis (3 questions) → inflammation of the liver that causes liver cell damage ○ ○ Chronic hepatitis ( 6 months) can lead to cirrhosis of the liver ● Causes → bacteria, toxins or viruses , 6 viral types → A, B, C, D, E, G ● Hepatitis A & E → fecal to oral (shellfish from contaminated waters is a major source) ● Hep. A stages ○ Pre-icteric: malaise, N/V, anorexia ○ Icteric: jaundice, clay colored stool, tea colored urine ○ Convalescent: SX resolves ● Hepatitis B,C, D & G → parenteral drug abuse, sex, blood & body fluids, ● Signs & Symptoms → jaundice, anorexia, RUQ pain (due to hepatomegaly), clay-colored stools, tea-colored urine (due to bilirubin leakage), apendicitispruritus, elevated LFT’s (AST & ALT) & prolonged PT ● Treatment → symptomatic → vitamin K, anti-histamines, corticosteroids, anti-emetics & apply calamine lotion ● Nursing Interventions → improve sanitation, vaccination, no ETOH, instruct pt to balance rest and activity, patient cannot donate blood! HAND WASHING #1! ● Diet: low in fat, high in carbs and protein 3. Cytoscopy → direct visualization of the urethra, bladder, ureteral orifices, and prostatic urethra ○ ○ ○ Helps assess ureters and the pelvis of each kidney ○ Can obtain a urine specimen from each kidney to evaluate its function ○ Assist in performing a biopsy ○ Assist in removing calculi from the urethra, bladder and ureter ○ Performed in both lower and upper tract ● Lower tract cystoscopy ○ Pt. is usually awake; discomfort is equal to that of catheterization ○ Viscous lidocaine can be injected prior to the study