HESI MED SURG NEW MED SURG 203

HESI MED SURG NEW 1. Math- IM-mg/ml 2. Basic Nursing Skills/Nutrition-DASH diet- [med surg page 715- 716] Plan emphasizes fruits, vegetables, fat-free or low-fat milk and milk products, whole grains, fish, poultry, beans, seeds, and nuts. Compared with the typical American diet, the plan contains less red meat, salt, sweets, added sugars, and sugar-containing beverages. The DASH eating plan significantly lowers BP, and these decreases compare those achieved with BP-lowering medication. Additional benefits also include lowering of low-density lipoprotein (LDL) cholesterol. 3. Basic Nursing Skills/Nutrition- Esophageal Varices Other students’ notes: • No red foods or red dyed foods • No pointy foods like crackers • No hot beverages • Luke warm broth, popsicle [Lewis book pg. 1019] F.Y.I. Esophageal Varices are a complex of tortuous veins at the lower end of the esophagus, which are enlarged and swollen as a result of portal hypertension. Page 1022: the main therapeutic goal for esophageal and gastric varices is to prevent bleeding and hemorrhage. The patient should avoid ingesting alcohol, aspirin, and NSAIDS. So make sure you choose a diet that prevent bleeding or hemorrhage, so think SAFETY 4. Basic Nursing Skills/Safety-Hemodialysis-Low BP Other student’s notes and also in book Lewis page 1122 • Hypotension occurs as a result of rapid removal of vascular volume, decreased cardiac output, decreased systemic vascular resistance. S/S: lightheadedness, vomiting, seizures, vision changes, CP and cardiac ischemia. Treatment is a bolus of 0.9% NS and slowing the volume being removed. • Stop dialysis • Notify MD • Lay them flat raise feet higher than head- Trendelenburg 5. IV-ml/hour-heparin 6. GI/Hepatic/Oncology- Colon cancer-intestinal polyps Other student Notes: Polyps increases the risk for colon cancer. [Lewis book pg. 985] Adenomatous polyps are neoplastic. They are closely linked to colorectal adenocarcinoma. The risk increases with polyp size. 7. Integumentary-Shingles-Chronic pain Other student notes: • Unilateral clustered skin vesicles along peripheral sensory nerves on the trunk, thorax or face. Fever malaise, burning, pain, paresthesia, pruritus. Assess for s/s of infection and skin necrosis, neurovascular status, Bell’s palsy is a complication. • Asses patient’s pain first [Lewis book 436] Linear disturbance along a dermatome of grouped vesicles and pustules on erythematous base resembling chickenpox. Usually unilateral on trunk, face, and lumbosacral areas. Burning, pain, and neuralgia preceding outbreak. Mild to severe pain during outbreak. Treatment: Symptomatic: antiviral agents such as acyclovir, famciclovir, and valacyclvir within 72 hr to prevent postherpetic neuralgia. Wet compresses, silver sulfadiazine (Silvadene) to ruptured vesicles. Analgesis. Mild sedation at bedtime. Gabapentin (Neurontin) to treat postherpetic neuralgia. Usually heals without complications, but scarring and postherpetic neuralgia possible. Vaccine (Zostavax) to prevent shingles is available for adults’ ≥ 50 yr. 8. ACS- unrelieved chest pain also on 743 in Lewis book Other student notes: Unrelieved chest pain-severe, immobilizing chest pain not relieved by rest, positioning change or nitrates, is hallmark sign of MI Treatment for ACS (acute coronary syndrome) • Nitroglycerin q 5min up to 3 times • Call 911 if does not resolve after first one. • Take blood pressure • If unrelieved by Nitro OANM therapy (oxygen, Aspirin, Nitro, Morphine) • Three ways to get the artery open: Cath lab for stent or angioplasty, TPA not if they are a bleeding risk, CABG