NSG 331 Med-Surg Final Exam Review
1
MED-SURG FINAL EXAM REVIEW
TOPICS
CHAPTER 13
Dermatitis (p. 200)
1. Allergic contact dermatitis
2. Irritant dermatitis
3. Nummular eczema
4. Seborrheic dermatitis
5. Stasis dermatitis
6. Atopic dermatitis
• Usually called eczema
• Common, chronic, relapsing
• Often begins in childhood
• Familial hay fever, asthma, etc.
• Manifestations
✓ Pruritus –major manifestation
✓ Dry skin
✓ Acute onset with red, oozing, crusting rash
✓ Intense scratching leads to lesions, infection and scarring
• Treatment
✓ Hydrate the skin (soaks with colloidal oatmeal)
✓ Moisturize the skin
✓ Remove allergens
✓ Reduce inflammation
✓ Treat infection
7. Nursing Management of Dermatologic Problems
• Wet Dressings – damaged, oozing skin – remove crust and scabs – tap water at room
temp/vinegar
✓ Relieve itching
✓ Suppress inflammation
✓ Debride the wound
• Baths – large areas of the body – colloidal oatmeal (Aveeno)
• Topical Medications – Table 23-12 – occlude with plastic wrap to increase absorption
• Control Pruritus – break the itch-scratch cycle to prevent excoriation and
lichenification
✓ Lichenification – thickening of the epidermis with exaggerated markings
resembling a washboard
o Caused by chronic itching / rubbing of the skin
,NSG 331 Med-Surg Final Exam Review
2
• Prevention of Spread – gloves and adamant hand washing
,NSG 331 Med-Surg Final Exam Review
3
• Prevention of Secondary Infections – particularly to existing skin lesions
• Specific skin care – educate patient on skin care after dermatologic procedures and
hygiene
✓ Wounds kept moist and covered heal more rapidly, leave scab/crust undisturbed
CHAPTER 16
Dehydration
Fluid Volume Deficit (FVD): Hypovolemia
• Causes: decr intake, vomiting, fever, diarrhea, NG loss, hemorrhage, 3rd spacing, incr
insensible loss, diab insipid
• S&S: dry, pale cold clammy skin, wt loss, decreased turgor and cap refill, tachycardia,
postural hypotension, high HCT level, low U/O, low grade temp, altered mental status,
seizures, coma, restlessness, drowsiness
• Treatment: underlying cause, oral/IV fluids (0.9% NS), blood (if d/t hemorrhage), rest,
nutrition
• Nursing measures: VS, I&O, postural hypotension (safety)
Hypothalamic-pituitary regulation
o Body fluid deficit / Increases in plasma osmolarity activates osmoreceptors in
hypothalamus
▪ Activates thirst and release of ADH from posterior pituitary to retain
water (distal tubules)
▪ Thirst mechanism major defense against dehydration - Elderly have
reduced thirst mechanism
o Dec BP, nausea, pain, hypoglycemia, hypoxemia all stimulate ADH release;
▪ postop stress response, receiving analgesics/anesthesia = ADH release
and decreased osmolality
o Dry mouth will cause a person to drink even when there is no body water deficit
Renal Regulation
o Kidneys regulate water balance by adjusting urinary volume and excretion of
electrolytes
o Avg adult = kidneys reabsorb 99% of filtrate = 1.5L urine per day
▪ Kidney issues = less ability to regulate = edema, etc.
Adrenal cortical Regulation
o Release of hormones to regulate water and electrolytes
▪ Glucocorticoids – cortisol – anti-inflammatory = increase serum glucose
levels
▪ Mineralocorticoids – aldosterone =enhance Na retention/K+ excretion
(dec Na = RAAS activation
▪ Hormones regulate amt of water is retained
Cardiac Regulation
, NSG 331 Med-Surg Final Exam Review
4
o Natriuretic peptide (antagonist to RAAS) – cardiomyocytes: response to incr atrial
pressure & incr Na
▪ Decrease blood volume = atrial NP (ANP) and b-type NP (BNP) – renal
tubules – excrete Na/H2O
▪ Activate to decrease volume – elevated = CHF – inhibit aldosterone, renin,
ADH, angiotensin II
Gastrointestinal Regulation
o Oral intake accounts for most water (D/V = losing fluid/electrolytes)
o Secretes approximately 8000mL of digestive fluid that is reabsorbed (small amt
eliminated in feces)
▪ D/V – prevents reabsorption – fluid and electrolyte loss
Insensible water loss = Sweating
Sensible water loss = Excessive sweating – exercise, fever, excessive environmental heat
1
MED-SURG FINAL EXAM REVIEW
TOPICS
CHAPTER 13
Dermatitis (p. 200)
1. Allergic contact dermatitis
2. Irritant dermatitis
3. Nummular eczema
4. Seborrheic dermatitis
5. Stasis dermatitis
6. Atopic dermatitis
• Usually called eczema
• Common, chronic, relapsing
• Often begins in childhood
• Familial hay fever, asthma, etc.
• Manifestations
✓ Pruritus –major manifestation
✓ Dry skin
✓ Acute onset with red, oozing, crusting rash
✓ Intense scratching leads to lesions, infection and scarring
• Treatment
✓ Hydrate the skin (soaks with colloidal oatmeal)
✓ Moisturize the skin
✓ Remove allergens
✓ Reduce inflammation
✓ Treat infection
7. Nursing Management of Dermatologic Problems
• Wet Dressings – damaged, oozing skin – remove crust and scabs – tap water at room
temp/vinegar
✓ Relieve itching
✓ Suppress inflammation
✓ Debride the wound
• Baths – large areas of the body – colloidal oatmeal (Aveeno)
• Topical Medications – Table 23-12 – occlude with plastic wrap to increase absorption
• Control Pruritus – break the itch-scratch cycle to prevent excoriation and
lichenification
✓ Lichenification – thickening of the epidermis with exaggerated markings
resembling a washboard
o Caused by chronic itching / rubbing of the skin
,NSG 331 Med-Surg Final Exam Review
2
• Prevention of Spread – gloves and adamant hand washing
,NSG 331 Med-Surg Final Exam Review
3
• Prevention of Secondary Infections – particularly to existing skin lesions
• Specific skin care – educate patient on skin care after dermatologic procedures and
hygiene
✓ Wounds kept moist and covered heal more rapidly, leave scab/crust undisturbed
CHAPTER 16
Dehydration
Fluid Volume Deficit (FVD): Hypovolemia
• Causes: decr intake, vomiting, fever, diarrhea, NG loss, hemorrhage, 3rd spacing, incr
insensible loss, diab insipid
• S&S: dry, pale cold clammy skin, wt loss, decreased turgor and cap refill, tachycardia,
postural hypotension, high HCT level, low U/O, low grade temp, altered mental status,
seizures, coma, restlessness, drowsiness
• Treatment: underlying cause, oral/IV fluids (0.9% NS), blood (if d/t hemorrhage), rest,
nutrition
• Nursing measures: VS, I&O, postural hypotension (safety)
Hypothalamic-pituitary regulation
o Body fluid deficit / Increases in plasma osmolarity activates osmoreceptors in
hypothalamus
▪ Activates thirst and release of ADH from posterior pituitary to retain
water (distal tubules)
▪ Thirst mechanism major defense against dehydration - Elderly have
reduced thirst mechanism
o Dec BP, nausea, pain, hypoglycemia, hypoxemia all stimulate ADH release;
▪ postop stress response, receiving analgesics/anesthesia = ADH release
and decreased osmolality
o Dry mouth will cause a person to drink even when there is no body water deficit
Renal Regulation
o Kidneys regulate water balance by adjusting urinary volume and excretion of
electrolytes
o Avg adult = kidneys reabsorb 99% of filtrate = 1.5L urine per day
▪ Kidney issues = less ability to regulate = edema, etc.
Adrenal cortical Regulation
o Release of hormones to regulate water and electrolytes
▪ Glucocorticoids – cortisol – anti-inflammatory = increase serum glucose
levels
▪ Mineralocorticoids – aldosterone =enhance Na retention/K+ excretion
(dec Na = RAAS activation
▪ Hormones regulate amt of water is retained
Cardiac Regulation
, NSG 331 Med-Surg Final Exam Review
4
o Natriuretic peptide (antagonist to RAAS) – cardiomyocytes: response to incr atrial
pressure & incr Na
▪ Decrease blood volume = atrial NP (ANP) and b-type NP (BNP) – renal
tubules – excrete Na/H2O
▪ Activate to decrease volume – elevated = CHF – inhibit aldosterone, renin,
ADH, angiotensin II
Gastrointestinal Regulation
o Oral intake accounts for most water (D/V = losing fluid/electrolytes)
o Secretes approximately 8000mL of digestive fluid that is reabsorbed (small amt
eliminated in feces)
▪ D/V – prevents reabsorption – fluid and electrolyte loss
Insensible water loss = Sweating
Sensible water loss = Excessive sweating – exercise, fever, excessive environmental heat
