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
Prevention of Spread – gloves and adamant hand washing
, 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, 3 rd 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
, 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
Hypo/Hypernatremia (p. 279)
, Hypo/hyperK+ (p. 281)
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
Prevention of Spread – gloves and adamant hand washing
, 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, 3 rd 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
, 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
Hypo/Hypernatremia (p. 279)
, Hypo/hyperK+ (p. 281)
