INTERMEDIATE MED SURG FINAL (100 QUESTIONS & ANSWERS)

v. Water exercise is important, patient is able to have more control over the body c. During an acute exacerbation patient may be immobile and on bedrest i. Interventions include respiratory and urinary tract infection prevention ii. Pressure ulcer prevention d. Tell pt. to avoid fatigue, extremes of heat and cold, and exposure to infection e. Encourage early and vigorous treatment of infection f. Teach pt. to achieve good balance of exercise and rest g. Minimize caffeine, and eat nutritious meals (high in fiber may help with constipation) h. Bladder control is a major problem: Anticholinergics may help with spasticity, may need to teach patient self-catheterization Some Goals • Maintain or improve muscle strength and mobility • Use assistive devices for ambulation • Maintain urinary continence 3. Addison’s disease, assessment Addisons: hypofunction of adrenal cortex. Glucocorticoids, mineralocorticoids and androgens are reduced. Manifestations • Weakness anf fatigue • Weight loss • Anorexia • Increased ACTH causes bronze-colored skin hyperpigmentation (at pressure points such as joints and palmar creases) • Orthostatic hypotension • Salt craving • Nausea and vomiting • Diarrhea -Serum cortisol levels; decreased in adrenal unsufficiency -Blood glucose levels; decreased -serum sodium levels; decreased -Serum potassium levels; increased -BUN levels; increased Assessment Health History • Weight loss • Skin color changes • Nausea and vomiting • Anorexia • Abdominal pain • Weakness • Amenorrhea • Confusion • Intolerance of stress Physical Assessment • Height and weight • Monitor vital signs (hypotension may occur due to crisis) • Skin color • Hair quality • Muscle size and strength 4. ESRD, manifestations and specific assessments, GFR 15 or less a. Retained substances such as urea, creatinine, phenols, hormones, electrolytes, and water b. Uremia - symptoms may develop in other body systems - usually occurs with GFR 10 mL/min c. Problems with fluid elimination and require diuretic therapy d. As GFR decreases, the BUN and creatinine levels increase i. Elevations in BUN causes nausea, vomiting, lethargy, fatigue, and headaches e. Altered lipid metabolism leading to dyslipidemia f. Early: Nausea apathy, weakness, fatigue g. Vomiting, weakness, confusion, restless leg syndrome, paresthesia, sensory loss, irritability, kussmaul pattern, skin becomes pale and dry with yellowish hue h. History Assessment • Polycystic kidney disease • Diabetes • Hypertension • Systemic lupus erythematosus • Severe infections • Assess current use of drugs: o Decongestants and antihistamines cause vasoconstriction and increase BP o Antacids: high levels of salt can cause hypertension o NSAIDS o Analgesics o Antibiotics -Assess dietary habits -Measure height and weight, evaluate any recent weight changes - Assess support systems Physical • Daily weight (fluid volume status indicator) • Intake and output • Assess for edema, dysrhythmias, tingling, muscle tetany • Assess for s/s of infection • Monitor vital signs (BP AND HR) • Cardio: dysrhythmias, hypertension • Resp: SOB, kussmaul breathing leads to increased CO2 levels • GI: n/v, anorexia, odor in breath • Neurologic: Seizures may occur due to increasing BUN and hypertension, restless leg syndrome • Musculo: thin fragile bones • Skin: skin changes (yellow, bluish color), dry itchy skin • Reproductive: decreased libido 5. Chemotherapy: therapeutic communications regarding taking meds, teaching o Remind anxiety is common due to dependency, ability to pay, side effects, and poor outcomes o Remind for repetitive office visits and lab testing o Tell patietns they will be followed and support is ongoing o Provide info and support that can help minimize negative impact o Patient teaching, symptom management, and interventiosn to help patients self-manage (adjusting treatment schedules to permit patients to work, making referrals to support groups) o Arrange patients to meet with those who completed therapy o Regular supportive telephone contacts between office visits and assist with planning for transportation, nutrition, and emotional support available with Cancer society and Cancer lifeline Neutropenia o Avoid crowds o Take temp daily o Avoid fresh fruits and veggies, undercooked meat, fish , and eggs o Avod yard work o Avoid fluids at room temp for longer than 1 hour o Wash everything in hot water o Wash toothbrush daily o Don’t share toiletry Alopecia o Suggest use of a wig o Protect scalp using creams and head coverings Thrombocytopenia o Use electric razor and soft toothbrush o Don’t blow nose vigorously o No NSAIDs 6. CHF, in regards to digoxin toxicity Digoxin (Lanoxin): Increases force of cardiac contraction, decreases Hr, and allows complete emptying of ventricles, reducing volume in ventricles during diastole Use in CHF: increases CO, reduces HR, decreases O2 demand, increases renal blood flow (reduces sodium reabsorption allowing excretion of edema fluid • Primary cause of toxicity: HYPOKALEMIA o Use of diuretics (thiazides, loop diuretics) o Hyperkalemia: inhibits action of digoxin leading to dysrhythmias as well o Hypercalcemia and hypomagnesmia may also cause toxicity • Signs of toxicity o Early: anorexia, n/v, fatigue, headache, visual changes, depression o Late: dysrhythmias (bradycardia, av block) • Diseases of kidney and liver increase risk of toxicity because most preparations are metabolized and eliminated by these organs • OLDER ADULTS AT RISK FOR TOXICITY: due to decreased liver, kidney and metabolism function • Tx: withhold med and in case of life threatening: IV Digibind 7. Acute glomerulonephritis, onset of this disease is that they have elevated BP? o Manifestations i. Generalized body edema. Starts around low-pressure tissues (around eyes), then progresses to total body such as ascites or peripheral edema in legs ii. Hypertension (as a result of increased extracellular fluid volume iii. Oliguiria iv. Hematuria with smoky or rusty appearance (bleeding in upper urinary tract) v. Proteinuria vi. Fluid retention due to GFR vii. Abdominal or flank pain o Management i. Rest until glomerular inflammation (proteinuria, hematuria, and hypertension subside) ii. Edema is treated by restricting sodium and fluid intake and giving diuretics iii. Severe hypertension treated with antihypertensives iv. Dietary protein may be restricted (may increase BUN) v. Antibiotics if streptococcal infection is present 8. BUN and creatinine! Know this a lot, chronic kidney disease, a. BUN: 7-20 b. Creatinine: 06-1.2 As GFR decreases, BUN and creatinine levels increase o Creatinine: Can increase to 15-30 mg/dL o BUN: Can increase 10 to 20 times the creatinine finding