NSGu331uMed-SurguFinaluExamuReview
1
MED-SURGuFINALuEXAMuREVIEW
TOPICSuCHA
PTERu13
Dermatitisu(p.u200)
1. Allergicucontactudermatitis
2. Irritantudermatitis
3. Nummularueczema
4. Seborrheicudermatitis
5. Stasisudermatitis
6. Atopicudermatitis
• Usuallyucalledueczema
• Common,uchronic,urelapsing
• Oftenubeginsuinuchildhood
• Familialuhayufever,uasthma,uetc.
• Manifestations
✓ Pruritusu–majorumanifestation
✓ Dryuskin
✓ Acuteuonsetuwithured,uoozing,ucrustingurash
✓ Intenseuscratchinguleadsutoulesions,uinfectionuanduscarring
• Treatment
✓ Hydrateutheuskinu(soaksuwithucolloidaluoatmeal)
✓ Moisturizeutheuskin
✓ Removeuallergens
✓ Reduceuinflammation
✓ Treatuinfection
7. NursinguManagementuofuDermatologicuProblems
• WetuDressingsu–udamaged,uoozinguskinu–uremoveucrustuanduscabsu–
utapuwateruaturoomutemp/vinegar
✓ Relieveuitching
✓ Suppressuinflammation
✓ Debrideutheuwound
• Bathsu–ulargeuareasuofutheubodyu–ucolloidaluoatmealu(Aveeno)
• TopicaluMedicationsu–uTableu23-12u–uoccludeuwithuplasticuwraputouincreaseuabsorption
• ControluPruritusu–ubreakutheuitch-
scratchucycleutoupreventuexcoriationuandulichenification
✓ Lichenificationu–uthickeninguofutheuepidermisuwithuexaggeratedumarkings
resemblinguauwashboard
ou Causedubyuchronicuitchingu/urubbinguofutheuskin
,NSGu331uMed-SurguFinaluExamuReview
2
• PreventionuofuSpreadu–uglovesuanduadamantuhanduwashing
,NSGu331uMed-SurguFinaluExamuReview
3
• PreventionuofuSecondaryuInfectionsu–uparticularlyutouexistinguskinulesions
• Specificuskinucareu–
ueducateupatientuonuskinucareuafterudermatologicuproceduresuandu hygiene
✓ Woundsukeptumoistuanducovereduhealumoreurapidly,uleaveuscab/crustuundisturbed
CHAPTERu16
Dehydration
FluiduVolumeuDeficitu(FVD):uHypovolemia
• Causes:u decruintake,uvomiting,ufever,udiarrhea,uNGuloss,uhemorrhage,u3rduspacing,uincru
insensibleuloss,udiabuinsipid
• S&S:u dry,upaleucolduclammyuskin,uwtuloss,udecreaseduturgoruanducapurefill,utachycardia,
posturaluhypotension,uhighuHCTulevel,ulowuU/O,ulowugradeutemp,ualteredumentalustatus,use
izures,ucoma,urestlessness,udrowsiness
• Treatment:u underlyingucause,uoral/IVufluidsu(0.9%uNS),ubloodu(ifud/tuhemorrhage),urest,
nutrition
• Nursingumeasures:u VS,uI&O,uposturaluhypotensionu(safety)
Hypothalamic-pituitaryuregulation
o Bodyufluidudeficitu/uIncreasesuinuplasmauosmolarityuactivatesuosmoreceptorsuinu
hypothalamus
▪ ActivatesuthirstuandureleaseuofuADHufromuposteriorupituitaryutouretain
wateru(distalutubules)
▪ Thirstumechanismumajorudefenseuagainstudehydrationu-
uElderlyuhaveureduceduthirstumechanism
o DecuBP,unausea,upain,uhypoglycemia,uhypoxemiauallustimulateuADHurelease;
▪ postopustressuresponse,ureceivinguanalgesics/anesthesiau=uADHureleaseu
andudecreaseduosmolality
o Dryumouthuwillucauseuaupersonutoudrinkuevenuwhenuthereuisunoubodyuwaterudeficitu
RenaluRegulation
o Kidneysuregulateuwaterubalanceubyuadjustinguurinaryuvolumeuanduexcretionuofu
electrolytes
o Avguadultu=ukidneysureabsorbu99%uofufiltrateu=u1.5Luurineuperuday
▪ Kidneyuissuesu=ulessuabilityutouregulateu=uedema,uetc.
AdrenalucorticaluRegulation
o Releaseuofuhormonesutouregulateuwateruanduelectrolytes
▪ Glucocorticoidsu–ucortisolu–uanti-
inflammatoryu=uincreaseuserumuglucoseulevels
▪ Mineralocorticoidsu–ualdosteroneu=enhanceuNauretention/K+uexcretion
(decuNau=uRAASuactivation
▪ Hormonesuregulateuamtuofuwateruisuretainedu
CardiacuRegulation
, NSGu331uMed-SurguFinaluExamuReview
4
o Natriureticupeptideu(antagonistutouRAAS)u–
ucardiomyocytes:uresponseutouincruatrialupressureu&uincruNa
▪ Decreaseublooduvolumeu=uatrialuNPu(ANP)uandub-typeuNPu(BNP)u–urenal
tubulesu–uexcreteuNa/H2O
▪ Activateutoudecreaseuvolumeu–uelevatedu=uCHFu–
uinhibitualdosterone,urenin,u
ADH,uangiotensinuII
GastrointestinaluRegulation
o Oraluintakeuaccountsuforumostuwateru(D/Vu=ulosingufluid/electrolytes)
o Secretesuapproximatelyu8000mLuofudigestiveufluiduthatuisureabsorbedu(smalluamtu
eliminateduinufeces)
▪ D/Vu–upreventsureabsorptionu–ufluiduanduelectrolyteuloss
Insensibleuwaterulossu=uSweating
Sensibleuwaterulossu=uExcessiveusweatingu–uexercise,ufever,uexcessiveuenvironmentaluheat
1
MED-SURGuFINALuEXAMuREVIEW
TOPICSuCHA
PTERu13
Dermatitisu(p.u200)
1. Allergicucontactudermatitis
2. Irritantudermatitis
3. Nummularueczema
4. Seborrheicudermatitis
5. Stasisudermatitis
6. Atopicudermatitis
• Usuallyucalledueczema
• Common,uchronic,urelapsing
• Oftenubeginsuinuchildhood
• Familialuhayufever,uasthma,uetc.
• Manifestations
✓ Pruritusu–majorumanifestation
✓ Dryuskin
✓ Acuteuonsetuwithured,uoozing,ucrustingurash
✓ Intenseuscratchinguleadsutoulesions,uinfectionuanduscarring
• Treatment
✓ Hydrateutheuskinu(soaksuwithucolloidaluoatmeal)
✓ Moisturizeutheuskin
✓ Removeuallergens
✓ Reduceuinflammation
✓ Treatuinfection
7. NursinguManagementuofuDermatologicuProblems
• WetuDressingsu–udamaged,uoozinguskinu–uremoveucrustuanduscabsu–
utapuwateruaturoomutemp/vinegar
✓ Relieveuitching
✓ Suppressuinflammation
✓ Debrideutheuwound
• Bathsu–ulargeuareasuofutheubodyu–ucolloidaluoatmealu(Aveeno)
• TopicaluMedicationsu–uTableu23-12u–uoccludeuwithuplasticuwraputouincreaseuabsorption
• ControluPruritusu–ubreakutheuitch-
scratchucycleutoupreventuexcoriationuandulichenification
✓ Lichenificationu–uthickeninguofutheuepidermisuwithuexaggeratedumarkings
resemblinguauwashboard
ou Causedubyuchronicuitchingu/urubbinguofutheuskin
,NSGu331uMed-SurguFinaluExamuReview
2
• PreventionuofuSpreadu–uglovesuanduadamantuhanduwashing
,NSGu331uMed-SurguFinaluExamuReview
3
• PreventionuofuSecondaryuInfectionsu–uparticularlyutouexistinguskinulesions
• Specificuskinucareu–
ueducateupatientuonuskinucareuafterudermatologicuproceduresuandu hygiene
✓ Woundsukeptumoistuanducovereduhealumoreurapidly,uleaveuscab/crustuundisturbed
CHAPTERu16
Dehydration
FluiduVolumeuDeficitu(FVD):uHypovolemia
• Causes:u decruintake,uvomiting,ufever,udiarrhea,uNGuloss,uhemorrhage,u3rduspacing,uincru
insensibleuloss,udiabuinsipid
• S&S:u dry,upaleucolduclammyuskin,uwtuloss,udecreaseduturgoruanducapurefill,utachycardia,
posturaluhypotension,uhighuHCTulevel,ulowuU/O,ulowugradeutemp,ualteredumentalustatus,use
izures,ucoma,urestlessness,udrowsiness
• Treatment:u underlyingucause,uoral/IVufluidsu(0.9%uNS),ubloodu(ifud/tuhemorrhage),urest,
nutrition
• Nursingumeasures:u VS,uI&O,uposturaluhypotensionu(safety)
Hypothalamic-pituitaryuregulation
o Bodyufluidudeficitu/uIncreasesuinuplasmauosmolarityuactivatesuosmoreceptorsuinu
hypothalamus
▪ ActivatesuthirstuandureleaseuofuADHufromuposteriorupituitaryutouretain
wateru(distalutubules)
▪ Thirstumechanismumajorudefenseuagainstudehydrationu-
uElderlyuhaveureduceduthirstumechanism
o DecuBP,unausea,upain,uhypoglycemia,uhypoxemiauallustimulateuADHurelease;
▪ postopustressuresponse,ureceivinguanalgesics/anesthesiau=uADHureleaseu
andudecreaseduosmolality
o Dryumouthuwillucauseuaupersonutoudrinkuevenuwhenuthereuisunoubodyuwaterudeficitu
RenaluRegulation
o Kidneysuregulateuwaterubalanceubyuadjustinguurinaryuvolumeuanduexcretionuofu
electrolytes
o Avguadultu=ukidneysureabsorbu99%uofufiltrateu=u1.5Luurineuperuday
▪ Kidneyuissuesu=ulessuabilityutouregulateu=uedema,uetc.
AdrenalucorticaluRegulation
o Releaseuofuhormonesutouregulateuwateruanduelectrolytes
▪ Glucocorticoidsu–ucortisolu–uanti-
inflammatoryu=uincreaseuserumuglucoseulevels
▪ Mineralocorticoidsu–ualdosteroneu=enhanceuNauretention/K+uexcretion
(decuNau=uRAASuactivation
▪ Hormonesuregulateuamtuofuwateruisuretainedu
CardiacuRegulation
, NSGu331uMed-SurguFinaluExamuReview
4
o Natriureticupeptideu(antagonistutouRAAS)u–
ucardiomyocytes:uresponseutouincruatrialupressureu&uincruNa
▪ Decreaseublooduvolumeu=uatrialuNPu(ANP)uandub-typeuNPu(BNP)u–urenal
tubulesu–uexcreteuNa/H2O
▪ Activateutoudecreaseuvolumeu–uelevatedu=uCHFu–
uinhibitualdosterone,urenin,u
ADH,uangiotensinuII
GastrointestinaluRegulation
o Oraluintakeuaccountsuforumostuwateru(D/Vu=ulosingufluid/electrolytes)
o Secretesuapproximatelyu8000mLuofudigestiveufluiduthatuisureabsorbedu(smalluamtu
eliminateduinufeces)
▪ D/Vu–upreventsureabsorptionu–ufluiduanduelectrolyteuloss
Insensibleuwaterulossu=uSweating
Sensibleuwaterulossu=uExcessiveusweatingu–uexercise,ufever,uexcessiveuenvironmentaluheat
