MED SURG II MASTER HESI REVIEW

MED SURG II MASTER HESI REVIEW. Diabetes Insipidus – page  Caused by a deficiency of production of ADH or a decreased renal response to ADH.  Clinical Manifestations: Polydipsia and Polyuria.  Diagnostic Studies: Water deprivation test (pt deprived of water for 8-12 hrs and then given desmopressin acetate subcut or nasally), Measure level of ADH after an analog of ADH is given.  Types of Diabetic Insipidus: Central DI (results from an interference of ADH synthesis, transport, and release. Ex: brain tumor, head injury, brain surgery, CNS infection), Nephrogenic DI (results from inadequate renal response to ADH despite presence of adequate ADH. Ex: Drug therapy, renal damage, hereditary renal disease), Primary DI (Results from excessive water intake. Ex: Structural lesion in thirst center, psychological disorder).  Nursing Management: Early detection, Maintaining adequate hydration, and patient teaching for long-term management. 2) Healthcare associated pneumonia  Also known as nosocomial pneumonia, pneumonia in a non-intubated patient that begins 48 hours or longer after admission to hospital and was not present at the time of admission. Ventilatorassociated pneumonia, also a type of HAP, refers to pneumonia that occurs more than 48 hours after endotracheal intubation.  Treatment: Antibiotics that can be started as soon as sputum cultures identify the exact pathogen.  Risks: In treatment of pneumonia, risk of developing multidrug-resistant organisms. Limits the available antibiotics that can be used as treatment. 3) Diabetes Mellitus long term complications  Stroke  Hypertension  Dermopathy  Atherosclerosis  Nephropathy  Peripheral neuropathy  Neurogenic bladder  Retinopathy, Cataracts, Glaucoma, Blindness  Coronary Artery Disease  Gastroparesis  Islet Cell Loss  Erectile Dysfunction  Peripheral Vascular Atherosclerosis  Gangrene  Infections  Examinations performed Daily, Annually, or when you visit HCP: Funduscopic, Fundus photography, Urinalysis, Feet Examination, and Stress Tests. MED SURG II – MASTER HESI REVIEW Page 2 of 38 4) Renal dosing/ issues with drugs – page 1020 Box 44-3 ANTIBIOTICS OTHER DRUGS OTHER AGENTS Amikacin Captopril Gold Amphotericin B Cimetidine Heavy Metals Bacitracin Cisplatin Cephalosporins Cocaine Gentamicin Cyclosporine Neomycin Ethylene Glycol Polymyxin B Heroin Streptomycin Lithium Sulfamidies Methotrexate Tobramycin Nitrosoureas Vancomycin NSAIDS Phenacetin Quinine Rifampin Salicylates 5) Spinal cord injury – page  Classification: (1) Mechanism of Injury, (2) Level of Injury, (3) Degree of Injury.  Clinical Manifestations: Motor and Sensory effects, Respiratory System (decrease in vital capacity volume), Cardiovascular System (bradycardia, peripheral vasodilation, hypotension), Urinary System (urinary dysfunction), Gastrointestinal System (incontinence, impaction, ileus, megacolon, decreased GI secretion) , Integumentary System (skin breakdown, pressure ulcers), Thermoregulation (Adjustment from body temp to room temp), Peripheral Vascular Problems (Pain, VTE, PE)  Emergency Management: Table 60-3 Ph. 1425  NURSING ASSESSMENT o Subjective Date: Health History o Objective Data: Poikilothermism (unable to regulate body heat) o Integumentary System: Warm dry skin below level of injury o Respiratory: Injury at C1-3-Apnea, Inability to cough. Injury at C4-Poor Cough, diaphragmatic breathing, hypoventilation. Injury at C5-T6- Decreased respiratory reserve. o Cardiovascular: Injury above T6-Bradycardia, hypertension, absence of vasomotor tone. o Gastrointestinal: Decreased or absent bowel sounds, abdominal distension, constipation, fecal incontinence, fecal impaction. o Urinary: Retention, flaccid bladder, Spasticity with reflex bladder emptying. o Reproductive: Priapism, altered sexual function o Neurologic: Complete-Areflexic, flaccid paralysis, hyperactive deep tendon reflexes, bilaterally positive Babinski test. Incomplete- Mixed loss of voluntary motor activity and sensation.