Med Surg Exam 3 Notes and Study Guide: Primary Concepts of Adult Nursing. Disease Analysis: by Diagnostics, Clinical manifestations, Medical management and Nursing management.

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Med Surg Exam 3 Notes Primary Concepts of Adult Nursing (Nova Southeastern University) Hypothyroidism *Hyposecretion of thyroid hormoneslowed metabolic rate* • Thyroid deficiency can aff... ect all body functions and can range from mild, subclinical forms to • Clinical manifestations o Extreme fatigue (makes it difficult for person to • Medical management o Objectives: restore a normal metabolic state by replacing the missing hormone, as well as prevention of disease progression and complications • Nursing management o Medications are administered to the patient with extreme caution because of the potential for altered metabolism and excretion, depressed metabolic rate and respiratory status Med Surg Exam 3 Hyperthyroidism *form of thyrotoxicosis resulting from excessive synthesis and secretion of thyroid hormone by the thyroid* • Clinical manifestations o Nervousness; emotionally hyper excitable, irritable, apprehensive, cannot sit quietly, o T4 • Medical management o Appropriate treatment depends on underlying cause • Nursing management o Nutritional status: appetite is increased but may be satisfied by several well balanced meals of small size. Avoid highly seasoned foods to reduce diarrhea. Weight and dietary intake are 2 Med Surg Exam 3 Thyroid Cancer/Thyroidectomy • Diagnostics • Medical management o Treatment of choicesurgical removal (thyroidectomy)  Attempts are made to spare parathyroid tissue to reduce risk of post op hypocalcemia • Nursing management o Important pre-op goals: prepare patient for surgery and reduce anxiety  Quiet and relaxing activities are encouraged o Post-op care  Periodically assess surgical dressings  Rest, relaxation, adequate nutrition and avoid putting strain on incision 3 Med Surg Exam 3 Pituitary Hypersecretion/Hyposecretion *anterior pituitary: FSH, LH, ACTH, TSH, GH* • Hypersecretion ACTH TSH • Hyposecretion o Can result from disease of pituitary gland itself or disease of hypothalamus o Result is extreme weight loss, emaciation, atrophy of all endocrine glands and organs, 4 Med Surg Exam 3 Hyperparathyroidism *caused by overproduction of parathormone by parathyroid glands and is characterized by bone decalcification and development of renal calculi containing calcium* • Diagnostics o Elevation of serum calcium levels and an elevated concentration of parathormone • Medical • Nursing • Complication: hypercalcemic crisis o Acute hypercalcemic crisis can occur with extreme elevation of serum calcium levels 5 Med Surg Exam 3 Hypoparathyroidism *caused by abnormal parathyroid development, destruction of glands, and vitamin D deficiency* • Most • Diagnostics o Positive Chvostek’s sign  Sharp tapping over facial nerve causes spasm or twitching of mouth, nose & eye o Positive Trousseau’s sign  XRAY shows increased bone density • Medical o Goal: increase serum calcium level to 9 or 10 mg/dL (2.2 to 2.5 mmol/L) and to eliminate  egg yolk are restricted due to high phosphate • Nursing o Care of post op patient directed toward detecting early signs of hypocalcemia and anticipating signs of tetany, seizures, and respiratory difficulties 6 Med Surg Exam 3 Pheochromocytoma *tumor that is usually benign and originates from chromaffin cells of the adrenal medulla* • Clinical manifestations o Typical triad: headache, diaphoresis, and palpitations in patients with hypertension • Diagnostic o 5 Hs  Hypertension, headache, hyperhidrosis (excessive sweating), hypermetabolism, and hyperglycemia • Medical o During an attack of hypertension, tachycardia, anxiety, and the other symptoms of pheochromocytoma, bed rest with head of the bed elevated is prescribed to promote an • Nursing 7 Med Surg Exam 3 Adrenal Insufficiency (Addison’s Disease) *occurs when adrenal cortex function is inadequate to meet the patient’s need for cortical hormones* • Autoimmune or idiopathic atrophy of the adrenal glands is responsible for the vast majority of cases • Clinical manifestations o Muscle weakness, anorexia, GI symptoms fatigue, o of  untreated • Diagnostics o Confirmed by lab tests (hypoglycemia, hyponatremia, hyperkalemia, leukocytosis) • Medical o Immediate treatment is directed toward combating circulatory shock  Restore blood circulation, administer fluids and corticosteroids, monitor vital signs, • Nursing o Assessing the patient  Presence of symptoms of fluid imbalance and patient’s level of stress 8 Med Surg Exam 3 Cushing Syndrome *excessive adrenocortical activity* • Commonly caused by the use of corticosteroid medications and is infrequently the result of excessive corticosteroid production secondary to hyperplasia of the adrenal cortex • Clinical manifestations o Central type obesity (buffalo hump in the neck, a heavy trunk, relatively thin extremities) o Skin is thin, fragile, and easily traumatized (ecchymosis and striae develop) • Diagnostics o Serum cortisol, urinary cortisol, and low dose dexamethasone • Medical o Surgical removal of tumor is treatment of choice; radiation has Nursing 9 Med Surg Exam 3 Hepatitis • Systemic viral infection that causes necrosis and inflammation of liver cells • Hepatitis A: fecal oral transmitted o No jaundice, many asymptomatic, mild flu Hepatitis B: blood, saliva, semen, vaginal secretions o Major cause of cirrhosis and liver cancer Hepatitis C: blood, sexual contact o Not curable, no benefit from rest or diet o No vaccine Portal Hypertension • Increased pressure throughout portal venous system that results from obstruction of blood flow 10 Med Surg Exam 3 Ascites *increased abdominal girth and rapid weight gain, fluid in peritoneal cavity* • Failure of liver to metabolize aldosterone results in increased sodium and water retention by kidneys • Clinical manifestations • Diagnostics o • Medical o Dietary modifications  Goal: negative sodium balance to reduce fluid retention  Added salts, butters, canned foods, should be avoided • Signed consent, empty bladder, upright position, monitor for hypovolemia, report increase in temperature, check site for leakage • Nursing o Monitor I&O, abdominal girth, and daily weight 11 Med Surg Exam 3 Hepatic Cirrhosis *replacement of normal liver tissue with fibrosis that disrupts the structure and function of the liver* • Clinical manifestations: liver enlargement, portal obstruction, ascites, infection, peritonitis, edema, • Diagnostics • Medical o Management based on presenting symptoms  Antacids used to decrease gastric distress and minimize GI bleeding risk • Nursing: promote rest, improve nutritional status, provide skin care, reduce risk of injury o Jaundice (hyperbilirubin), ascites (low albumin), altered LOC, paracentesis to drain fluid, give o Home teaching: exclusion of alcohol from the diet, sodium restriction in diet 12 Med Surg Exam 3 Hepatic Encephalopathy *neuropsychiatric manifestation of hepatic failure associated with portal hypertension and shunting of blood from portal venous system into the systemic circulation* • Life threatening complication of liver disease that occurs with profound liver failure • This • Clinical manifestations o Earliest symptoms: mental changes and motor disturbances o origin • Diagnostics o Electroencephalogram shows generalized slowing, increase in amplitude of brain waves, and characteristic triphasic waves • Medical o Focuses on identifying and eliminating the precipitating cause, initiating ammonia lowering therapy, minimizing potential medical complications of cirrhosis and depressed consciousness, • Nursing o Maintain a safe environment to prevent injury, bleeding, and infection o Potential for respiratory compromise is great given the patient’s depressed neurologic status 13 Med Surg Exam 3 Cholecystitis *inflammation of the gallbladder* • Causes pain, tenderness, and rigidity of the upper right abdomen that may radiate to the mid sternal area or right shoulder and is associated Gallbladder Surgery • Goals of surgery: relieve persistent symptoms, remove cause of biliary colic, treat acute cholecystitis o Vitamin K may be administered if prothrombin level is low • Post op o Low Fowlers position o Fluids administered IV, soft diet started after bowel sounds return (usually next day) o NG suction (was inserted immediately before surgery) relieves abdominal distention o Pain: administer analgesics, help patient turn, cough, breathe deeply, cover with pillow o Improve respiratory status: deep breaths and cough every hour to expand lungs fully and  , abdominal distention, and temperature elevation  infection or disruption of GI tract 14 Med Surg Exam 3 Cholelithiasis *calculi/gallstones* • Form in the gallbladder from solid constituents of bile; vary greatly in size, shape and composition • Clinical manifestations • Diagnostics o Ultrasonography is diagnostic procedure of choice because it is rapid and accurate and can be used in patients with liver dysfunction and jaundice • Medical o Major objectives are to reduce the incidence of acute episodes of gallbladder pain and cholecystitis 15 Med Surg Exam 3 Acute Pancreatitis *auto digestion of the pancreas leading to inflammation* • Pancreatic • Clinical manifestations o Severe abdominal pain is major symptom that causes patient to seek medical care • Diagnostics o Serum amylase and serum lipase are elevated o Increased WBC and hypocalcemia also present o XRAY differentiated pancreatitis from other disorders that may cause similar symptoms • Medical o All oral intake withheld to inhibit stimulation of pancreas and its secretion of enzymes • Nursing o Relieve pain and discomfort o Improve breathing pattern: semi Fowlers position to decrease pressure on the diaphragm by a  At risk for skin breakdown because of poor nutritional status, enforced bed rest, and restlessness which may result in pressure ulcers and breaks skin integrity  Even more increased risk in patient with drains put in (monitor drains for leakage)  Turned every 2 hours o Monitor complications 16 Med Surg Exam 3  Fluid and electrolyte disturbances (note skin turgor and mucous membranes, weigh daily, measure I&O, assess for ascites and abdominal girth daily) Chronic Pancreatits *progressive destruction of the pancreas that leads to inflammation* • Clinical manifestations o Severe upper abdominal and back pain, accompanied by vomiting o little as 10% of pancreatic function remains  Digestion of proteins and fats is impairedstools become more frequent, frothy, and foul smelling because of impaired fat digestionsteatorrhea • Diagnostics o ERCP is most useful • Medical o Directed toward preventing and managing acute attacks, relieving pain and discomfort, and managing exocrine and endocrine insufficiency of pancreatitis o stays  Patient teaching: may experience weight gain and improved nutritional status 17 Med Surg Exam 3 • Type 1 Diabetes Mellitus o Combines genetic, immunologic, and possibly environmental factors contribute to beta cell destruction o Destruction of beta cells results in decreases insulin production, unchecked glucose production by the liver, and fasting hyperglycemia • Type 2 o Insulin resistance and impaired insulin secretion  with the increased demand for insulin, the glucose level rises and type 2 diabetes develops o Usually detected incidentally • Clinical manifestations o Class 3 Ps  Polyuria and polydipsia: occur as a result of the excess loss of fluid associated with infections • Diagnostics o Elevated A1C • Medical o Main goal is to normalize insulin activity and blood glucose levels to reduce the development of • Nursing o Manage glucose control in hospital setting (blood glucose target 140-180) • Hypoglycemia o Blood glucose falls below 70, insulin reaction o Can occur when there is too much insulin, too little food, or excessive physical activities o 15g fast acting carbohydrates given (no table sugar added) o Unconscious patient1 mg glucagon o Prevented by consistent pattern of eating (snacks may be needed), insulin, and exercise 18 Med Surg Exam 3 • ADH (vasopressin) retains water Diabetes Insipidus *deficiency of ADH* o Without ADH, there is an enormous daily output • May occur secondary to head trauma, brain tumor, or surgical ablation of pituitary gland • Clinical manifestations • Diagnostics o Fluid deprivation test (withhold fluids for 8-12 hours) • Medical o Replace ADH • Nursing o Physical assessment and patient education  Signs and symptoms of hyponatremia SIADH *excessive ADH secretion* • Patients cannot excrete a dilute urine, retain fluids, and develop a sodium deficiency • Medical o Eliminate underlying cause, if possible o Restrict fluid intake o Diuretic agents • Nursing o Daily weight 19 [Show More]

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