CASES

MEDICAL
CARDIO-PUMONARY
o Anemia (reduction in concentration of erythrocytes (RBCs) or hemoglobin)
Description
- Condition in which the blood lacks adequate healthy red blood cells or hemoglobin, with most
common causes being acute blood loss, decreased or faulty red blood cell production, or the
destruction of red blood cells.
- There are several types of anemia, with the main types being anemia related to acute and
chronic blood loss, anemia of chronic diseases including cancers, immunodeficiency syndrome,
renal disease, liver disease, and autoimmune condition), anemias caused by nutritional
deficiencies (such as iron, folate, or vitamin B12 deficiency), and hereditary anemias (including
sickle cell anemia and thalassemia).
- Treatment of anemia focuses on treating the cause of the condition and varies based on the
type of anemia.
-

o Angina Pectoris
o Asthma
o Bronchiectasis
o Bronchitis
o Bronchopneumonia
o Chronic Obstructive Pulmonary Disease
o Congestive Heart Failure
o Coronary Artery Disease
o Deep Vein Thrombosis
o Dilated Cardiomyopathy
o Fluids and Electrolyte Imbalance
o Hypertension
o Kawasaki disease
o Leukemia
o Lung Cancer
o Mitral Valve Prolapse
o Myocardial Infarction
o Myocarditis
o Pericardial Effusion
o Pericarditis
o Peripheral Vascular Disease
o Pneumonia
o Pulmonary Tuberculosis
o Rheumatic Heart Disease
o Thrombocytopenia
o Thrombophlebitis

NEUROLOGICAL
o Alzheimers
 o Brain Tumor/Cancer
o Cerebrovascular Accident
o Diabetes Insipidus
o

SURGICAL (mosbey)
 Amputation
Data Base
Etiology and Pathophysiology
-Surgical removal of an extremity
-Intervention for conditions (e.g., malignant tumor, arterial insufficiency, extensive trauma, congenital
malformation)
Clinical Findings

 Aneurysectomy
 Arthroplasty
 Arthrotomy
 A-V fistula creation
 Bleeding esophageal varices
 Bone grafting
 Bowel resection
 Cataract extraction with intraocular lens implantation
 Cholecystectomy
 Choledocholithotomy
 Choledocholithotripsy
 Close reduction
 Cochlear implant
 Craniotomy
 Creation of ileal conduit
 Cystectomy
 Diskectomy
 Excision of thoracic tumor
 Exploratory laparotomy
 Fractures
 Gastric reaction
 Gastrointestinal bleeding
 Gunshot wounds
 Hacking wounds
 Hemorrhoidectomy
 Hemothorax
 Hemiorrhaphy
 Hydrothorax
 Laminectomy
 Laryngectomy
 Lobectomy
 Mastectomy
 Myringotomy
 Nephrectomy
 Open reduction and internal fixation
 Orchiectomy
 Pancreatectomy
 Partial hip arthroplasty
 Pelvic traction
 Pericardiotomy
 Pneumonectomy
 Pneumothorax
 Scleral buckling
 Shoulder replacement
 Skin grafting
 Spinal fusion
 Splenectomy
 TAHBSO
 Thoracostomy
 Thyroidectomy
 Total hip replacement
 Total knee replacement
 TURP
 Tympanomastoidectomy
 Tympanoplasty
 Ureteral stent insertion
 Vehicular accident
 Vein stripping
 V-P shunt

PROCEDURES

 Head to toe assessment

 Abdominal sounds
 Breath sounds
 Glasgow coma scale
 Heart sounds
 Level of consciousness
 Peripheral pulses
 Pulse oximetry
 Pupil size and reaction to light
 Skin integrity
 Use of pain scale
 Administering peritoneal dialysis
Description
1. The peritoneum acts as the dialyzing membrane (semipermeable membrane) to achieve
dialysis, and the membrane is accessed by insertion of a PD catheter through the abdomen.
2. PD works on the principles of osmosis, diffusion, and ultrafiltration; PD occurs via the transfer
of fluid and solute from the bloodstream through the peritoneum into the dialysate solution.
 3. The peritoneal membrane is large and porous, allowing solutes and fluid to move via osmosis
from an area of higher concentration in the body to an area of lower concentration in the
dialyzing fluid.
4. The peritoneal cavity is rich in capillaries; therefore, it provides a ready access to the blood
supply.

Contraindications to PD
1. Peritonitis
2. Recent abdominal surgery
3. Abdominal adhesions
4. Other GI problems such as diverticulosis

Access for PD 1846

1. A siliconized rubber catheter such as a Tenckhoff catheter is surgically inserted into the client’s
peritoneal cavity to allow infusion of dialysis fluid; the catheter site is covered by a sterile dressing that
is
changed daily and when soiled or wet.
2. The preferred insertion site is 3 to 5 cm below the umbilicus; this area is relatively avascular and
has less fascial resistance.
3. The catheter is tunneled under the skin, through the fat and muscle tissue to the peritoneum; it
is stabilized with inflatable Dacron cuffs in the muscle and under the skin.
4. Over a period of 1 to 2 weeks following insertion, fibroblasts and blood vessels grow around the
cuffs, fixing the catheter in place and providing an extra barrier against dialysate leakage and bacterial
invasion.
5. If the client is scheduled for transplant surgery, the PD catheter may be either removed or left in
place if the need for dialysis is suspected post-transplantation.

Dialysate solution
1. The solution is sterile.
2. All dialysis solutions are prescribed by the PHCP; the solution contains electrolytes and minerals
and has a specific osmolarity, specific glucose concentration, and other medication additives as
prescribed.
3. The higher the glucose concentration, the greater the hypertonicity and the amount of fluid
removed during a PD exchange.
4. Increasing the glucose concentration increases the concentration of active particles that cause
osmosis,
increases the rate of ultrafiltration, and increases the amount of fluid removed.
5. If hyperkalemia is not a problem, potassium may be added to each bag of dialysate solution.
6. Heparin is added to the dialysate solution to prevent clotting of the catheter.
7. Prophylactic antibiotics may be added to the dialysate solution to prevent peritonitis.
8. Insulin may be added to the dialysate solution for the client with diabetes mellitus.

 Application of anti-embolism stockings

 Application of ACE wrap
 Arterial stick for ABG
 Assist with chest tube insertion
 Assist with lumbar puncture
 Assisting paracentesis
 Blood and blood products transfusion
 Blood glucose monitoring
 Care of chest tube drainage
 Care of skeletal traction
 Cast care
 Charge nursing
 Checking for bruit
 Chemotherapy
 Chest physiotherapy
 Collecting mid-stream urine sample
 Collecting sputum specimen for culture and sensitivity
 Collecting wound specimen for culture and sensitivity
 Colostomy care
 Computerized nursing documentation
 Continuous bladder irrigation
 CPR
 CVP set-up and monitoring
 Ear instillation
 Enema
 Epidural catheter infusion
 Eye instillation
 Foley catheter insertion/care
 Gastroccult testing
 Hemoccult testing
 Hemodialysis access catheter car
 Heparin drip administration
 Heparin lock insertion and maintenance
 ICP monitoring
 Ileostomy care
 IM injection
 Incentive spirometry
 Insertion of suppository
 Isolation precautions
 IV site care
 Nebulization
 NGT feeding
 NGT insertion
 Open wound irrigation
 Oxygen therapy via: Nasal cannula, Venturi mask, T-piece
 Patient teaching
 Patient controlled analgesia
 PEG feeding
 Peripheral blood draws
 Peripheral IV cannulation
 Post-mortem care
 Post-op dressing changes
 Precepting new employees
 Subcutaneous injection
 Suicide precautions
 Suture removal Taking 12-lead EKG
 Total parenteral nutrition
 Tracheostomy care
 Tracheostomy suctioning
 Use of inhalant puffers