CATHY PARKES Deere) Dies | Expected values: Creatinine, BUN, Urin | Nursing care during CystogrephyiUrography Hemodialysis Parposelindcabons Nursing care before, ng, afer procecire CF oh te al Creatinine, BUN, Urinalysis, Cystography/Urography ‘Seas tore dente an Suny not Maney ae eyo 88 mo. ved ny Untaiys: Specie gravy shoul be between 40-1025, No short, pte, nes ou atv, es id bo Enon nga tae ae reese. Pen ae i + nf ag foster: clouy ou sang une, Siary ufone), unays pose reckoenerase, rian Hemodialysis Eliminates excess hid. elocro}tes and ‘tale prac rom he cay, Used pars atta or ‘Shrond tcney eseaee Usaly gone ames wank var pln asc ge cr ru sta pues). Assoae val ino, ab values, sweght Tptaptocedure: Mentor fr hypotension, esrning, iy lod Aarmtor rtosap ano potent cla 82 re adn aire sate reverse heer tices: Decrpasd 0 andi value apace ompare weigh to before procedure io astnate fu removed (ie hud > tig)Patient teaching: modialysis + inereace protein intake ater lai, 28 potsin is ost Patent eaching ‘weheseh exchange, Ccomplestens ane nursing actions «+ Roearryng toms wth am wth access ste 1 Dont soap an arm win access ste. | 1 eror hand exercoes to mature ls, | compations * Daoaullprum syndrome (symetoms: n, cocreased | LOG sezure) dustoincreaced IGP. Siowelalas | ‘xchange rata E «+ Hypotension. Administr iV uids or codes as ordared. Slow exchange rato. Loner HOB. | ‘hat? ‘Nursing cae afore and aun procedure Faw a Peritoneal Dialysis Poritonca Dialysis: nalaton and dveling ofFypartonic {lysate solution inthe portonel cavity to remove wasts products. Alleratve to homedialysis for oider ads, Intolerance fo anesogularts, vascular accose flies. Preprocedue; Assess weight Warm dalsate solu Use ‘ols ecnnique when accessing eather nso si. Intraprocedure: I. ‘Compare infow vs. outiow of dialysate 1 Koop euttow ower han patients aeomen 1 Monitor car of aufow ~ shouldbe clear to yelow. Bloody, cloudy outflow incicates possiole infection! | Porltoneal Dialysis ‘Complications: Peritoneal Dialys ortonits (6x: fover, purulent crainege, erythema, ‘Complcations | ‘swoling, discolored dialysato) ‘+ Protein loss (increase protein in et) ‘Hyporglycomia (administer insulin 2s needed) we ‘+ Poor inflowloutfow (chock for kinks in tubing ‘address constipation, repesition patient, milk {ubing to break up lots), Kidney Transplant Kidney Transpl | Nursing care before aed after procedure 1 Ferrmbasternoaton ss oes Patent teaches 1 Netiorritetonfamplons ver, orhema, incon! we + Rag aun pene mer hpennn | eerie . | SSS in ttm tame | 5 Reames | 5 Gem ete acing’ Loma ght, gh rte. ew sun et ‘ci ona pai‘Glomerulonephritis | Glameuloneis: ue complex isoase resin it Glomerulonephritis Infrenaton of gore Whats 7 3 tacos ‘S45; Orestes une cups, nl ylune exces (edema, SignetSyrptoms | Sepitaain demon, ypersrson) SP cat ctr stv sop, ee Glomerulonophritis sing ea Stomenuton a Monitor weight (report weight gain of 2 Ib in 24 hr, turing cae orSis int week) Monitor I8s, labs. Restrict fluids, socium, se & Ya @) se “Therapie proectre ‘Acute Kidney Injury ‘Prerenal AKI; Due to de 2d blood flow to | Acute Kidney i ‘oye (hook, eat, hypovlema, rnd | pe ofA ‘sour aosiucion) “+ ntrsrenal AKI: Diect damage to kidneys (physical eT trauma, hypoxic injury, chemical nury du toxin or medications). = ‘+ asvonal AKI. Oue fo obstruction leaving the ketneys (stone, tumor, BPH) ‘Acute Kidnoy Injury ‘Onset: Onset to development of oliguta (hours: ays) ‘Olguria: Urine outputs 100-400mU24 hours (1-3 ‘weeks Diuresi: Start of kidney recovery large amount of ine excratoc (2-5 eats). oocovery: Continues unt complete recovery (up to ‘yen. Diet: Restrict potassium, phosphate, magnesium taka, meee protein intake,Chronic Kidney wats Re tacors (CKD) Chronic Kidni ‘Syms Injury (CKD) =P o& te @| Ga Chronic Kidne l (CKD) ee ‘ee Urinary Tract infection (UTI Whats? Fk aco, Signe/Symptoms, ‘ria rests eae el Chronic Kidney Injury (CKD) ‘GRD: Gradual, reversible foss of kidney function | Risk tactrs: Aging, denyration, AKI, Diabetes, | Hypertension, Conic glomendonephrits, mecicatons {gertaric, NSAE scmmure doves Stage: CFR 00 nin Stage 2: GFR 60-89 milfin Stage 3: GFR 30-59 milfnin + Stage &: GFR 15.29 miimin + Sige 5: GFR< 15min Chronic Kidney Injury (CKD) ‘Symptoms (mostly result of fd volume oveioad Juguar distention, hypertension, dyspnea, tachypnea, | freckles, parpheral edema, lethargy, tremors. uri, uremic fost abe: = Elevated creatinine, BUN ‘+ Decreased sodium, caleium + Increased potassium, phosphorus, magnesium Decreased Hab and Het Urinalysis: nematri, proteinuria i ‘Weigh patent aly (tha weight gain = 1L ful retain). {Diet High carte, moserat at Rastet Sedum, Potassium, pnospherus, magnesium. Protect sn fom oreakcown {ropa patent x hemody, Promote requent ret periods | ede: Digoxin, sacium pyrene (eo raduee serum _polasium), enthvopsiet fo Retease RBC producto), ‘rosemide, Avoid NSAIDs, convast ye, and magnesium. | Snes nti ‘Tract Infection (UTD) LUTE Infect in ww urinary tat, usualy caus by E cl Fisk factors: Female gender (shor urotra, close prenity Ie recur), mropause, sexual inrcours, pregnancy, Siete cocoa, wt bang sus Fecuont bath Unaty catheters, stot ncontnence, Dabets, Inco plete Bladder omotyng, S88; Abdominal pain, dysuta(rnary equencyixgency) ‘ever nv, oma, pyera, eloudyoutemeling urine, Contin older sa),Ga EM Urinary Tract Infections (UTIs, a: Anblnes (croguotes,nichnetoin ine | SleramesPrenazopie adalat Urinary Tract infections (UTIs) tess ee mean | : | Bh | eee I |: Biter i : | eeeesiee ema rton, | rs |" Raia mouitos gece Pyelonephritis Paani ey Wb, ly cased bE al Snow Pyolonephritis | gathene SST Fee novrt wt iota Ret eco Ee MmSyerone ceteretesr Natt ene eae ee Ssrramereouein sie a ee 4% Les TEVESTSTEN | Urollthiasis || Bisiciactons: Male gender, damage to urinary trac tring, Pigh What i | Sey or katy un. unary vtec. enya. Fi factors, Siga/smotoms, Sa Severe pin lark pan pens rca saben) Nursing cre, Medications Sy, lager, a, year, ep, " ra nora using care: oot Rs sain arin (ne sve sone for = Isp analys). erase so 9 Lay. encourage anbulton nad: Ope anapesbs or NSAIDS tnkspasmose ons ut ‘epuyni) EEE Urolthiasis fee | |= ‘ons Sh rds ato SEN lon — Fe ana cg ay epc Pant dain ningun 2 Sinn ont sna ss ipa Ws ak 22 ay gi, be a | 1 Resins tpi ri acta tie + HESaSC aes i cossnenin crates san L ‘Muar, srawoemies, Nests, cnocoiste, us, tea. va + Pocus nan cide gripe ost, he grains, legumes), ‘enneanseyWatis tf Symptoms, Medications and comeetons Patent teaching fa tee) istocele/Rectocel iat ve thay? Rk aco, ‘Treatment a a te @ Fear eae Fibrocystic Breast Condition Sins'Symotoms Days & ts ‘| ati ects . ‘Sas for fens uncer Racorenvod Sesto iN Mato coe mero eed aout). fe ace at ete Fi errr Sorte ae + Endemisis: Orie endmetit tases oss ee ‘Surfennver ons no SEES ‘Menopause ‘Menopause: Corsica of navoasropuiads 12 ara) ‘Symptons Vet tesnar,onreaseden al seen od Sigs decease bone ny. crmane Tory (Ht) or tance, or FRravorat Provrte hot fate oduae vaginal osu oly tnd cetease ah ofbane acres. Taking HT creases aot ‘inbolic events (OVT, stoke) and boast ancerTeshing ‘Gut smoxing mes ‘Rragtreetigh cecangs, and one eae sacking 1 rca eng prtongea perc fre ove an sth (eperequaty ‘+ Noni! Vr cmptons: rater an, oem, ‘art era) oa Cystocele/Rectocole ‘GystossTaMRactocsle: Cystocele ie protusion oF Biacder through anterior vaginal wal. Rectocele is protrusion ofractum though pesteioe vaginal wal isk factors: Obesity, oder age, chronic constipation {amiy Fistor, forceps delivery. t * Yanra passary (sevice use to prende supcrt and nee aaa She rang) + Kool eae (contacto apa and rca + Suga epeie Fibrocystie Breasts: Noncancerous conaion ‘eusing development of forte connective issue nd cysts in he breasts, ‘S85: Breast pain. Rubber-ke lumps, particulary In upperiouter quadrant of breasts Diagnosis: Breast ultrasoundeae eas Male diagnostic procedures Prostate Speci rtigen (PSA) Digital Rectal Exar (ORE) = oh te | Male diagnostic procedures | PSA: Measures re amount of petin produced by the FFostate lane nthe Doodstream Increased amount of PSA an nacate presence of prostate cance ce banign prostate Fypettasia BPH. De NOT da DRE prio raving boos fora PSAD 5 Recormerdes suey fr mars 0 teh Arerean men Scien wt fly hry sol sat seen ete + PSA angimt rogue tater roan, DRE: Paoation othe prostate and trough the rectal Provider insets finger foe aus. * Atreancings Enger had poset, regula shape ear “7 Benign Prostatic Hyperplasia (BPH) inate? SignsSypoms, Labs Meco, ProcecuresSunpery 8 TURP surgery Post.op musing care TURP surgery ost-op mesiatons Paton acting =P gh tee) Benign Prostatic Hy TPH Enlegener! oe posal gu! hatte whe Stew ror baad resding nay rvrean, Ta rosin Incense tke coon andrea mt te ey ‘SRS; Urner eqcnoy, gency, rere, Pesta, [Teonsnonae Poona dring reced unnan sreom fe Homatua, oda. Power! uber vst ose ‘Emote PSA rrened WRG used ineBUM wih dy elvan ‘Ma: Arerogen nba fiasco, Perghorly cag ‘ieerorge famosa en re Hoos vt ptt {Tans reeln of setae TURP suey. Seas ae TURP surgery ‘+ Pationtwithave nding 3a catheter. 1 erferm contnaous blader migaton (C3!) th NS ot preserbod soliton, Goal sheep nigaton oui ight pink Intease CE rate if rigaion outiow i right ed, hetehup-appearing, o contains clos ieateter becomes sbsucod (syremoms:acoer spasm, reucedcutton) Tum of Cl, gate wS0r ‘sing lxge pston syringe + Expoctod:pationt will have a continuous need to nate TURP surgery Analgesics ‘+ Antspasmodies (to prevent bladaar spasms) ‘Antes (prophyiactc) ‘Stool sonaners (to prevent straining) Pationt teaching: Drink 12 (or more) oz glasces of water por doy + Avs caffeine o alcoho! bladder stu) + Ifutine is bloody, stop activi, res, and increase id intake,| Diagnostic Procedures | Mace aetons | Degas ee Arthroplasty hats? Patent symptoms Contvaindkatons Preop care ey ge te @| Arthroplasty. Kae artropiasy postop care a a el 189 Arthroplasty io aneoniesty pastep care fF gh te | ntisoptic soap the righ before and moming of surgery. La ee Procedures "ARASH: Aloe veuszlon of he internal ucts of ‘Contandeate paint has ection or canna Don Beast 40 degrees. | Fluciegr Scan Radioactive rat neces nous before | scan. Repeat scans 24,4, 72 Now's Bune sean delecs | ‘ters, fectures, bone daeaao. Callum sean are more Senatve than bone aoa [xa Used to determine bone mass and presence of Newtiesplacedinto muscle, and |? alviyrecarase during usc coneacion Used {o dagnose causo of muscle weakness, Arthroplasty Arthroplasty: Replacement ofa diseased joint wih a prosthetic ont Used for patients with osteoarts, theumatold artis, trauma, er congental detects, Patient symptoms: Joint pan, crepe, sweling CContraindications: Currenbrecent infection, atrial insufficiency to affected extremity. |_| Pro-op: Administer epostin alta to ineroase Ho, ‘uiologous blood donation. Advise patent to sorb w/ Arthroplasty Post-op Care Intate continuous passive motion (CPA) mactine Immediately ator surgery (if ordered). DO NOT place plow under knee (or use knee atch) inorder to prevent exon contractures ‘Administer analgesics, antbioics, anticoagulants, toa therapy, PPrform neurovascular checks every 2-4 hours Patent should NOT kneel of do deap-knae bene, sp antrepaty Potop cae Pe yuo, ce pa nye pone cum aero 2 Enaaurgs ey ambuston tot verses. 1 ies abtioncowce bomeentags No Sossingof ‘not aw fesion of hip grater than 90 door Enea ote peers tos conctaion wis | + Montero cng stocation: onset of severe oan, |; hearing a pop shotaned alecied exert, eral roles cf sfeces exter + Use tote tte saat hve iow cha,* Tag (rp even exert see ate, pace Amputations SSS Shem wn " Tndestons : "Nursing cre ater amputation + ih ci ae oro eed te ote itt uo i poi concn ga ea wn backs, & | Eee tee eet rent TEINS, Onoposi ee EEE cee fe cates arpa marae, ‘Se. Sotoraneonwioninsiegen Ses ee ate SS ermmeaen Sent ee es eeienareneety ae Sere erg ‘weight bearing exerices, Pome say MUSCULOSKELETAL SY Osteoporosis Whatie sk acer, Signe/Sptons, Diagnosis ‘iedeavons, Patent aaching =F ay te @| Fractures Ged smal rectus: Dogs nl reak Si ce | Fractures won (compound) fracture: Breaks skin surface, ‘toed (ip, Open compan) facta, inceased ako irecion. ‘Campi v noomplee tach Completa fracture: Goes tough entre bone. Tacture: Goes part way trough bone. ‘Comminuted fracture: Bone spltin muitple pieces. 5p oy ‘Gomprossion facture: Gre of mre tones nspae van and calapes (de losting or) 8 Obie fractures Frecture occurs at an oblique ange. | iat facta: Procure fom biting moot (ge of PSGScESael | RRS anne, ro a trauma, bone cancer subetanes abuse, Flick factors, Sgra'Symptoms, Nursing owe | SES. Pan cops, tory n extomiy, muscle spasms, Medeatons, Surgeries ‘ecaria,eccnymesis Nursing ear Stabe affected aoa, lovato atecod ib, ppl Ic, porn neurovascuatassasemonts avery our re: Exiomal ratio: pins atached to extemal fame 1 Opes reducton and nema vation ORIFY ane, plates, ee, 0os used toma 188 ——e—e—e—eFractures: neurovascular assessment Pain evel ‘Sonsation (numbness, tingling, lack of sonsation) Skin temperature Capilary rail (@nould be <= 2 seconds) Pulses EP o& te #1) Fractures ‘Coronet of nowovase asasement WS Ss [casts Handle plaster casts with your palms (ot ‘ingertps!) and wearing gloves unt cast is dry. “+ Elevate cast above level of heat for fist 24-48 howe ‘Tl patent not to place objects under cast * ltching can be relied by blowing cod air rom 2 hai yer under cast ‘+ Report to provider: Hotspots, areas wth incceased ‘drainage, malodorous areas Immobilization devices: L “Types of traction — ‘Skin: Weighs ached to patent’ shin to decronso ‘muscle spasms and lnvabize the extremity before Traclon: Types of action surgery. Exam ‘Bryant actin (lor hip dyslasia in cieran) + Bucks traction (tr hip fractures in adult pint). Solota: Secs are inserted ino te bone. Used forlng | bone facture, ‘wrench ta release rods attached tothe vest, 20 CPR ‘canbe performed! TSS ere ‘Nursing Care of Immobilization devices. ‘Assess neurovascular status every Nour for frst 24 brs, then every 4 hours afterwards, SSeEns immobilization devices ore | | . Sareea eae re Y ees Mae cert el cote I 2a one, Se ene an a For hao traction, move patent as @ unit and donot | = apply pressure to reds.|___ Pin site care, compartment syndrome + Monorfor sions of infection: ireased dine, | Pin ste cre trytnema loosening of pins, skin tenting a pin site | Fracture complications + Clean pins using & NEW eoton tp swab foreach pi. Compartment syndrome: whats, nptoms, treatment {Donel remove crusting apn sto! {cSmypartnet syndrom neraaead peseure witn ry " |__| muse comparmont ofan etry that mare creulation. | Late ae | 1k Alieecarrose = aa ___ Fracture Complications. “EaLemboligin: Fat globule from bone marrow travels t lungs, impating rspiratons. Long bone and hip ‘factures are most common, +” Symptoms: Dyspnea, confusion (early sign), Tachypnes, tachycardia, petechiae on Upper body Alato sont) 4 | osteomystts: Bona infection ; | | Oo Symptoms Bone pan ertheme, edeme, fever, | || 7 stead wie E = | | + Hato engtom nit hrpy sual 164 H Fracture Complications Fatembolar: what it, sympoms Osteomyelitis: whats, symptoms, teaent “ebriement of bone, hyperberic ongen therapy BeUResa tania Ostooarthits Ostooarthritis | | SR Posie capnestoneraranar whatiei? Risk ncors: Older age, women, obesity, smoking, epeiive sess on ts Sumploms: Jit paises, cpus, enlarged joins, erberden's nodes (stalin alangeal joints). Boucharas | y | | ols ronal phous ih cE] | | Pegg Ee ee? Baan res | ‘+ Splinting andlor use of assistive devices, Fisk ators, Symptom Paton earonenehing {Physical horepy {TENS (ranscutancous sects nave staiation) SeERSai Osteoarthritis Osteoarthritis ‘Oral analgesics (acetaminophen, NSAIDs) Medications Topical analgesics (capsaicin): Wear gloves when Surgery applying. do not apoly on areas with broken skin, ‘buming sensation is normal ‘“ Glucosamine: Ineveases syrevil fuid production ‘and helps rebuild carlage, + Injections: glucocorticoids, hyaluronic acid ‘Surgery: Total joint antropiastyative deoase process Pain wih activity, get bettor wih ost ‘Atecs spect ns, NOT eymmetcal ‘ects ALL Jos, symmetrical Swan neck and ovtonnere deformites, Pattve teu faster Meee Diagnostic Test Clue snd Sonsiivty: Used to identity and treat Doctoral skin sions. Get culture prior to etarting antibiotiest Final eaultsin 72 hours “+ Cuiture denies the pathogen. ‘+ Sensitivity determines which antibiotic can be used toil the pathogen, 1: sive Used to diagnose viral skin lesion, 2051 Used to diagnose fungal skin lesion. MIE Treatment of skin infoctions Sociol injections. Bathe wantbactenal soap. ‘Treatment of: Remove dried exudate before applying topical Bact e antibacterial ointments. ‘ ch os Vil nections: Apply Burrow's solution to promote am crusting of lesions. Avold restrictive ciothing, Topical antiviral ointments (ex: acyciovir can be used Fungal infections: Apply antfungal cream or powder (ex: clotimazole) BID for 1-2 weeks after lesions are no longer vibe. ESE cE laa filme ec nareuts neoacten Sharats by pers ef anon ar emacs, gel paches tigturbleg a + yc sec amaroone Dont ep oe tn, EE cay neeepreeamarnae Feeney era, — SERRE teen heou greg ssonergate Peseta tee cee es aeDEE Seborrheic Dermatitis af ah ta a DCSE Burns =F of ta @| cE Burns ey ge te | INTEGUMENTARY SYSTEM. Bums INTEGUMENTARY SYSTEM Seborrheic Dormatit 50 lammation a aeas that onto ‘high love of exbaceous glands ex: eal, foraheas. nose, {mn aula). Characterize by pene of exacerbations end Fomsions Most common pe anf "Waxy or ay plaques or sles in ol pars ot + Topical cotcoeoride 1 Atisboreie shampoos (Le. shampoos containing selenium) Use several ines a week, fave In Rar fot 23minutes MESES i Cotas of 20 tno + Had = 66 bch am = uch ng» 18%, arr torso= poner too™ se poral en i Damage eptioms. Renk clr, no tr. + Si Damage to ier, and sear bicees tose : oe encase coco hie NS bine Sly case Se er ee Novice Har ctr veers + Deep al ekness: Domne al shin yes Bick coker. INTEGUMENTARY SYSTEM Burn: au ent Pd she toes spec, esting po + Ube Eval et Hob Hypanatei hypekaen LEST Sie tence carn, on * Buld mdz (Ore to 48-72Rowsarinuy. Fuge vac ys, + Late Doscased He, Hop. Hyponomia, ypc Dereacod prota albumin Tri Boge when wouns ee heae, and ons when econsrucive pocoure are cpt. INTEGUMENTARY SYSTEM + Prevent infestan: no rah plansowers, no resh frutsvegnes, it vistors. + rode tttional support nerease aloe and potin Inake, Provide TPN as ordered. + Preserve pation mobity Active and pasive ROM feverees to prevent conrsctures. Apply pressure sressegs ss oresDEES Burns ee tes Deen ee Burns ra for fr a ta #| gnostic te Water ception test Vasopressin test tee NOTTS Diagnonti testa mainenaaee fate 8 MEE eSSe Burns + Stop burning process. Flush chemical burns with fo volumes of war De not ep roma lotons ‘or tor to bums, + -Ramtrtlanus vacin (feppeaba. Nanton sway" Singed oyebrows, nasal hae, md sooty sputum are indieations of inhalation ee BoB reresongeres oo ce rt eR tan elecons oan ‘plasma expanders os MeN : eoieaemeee oe . ‘Slo outdneneflvaene: Aca does ma pestte Sees ee Sennen 2 Sa eee Se eecrennnsenwe + Sagoteenns Diagnostic tests air derivation fect Tests to coef the Kigraye are abo to concentate ure when blood oamaaty mcrease. F Keine re unable o concentrate uno, i is wecatve of hpnogene Diabetes insipidus, ‘+ Procecure Obtain weight and send boos, rine ‘amples tolab nour \Yasooressi iss: Tests to see ecninstion of subcutaneous vasoressin increases une spec oraiy. IF ‘oeoprensn causes Ineeaze insrne spect gray, ns Indeatve of neurogenic Diabetes Insipidus (1 ssue wth try ene, EY MESan Diagnostic Tests Dexamethasone suppression est; Tesi to soe F ‘administration of dexamathasone (sterad sim #0 ‘naturally occuring cortisol results in dacreasad levels ‘OnACTH and corte. thar ie NO deeroaee, this is indecatve of Cushing's disease. ACTH Stimulation tos: Tosi 6 600i administration of ACTH inereases levels ofcortal in body. If thece is NO increase, this is incicatve on Addison's disease. ‘+ Procedure: Collet two 24-hour urine samples (one before and one ater administration of ACTH),iagnostic tests | Fasting bood glucose | ral iene tlerance fst | Habate | a tee) | Pheochromocytoma tee 180 \jabetes Inspidus What se? Sions and symptoms abe [EP o& te @| Syndrome of Inay late ADH (SIADH) ‘What it? ‘Causes ‘SignsiSymptoms oF ob ta el Diagnostic Tests text Nox vel < 110 mgs. oral glucose tolerance teat: Fast fo 10-12 hours before test Take fasting leas gluco. Patent consumes specie ‘gmount ef lucoce Blood sample akan every 30 mrutes for hours Normal levle 0 mo WinbiAIc. BEST Indicator of average blocd glucose evls ‘verte pas 3-4 monte. ‘Se 5 Phindcats no dabetes [Betugen 87 = Os indatespro-dabetes Pheochromacytoma ‘Pheochromocytoma: Benign tumor on adrenal land ‘auses hypersecretion of catecholamines, resutng in Increased sympathotie reeponse inthe body. Sympions: Tachycardia, hypertension, cigphoress, Diagnosis: Pesme-tres metanephrine test, clonidine “suppression test Meds: Ant-hypertensive medications unit surgery. ‘Surgery: Remove tumor from adrenal land, i Pee Diabetes Inspidus SR Deny AO esa 1 Large amour of ld une, oy ype surance ymca es, ests Ba * ua: gecrenseo svete ty (1009), decreed + Bing! NEREASED Soom xmcay (= 10'mOem), Diagntse tar dentaten ast Vasopressin ts [ist Abe estore oo or sacopose, Pevvanaas tna, ca? sam assageeey Bare Irion " Ease ‘Syndrome of Inappropriate ADH (SIADH) SIADIi: Excasive release of ADH tom ne posterior ‘pituitary gland, resulting in increased reabsorption of ctr (nt stu by he rays uns: Bran tumor, aad monn, mediators | S&S: Small amounts of concentrated urine. Fluid volune excess (ocicarsahyprtron,crecis, | Stoned eck vs wet gan) heaton \reainens,musse camping conten S62iKes comaSyndrome of Inappropriate ADH (SIADH) || * lememeneatensmatertye 3a Nursing Care (nudeg medications) a socks eainaeas Nninanienes Gnome oh ta a Fhe esto, Monit 80s (watch for hyponatremia!) ‘Weigh patient diy. Provide hyprini Vf (ex 8% NaC, Acministr roseride (cure) as ordre. A mo rsinmag nee 1 iene ale ee ce mamaria Rermereereey iGiecestorers ugetteaoe Heesctemnemme/ ers EEE cee nemo fe hene inners reer ee i Synthesis Pathways ‘Thyroid hormones Conta Hyperthyroidism {jot Exeass thyroid hormones (3 and TA) ‘eleased for tyra gland, resuling in hypermetaboti ste. | Causes: ‘Primary (sve wid lene) Graves disease (ost ‘omnmon caus, autsinmune as) er hess nodule causes hypersecretion af TT. ‘+ Secondary (ssue wih puta gana): Amero putary |: ‘Ban procures too much TSH (Sue tumor + Teniay (osue win hypothalamus: Hypomlamas > ‘rodces eo mucn TRH, ft ‘SHS: Tachycardia, hypertension, heat intolerance, ‘exophthalmos, weightloss, insomnia, carthea, warm! sweaty sin. Labs: Increased T3/T4, decreased TSH (in primary ‘Nursing care Fee eden) | Nursing eae: | * Nation, increase pationt's calories, protein | te 186 | + Exophthaimos: Tape eyelids closed, provide aye ricentHyporthyroldism | Imm NDOCRINE SYSTEM agit My sen ent ite, seca OR, + Sin pn os ps, ey, ‘Suge’ Thc moval of yi and Patent wit ood ye eplaceman herapy fo te fet of eta ‘lace pater niger poston 1 rower ara manor hanertagng Check desig an ‘ack ak for utd. Supper puter head sed rece ‘ith pilowshenchags, each feat vos neck ‘centice + Have tacheosiomy sup awe abe. 1 Monitor or sign of parathyroi land damage S8S of {yporloma rates tena ut es, ‘musce och. postive Choe» Touseus Ses ‘emer cleun ues fr Yoetent of hyposaem + Barter sero ora ean postop 188 2 Thyroidectomy Pt rececure Nursing care “romonts ria metros gang ome * Ribas si coerce" Serta ue pl Pc pata 4 Shinar eF ee a Gee ne ean - Teena ugaa map sige rE eaten | Seeaeticrseas aamtiymer” | [keane eerie i Nursing care: + Encourage frequent rest pcos. {Encourage low-caloe high-fiber diet and inereased activity to promote weight oss and prevent ‘Sonstipaion. No fiber laxatives (ntrfes with fevotnyroxine absorption). | | 7 |) «Sera De comtngana inieeneaes I ea Se aera gait | ether ry Hypothyroidism Nursing cae eds water‘Causes: Untreated hypetyroiis, ection! hess, sup eiscontnuaton of levatyroxine > Sumploms. Hypoxia, decreased cardiac outst, Aecteased LOC, bracycarda,typotension. hypatnermia. i 2 Musing care: Matin patont array, monitor | ECG, warm paler, aumsterlaroe doses of | levothyroxine i Eee Cushing's Syndrome ‘as Same: Ovrom of conctoy ne wane Cushing's Syndrome ‘What it? ‘Causes Sign! a Le sie Cushing's Syndrome Cushing’s Syndrome a Blagg 1 i brome eum, eae nt of potas, ‘aciyeme Renata | tear re | “Torapauti procesureneurgetes 1 Ppa un nm tresiou | = 1 Tdecsras aera conor een, | (=) a | |Besaesantee rn I | = Spe fi ect maticn \ | oe = ‘Misting fennel ser ga eaneneenorere Somme eerie |e ENDOCRINE SYSTEM lypophysecton + Wont or 3s of CF ak Hypopieysecioen > Hala in riage (len center, etlow Post procedure Nusing care » Sheottaning ainage 5 ler orange ram ne nose 5 Heaasche . ee ell oP gi, seers | a seoiesreece neces act S| | . Shalem + Dont brush tet or 2 weeks (ossing and rising | mouth OK),‘Addison's Disease Causes Slonsymoms oe te @| Addison's Dis Diagnosis Ninel are Compiesions| ‘EP o& te @| Diabetes Mellitus What i @? Stype8 | =? a te «| Diabetes Malus | es Signs/Symetoms: | eT & te él I ‘Addison's Disease | Aaison’sDisaase: adequate secretion of pormones by — | {etee cox astro, rs, sx Noman. Primary (adenccrtalnauteleny): damage or 7 Reutatech ade | Gatinaion tino) + Seton pin stncton pty mare | gag Meee emanate (oronze kn | Ee erent parla and calcium. Dcreazad |Fedum goose sorts EEA ‘Addison's Disease ‘ibaa: ACT Snub os mins ACTH, measure | ong ep tr 30, Pet OT hnanyaagaons cone ee donate {Sond Aston erie 00 ran | usage ‘rst seats toes pednsoe) ‘emer hte, skchoycs a err (Can glons)cacun some nen «= Frathypeayams ot sspnncts gos doce aoe tea ei enc Enea Diabetes Molitus Diahaios Miliias: Crone rypergycemia dua ineuffoent insulin producten by he pancreas andr insulin resistance of el inthe body. ‘Types of Diabetes ‘ulommune ystineion Patera re nauin- dependent. Usually stats a younger a=. ‘+ TYEE 2 DME Progressive sul resistance an ‘eereasea insunprocucton ct chesty, nace, sna rod. Usualy stars ater. ‘+ Gestational DM High bood glucose curing pregnancy Diabetes Melitus Risk factors: Obesity, hypertension, hyperipideria, ‘smoking, genetics, race (African American, American Indian, Hispanic populations), inactivity ‘SES: 3 Ps (polyuria, polydipsia, polyphagia), hyperglycemia, weightloss, dehydration (decressed skin turgor, weak pulse, hypotension, dry mucus membranes), ty bres odor, Kussmaul respirations (Incressed rate and depth of respirations), ay, headache, decreased LOC, + “Type 1 ON Destruction ofbeta ob in panereas du |Diabotos Mellitus [Sa ew naa emia | Dagnoss FB ioe: Best indcator of vermont complance ee aa esoatone | i a al er of otra congnc, oa a ‘tin Dabels a paie <7 & et) “eee. . cndbpadentsttgen nom meter ipo Ming insuins: Draw up dear (shorter-acting | insulin) before cloudy onger-sting insulin). | Never mixlong-actng insu (2. Insulin glarine) | © wetrotner insulins. I | + Monitor for signs of hypoglycemia (contusion, | | ‘daphoresis, neadache, shakiness, blurred vision, ‘decreased coordination). Hypoglycemia Famopivoernia ‘iypoulveemils aod uease <= 70 maya Hypoglycemia onsets: nat ood ghcnse eval nate rypogyenmi? © Consima absorbed catohysrate (ox: ‘Management of hypoghjeama n conscious and ‘ore ors ck ° unoareoous patents + Recheck Sood glucose ln 15 min. fst <= 70 mpl, ‘span shove i and chk aga 15m : eerie & tet) See tonal Be Coreen Soe alent is corscous (an can saw sale), have aot salen aaneune a earbenyeras ance E Foot cate for Diabetics [epee cay ‘et wa lope wih nas, ese lukewarm water. Foot care for Diabetics Key pationt eacing TaDiabetes Melit Compsicaons =? a Ye #| fT ENCOCRINE SYSTEM] Diabetic complications, DA: Rick aces, symptoms, nbs Tbe el Ee ay DKA and HHS Nursing Ca Ptienttescing a ta ai|| White Blood Colls ‘Expected anges Louokopens, Leukceyess, Neuopeni, Let Shit =P gh te @| Diabetes Mellitis complications. {+ Cartovasctr 08856 Ml mpeensin DabeteetnonstyIrgares sen 5 Sapte nee, Nev ae arg ornate «_Diaeteneprepany: Key esrage 1 isete ktesaee [ORAL Lietveteig craton wih Eloes gusse >000 mga aravetones nace an une. Repisenset ere common wen Type Oh + fivpemicemleperamns si 5 Lésteatoang eon bine pcos > 60 maine eto, sue tienyeemton Gres ont ere common wth Typ Diabetic complications pata: ten, st nated or ncaa jn 78 af HO tre no rin Het | een eee + Bly fred une 200 mer wept or Leuicopenia WBC < 4,000/mm*. Can indicate presence ‘Fautoimmune disease, bone marrow suppression, drug toxiiy LLoukacytosis = WAC » 10,000/mm. Can ineicato presence oFinfecton or inflammation. | Neutropenia = Neutrophil count « 2,000imm*. Inaicates compromised immunity “Loft shift” [banded neutrophils) = immature nautopnis when body = fghtng infection, Indicates release of|IMMUNE SYSTEM ‘Types of WBCs ‘+ Neutrophils (55-75%): Increased during acute Bacterial infections ‘Types of WBC + Lumphocvtes (20-40%) Increased during chronic Dactenal of vial infect, + Monocytes (28%): Inereased during protozoal and val infections, tuberculosis, ehrene iiammation + Eosinophils (14%): Increased during allergic reactions of paraste infections, ‘+ Basophils (0.5-1%| nereased cue to leukemia IMME “Types of immunity of immuni ‘tive natural immunity: Body proauses anibodes ae sual inresponse o exposure ta ive pathogen. | sve tal ‘ete ata! Immunity: Body produces abodes acs rtal inresponse vaccine Paste ala Passive natural immunity: Antaedos are passed v from the mom to or baby tough the placentaor | [=F a . breastmilk E Passive artical immunity: immunogiobuins are fh dminsteres'© an rival ater ney have een {f ae xpesed toa pathogen E Ba F Key adult immunizations. arog * Frmuresonpeiled Mies cae snsie ore ine + $igoossea atin: Rccmrensa inhale Wan roar iagaasta or otters ncage doe «+ Hepes got arene enone erase Se yore 8 Koy adult immunizations Pheumococsl, Meningococal, Herpes zoster Key points about vaccines Expociod side eles using cre, Doourentation expiants, ot Eien iy SS Low + Muraing ete Arse arto cot cores Sada perio raacn oes tary * BinutBerownrion am, pis nanesicesegraare 4 ett gaat ec ef ge tee 209 I MESA Vaccines Fang HE NOT ed or ON COS a HT So Srneus rantiyctfeocon oa acne. vuuinn Seay cvconaon Pregame: my acces Sere tmmsadescane (a HW, cee, knptem sect : = | | | aide om. ta a) “Ste oo : Sateen Vaccines CConrsinccaions (general sr speciHIV/AIDS. nat HV? Fick actos, Symptoms ADS: CDs# count symptoms ef ge tee an HIV/AIDS Diagnose odiestons| Patent teaching =F gh tee! Lupus ati 2 ain yes of Ls Fk factor, Sire'Symploms =F gi te @| aa Com a gi, m aS HIVIAIDS, IV: Reoviue tat orgets COa+ prphoaree TSI sulting in dacreaeod neuro function and suscapiy ‘Gfectons AIDS = Stage end-stage) HIV ifcton Risk factors: Unprotected sox, multiple sox rarer etnaal exposure (ll prognari women shoul bo tote, Wraug use, neat cre werers. ‘Symptoms: Fu ne symptoms, weakness, ight ests, a0 Fenda, weight oe, rah q Stage 3 DS * GDL} < 20 saison? + Symptoms: Kapoa's sarcoma, TB, pneumonia, wasting lb ‘Sycrome, canal ofa ewoys, Rares, oer maton. (MNES HIVIAIDS DIagnasis: Posive ELISA est, confimed with Waser Diattast ‘Mods: 3-4 Anirtrovral medications (many end inv), Patione teaching Practice good hand hygiene, bathe daily with antimicrobial 900. ‘Avoid raw foods ‘Don't lean cat liter boxes, ‘Aveid sek people Practice safe sex {Ongoing menitoring of CD+ counts MNS ‘Lupus Lape Aviemore carder at causes One Inflation inthe body. Thera is no cur. Diseace ie charactorzed by ods of exacerbatons and remissions. + Disco ets ekin ott rash) 1 Siete: Afecs the connective dasues in mulsple exons Risk factors: Females, ages 2040, race (Aican erica, Asin. Nate American S&S: Fatigue, int pan fever, butterfly rash on face, Rayrave's phonomenon,aneia, pencacis, Iympnadonopathy. ope eerestnenneecoteesteee Le ea eae eee Soa eee ete {hydroxychloroquine), topical steroid creams for rash. Pala an aa lenencnieneenal eeseaeeaesIMMUNE Gout iat it? isk actors SigreSymptoms editions 2F o& tee 215 Rheumatoid Arthritis (RA) What? Fisk foctors Signs!Symptoms abe =F gh te al a6 Rheumatoid Arthritis (RA) Diagnose, Mecicatons, Procockres, Patent educate, ‘Complestons ey & te a7 Cancer Rak core ‘Staging TN) Degrosc ae & tee ‘Gout; infammatory arth, resuting information of uric ‘oie eystale in jonts ard boy becuse, Risk factors; Obesity, alechol consumption, high purine ‘it (moat), carciovascular disease, starvation doting, ‘SBS: Severe joint pain (most common in ‘metatarsophalangeal pit in great toe). Erythema, ‘Sweling, warmth in affected joint. Tophi wichronic gout Meds: + Acute gout: colchicine, NSAIDs, coriosterods. {Chron gout: allopurrol, probenecta Rhoumatold Arthritis (RA) Characterized by prods of exacertatons ana reissions isk actors: Female gender, ages 20-50, genetics, ‘SBS: Jant pai, morning ness, skg.o, nt sveling itfeyéhema and warn wan neck and boutomire ‘etomites in angers, subcutaneous nodules, fever, red sclera, bmphacenopahy. Labs: Positive Rheumatoid Factor (RF) antibody, Positive ANA titer: Elevated WBCS, ESR and GRP IMMUNE SYSTEM Rheumatoid Arthritis (RA) ‘Diaanasias Artrocentesis (aspiration of syroval uid fom in to test for Os, RE Meds: NSAIDs, immuncouppressais (prednisone, ‘etotrxat), antitarilagets(hydroxychlroqune). Brocadures Posmapherost (te remove antbosis rom ood, total jt artrtasy. Balen education: Tle Ret shower 0 reheve morning sifess, physical activ fo prasere ROM, use of assistive ‘Comaicalions: Sjogren's syndrome (dry eyes, cry mouth fry vagina), UNE SYSTEN Cancer (RISK Iaciors OWer age, gonetes, smoking, sur ‘exposure. Det high in fat andor red mest, ow in fiber, Staging (TNM) ‘© T= Tumor (T1 ~ 4): sae and extent of tumor ‘+ N= Node (NO—N3) number of regional mph notes invoives| + M= Metastasis (MO, M'): presence of metastasis (Wo = no matastasi, Mi ~ metastasis presen!) Diagnosis: biopsy (dfintve),imagng (URI, CT, PET oan, ultrasound), k iCancer Treatment options ‘Complications associated with cancer tratment a1 Chemotheray Preventing Infection Nursing care st ot te @| Preventin: Paton teaching Infection Chomot complications "Nursing care and Patent teaching fer: Mawttion Mucosis er o& te @ = ge te @| & tee mt Cancer Teeatment onions; Tumor excsion, chenotierapy {eestoys rapidly cving cals, acrinistres trough Implant porto central 1 catotr). radiation therapy hormonal heraoy,enmacesherepy. ‘lait (ue ineeased metals, nai 1 ‘digest ancor abso nuns, nv dve to chemo) Infocon cus te lnmunosuppression) ‘Acpecia ‘Mucosts(intammation of gurninouth Anam, hrmboeytopene ue fo msmunesuperession ‘Chemotherapy: Preventing Infection + Inite neutropenic precautions for WBC < 1,000 re ‘+ Monitor temperature; epor temp > 37.8 degrees C. ‘Restrict vistors wno are il, ensure vistors perform frequent and hygiene ‘Avoid invasive procedures. No fresh flowers, plans Keep dacicated equipment in patients room, ‘Administer flgrasim o increase WEG count Chemotherapy: Preventing Infection + Take temperature cally report temperature greater an 37 8 degiees C. + Rid crowds {eld och fits and voggies. 1 eid yard work, gardonrg. Do not change cat ter box ‘Da noteonsume figs tat have been sting steoom fr tompettire = rout i \issh dishes in hat waar or in ctwasher, Wath fochonush in dhwacher daly or thse bleach soliton): Do not share toes wih thers! INS ‘Chemotherapy complications Tanto ERE ca: Ary rome as ox onsen, + Eee cat: bt ng pan ess, a or ‘eam erparre ood, ar one 8 igs, Nh betan muertonc dt Use spelen a add Nursing cave: Provide orl care lore an after mel ering hee glyenn or alcohol conning foutiwach Pea mou woo calunn von 3 ey Ue sat tobias Eat sottend ods (vcd spy, sah, Seid ode) scramble oge ao & ood choeeChemotherapy complications Nursing care and Patent caching for ‘Anema, twombocytopenia =? oe ‘a &| Radiation therapy Paton care an teaching ef ah te z| Skin cancer Toe man ps & te é 2s Skin cancer [ABCDE assessment cf skin lesions ‘Treatment options /Anemiathrombocytopenia: ‘Nursing care: Administer epoetin alfa (increases RBC) and fortous sulfate 2s prescribed. Montor for blood in stoo, urine, and vomit. Avoid IVs and injactions when possible. Apply prolonged pressure aftr blood draws or injections + Patent teaching. Use electric razer, sof toothbrush. AvolG blowing nose vigorously. Avoid NSAIDs. Prevent injury due to risk of bleeding IMMUNE Radiation therapy Fiigpal Radiation ‘PSUR over args area wil bs marked, donot wash off + ash Skin over elected area wih mitsoap and wate, bey pat ry. se Internal Reciaon Ther ‘Paap door coaed, it waming on coor, Lira stor fo 30 mi, vst, mantain distance of >= 6 1 Henle apron end doumeler hm Bede, IONS ‘Skin cancer =u + Squamous ca; Rouphvscaly lesion; atts epdeims. ‘+ Basal col: Smalbwaxy nodules; affects epidermis ‘and possily dermis. Most common type of skin + Malanoma, New mole or change in mele. Most ‘deadly form of skin cancor Use ABCDE assessment MNS ‘Skin cancer [ABODE assessment ‘Ax Asymmetry B= Border (regular) C= Color (pigment varies across mele) = = Diametar (width > 6mm, the size of pencl eraser) = E= Evolving (change in appearance, ornew bleeding) Treatment: Excision, cryosurgery, topical fenemesherapy (-fuorourecl cream), Mohs surgery. Fate‘yma leukemia? Wiha i iymphoma? Nursing care prone, treatent options =? go te @| DNS EM Broast cancer Risk actors, Sgne/Sympioms, Treatment optone Nursing eure and pao teaching of mastectomy =? a te @| D JUNE SYSTEM Prostate Cancer Fisk aco, Signs/Symptms, ‘La, Trestment opsons EP gh te €| Surgery Phaces of Anesthesia (2) Modicaton prvided curing sugary et ge te Leukemiallymphoma LURGIRIA: Cancer affecting WECs; causes deatrcion |ofbone marrow. Overgrowth of cancerous WCs | provents growth of RECs, platalats, and normal WECs, ‘Lymphoma: Cancar affecting lymphocytas and iran ‘des. Two ypes: Hodgkin's ard Non-Hodgkin's yemphoma, riorties: Prevent infection (duo to neut-opania) | Prevent injury (éue to tombocytoperia) FE | Treatment: Chemotherapy, raciaton, sone marrow | [wansolan 4 IMMUNE Breast cancer ots Conds a Tamy son), oxy moran, ie Fstop gr s of er cones smo, mono replacenert theropy, bay. Fem roron onoolore, Degg ep ‘Teaimen:Parmone heaps Voor tmonon, impoctomy, mately). ata wan oot ing. 1 Domtsiber econ oa Sad rnd rssein Risk factors: Oiler age, high ft cet, (Aean Americans at higher sh, fay history. ‘S&S: Urinary retention, hesitancy, frequency. Frequent bladér infctons, hematuria (late sign). Labs: Elevated PSA (> 4 nim). Take PSA before digital rectal exam. “Treatment: Hormone therapy (ouprois), ‘homotherapy,radiaton, prosiatectomy. Surgery performed, airtenance of away + Emergence: Completion of sugary, away removed. ‘Saraery ede Anesthetics (or beraodlazapnes,popot) * Opi anaes ox Tontany) 1 Antemotes (ox ensarsetron metolopramise) 1 Nouromusouiar bockee agents (x: succnylchone) 1 Anterenargs (x ane)Informed Consent Providoreepensibiis RN responstbios Malignant Hyperthermia Post-op Nursing Care Nasing cae ater ae fom PACU a ‘a é| 26 SSneeaw Informed Consent nee, + Conmuncale purse of proce, ad comets lauipsan rosa ena poate pray ngage {Use meet teeta. + Sipe ris vs beta 1 Dosmbe ner opens eat the exnatn, saiegponstanes: ae Ete rio gre he pate the above omaton 1 Erne pst corpo gv cmesconse fat a aut eraropmecmner nt oare) 1 Neti rr pater has ve questions or dost Malignant Hyperthermia [Malignant iyperhermia: Hypermotabolc Covaiion induced by anesthete agents in surgery. |Sumotoms: FEVER, tachycardia, hypotension achypnea, dysythmias, muscle gilt, motted skin, eyanosis, |Tcestment: * Discontinue surgery. {Ramanan canfeone (muscle relaxant) as orered 1 emanate 100% oxygen, aoiin ABC 1 Raminstr cod NaC! 1 Hid, appl cootingBanket Post-op Nursing Care: PACU assessment pre-op love), respratons, lung sounds. Suction ‘Secretions if needed 1+ Assase Cireulaion. Assess fr signs of hemorrhaging hypotension, tachycardia), skin Coloriemp, peripheral pulses, ECG readings ‘Assess vil signs (stable for dc from PACU) Monitor 180s, Ensure urine output >= 20 mh ‘Assess surgical wounds, incisions, dressings Eneure roturn of gag and ewallow reflexes. Sens SNS Post-op Nursing Caro: Nursing care after PACU ‘+ Assess ainvay. Check S02 (should be » 95% or at Encourage early ambulation Prevent DVTs: apply SCDs, repost frequently, administer antoagulants ‘+ Treat pain, nausea | Monitor for $48 of infection at surgical site {radness, extreme tandecness, puruont drainage) > Expected findings: pink wound edges, light edema, slight crusting at incision i ‘+ Teach patent to spint wicoughing and deep breathing,