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Study Guide for N120 HESI Cardiovascular y Coronary Artery Bypass Graft (CABG): the construction of new conduits

(vessels to transport blood) between the aorta, or other major arteries. o Requires use of Sternotomy (opening of the chest cavity) & the use of cardiopulmonary bypass (CPB). o Internal mammary artery (IMA); most common artery for graft o Palliative treatment for those with CAD, not a cure Stent: an expandable meshlike structure designed to maintain vessel patency by compressing the arterial wall & resisting vasoconstriction Peripheral Vascular Disease (PVD) o Most common disease of the artery caused by build-up of fatty material w/in the vessels (atherosclerosis). o A gradual process where the artery gradually becomes blocked, narrowed, or weakened. o Causes: ischemia, gangrene, stroke, blood clot o Risk factors: positive family Hx, > 50 yrs old, overweight/obese, inactive lifestyle, Diabetes, BP/cholesterol/or LDL (bad cholesterol), plus high triglycerides & low HDL Congestive Heart Failure (CHF) o an abnormal clinical condition involving impaired cardiac pumping. o Results in characteristic pathophysiologic changes of vasoconstriction & fluid retention. o Classified as:  Systolic failure (inability to pump blood)  Diastolic failure (inability of ventricles to relax & fill during diastole). o Left sided Heart Failure is related to respiratory conditions => ex) Pulmonary edema  Dyspnea, wet lung sounds, confusion, cough, tachycardia o Right sided Heart Failure is related to peripheral conditions => ex) Peripheral edema  Peripheral edema, distended neck veins, nocturia, weakness, weight gain o Collaborative management: decrease intravascular volume, decrease venous return, decrease afterload, improve gas exchange/oxygenation, reduce anxiety,  B-blockers, ARB s, Ace Inhibitors, Diuretics, Nitrates Dysrhythmia: Cardiac dysrhythmia occurs when the average adult HR falls below or rises above the normal range of 60 to 100 beats per minute (see page 849 for various types) o can be seen using and electrocardiogram (ECG) o determine serum drug levels (especially K & Mg), determine drug levels Deep Vein Thrombosis: a disorder involving a thrombus in a deep vein (most commonly the iliac & femoral veins) o the treatment options are anticoagulation, thrombolysis, embolectomy, surgical revascularization, or amputation  Anticoagulants are administered immediately to prevent further enlargement of a thrombus and inhibit embolization. (Administer heparin!!!!!)  Prior to administering Heparin, check PTT or APPT values!!!  1.5-2.5 times the normal control  When using heparin, don t massage area or aspirate

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Respiratory Trauma y Acute Respiratory Distress Syndrome (ARDS): Serious reaction to numerous injuries to the lung. o Characterized by inflammation of the lung, parenchyma leading to impaired gas exchange with concomitant systemic release of inflammatory mediators causing inflammation, hypoxemia and frequently resulting in multiple organ failure. This condition is often fatal, usually requiring mechanical ventilation and admission to an ICU. A less severe form is called acute lung injury. o S/s: SOB, tachypnea, & confusion Emphysema: Increase size of air spaces w/ loss of elastic recoil of lung due to hyperinflation of distal airways causing airway obstruction. mphysema & bronchitis are known as COPD o Destruction of alveolar walls & diffuse airway narrowing causes resistance to airflow because the loss of supporting structure & bronchospasm further impeded airflow. o Clinical manifestations: cyanosis, barrel chest, crackles, dyspnea, clubbing Superior Vena Cava (SVC) syndrome: results from obstruction of the superior vena cava by a tumor or thrombosis. Most common causes are lung cancer, non Hodgkins lymphoma, & metastatic breast cancer. o Clinical Manifestations: Facial edema, periorbital edema, distention of the veins of the head/neck/chest, headaches, & seizures. o Treatment: radiation therapy to site of obstruction (chemotherapy may also be used) Laryngospasm: a brief spasm of the vocal cords that temporarily makes it difficult to speak or breathe. o Clinical Manifestations: Inspiratory stridor, sternal retraction, acute respiratory distress o Treatment: O2, pos. pressure ventilation, IV muscle relaxant, Lidocaine, Corticosteroids Breathing Exercises: may assist the patient during rest and activity by decreasing dyspnea, improving oxygenation, and slowing the respiratory use. o Typically performed by Respiratory or Physical Therapists o Main types are:  Pursed Lip Breathing: purpose is to prolong exhalation and thus prevent bronchiolar collapse and air trapping. (slows RR) y Patient taught to inhale slowly through nose and exhale slowly through purse lips (as if whistling) y Recommended for severe COPD (diaphragmatic breathing may cause hyperinflation, thus is not recommended in this case)  Diaphragmatic Breathing: focuses on using the diaphragm rather than accessory muscles of the chest to 1) achieve maximum inhalation 2) slow the RR Fingernail Clubbing o a thickening of the flesh under the toenails and fingernails. The nail curves downward, similar to the shape of the round part of an upside-down spoon. o Seen in those suffering from chronic hypoxemia, cystic fibrosis, lung cancer, and bronchiectasis (also may be seen in COPD) Pneumonia: an acute inflammation of the lung parenchyma caused by a microbial organism. o Acquired via aspiration, inhalation, or hematogenous spread o Clinical Manifestations: fever, chills, SOB, cough (productive purulent sputum), chest pain, confusion (elderly), hypoxia o Treatment: antibiotics (penicillin), antipyretics, analgesics, bronchodilator, flu/pneumonia vaccine, increase fluids, breathing/coughing exercises, O2 therapy

Crush Injury: occurs when a body part is subjected to a high degree of force or pressure, usually after being squeezed between two heavy objects. o May result in: bleeding, bruising, compartment syndrome, fracture, laceration Chronic Obstructive Pulmonary Disorder (COPD): a preventable & treatable disease state characterized by airflow limitation that is not truly reversible. o Encompasses chronic bronchitis and Emphysema o Cigarette smoking is a major risk factor toward COPD o Characterized by chronic inflammation found in the airways, lung parenchyma, and pulmonary vasculature. o S/s: barrel chest, decreased abd. breathing, relying on intercostals/accessory muscles for breathing, non productive cough, purse lips breathing, hypoxemia, cyanosis o ABG s: usually assessed in the severe stages and monitored in those hospitalized with acute exacerbations. values 7.35-7.45 35-45 mmHq 21-27 mEq/L Sample Ranges

pH PCO2 HCO3

X Respiratory Metabolic Acidosis Alkalosis

X Respiratory Metabolic Alkalosis Acidosis

Endocrine y Chvosteks sign (tetany???) o Chvosteks sign is a contraction of facial muscles in response to a light tap over the facial nerve n the front of the ear. o Also indicates hypocalcemia with latent tetany. o Tetany is the increased nerve excitability and sustained muscle contraction. Troussseau s sign: refers to carpal spasm induces by inflating a blood pressure cuff on the arm. Cushings Syndrome: A spectrum of clinical abnormalities caused by an excess of corticosteroids (glucocorticoids in particular). o Clinical Manifestations: weight gain, hyperglycemia, protein wasting, loss of collagen, HTN, mood disturbances, moon face o Primary Goal: to normalize hormone secretion  Goal of Drug Therapy: inhibition of adrenal function. o Tx: surgical (laparoscopic adrenalectomy) or meds (Mitotane, Metyrapone, aminoglutethimide, ketoconazole) Diabetes o Diabetes mellitus is a chronic multisystem disease related to abnormal insulin production, impaired insulin utilization, or both. o Type I Diabetes Mellitus: formerly known as juvenile onset or insulin dependant diabetes, type I diabetes most often occurs in those under 30 yrs of age. This condition is the end result of a long standing process in which the body s own T cells attack and destroy pancreatic B cells, which are the source of the body s insulin.  Classic symptoms of type I diabetes include Polydipsia, Polyphagia, and Polyurea (the 3 P s) o Type II Diabetes Mellitus is formerly known as adult onset diabetes usually occurring in those over 35 yrs (kids at high risk today), & involves the pancreas being able to make endogenous insulin which is either insufficient for the needs of the body, &/or is poorly utilized by the tissues.  Clinical manifestations are often nonspecific but often include: fatigue, recurrent infections, prolonged wound healing, visual changes Hyperparathyroidism: a condition involving an secretion of parathyroid hormone (PTH) o Associated with increased serum Calcium levels  Excessively high levels of circulating PTH usually lead to hypercalcemia and hypophosphatemia o Clinical Manifestations: weakness, loss of appetite, constipation, incr. need for sleep, emotional disorders, kidney stone, and shortened attention span.  May result in calcium loss from bone (decrease bone density)  May cause renal caliculi o Tx: moderate Ca intake and increase fluid intake, Biphosphonates, Calcimimetic agents (incr sensitivity of Ca receptor on parathyroid gland) Propanolol (thyroid???) o Beta blockers such as propanolol can help to control the heart rate, and intravenous steroids may be used to help support circulation o Reduces HR, myocardial irritability, and force of contractions.

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Parathyroid: The parathyroid glands secrete parathyroid hormone (PTH) also known as parathormone. Its role is to regulate the blood level of calcium by acting on bone, kidneys, and GI tract (indirectly). o PTH stimulates renal conversion of Vitamin D which enhances the intestinal absorption of Calcium. o When Ca serum is low, PTH secretion rises; when Ca serum is high, PTH secretion falls. o Low Ca levels allow Na to move into excitable cells, decreasing the threshold of action potentials with subsequent depolarization of the cells.  Results in Tetany (increased nerve excitability & sustained muscle contractions) Adrenalectomy: the surgical removal of one or both adrenal glands o may be performed through laparoscopic or open surgery o an open surgical adrenalectomy is used to treat adrenal cancer. Diabetes A1C: a test useful in determining glycemic levels over time. o Used by diabetic patients and health care providers to monitor success of treatment and to implement changes in treatment modalities o Indicates the overall glucose control for the previous 90-120 days. o For people with diabetes, the ideal A1C goal is 7.0% or less according to the ADA. The American College of Endocrinology recommends an A1C of less than 6.5%.  Normal HbA1C levels decrease the incidence of neuropathy, nephropathy, and retinopathy. Diabetic Neuropathy: nerve damage that occurs because of the metabolic derangements associated with Diabetes Mellitus. o the most common type is sensory neuropathy, which may lead to the loss of protective sensation in the lower extremities, and coupled with other factors, this significantly increases the risk for complications that result in a lower limb amputation. o Autonomic Neuropathy can affect nearly all body systems and lead to hypoglycemic unawareness, bowel incontinence/diarrhea, and urinary retention.  A diabetic w/ postural hypotension should change from a lying or sitting position slowly. Myxedema coma: mental sluggishness, drowsiness, and lethargy of hypothyroidism may progress gradually or suddenly to this notable impairment of consciousness or coma. o S/s: subnormal temperature, hypotension, hypoventilation Propylthiouracil (PTU): a first line antithyroid drug which inhibits the synthesis of thyroid hormones. Also blocks peripheral conversion of T4 to T3. (not curative) o There is a high rate of recurrence of hyperthyroidism if this drug is discontinued. o Lowers hormone levels more quickly but must be taken three times a day. Tracheostomy: a stoma that results from the tracheotomy (surgical incision into the trachea for the purpose of establishing an airway). Indications for a tracheotomy are to: o Bypass an upper airway obstruction o Facilitate removal of secretions o Permit long term mechanical ventilation o Permit oral intake & speech in a patient who requires long term mechanical ventilation. Parathyroidectomy: partial or complete surgical removal of the parathyroid glands. o Leads to a rapid reduction of chronically high Ca levels What is the only kind of insulin that can be given via an IV? => Regular Insulin

GI/Hepatic/Renal y Appendicitis: an inflammation of the appendix (a narrow blind tube extending from the inferior part of the cecum). o Most common causes are obstruction of the lumen by accumulated feces (fecalith), foreign bodies, tumor of the cecum or appendix, or intramural thickening caused by excessive growth of lymphoid tissue. o S/s: periumbilical pain, anorexia, n/v (pain located around McBurneys point) o Preop:  Until physician sees patient, the patient remains NPO  Place ice bag to right lower quadrant to decrease flow of blood to the area and impede the inflammatory process. (heat may cause appendix to rupture)  Surgery performed as soon as a Diagnosis is made. o Postop:  Patient observed for evidence of peritonitis  Ambulation begins day of surgery or the first postop day  Diet advanced as tolerated by patient  D/c on first or second post op day Diverticulitis: results from retention of stool and bacteria in the diverticulum, forming a hardened mass called fecalith. This causes inflammation and usually small perforations. o Inflammation spreads to the surrounding area in the intestines causing the tissue to become edematous (abnormal accumulation of fluid in the body tissues or in the body cavities causing swelling or distention of the affected parts) o Diet: high fiber diet (mainly from fruits and vegetables), intake of fat/red meat, Guaiac Test: finds hidden (occult) blood in the stool (bowel movement) o ***Vitamin K should be administered if blood is evident in the stools, as vitamin K may help in clotting the source of the bleed. N/G Tube: a silicone tube that is inserted through the nose down into the stomach, and is used for short term feeding problems. (use x-ray to determine placement prior to initiating feeding) o Coughing, cyanosis or choking may indicate that the NG tube has passed through the larynx. If this occurs, retract tubing so it is out of the larynx & reinsert into the stomach. Perforated Ulcer: perforation of a peptic ulcer occurs when the ulcer penetrates the serosal surface, with spillage of either gastric or duodenal contents into the peritoneal cavity. o Larger perforation = longer duration that the patient had the ulcer o Bacterial peritonitis may occur within 6-12 hours o Treatment: H2 Receptor Blockers, PPI s, antibiotics, antacids Ulcerative Colitis: part of the group (along with Crohns Disease) called Inflammatory Bowel Disease (IBD). Characterized by chronic inflammation of the intestine with periods of remission interspersed with periods of exacerbation. o Ulcerative Colitis usually begins in the Rectum and advances to the cecum spreading in a continuous pattern (unlike Crohns disease). o S/s: bloody diarrhea and abdominal pain o Goals of Treatment:  Res the bowels  Alleviate stress  Control inflammation  Provide symptomatic relief  Combat infection  Improve quality of life  Correct malnutrition

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Reflux (cancer risk): in GERD, there is a risk of Barrets Syndrome, which is a precancerous lesion that increases the risk for esophageal cancer Systemic Lupus Erythematosus (SLE): a multisystem inflammatory disease of autoimmune origin. A complex disorder of multifactorial origin resulting from interactions among genetic, hormonal, environmental, and immunologic factors. o **Skin care is extremely important; wear protective clothing and sunscreens when outdoors, however try to minimize outdoor exposure to the sun if at all possible. Dilutional hyponatremia: metabolic condition in which there is not enough sodium (salt) in the body fluids outside the cells. Causes hypoosmolality with a shift of water into the cells. o S/s: n/v, confusion, lethargy, muscle weakness, spasms, seizures, LOC, restlessness o Nursing Interventions: fluid restriction, IV hypertonic saline solution, fluid replacement with sodium containing solutions. Hypermagnesemia: an electrolyte (magnesium) imbalance caused by an increase in magnesium intake accompanied by renal insufficiency or failure. o Depresses neuromuscular and CNS functions o S/s: lethargy, drowsiness, n/v, deep tendon reflexes, somnolence, resp./cardiac arrest Kayexalate (ARF??): hyperkalemia is one of the most serious complications in Acute Renal Failure (ARF) as it can cause life threatening cardiac dysrhythmias. Sodium polysterene (Kayaxalate) and dialysis remove potassium from the body. o Causes diarrhea Peritoneal dialysis (CAPD); used to treat Chronic Kidney Disease (CKD) o Continuous Ambulatory Peritoneal Dialysis (CAPD): carried out manually by exchanging 1.5-3 L of peritoneal dialysate at least 4 times daily, with dwell times of 4 to 10 hours. Potassium Hypokalemia Indicators: o Clinical Manifestations:  Cardiac changes; impaired repolarization, flattened T wave, emergence of a U wave, increased (possible peak) P wave, Lethal Ventricular Dysrhythmias, bradycardia  Decreased GI motility  Paresthesias (decreased reflexes)  Polyuria  Hyperglycemia  Muscle weakness (soft flabby muscles) Urolithiasis: calculi in the urinary tract, bladder, ureters, and kidneys o predisposed by immobility, hypercalcemia, UTI, urine stasis, high urine specific gravity o S/s: acute sharp pain, dull tender ache in flank, n/v, hematuria, abd distension GERD (Bed Blocks???): the nurse should ensure that the head of the bed is elevated to approximately 30 (usually on 4-6 inch blocks) & that the patient does not lie down after eating. T-tube: a narrow flexible tube in the form of a T that is used for drainage; especially of the common bile duct Paralytic ileus: a lack of intestinal peristalsis and presence of no bowel sounds o (intervention):  Patient placed on NPO status  Insertion of NG tube (decompress bowel)  Insertion of IV (NS or Lactated Ringers + Potassium)  No improvement in 24-48 hours? => surgery to remove obstruction o Goals: 1) relief of the obstruction 2) Correction & maintenance of fluid/electrolytes

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Acute Renal Failure: a clinical syndrome characterized by a rapid loss of renal function with progressive azotemia (accumulation f nitrogenous waste products like urea nitrogen and creatinine in the blood). o (renal cause):  Prerenal causes: due to factors external to the kidneys that reduce renal blood flow and lead to decreased glomerular perfusion & filtration.  Hypovolemia, dehydration, hemorrahage, GI losses, diuresis, hypoalbuminemia, burns  Decreased CO, dysrhythmias, cardiogenic shock, HF, MI  Decreased peripheral vascular resistance, anaphylaxis, neurologic injury, septic shock  Decreased renovascular blood flow, bilateral renal vein thrombosis, embolism, hepatorenal syndrome, renal artery thrombosis  Intrarenal causes: conditions that cause direct damage to the renal tissue (parenchyma), resulting in impaired nephron function.  Prolonged prerenal ischemia  Nephrotoxic injury , drugs, radiocontrast agents, hemolytic blood transfusion reaction, severe crush injury, chemical exposures  Interstitial nephritis, allergies (meds/antibiotics), infections  Acute glomerulonephritis  Thrombotic disorders  Toxemia of pregnancy  Malignant HTN  SLE  Postrenal causes: involve mechanical obstruction of urinary outflow, thus impairing kidney function.  Benign prostatic hyperplasia  Prostate cancer  Bladder cancer  Spinal cord disease  Calculi formation  Strictures  Neuromuscular disorders  Trauma (back, pelvis, perineum) Hyponatremia (what is the best IV): 5% Dextrose in water, hypotonic saline Fluid Volume: o Fluid Volume Excess: results from excessive intake of fluids, abnormal retention of fluids, or interstitial to plasma fluid shift.  removal of fluid w/o producing abnormal changes in the electrolyte composition or osmolality of ECF  Diuretics & fluid restriction are primary forms of therapy o Fluid Volume Deficit: can occur with abnormal loss of body fluids inadequate intake, or a plasma to interstitial fluid shift  Correct underlying cause and replace both water and any needed electrolytes. Parecentesis (bleeding?): needle puncture of the abdominal cavity o may be performed to remove ascetic fluid (tends to accumulate thus this is temporary) o Liver disease, one of the main causes of abd fluid build-up, can also cause susceptibility to clotting problems. After the needle is removed from the abdomen, bleeding may continue to occur from the vessels providing blood flow to the inner abdominal wall.

PET -Oncology o A diagnostic examination used to detect cancer, determine the stage of cancer, & evaluate effectiveness of cancer tx, such as chemotherapy or radiation therapy. o Permits a physician to accurately image many organs of the body w/ a single scan in order to detect malignancy. Laxative abuse: overuse of laxatives may lead to chronic constipation o People who continue to use laxatives & enemas eventually become unable to have a bowel movement w/o them. (many abuse laxatives to lose weight) o At risk for dehydration as well as electrolyte imbalance UTI (Clean catch specimen): in order to test for a UTI, the patient will need to provide a clean catch specimen. o Instruct the patient to fill the urine cup midstream (urinate a little, stop, then fill specimen cup w/ as much with the remaining urine). Crohns disease: inflammation involves the all layers of the bowel wall o S/s: diarrhea, colicky abdominal pain, weight loss (due to malabsorption), fever, rectal bleed (not as common as in Ulcerative Colitis) Esophageal varices o Teach: Avoid ingesting alcohol, aspirin, and irritating foods o Goal: avoidance of bleeding and hemorrhage Hepatitis C: infection caused by a virus that attacks the liver and leads to inflammation o Transmission usually due to percutaneous needle exposure or other blood exposure and undetected parenteral transmission o Generally asymptomatic (early) later on, s/s may be:  Fatigue  Muscle & joint pains  Fever  Tenderness in the area of your liver  Nausea or poor appetite o Although positive for Hepatitis C, one may not need Tx (severe cases need Tx) Teaching-Ileostomy care-stoma o Explain that an ostomy is a surgical opening in the body for discharge of body wastes o Describe underlying conditions that result in the need for an ostomy o Perform activities like:  Remove old skin barrier, cleans skin, and apply new skin barriers  Apply, empty, clean, and remove old pouch  Empty pouch before it is 1/3 full to prevent leakage  Irrigate colostomy to regulate bowel elimination o Explain how to contact the enterostomal therapy nurse w/ questions o Explain dietary & fluid management  Id a well balanced diet and dietary supplements to prevent nutritional deficiencies  Id foods to avoid to reduce diarrhea, gas, or obstruction (w/ illiostomy)  Drink at least 3000 ml/day of fluid to prevent dehydration  Explain how to contact RD w/ questions  Explain how to recognize problems & how to contact the appropriate HCP. o Describe community resources to assist w/ emotional/psych. adjustment to the ostomy o Explain the importance of follow up care o Describe the ostomy s potential effects of sexual activity, social life, work, and recreation and strategies to manage these influences.

Immune/Hematology/Fluid and Electrolytes y y Hemolyzed specimen: Platelets (thrombocytes): function in initiating the clotting process by producing a plug at the site of the injury. o Normal platelet count: 150,000-450,000/mm3 o Increased platelet count signifies the possibility of a clot o Decreased platelet count signifies bleeding Decreased neutrophil is a condition known as neutropenia, and is identified as a neutrophil count less than 1000 to 1500 /ul. o Normal levels: 4000-11000/ul o Predisposed to infections of normal flora  Minor infections lead rapidly to sepsis (immediate treatment necessary) o Collaborative care:  Determine case of neutropenia  Id offending organisms if an infection has developed  Institute prophylactic, empiric, or therapeutic antibiotic therapy  Administer hematopoietic growth factors  Institute protective environmental practices, like strict hand washing, visitor restrictions, and a private room if hospitalized. Risk factors for skin cancer o Having a fair skin type o History of chronic sun exposure o Family history of skin cancer o Environmental factors (living near equator, outdoor occupations, frequent outdoor activities) o Indoor and outdoor tanning o Smoking HIV CD4 count: below 200 cells/ul + opportunistic infection + wasting + ADC = AIDS Dx o Pathology:  RNA virus binds to specific CD4 and chemokine receptors to enter cell.  Reverse transcriptase assists to make viral DNA  Viral DNA enters cell nucleus and splices itself into genome permanently.  Consequence of integration into genetic structure  All daughter cells are infected  Viral DNA will direct cell to make HIV  Cells w/ CD4 receptor sites infected  T helper cells, lymphocytes, monocytes/macrophages, astrocytes, oligodendrocytes  Immune dysfunction results mostly from destruction of CD4 T cells which are key from immune recognition and defense against pathogens.  Viral activity destroys 1 billion T cells daily  Immune problems begin when CD4 T cells ddrop below 500 cells/ul  Normal range is 800-1200 cells/ul Well differentiated cells

Integumentary/Oncology y y Flu-like syndrome: Tumor lysis syndrome (TLS)-hyperkalemia: a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. o 4 hallmark signs of TLS are:  Hyperuricemia  Hyperphosphatemia  ***Hyperkalemia***  Hypocalcemia o Goal: preventing renal failure and severe electrolyte imbalances Prophylactic mastectomy (post op) Patient stays in the hospital for 1 to 3 days (depending on the type of surgery)  simple mastectomy = patient may go home on the same day.  Most go home after 1 to 2 days.  may stay longer if you have breast reconstruction. o Many women go home with drains still in their chest. The doctor then removes them later during an office visit. o Patient may have pain around the site of your incision after surgery. o Fluid may collect in armpit called seroma (relatively common).  It usually goes away on its own, but it may need to be drained. Allopurinol (prior to chemotherapy) o This medication, also known as (Zyloprim), is used for the treatment and prevention of gout attacks and certain types of kidney stones. It is also used to treat elevated uric acid levels in the blood and urine, which may occur in patients receiving chemotherapy for treatment of leukemia, lymphoma, and other types of cancer. If left untreated, high uric acid levels in those receiving cancer chemo may cause kidney stones and kidney failure. IV site care Stomatitis (antineoplastics) Agranulocytosis: failure of the bone marrow to make enough white blood cells (neutrophils) AIDS dementia: Decline in mental processes is a common complication of HIV infection (and many other conditions. The AIDS dementia complex affects behavior, memory, thinking, and movement o symptoms include decline in thinking, or "cognitive," functions such as memory, o

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reasoning, judgment, concentration, and problem solving. o Furthermore, changes in personality and behavior, speech problems, and motor (movement) problems such as clumsiness and poor balance occur.
y Radiation therapy (tender skin): the skin contains rapidly proliferating cells, thus is affected by radiation therapy. o The skin changes induced by radiation may be acute or chronic based on the area, dosage, and technique. o Skin care to manage most desquamation includes keeping tissues clean w/ normal saline compresses or modified Burow s solution soaks and protected from further damage with moisture vapor- permeable dressings or Vaseline.

Musculoskeletal/Neuro y Cast care tightness: Cast Syndrome may occur if the body cast is applied too tightly and the cast compresses the superior mesenteric artery against the duodenum. o Results in patient complaining of abdominal pain, n/v, & abdominal pressure. o Tx: gastric decompression w/ NG tube, remove or split cast. Compartment syndrome: a condition in which the elevated intracompartmental pressure w/in a confined myofascial compartment compromises the neurovascular function of the tissues w/in that space. o Causes capillary perfusion to be reduced below a level necessary for tissue viability and is classified as acute, chronic/exertional, or crush syndrome. o Characteristics of an impending Compartment Syndrome:  Paresthesia (numbness & tingling)  Pain (distal to injury & unrelieved by opioid analgesics in addition to pain on passive stretch of muscle traveling through compartment)  Pressure (increases in compartment)  Pallor (coolness, & loss of normal color of the extremity)  Paralysis (loss of function)  Pulselessness (diminished/absent peripheral pulses) o Assess urine output (watch for myoglobinurea; red/brown urine & s/s of ARF) Hip replacement (dislocation) (Athroplasty) o Athroplasty performed in order to relieve pain, improve or maintain ROM, and correct the deformity. o Foam pillow placed between joints in order to prevent dislocation o Physical therapy initiated first postop day & weight bearing exercises w/ a walker begin o Monitor for infection, and prevention of DVT are key concepts for home care. Rheumatoid arthritis (use of heat): the use of heat for Rheumatoid Arthritis is an excellent nonpharmacological remedy. Hip replacement o post op activity  Emboli prevention  pain management  Ambulation  CPT  Wound care  Management of catheter  Patient teaching (home care)  Management of Hemovac  Bed rest w/ legs abducted o chest pain-report findings activity Osteoporosis (goal): o Reduce bone loss o Prevent fracture o Control pain o Prevent diability Fractured ribs: a condition known as Flail Chest may result from multiple rib fractures, causing an unstable chest wall. o Dx is made on the basis of fracture of two or more ribs, in tow or more separate locations, causing an unstable segment. Laminectomy (reposition): this procedure involves the surgical excision of part of the posterior arch of the vertebra to gain access to part of or the entire protruding disk to remove it.

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Brachytherapy (precautions) o A form of radiotherapy where a radiation source is placed inside or next to the area requiring treatment. Commonly used as an effective treatment for cervical, prostate, breast, and skin cancer, and can also be used to treat tumors in many other body sites. Can be used alone or in combination with other therapies such as surgery, External Beam radiotherapy, and chemotherapy. o If temporary barchytherapy is used, there is no risk to friends or family from being in close proximity with the patient. o In permanent brachytherapy, low dose radioactive seeds are left in the body following treatment, and devrease over time. However, as a precaution, those receiving permanent brachytherapy may be advised to not hold any small children or be close to pregnant women for a short time following treatment. Cranial radiation: intracranial metastasis occurs in up to 39% of patients with Small Cell Lung Cancer (SCLC). This procedure is effective in preventing metastasis (20%), although it is not known if it increases survival. Toxicities of this therapy may include scalp erythema, fatigue, and alopecia. o Most chemotherapy drugs do not penetrate the blood brain barrier, thus this procedure is used.

Operative y y y Ambulation (postop): usually patients ambulated day of operation or 1st day postop. OR surgical scrub: The scrub nurse follows the designated scrub procedure & remains in the sterile field. Postop risk o Airway Obstruction o Hypoxemia o Hypoventilation o Hypotension/HTN, dysryhthmias, Deep Vein Thrombosus o Emergence delirium, delayed emergence o Pain/discomfort o Hypothermia o Acute urinary retention o n/v o wound dehiscence Preop teach assess (checklist, allergy, NPO) Op permit (legal for RN): nurse can witness the patient sign the consent form ensuring that the patient was fully informed, understood everything, and signed the consent voluntarily. PACU assessment o General info: name, age, ACP, Surgeon, surgical procedure o Patient Hx: indication for surgery, medical hx, meds, allergies o Intraoperative management  Anesthetic medications  Other meds received preoperatively or intraoperatively  blood loss  fluid replacement totals (blood transfusions???)  urine output o Intraoperative Course  Unexpected anesthetic events or rxns  Unexpected surgical events  Vitals and monitoring trends  Results of intraoperative lab tests Malignant hyperthermia: a rare metabolic disease characterized by hyperthermia w/ rigidity of skeletal muscles that can result in death. o Occurs in affected people exposed to certain anesthetic agents. Suctioning needed: this procedure is done especially for patients who have a tracheostomy and are breathing through a trach. o Be sure to use aseptic/sterile technique throughout the procedure o Apply suction only when w/drawing catheter (gently rotate)  Never suction from more than 10-15 seconds (pass 3 or fewer times) o Suction when:  Adventitious breath sounds are hear  Secretions are present  Gurgling sounds are noted

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Laboratory Values y y y y y y y y y PT: 10-13 seconds INR: <2 aPPT: 25-39 seconds Hgb: 13.2-17.3 g/dl (men)/11.7-15.5 g/dl (female) Hct: 43%-49% (male)/38%-44% (female) WBC s: 4500-10000 mm3 Potassium: 3.5-5.0 mEq/L Sodium: 135-145 mEq/L Magnesium: 1.6-2.6 mg/dL Conversion Factors 1 L = 100 ml 1 ml = 1 cc 1 dram = 4 ml 1 tbs = 15 ml 1kg = 1000 g 1mg = 1000 mcg 1 oz = 30 ml 1 unit = 1000 milliunits Pounds (lbs)-Kilograms (kg): divide by 2.2 Kilograms (kg)-Pounds (lbs): multiply by 2.2 Ounces (oz)-Pounds (lbs): divide by 16 Essential Calculations Desire x supply = Amount Have IV Piggy Back: mL x TF = gtt/min min for microdrip TF= 60 gtt (macrodrip is given as there are many) 1g = 1000 mg 1 g = 15 gr 1 tsp = 5 ml 1 kg = 2.2 lbs Check PT/INR prior to administering Coumadin Check aPPT prior to administering Heparin

Finding the amount of a drug in a solution:

Amount of Drug Amout of Fluid (mL) = hrs

= amount of drug in mL

How long an IV will run:

number of mL number of mL/hr

mg/min-Rule and Calculation: y y y y Reduce numbers in standard solution to mg/mL Change mg-mcg Divide by 60 to get mcg/min Solve for mL/hr