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304 med surg
final review (all topics)
| Column 1 | Column 2 |
|---|---|
| Fluid & Electrolytes | • Balance critical for organ function & homeostasis • Nurse role: assess, monitor labs/VS, identify imbalances • Fluids: intracellular (~2/3), extracellular (plasma) |
| Fluid Volume Deficit (Hypovolemia) Pathophysiology | • Causes: ↓ food/fluid intake, GI loss, trauma • S/S: weight loss, ↓ turgor, tachycardia, dry mucosa • Other: dizziness, confusion, thirst, ↑ Hgb/Hct • BP ↓, HR ↑ (compensation); ↑ BUN/Cr |
| Treatment for fluid volume deficit | • Tx: I&O, daily weights, monitor vital signs • Fluids: oral fluids if tolerated, IV fluids (NS/LR) |
| Nursing interventions for Fluid Volume Deficit | Monitor CMP Monitor vital signs and mental status Monitor skin turgor Daily weights with I/Os Medication Hx (concurrent diuretic use) |
| Fluid Volume Excess (Hypervolemia) Pathophysiology | • Cause: Na⁺ + water retention • S/S: edema, JVD, lung crackles, ↓ Hgb/Hct |
| Treatment for Fluid Volume Excess | sodium restriction (<2g daily intake) fluid restriction diuretics (Furosemide/Spironolactone) hemodialysis in severe cases |
| Hyponatremia Pathophysiology | serum sodium under 135 mEq/L Cause: vomiting, diarrhea, SIADH, diuretic use, adrenal insufficiency, diaphoresis S/S: hypotension, tachycardia, neuro changes (cerebral edema), headache, abdominal cramping |
| Hyponatremia treatment | sodium replacement NS/LR IV bolus hypertonic IV bolus if severe |
| Hypomagnesemia pathophysiology | Mg2+ <1.8 mg/dL S/S: tremors, muscle spasms, fatigue, weakness, arrhythmias |
| Hypomagnesemia treatment | IV Magnesium sulfate on infusion pump (NEVER IV PUSH) In case of Mg toxicity --> tx with Calcium Gluconate |
| Nursing Interventions for Hypomagnesemia | assess reflexes during Mg infusion b/c acute toxicity leads to decreased reflexes assess urine output monitor vital signs |
| Nursing Interventions for Hyponatremia | monitor skin for turgor/dry mucosa assess for mental status |
| Nursing Interventions for Fluid Volume Excess | assess lung sounds for crackles (pulmonary edema) assess for ↓ BUN and ↓ hematocrit assess electrolyte and kidney function monitor I/Os and weight monitor for dietary sodium restriction |
| Hypocalcemia Pathophysiology | Ca <8.5 mg/dL Causes: Malabsorption, osteoporosis, inadequate diet S/S: tetany, paresthesia, hyperactive deep tendon reflex, + Trousseau's Sign, Chvostek's Sign Risk for seizure, respiratory depression, laryngospasm, abnormal clotting, anxiety |
| Hypocalcemia precautions | Seizure and fall precautions padded side rail low bed height |
| Hypocalcemia treatment | IV calcium gluconate alternative - oral calcium + Vitamin D dietary: ↑ dark leafy green vegetables, dairy |
| Nursing Interventions for Hypocalcemia | monitor vital signs assess deep tendon reflexes (decreased Ca2+ = hyperactive reflex) cardiac monitor for cardiovascular status |
| Hypokalemia pathophysiology | K+ <3.5 mEq/L Causes: diuretics, insufficient intake, GI loss, diaphoresis S/S: muscle weakness, fatigue, cramps, constipation, arrhythmia |
| Hypokalemia treatment | IV pump KCl oral potassium supplements (ER tablet/powder) NEVER give IV potassium push (unless you really hate them lol) |
| Nursing interventions for Hypokalemia | cardiac monitoring for arrhythmia risk monitor ABG assess for digoxin or digitalis use |
| Hyperkalemia pathophysiology | K+ >5 mEq/L cardiac arrest risk S/S: muscle weakness, palpitation, chest pain, arrhythmia/MI Tall peaked T waves Prolonged PR interval |
| Nursing Interventions for Hyperkalemia | cardiac monitoring for MI/arrhythmia risk assess CMP and renal function monitor vital signs dietary education for high potassium foods assess FSG prior and 1h after to insulin administration |
| Hyperkalemia treatment | IV pump calcium gluconate (given first to stabilize heart rhythm) 10u regular insulin IV push + 50mL D50 dextrose oral Lokelma (binds to K+ in GI for elimination) bicarbonate for acidosis |
| Pain | Pain is subjective Use pain scales (numeric, FACES) |
| Administration of pain medications | Assess pain before and after medications Monitor vital signs before opioid administration |
| Nursing considerations for Opioid/Narcotics administration | avoid EtOH and heavy machinery assess for constipation assess respiratory depression, neuro changes monitor vital signs before med admin assess pain before/after med admin |
| Non-pharmacological pain management | comfort measures repositioning music therapy guided imagery |
| Nonverbal indicators of pain | tachycardia diaphoresis increased respiratory rate facial expression |
| wound care/skin breakdown | risk for immobility, decreased consciousness, increased moisture for skin breakdown (incontinence) friction when moving pt *documentation of ALL skin ulcers* |
| Management for skin breakdown | turn Q2h keep skin dry/barrier creams mobilization |
| Nursing Interventions for skin breakdown | monitor for infection (erythema/drainage/fever) dressings per order (with possible debridement) adequate nutrition with high protein (dietician referral) monitor serum albumin levels |
| Perioperative Nursing Phases | Pre, Intra, Post |
| Pre-op phase | labs and informed consent (provider obtained with nurse witness) know surgical site establish IV line and give med admin pt to use bathroom prior to anxiolytic use d/t fall risk |
| Wound dressings | Wet vs dry dressings Protective barriers w/o dressing (passive dressings) Filler dressings for deeper wounds Debridement of tissue |
| anesthesia risks/complications | anaphylaxis malignant hyperthermia respiratory depression/hypoxia hypothermia |
| Malignant Hyperthermia pathophysiology | cause: anesthesia adverse reaction (emergency) early S/S: tachycardia (>150 BPM) late S/S: rapid fever, muscle rigidity |
| Malignant Hyperthermia treatment | IV fluids (to cool) Dantrolene (reverse symptoms) |
| types of anesthesia and complications | local epidural - hypotension d/t vasodilation spinal - headache d/t CSF leak |
| Intra-op phase | monitor patient for anesthesia complications (malignant hyperthermia/anaphylaxis/respiratory depression) |
| Post-op phase | transfer to PACU (post anesthesia care unit) assess respiratory/neuro/cardiac status |
| Post-op phase nursing interventions | cardiac monitor + BP monitor + SpO2 + respiratory rate assess pain assess alertness notify MD STAT for hypotension - hypovolemia/blood loss risk (5 min BP triage) assess peripheral pulse assess airway (laryngeal stridor) |
| laryngeal stridor | *Medical emergency* hypopharyngeal obstruction d/t lower jaw and tongue falling backwards audible noisy/irregular respirations from choking declining SpO2 |
| Reglan considerations | NO Reglan (Metoclopramide) IV push d/t ADR -- tardive dyskinesia Use IVPB administration assess for facial movement disorder |
| Discharge considerations | Aldrete score 7+ for discharge need stable BP, respiratory function, O2 sat, alertness No driving/heavy machinery |
| Post-op complications | Hypovolemia from post-surgical hemorrhage Risk for increased pain Risk for altered airway patency (d/t vomiting) Risk for PNA (if not using incentive spirometer) |
| Incentive Spirometer | device for taking slow deep breaths --> helps clear out secretions and improve lung functions especially in post-surgical setting |
| Interventions for respiratory disorders | #1 priority is ABC (Airway Breathing Circulation) sit pt up O2 administration (cannula, facemask, non-rebreather, venturi) |
| Pneumonia Pathophysiology | inflammation of lung parenchyma d/t mycobacteria/fungi/virus Risk factors: CHF, DM, alcoholism, COPD, AIDS, cystic fibrosis, influenza S/S: cough, fever/chill, confusion, SOB, chest pain, fatigue Risk for septic shock or respiratory failure |
| Pneumonia treatment | O2 and IV fluids Abx (for bacterial PNA only) antipyretics for fever antitussives/decongestants/antihistamines |
| Nursing interventions for Pneumonia | assess respiratory status and vital signs monitor secretions and cough for quality/changes assess lung sounds for wheezing/rhonchi/diminished sounds hand hygiene |
| Antibiotic tx for Bacterial Pneumonia | usually use broad spectrum prior to culture (Zosyn) S. Pneumoniae + S. Aureus commonly seen |
| Pneumonia prophylaxis | pneumococcal vaccine for young adults (19+), immunocompromised and booster for elderly (65+) |
| Aspiration Pneumonia | d/t inhalation of foreign material causing inflammatory reaction (dysphagia/stroke pts) need swallow evaluation |
| Nursing considerations for Tube Feeding | check placement of PEG tubes and NG tubes NG tubes can go into lungs and cause aspiration PNA |
| COPD pathophysiology | d/t chronic emphysema vs chronic bronchitis Risk factor for smoking/2nd hand smoking Use of accessory muscles/sternocleidomastoid muscle and tripod positioning for impaired breathing Barrel chest 1:1 AP: transverse ratio |
| Chronic bronchitis (COPD) pathophysiology | Blue Bloater S/S: cyanosis, hyperventilation, increased sputum, hypoxia, hypercapnia, clubbing, fatigue, coarse voice, accessory muscle use |
| Hypercapnia | increased CO2 levels in blood, commonly seen in COPD/chronic bronchitis |
| Chronic bronchitis nursing considerations | Avoid excessive O2 supplementation d/t hypercapnia and respiratory depression risk 2-3 L O2 max usually 91-92% O2 sat Ask normal baseline O2 sat for patients |
| Chronic Emphysema (COPD) pathophysiology | Pink Puffer S/S: barrel chest, hyperventilation, pink skin complexion, hypercapnia |
| COPD treatment | Smoking cessation Bronchodilators (albuterol) Anticholinergics Corticosteroids (prednisone, solumedrol) Antibiotics Mucolytics/antitussives O2 supplementation PRN (2-3L low flow) Pneumonia and flu vaccinations |
| COPD nursing considerations | monitor CBC for infection with corticosteroid use |
| Asthma pathophysiology | Chronic inflammatory airway disease of hyperresponsiveness, mucosal edema and mucus production Strong allergy component (IgE mediated) S/S: cough, chest tightness, wheezing, dyspnea Reversible with tx |
| Asthma nursing interventions | Education on identification and avoidance of triggers Avoidance of cigarette smoke Assess lung sounds Ask for intubation Hx (indication of severity) *SILENT CHEST = MEDICAL EMERGENCY* |
| Asthma treatment | SABA- Albuterol (SABA short acting beta agonist - rescue inhaler) LABA - long acting beta agonist Nebulizers Leukotriene modifiers (allergy) IVPB Magnesium (smooth muscle relaxant for wheezing) |
| Anaphylaxis pathophysiology | Severe life threatening allergic reaction S/S: rash, neuro changes, respiratory difficulty, angioedema, bradycardia/tachycardia, hypotension, syncope, diaphoresis, N/V, anxiety, laryngeal edema, stridor Intervention dependent on severity |
| Anaphylaxis treatment | #1 line - 1:1000 epinephrine IM (EpiPen) Benadryl (antihistamine) Pepcid (H2 blocker) Albuterol O2 supplementation IV fluids if not contraindicated |
| Retinal detachment pathophysiology | S/S: shade or curtain coming across vision of eyes, bright flashing lights, floaters cause: trauma, DM, age MEDICAL EMERGENCY |
| Retinal detachment tx | only surgical treatment scleral buckle vitrectomy |
| Glaucoma pathophysiology | "silent thief of vision" open angle (chronic) vs closed angle (acute med emergency) S/S: blurry vision, halos, difficulty focusing, difficulty adjusting to low light, eye pain, headache |
| Glaucoma treatment | Betablocker (Timolol) - need lifelong therapy Cholinergic (Pilocarpine - ADR risk mostly used for closed angle) Assess for concurrent B-blocker use |
| Cataract Post-surgical Considerations | Verbal discharge teaching Avoidance of lying on surgical side Resume activities as directed by MD Avoid strenuous activities (>15 lbs) Avoid bending/stooping for extended time Avoid holding in sneeze and with open mouth |
| Conductive hearing loss | Inefficient sound transmission through outer/middle ear into inner ear Causes: ear canal damage/occlusion, tympanic membrane damage, middle ear diseases |
| Sensorineural Hearing loss | Damage to inner ear (cochlea or auditory nerve) Causes: Congenital, Ototoxic drugs, Severe infections, Tumors |
| Weber test | Tests bone conduction AC>BC = normal AC<BC = conductive hearing loss |
| Rinne test | Tests tuning fork on top of head Sound lateralizes to worse ear = conductive hearing loss Sound lateralize to better ear = sensorineural hearing loss |
| Mastoiditis pathothysiology | Inflammation of mastoid cells in middle ear d/t infection |
| Nursing considerations for the deaf | Use low tone and normal voice Speak slowly and distinctly Face impaired ear Use gestures/facial expressions Provision of whiteboard |
| Mastoiditis treatment | IV Antibiotics Oral Antibiotics Mastoidectomy if necessary |
| Meniere's Disease pathophysiology | Abnormal inner ear fluid balance d/t endolymphatic sac malabsorption or endolymphatic duct obstruction S/S: Vertigo, tinnitus, pressure in ear, N/V |
| Meniere's Disease treatment | Sodium restriction 1-1.5 g/daily intake (reduce ear fluid) Meclizine Ondansetron |
| Peripheral Arterial Disease pathophysiology | Chronic illness of plaque/platelet aggregation in peripheral arteries S/S: INTERMITTENT CLAUDICATION, aching, cramping, fatigue/weakness leg pain relieved by rest in early stage -> resting pain Toe ulcers |
| Peripheral Arterial Disease Nursing Education | Dangle legs over side of bed for leg pain Exercise education (walking/isometrics) Smoking cessation Stress reduction (BP management) |
| Peripheral Vascular Disease pathophysiology | Vascular disorder preventing venous blood return to heart Increased risk of MI/stroke, DVT/PE Ankle ulcers |
| Virchow's Triad | Risk factor for vascular thrombosis -Endothelial damage -Venous stasis -Altered coagulation |
| Hyperlipidemia | Elevated blood serum lipids (triglycerides/cholesterol) - LDL <100 mg/dL optimal Stroke/MI and vascular disease risk factor |
| Hyperlipidemia treatment | Dietary modification with low cholesterol Weight loss and exercise Statin therapy (need CMP and CK monitor) |
| Venous thrombus embolism risk factors | Virchow's Triad (altered coagulation, endothelial damage, venous stasis) Smoker Oral contraceptive Long periods immobilization/venous stasis (sitting/lying down) |
| Hypertension pathophysiology | elevated BP S/S: Headache, dizziness, blurred vision, tachycardia |
| Hypertension treatment | Sodium restriction (<2g daily) Calcium channel blocker (Amlodipine) Angiotensin Receptor Blocker (Losartan) Angiotensin Converting Enzyme Inhibitor (Lisinopril) Beta-blocker (Metoprolol) Diuretics/Thiazides (HCTZ) |
| ACE Inhibitor ADR | Angioedema (occurs within days to months to years) Lisinopril, Enalapril |
| Diabetes Mellitus Type 1 Pathophysiology | Autoimmune destruction of insulin producing pancreatic B-cells (absolute insulin deficiency) Genetic component, childhood development Need lifelong insulin therapy S/S: Polyuria, polydipsia, polyphagia, hypoglycemia, dizziness, diaphoresis DKA risk |
| Diabetic Ketoacidosis | Abnormal metabolism of carbs/protein/fats due to lack of insulin, acidosis d/t elevated ketone bodies S/S: Hyperglycemia, Dehydration, Serum and urine ketone elevation, vomiting |
| Diabetes Mellitus Type 2 Pathophysiology | Acquired insulin resistance/deficiency HHS (Hyperosmolar Hyperglycemic State) S/S: Polyuria, polydipsia, polyphagia, hypoglycemia, dizziness, diaphoresis |
| Hyperosmolar Hyperglycemic State | DMT2 complication with minimal/absent ketosis |
| DKA/HHS treatment | IV fluids for dehydration with I/Os IV insulin Monitor electrolytes (hypokalemia risk with insulin infusion) |
| Diabetes management | Oral medications and insulin Diet education Skin care and foot care education (toe, toenail, foot wound check) Exercise with carbohydrate snack Proper vaccination schedule d/t higher risk of infection |
| Basal Bolus Regimen | Basal insulin = long acting insulin (lantus) Bolus insulin = short acting insulin (Humalog) |
| Peptic ulcer disease pathophysiology | Erosion of mucus membrane in the stomach, pylorus or esophagus H. Pylori infection NSAID overuse Increased gastric acid production Smoking/EtOH use |
| Nursing Considerations for PUD | Assess PHx - Diet and lifestyle - prior H. Pylori or stomach infection - NSAID use |
| Acute pancreatitis pathophysiology | Obstruction of pancreatic duct leading to back up of enzymes and digestion and inflammation of pancreas S/S: Severe abdominal pain, back pain, N/V, shock symptoms, hypotension, tachycardia |
| Chronic pancreatitis pathophysiology | Progressive inflammatory disorder of pancreas with destruction and replacement of fibrotic tissue -> obstruction of pancreatic/bile ducts S/S: Abdominal pain (recurrent), weight loss, N/V, frothy/foul smelling stool |
| Acute pancreatitis treatment | IV fluids for hydration and electrolyte/fluid correction NPO status Monitor CMP and pancreatic markers |
| Chronic pancreatitis treatment | IV fluids for hydration and electrolyte/fluid correction Monitor CMP and pancreatic markers |
| Hiatal hernia pathophysiology | Herniation of upper portion of stomach thru the diaphragm into the thorax S/S: heartburn, chest pain, bloating, burping, dysphagia *airway precautions* |
| Hiatal hernia treatment | Surgery if severe Lifestyle modification with smaller more frequent meals |
| Diverticulitis pathophysiology | Inflammation of diverticulum S/S: (LLQ) abdominal pain |
| Which GU organs are affected in lower UTIs? | Bacterial cystitis: inflammation of the urinary bladder Bacterial prostatitis: inflammation of the prostate gland Bacterial urethritis: inflammation of the urethra |
| How does infection occur in lower UTIs? | For infection to occur, bacteria must: Gain access to the bladder Attach to and colonize the epithelium of the urinary tract Evade host defense mechanisms Initiate inflammation |
| How does infection occur in lower UTIs? | Bacteria enters the urinary tract in 3 ways: Transurethral route (ascending infection) *most common route, often from fecal contamination) Through the bloodstream (hematogenous spread) By means of a fistula from the intestine (direct extension) |
| How does infection occur in lower UTIs? | Many UTIs result from fecal organisms ascending from the perineum to the urethra and bladder |
| Who is most likely to develop an infection for lower UTIs? | In females, the shorter urethra offers less resistance to bacteria |
| Clinical Manifestations of lower UTIs. | Uncomplicated lower UTI symptoms: Burning on urination Urinary frequency and urgency Nocturia, incontinence, suprapubic or pelvic pain Hematuria and bladder or back pain |
| Clinical Manifestations of lower UTIs. | Complicated UTIs can range from asymptomatic bacteriuria to Gram-negative sepsis with shock Signs and symptoms depend on the infection’s location and whether it is acute or chronic |
| Gerontologic Considerations of lower UTIs. | Incidence of bacteriuria increases with age and disability Older adult females are at higher risk due to: Pelvic prolapse, cystocele, rectocele Urinary reflux, incontinence, vaginal atrophy Estrogen deficiency |
| Gerontologic Considerations of lower UTIs. | Older adult females are at higher risk due to: UTIs are the most common infection in older adults Structural abnormalities and decreased bladder tone increase UTI risk Indwelling catheters significantly increase the risk of CAUTI |
| How do we obtain the diagnostic urine for lower UTIs? | Clean-catch midstream urine specimen is used to establish bacteriuria Contamination of urine samples occurs less frequently in males |
| Medical Management of lower UTIs. | Patient education Acute Pharmacologic Therapy Ideal medication for UTI in females: Eradicates bacteria with minimal effects on fecal and vaginal flora Affordable, few adverse effects, low resistance Effective against E. coli and other fecal flora |
| Medical Management of lower UTIs. | Acute Pharmacologic Therapy Treatment regimens: Single-dose, short-course (3 days), 7-10 day regimens Longer courses for males, pregnant people, and complicated UTIs Hospitalization and IV antibiotics may be necessary |
| Medical Management of lower UTIs. | Long-Term Pharmacologic Therapy: 3 day treatment usually adequate for females, but some may have recurrent infections Recurrence within 2 weeks suggests original strain remains Recurrent infections in males usually caused by the same organism |
| Medical Management of lower UTIs. | Long-Term Pharmacologic Therapy: Cranberries and probiotics may help prevent recurrent UTIs Antibiotic therapy is more effective for treatment |
| Nursing Care for lower UTIs. | Focus on treating the underlying infection and preventing recurrence Assessment: Obtain history of signs and symptoms Assess pain, frequency, urgency, hesitancy, and changes in urine Evaluate voiding patterns, hygiene, and knowledge of medications |
| Nursing Care for lower UTIs. | Nursing diagnoses: Acute pain associated with infection Deficiency knowledge about factors predisposing to infection and recurrence |
| Nursing Care for lower UTIs. | Relieving pain: Pain relief with effective antimicrobial therapy Antispasmodic agents may relieve bladder irritability and pain Analgesics and heat application help relieve pain and spasm Encourage liberal fluid intake to flush bacteria |
| Nursing Care for lower UTIs. | Relieving pain: Avoid urinary tract irritants (e.g. coffee, tea, citrus, colas, alcohol) Encourage frequent voiding to prevent bladder overdistention and urinary stasis |
| Potential complications we are looking out for in lower UTIs. | Sepsis (urosepsis) Acute kidney injury or chronic kidney disease from extensive infective or inflammatory processes |
| How are we monitoring for complications in lower UTIs? | Early recognition and prompt treatment prevent complications Educate patients to recognize early signs and symptoms Prescribe appropriate antimicrobial therapy, liberal fluid intake, frequent voiding, and hygienic measures |
| How are we monitoring for complications in lower UTIs? | Increased risk of Gram-negative sepsis with UTIs Careful assessment of vital signs and level of consciousness Report positive blood cultures and elevated WBC counts immediately Early detection and treatment reduce mortality rate associated with CAUTI |
| How are we monitoring for complications in lower UTIs? | Monitor kidney function and evaluate for strictures, obstructions, or stones |
| Patient Education for lower UTIs. | Hygiene Shower rather than bathe in a tub because bacteria in the bathwater may enter the urethra. |
| Patient Education for lower UTIs. | Hygiene Clean the perineum and urethral meatus from front to back after each bowel movement to reduce concentrations of pathogens at the urethral opening and the vaginal opening. |
| Patient Education for lower UTIs. | Fluid Intake Drink liberal amounts of fluids daily to flush out bacteria. It may be helpful to include at least one glass of cranberry juice per day. Avoid coffee, tea, colas, alcohol, and other fluids that are urinary tract irritants. |
| Patient Education for lower UTIs. | Voiding Habits Void every 2 to 3 hours during the day, and completely empty the bladder. This prevents overdistention of the bladder and compromised blood supply to the bladder wall. Both predispose the patient to urinary tract infection. |
| Patient Education for lower UTIs. | Voiding Habits Females should void immediately after penile-vaginal intercourse. |
| Patient Education for lower UTIs. | Keep in mind that if bacteria continue to appear in the urine, long-term antimicrobial therapy may be required to prevent colonization of the periurethral area and recurrence of infection. |
| Patient Education for lower UTIs. | If prescribed, test urine for the presence of bacteria following the manufacturer’s and health care provider’s instructions. Notify the primary provider if fever occurs or if signs and symptoms persist. |
| Patient Education for lower UTIs. | For recurrent infection, consider daily consumption of cranberry juice or capsules. Take medication exactly as prescribed. Special timing of administration may be required. Consult the primary provider regularly for follow-up. |
| Which GU organs are affected in upper UTIs? | Less common than lower UTIs Chronic pyelonephritis Interstitial nephritis Kidney abscesses |
| Which GU organs are affected in upper UTIs? | Acute pyelonephritis: Leads to enlargement of the kidneys with interstitial infiltrations of inflammatory cells Abscesses may be noted on or within the renal capsule Atrophy and destruction of tubules and glomeruli may result |
| How does infection occur in upper UTIs? | Common cause of urosepsis Upward spread of bacteria from the bladder Spread from systemic sources via the bloodstream Obstruction in the urinary tract (stones like urolithiasis and nephrolithiasis) |
| Clinical Manifestations of upper UTIs. | Acute pyelonephritis: Chills, fever, leukocytosis, bacteriuria, pyuria Low back pain, flank pain, nausea, vomiting, headache, malaise, painful urination Pain and tenderness in the costovertebral angle Urgency and frequency |
| Assessment & Diagnostics for upper UTIs. | Acute pyelonephritis: Ultrasound or CT scan to locate obstruction in the urinary tract IV pyelogram if functional and structural abnormalities are suspected |
| Assessment & Diagnostics for upper UTIs. | Acute pyelonephritis: Urine culture and sensitivity tests to determine causative organism pyuria>leukoesterase and nitrites present >10,000 CFUs and symptoms |
| Assessment & Diagnostics for upper UTIs. | Acute pyelonephritis: Radionuclide imaging with gallium citrate and indium111-labeled WBCs to identify infection sites |
| Medical Management for upper UTIs. | Acute pyelonephritis: Outpatient treatment if no acute symptoms of sepsis, dehydration, nausea, or vomiting Hydration with oral or parenteral fluids is essential |
| Medical Management for upper UTIs. | Acute pyelonephritis: 2 week course of antibiotics recommended for outpatients Follow-up urine culture 2 weeks after completion of antibiotic therapy |
| Nursing Care for upper UTIs. | Early recognition of worsening infection to prevent urosepsis Administer prescribed antibiotics promptly Promote hydration (oral or IV fluids) Encourage frequent voiding to reduce urinary stasis |
| Nursing Care for upper UTIs. | Monitor for signs of complications (sepsis, kidney injury) Maintain hygienic measures |
| Patient Education for upper UTIs. | Wipe front to back Void after sexual activity Avoid holding urine; void frequently Increase fluid intake to flush bacteria Avoid irritants (caffeine, alcohol if symptomatic) Maintain perineal hygiene (clean, dry area) |
| Patient Education for upper UTIs. | Avoid tight or non-breathable underwear Complete full antibiotic course Recognize early symptoms (fever flank pain, urinary changes) |
| Potential complications we are looking out for in upper UTIs. | Urosepsis (most important, can become life-threatening) Acute kidney injury (from infection/inflammation of kidney tissue) Chronic kidney disease (if damage is prolonged or recurrent) |
| How are we monitoring for complications in upper UTIs? | Monitor vital signs (especially fever because can lead to sepsis) Assess level of consciousness (early sepsis change) Monitor WBC count (infection severity) Report positive blood cultures immediately Evaluate obstruction, strictures, or stones |
| How are we monitoring for complications in upper UTIs? | Check kidney function labs (detect AKI): Creatinine BUN Electrolytes |
| The Use of Urinary Catheters:Who are good candidates for urinary catheters? | Suprapubic catheters: Inserted through suprapubic incision, connected to sterile closed drainage system Suprapubic catheters Advantages: Greater mobility Less risk of bladder infection Measurement of residual urine without urethral instrumentation |
| The Use of Urinary Catheters:Who are good candidates for urinary catheters? | Postoperative drainage Accurate urine output monitoring Neurogenic bladder dysfunction Urine retention End of life care |
| Nursing Care for Urinary Catheters. | Preventing CAUTI: Strict aseptic technique Secure catheter Inspect urine Daily perineal care Maintain closed system Discontinue use as soon as feasible |
| Nursing Care for Urinary Catheters. | Catheter-associated urinary tract infection (CAUTI): Most common health-care associated infection Associated with indwelling urinary catheters Occurs when a catheter is in place for more than 2 days |
| Nursing Care for Urinary Catheters. | Ensure adequate urinary drainage and preserve kidney function |
| Is pyuria always found in LUTI? Does its presence always mean that the patient has a UTI? | No not always found in lower UTI. Its presence does NOT always mean patient has UTI. |
| What is renal calculi? | Stone formation anywhere from kidney to bladder Concentrated buildup of calcium oxalate, calcium phosphate, or uric acid Types of stones: Struvite stones Cystine stones Oxalate stones |
| How/Why does renal calculi occur? | Infection Urinary stasis Periods of immobility Increased calcium concentrations |
| Where in the GU tract can they develop? | Nephrolithiasis: stones in the kidney Urolithiasis: stones in the urinary tract |
| Clinical Manifestations of renal calculi. | Symptoms depend on: Obstruction, infection, edema Pain and discomfort: Intense, deep ache in costovertebral region Radiates anteriorly and downward Hematuria and pyuria |
| Clinical Manifestations of renal calculi. | Renal colic: Acute pain, nausea, vomiting Ureteral colic: Colicky, wavelike pain radiating to thigh and genitalia Bladder stones: Irritation, UTI, hematuria, urinary retention |
| Assessment and Diagnostics for renal calculi. | Diagnosis based on: Symptomatology, examination, diagnostic tests Blood chemistries and 24 hour urine test: Measurement of calcium, uric acid, creatinine, sodium, pH, total volume Stone analysis: Determines composition and underlying disorder |
| Assessment and Diagnostics for renal calculi. | Diagnostic test: Urinalysis Kidneys, ureters, and bladder (KUB) X-rays Noncontrast CT scan Abdominal ultrasound |
| How do we manage stones? | Nutritional therapy for stone prevention. Fluid intake: 8-10 glasses of water daily IV fluids if necessary Calcium stones: Restrict dietary calcium, liberal fluid intake Medications: ammonium chloride, thiazide diuretics |
| How do we manage stones? | Nutritional therapy for stone prevention. Uric acid stones: Low-purine diet, avoid high-purine foods Medications: allopurinol Custine stones: Low-protein diet, alkalinize urine, increase fluid intake |
| How do we manage stones? | Oxalate stones: Increase fluid intake, limit oxalate-rich foods |
| Medical therapy for stone management. | Goals: Eradicate stone, determine stone type, prevent nephron destruction Control infection, relieve obstruction Pain relief: Opioid analgesics, NSAIDs |
| Medical therapy for stone management. | Fluid intake: Encouraged to increase hydrostatic pressure and dilute urine Nutritional therapy: Fluid intake, dietary modifications based on stone type |
| Surgical therapy for stone management. | Indication: Stone does not respond to other treatments Correct anatomic abnormalities Nephrolithotomy Nephrectomy Pyelolithotomy Ureterolithotomy Cystotomy Cystolitholapaxy: instrument inserted through urethra to crush bladder stone |
| Nursing Assessments for renal calculi. | Assess for pain, discomfort, nausea, vomiting, diarrhea, abdominal distention Signs of UTI: chills, fever, frequency, hesitancy Signs of obstruction: frequent urination, oliguria, anuria Inspect urine for blood, stones, gravel |
| Nursing Assessments for renal calculi. | Obtain patient history, factors predisposing to urinary tract stones Knowledge about renal calculi and prevention measures |
| Interventions for renal calculi. | Severe acute pain requires immediate attention Pain relief using opioid analgesics, IV NSAIDs Encourage and assist patient to a position of comfort Monitor pain level, report increase in severity to HCP |
| Education for renal calculi. | High risk for recurrence: Educate about causes and prevention Fluid intake: Maintain high fluid intake, excrete >2,000mL urine daily Urine cultures: Perform every 12 months initially |
| Education for renal calculi. | Increased mobility: Prevent renal drainage issues, alter calcium metabolism Avoid excessive vitamins and minerals Post-procedure care: Signs of complications, follow up for kidney function |
| Potential complications of renal calculi. | Infection and urosepsis (from UTI and pyelonephritis) Obstruction of the urinary tract by stone or edema Subsequent acute kidney injury |
| Managing potential complications. | Encourage fluid intake: Prevent dehydration, increase hydrostatic pressure Monitor urine output and voiding patterns Encourage ambulation: Promote stone passage Strain all urine: Determine type of calculi |
| Managing potential complications. | Monitor for signs of infection: Decreased urine volume, bloody or cloudy urine, fever, pain Frequent nursing observation: Detect spontaneous passage of stones |
| Which GU organs are affected in BPH? | Prostate Kidneys bladder Ureters Urethra or bladder neck |
| What population does BPH occur in? | Common in aging males older than 40 years |
| Clinical Manifestations of BPH. | Symptoms may range from mild to severe: Urinary frequency, urgency, nocturia, hesitancy, decreased force of stream Sensation of incomplete bladder emptying, dribbling, and abdominal straining |
| Clinical Manifestations of BPH. | Chronic urinary retention can lead to azotemia and kidney failure Generalized symptoms may include fatigue, anorexia, nausea, vomiting, and pelvic discomfort |
| Medical Management of BPH. | Goals: improve quality of life, urine flow, relieve obstruction, prevent disease progression Treatment depends on symptom severity and patient condition: Emergency catheterization for inability to void Watchful waiting for mild symptoms |
| Medical Management of BPH. | Pharmacologic treatment: Alpha-adrenergic blockers relax bladder neck and prostate Tamsulosin (Flomax) 5-alpha-reductase inhibitors decrease prostate size Finasteride |
| Surgical Management of BPH. | Surgical resection options: Transurethral resection of the prostate (TURP) Transurethral incision of the prostate (TUIP) Open prostatectomy Laparoscopic and robotic-assisted laparoscopic prostatectomy |
| Surgical Management of BPH. | Minimally invasive procedures and resection of the prostate gland: Transurethral microwave thermotherapy and transurethral needle ablation Prostatic stents for patients with urinary retention |
| Post-prostatectomy care. | Potential complications for patients undergoing prostatectomy: Hemorrhage Infection VTE Catheter obstruction Complications with catheter removal Urinary incontinence Sexual dysfunction |
| Post-prostatectomy care. | Stool softeners may be prescribed to prevent excessive straining Observe for signs of bleeding: Bright-red urine Blood clots |
| Post-prostatectomy care. | Ensure catheter patency: Catheter irrigation may be prescribed to prevent obstruction by blood clots After catheter removal, some urinary incontinence may occur, which generally subsides over time |
| Post-prostatectomy care. | Encourage early ambulation to reduce VTE risk and provide pain relief using prescribed medications, warm compress, or sitz baths |
| Patient education for Post-prostatectomy care. | Instruct on signs of complications to report: Bleeding Fever Decreased urine output Calf pain Wound changes UTI symptoms |
| Patient education for Post-prostatectomy care. | Demonstrate and encourage perineal muscle exercises: Tightening buttocks, hold, relax and repeat for 10-20x per hour Practice interrupting urinary stream |
| Patient education for Post-prostatectomy care. | Teach catheter and wound care if wound or suprapubic catheter present Patients may resume usual activities as able, robotic surgery patients may recover faster (7-10 days) |
| Patient education for Post-prostatectomy care. | Reassure that bladder control returns gradually: Dribbling and cloudy urine may persist for a few weeks |
| 4 cardinal signs | Tremor Rigidity Bradykinesia Postural instability |
| Tremor | Slow, unilateral resting tremor Present in the majority of patients at diagnosis Disappears with purposeful movement and during sleep Manifestations Rhythmic, slow turning motion of the forearm and hand |
| Tremor | Motion of the thumb against the fingers as if rolling a pin |
| Rigidity | Resistance to passive limb movement Jerky increments (lead-pipe or cogwheel movements) Involuntary stiffness increases with voluntary active movement Common stiffness areas Arms, legs, face, and posture Early symptom Shoulder pain due to rigidity |
| Bradykinesia | Overall slowing of active movement and speech Patients take longer to complete activities Difficulty initiating movement Common difficulties Rising from a sitting position Turning in bed |
| Postural instability | Develops postural and gait problems Loss of postural reflexes Propulsive gait Posture Forward flexion of the neck, hips, knees, and elbows Increased risk for falls Difficulty in pivoting |
| Pathophysiology. What happens to which neurotransmitter? | Associated with decreased levels of dopamine Resulting from degeneration of dopamine storage cells in the substantia nigra Acetylcholine (excitatory) and dopamine (inhibitory): Leads to more excitatory neurotransmitters than inhibitory |
| Assessment and Diagnostic findings in Parkinson’s Disease. | Diagnosis based on clinical history and presence of cardinal manifestations Tremor, rigidity, bradykinesia, postural changes* Early diagnosis challenging Symptoms often noticed by family members Diagnostic tools |
| Assessment and Diagnostic findings in Parkinson’s Disease. | PET and single-photon emission CT scanning Positive response to levodopa trial confirms diagnosis |
| Other clinical manifestations of Parkinson’s. | Gradual onset and slow progression Either tremor dominant or nontremor dominant Autonomic symptoms Excessive sweating, drooling, orthostatic hypotension Gastric and urinary retention, constipation, sexual dysfunction |
| Other clinical manifestations of Parkinson’s. | Dysphagia and vision/olfactory changes Choking Psychiatric changes Depression, anxiety, dementia, delirium, hallucinations, psychosis Cognitive changes (more severe) Diminished executive functions, attention difficulties, decreased thinking |
| Medical management for Parkinson’s. | Treatment focuses on controlling symptoms and maintaining functional independence.* Individualized care based on presenting symptoms and social, occupational, and emotional needs |
| Medical management for Parkinson’s. | Mainstay of pharmacologic management Levodopa, often combined w/ carbidopa Adverse effects: Dyskinesia, nausea, vomiting, decreased BP, confusion |
| Medical management for Parkinson’s. | No current medical or surgical approaches prevent disease progression Surgical options considered for disabling tremor, rigidity, or severe dyskinesia |
| Surgical management for Parkinson’s. | not common Considered for disabling tremor, rigidity, or severe dyskinesia Deep brain stimulation (DBS): Most effective interventional therapy Involves surgical implantation of an electrode into the brain |
| Surgical management for Parkinson’s. | Magnetic resonance-guided high-intensity focused ultrasound (MRgFUS): Approved for tremors Creates tissue damage at specific targets in the brain |
| Parkinson Nursing Focus. | Gather information on how the disease affects ADLs and functional abilities Observe for degree of disability and functional changes Useful assessment questions Leg or arm stiffness, irregular jerking, freezing, excessive mouth watering |
| Parkinson Nursing Focus. | Observe for quality of speech, facial expression, swallowing deficits, tremors, slowness of movement* |
| Potential complications of Parkinson’s. | Sleep disturbances Psychiatric disturbances |
| Managing potential complications of Parkinson’s. | Planned program of activity: Prevents daytime sleeping, disinterest, and apathy Interventions for sleep disturbances: Limit caffeine intake, assess for nocturia Monitor for signs of depression: Interprofessional approach for treatment |
| Managing potential complications of Parkinson’s. | Manage psychiatric disturbances: Low doses of antipsychotic drugs, minimize medications with psychiatric side effects |
| Goals for the patient with Parkinson’s. | Achieve adequate bowel elimination Attain and maintain acceptable nutritional status Achieve effective communication Develop positive coping mechanisms Enhance swallowing in Parkinson’s Disease Encourage use of Assistive Devices |
| Goals for the patient with Parkinson’s. | Improve functional mobility* Maintain independence in ADLs* |
| Improve functional mobility* | Progressive daily exercise program Increases muscle strength, improves coordination, reduces rigidity Exercises Walking, stationary biking, swimming, gardening Stretching and range of motion exercises |
| Improve functional mobility* | Promote joint flexibility Special walking techniques Concentrate on walking erect, use a wide-based gait, swing arms, raise feet |
| Maintain independence in ADLs* | Encourage, educate, and support during ADLs Environmental modifications Compensate for functional disability Adaptive or assistive devices Hospital bed, bedside rails, overbed frame with trapeze |
| Maintain independence in ADLs* | Occupational therapist Evaluate needs, recommend adaptive devices, education patient and caregiver |
| Achieve adequate bowel elimination | Factors causing constipation: Muscle weakness, lack of exercise, inadequate fluid intake, poor sleep quality Regular bowel routine Follow a regular time pattern, increase fluid intake, eat foods with moderate fiber content Avoid laxatives |
| Achieve adequate bowel elimination | Factors causing constipation: Psyllium decreases constipation but carries risk for bowel obstruction Improve sleep quality- associated with constipation management |
| Attain and maintain acceptable nutritional status | Difficulty maintaining weight Slow eating process, dry mouth, difficulty chewing and swallowing Risk for aspiration due to impaired swallowing, accumulation of saliva Monitor weight weekly to check caloric intake adequacy |
| Attain and maintain acceptable nutritional status | Supplemental feedings increase caloric intake Nasogastric or PEG tube may be necessary as disease progresses |
| Achieve effective communication | Speech disorders common Low-pitched, monotonous, soft speech Conscious effort to speak slowly Face listener, exaggerate pronunciation, speak in short sentences |
| Achieve effective communication | Speech therapist: Design speech improvement exercises, assist family and health care personnel Small electronic amplifier: Helpful if difficulty being heard |
| Develop positive coping mechanisms | Encourage active participation in therapeutic program Undermines goal of improving coping abilities and promoting positive self-concept |
| Develop positive coping mechanisms | Social and recreational events: Set achievable goals Improvement of mobility Encourage independence Carry out tasks involved in meeting daily needs Avoid doing things for the patient |
| Enhance swallowing in Parkinson’s Disease | Common swallowing difficulties and choking Risk for aspiration and pneumonia Upright position during meals Semisolid diet with thick liquids easier to swallow Avoid thin liquids |
| Enhance swallowing in Parkinson’s Disease | Swallowing sequence: Place food on tongue, close lips and teeth, lift tongue up and back, swallow Control saliva buildup Hold head upright, make conscious effort to swallow |
| Encourage use of Assistive Devices | Electric warming tray: Keeps food hot, allows rest during prolonged eating time Special utensils: Stabilized plate, nonspill cup, eating utensils with built-up handles Occupational therapist: Assist in identifying appropriate adaptive devices |
| What part of the brain is involved in meningitis? | Inflammation of the meninges |
| What are the causes of meningitis? | Bacterial (septic) Viral (aseptic) Fungus Parasites Toxins |
| Clinical manifestations for meningitis. | Constitutional signs: Headache, fever, chills, tachycardia Meningeal irritation signs Other symptoms: Rash (meningococcal meningitis) Disorientation, confusion, nausea, vomiting Seizures, increased ICP, coma |
| Meningeal irritation signs | Nuchal rigidity (stiff neck) Photophobia (sensitivity to light) Positive Kernig sign (pain on knee extension) Positive Brudzinski sign (knee/hip flexion on neck flexion) |
| Assessment and diagnostics findings for Meningitis. | Diagnostic testing is vital to identify the causative organism CT scan of the head before lumbar puncture if risk factors for increased ICP are present Blood and CSF bacterial cultures and gram staining for rapid identification |
| Assessment and diagnostics findings for Meningitis. | CSF values in bacterial and viral meningitis Bacterial (Septic) Meningitis: Opening pressure >180 Cloudy CSF Elevated WBC Neutrophils >/=80 Elevated protein Decreased glucose Elevated CSF pressure |
| Assessment and diagnostics findings for Meningitis. | Viral (Aseptic) Meningitis: Opening pressure variable Clear CSF Elevated WBC Neutrophils <40 Normal or elevated protein Normal glucose Elevated CSF pressure |
| Prevention of Meningitis | Vaccination recommendations: Meningococcal conjugated vaccine for children aged 11-12, with a booster at 16 Vaccination against Hemophilus influenzae and S. pneumoniae for at-risk individuals |
| Prevention of Meningitis | Close contacts of bacterial meningitis patients should receive prophylactic treatment Medications: rifampine, ciprofloxacin, ceftriaxone Start within 24 hours of exposure |
| Medical management of Meningitis. | Supportive measures: Treating dehydration and hypovolemic shock Managing seizures with anticonvulsants Assessing and treating increased ICP |
| Medical management of Meningitis. | Early diagnosis and timely antibiotic administration are crucial Penicillin G combined with a cephalosporin (e.g. ceftriaxone, cefotaxime) |
| Medical management of Meningitis. | Dexamethasone as an adjunct to antibiotic treatment: Reduces hearing loss and neurological symptoms Administer before or with the first antibiotic dose |
| Nursing management of Meningitis. | Nursing interventions: Infection control precautions until 24 hours after antibiotic initiation Pain management and rest in a quiet, dark room Treating elevated body temperature Ensuring adequate hydration Close neurologic monitoring |
| Nursing management of Meningitis. | Collaborative care with health care team |
| Nursing management of Meningitis. | Additional care: Protecting from injury due to seizures or altered LOC Monitoring body weight, serum electrolytes, and urine output Preventing complications from immobility Providing family support and resources |
| Types of Multiple Sclerosis | Remitting-relapsing (RRMS) Secondary progressive Primary progressive (PPMS) Clinically isolated syndrome (CIS) |
| Risk factors and likely diagnosed age ranges for MS? | Higher northern latitudes Vitamin D deficiency Smoking Obesity Epstein Barr virus infection Commonly diagnosed between ages 20 and 50 |
| Which sex is more likely to be affected by MS? | Females |
| Is MS reversible/curable/treatable? | No cure for MS Treatment aims to delay progression, manage symptoms, and treat exacerbations |
| Pathophysiology of MS. | Autoreactive lymphocytes play a role: T and B lymphocytes cross the blood-brain barrier and produce pro-inflammatory cytokines Demyelination interrupts nerve impulses: Results in various manifestations depending on affected nerves |
| Pathophysiology of MS. | Plaques appear on demyelinated axons, further interrupting transmission Commonly affected areas: optic nerves, cerebrum, brainstem, cerebellum, and spinal cord Microglia may play a prominent role in chronic MS |
| Pathophysiology of MS. | Exact cause remains unknown Characterized as an inflammatory, immune-mediated disorder |
| Assessment/Diagnostics Findings in MS. | Diagnosis based on history, clinical examination, imaging, and laboratory findings MRI detects myelin plaque Lumbar puncture identifies oligoclonal banding McDonald’s Criteria Evoked potential studies define anatomical location of CNS lesions |
| Clinical Manifestations of MS. | Common symptoms Fatigue, muscle weakness, impaired gait, sensory loss, bladder problems, visual disturbances Fatigue is the most common and disabling symptom: Worsens throughout the day, exacerbated by heat and humidity |
| Clinical Manifestations of MS. | Pain caused by lesions on sensory pathways: Managed with medications, sometimes surgery Cognitive and psychosocial problems may occur: Memory loss, decreased concentration, emotional lability Bladder, bowel, and sexual dysfunction are common |
| Medical management of MS. | Disease modifying therapies (DMTs) delay disease progression of MS Acute exacerbations treated with high-dose corticosteroids Plasmapheresis for non-responsive cases |
| Medical management of MS. | DMTs target various mechanisms T-cell and B-cell depletion, immunomodulatory actions, limiting inflammatory cell migration DMTs reduce relapse frequency, neurologic deficits, and delay progression initiated as soon as possible for RRMS patients |
| Medical management of MS. | No cure; treatment aims to delay progression, manage symptoms, and treat exacerbations. |
| Symptom management of MS | Range of symptoms: muscle spasticity, fatigue, bowel and bladder dysfunction Interfere with daily activities Nonpharmacologic strategies are also important: Physical therapy, occupational therapy, lifestyle modifications |
| Symptom management of MS | Medications for symptom management: Antispasmodics, anticholinergics, stool softeners, alpha antagonists, antidepressants, analgesics, stimulants |
| Nursing assessment for MS | Address neurologic deficits and impact on patient and family: Observe mobility and balance for fall risk |
| Nursing assessment for MS | Assess for weakness, spasticity, visual impairment, incontinence, swallowing, and speech disorders Evaluate quality of life, coping, medication adherence, and patient-initiated goals |
| Nursing Interventions for MS | Individualized program of physical, occupational, and speech-language therapy: Combined with education and emotional support Educational plan for managing physiologic, social, and psychological issues: Enable self-management of chronic disease |
| Patient education for MS | Educate on maintaining independence: Assistive devices, self-catheterization, medication administration Develop education plan for medication administration: Side effects and exercises for activity maintenance |
| Potential complications for MS. | Constipation or fecal incontinence Communication issues and potential for aspiration Cognitive changes Managing therapies at home Changes in sexuality Urinary incontinence |
| What are we going to do about potential complications for MS? | Therapy & Mobility: Individualized program of physical, occupational, and speech-language therapy; combined with education and emotional support Manage symptoms to increase physical activity; Depression, pain, fatigue, walking difficulty |
| What are we going to do about potential complications for MS? | Therapy & Mobility: Walking to restore gait; Muscles trained to compensate for affected groups Upper extremity incoordination addressed with weights or neuromodulation devices |
| What are we going to do about potential complications for MS? | Therapy & Mobility: Relaxation and coordination exercises; Progressive resistive exercises for muscle strength |
| What are we going to do about potential complications for MS? | Exercise, Energy Conservation & Spasticity: Promote daily stretching exercises, warm packs (no hot baths), progressive weight bearing exercises, and prescribed orthotics to decrease risk of muscle spasticity |
| What are we going to do about potential complications for MS? | Exercise, Energy Conservation & Spasticity: Encourage work & exercise short of fatigue with air conditioning & frequent, short rest periods; Do not promote strenuous exercise Manage fatigue by encouraging sleep and hygiene |
| What are we going to do about potential complications for MS? | Safety & Functional Support: Fall prevention: have pt walk w/ feet apart for stability due to ataxia, provide training for transfer/ADL/assistive devices Sensory loss & pressure injury risk: get an occupational therapist for independence aids |
| What are we going to do about potential complications for MS? | Safety & Functional Support: Education on safe use of assistive devices |
| What are we going to do about potential complications for MS? | Nutrition & Lifestyle: Encourage healthy eating, include family in nutrition planning, be aware of corticosteroid use and mobility impairments being risk factors for obesity |
| What are we going to do about potential complications for MS? | Psychosocial Support & Monitoring: Assist with stress: promote self efficacy, well being, counseling referrals for families Monitoring: cognitive changes, psychological effects, risk of depression and suicide |
| What are we going to do about potential complications for MS? | Education & Care Coordination: Educational plan for managing physiologic, social, and psychological issue; Enables self-management of chronic disease |
| What are we going to do about potential complications for MS? | Education & Care Coordination: Education: side effects and exercises for activity maintenance, self catheterization, medication administration, assistive devices, provide education and reinforcement at home |
| What are we going to do about potential complications for MS? | Education & Care Coordination: assess physical and emotional status, coordinate outpatient services and resources like home modifications for independence |
| What are we going to do about potential complications for MS? | Communication: Communication: encourage contact with primary provider for changes Evaluate: Effective mobility, Reduced fall risk, Reduced fatigue, Effective coping, Absence of complication |
| What is Guillain-Barre Syndrome? | Acute, rapid segmental demyelination of peripheral and cranial nerves Presents as neuromuscular respiratory failure, paraesthesia, muscle weakness |
| How does Guillain-Barre Syndrome progress? | Resolvable due to schwann cell involvement & potential for remyelination (Schwann cells are cells in the PNS that can repair damaged myelin, allowing nerves to regain function through remyelination.)* |
| How does Guillain-Barre Syndrome progress? | Ascending progression of symmetric motor weakness (weakness begins in the lower extremities & progressively spreads upward on both sides of the body over time)* |
| How does Guillain-Barre Syndrome progress? | Cell-mediated and humoral immune attack on peripheral nerve myelin proteins Often after viral infection |
| Medical treatment for Guillain-Barre Syndrome. | Intensive care unit management using mechanical ventilation Therapeutic plasma exchange or IVIG Continuous ECG monitoring for cardiovascular risks Supportive care to prevent complications of immobility |
| Nursing treatment for Guillain-Barre Syndrome. | Supportive care to prevent complications of immobility Close monitoring of cardiac and respiratory status |
| What is Myasthenia Gravis? | Autoimmune disorder affecting the neuromuscular junction Characterized by muscle weakness, diplopia, ptosis, slurred speech, dysphagia Limb weakness associated with respiratory failure |
| Assessment and Diagnostic Findings for Myasthenia Gravis. | Blood tests for acetylcholine or anti-MuSK receptor antibodies CT or MRI scan for thymus gland enlargement Electrodiagnostics: Repetitive nerve stimulation (RNS) Single-fiber electromyography (EMG) |
| Medical treatment for Myasthenia Gravis. | Improving function and reducing circulating antibodies Immunosuppressive therapy: MMF, prograf, AZA, prednisone IVIG +/- therapeutic plasma exchange Anticholinesterase medications: Slows the breakdown of acetylcholine at the NMJ to improve strength |
| Medical treatment for Myasthenia Gravis. | **Magnesium should be avoided in these patients** |
| Surgical treatment for Myasthenia Gravis. | Thymectomy |
| Nursing treatment for Myasthenia Gravis. | Maintain patent airway Safety and energy conservation Education on pharmacological management and ADLs |
| What are seizures? | Episodes of abnormal motor, sensory, autonomic, or psychic activity Result from sudden excessive discharge from cerebral neurons Can involve localized area or entire brain |
| How are seizures different from epilepsy? | Epilepsy is more than one unprovoked, recurring seizure Differentiates between focal onset, generalized onset, and unknown onset seizures |
| Focal vs generalized seizures. | Focal (partial) seizures: originate within a localized area of the brain Generalized seizures: engage bilaterally distributed networks rapidly |
| Clinical manifestations for seizures. | Generalized seizures: involves both hemispheres, causing bilateral body reactions Intense body rigidity followed by alternating muscle relaxation and contraction Possible epileptic cry, tongue chewing, incontinence |
| Clinical manifestations for seizures. | Generalized seizures: Postictal state: confusion, difficulty arousing, potential sleep for hours |
| Clinical manifestations for seizures. | Focal seizures: subdivided into motor and nonmotor symptoms Impairment of consciousness or awareness, localization and progression of symptoms |
| Clinical manifestations for seizures. | Seizure range: from simple staring episodes to prolonged convulsive movements with loss of consciousness Initial pattern indicates brain region of seizure origin |
| Assessment and diagnostics for seizures. | Diagnostic assessment Determines type, frequency, severity, and precipitating factors of seizures Developmental history, including pregnancy and childbirth events Inquiry about illnesses or head injuries affecting the brain |
| Assessment and diagnostics for seizures. | Diagnostic examinations: biochemical, hematologic, serologic studies MRI: detects structural lesions, focal abnormalities, cerebrovascular abnormalities, cerebral degenerative changes |
| Assessment and diagnostics for seizures. | Telemetry and video recording: monitor electrical brain activity, determine seizure type, duration, magnitude SPECT: identifies epileptogenic zone for potential surgical removal Microelectrodes: probe action of single brain cells |
| Assessment and diagnostics for seizures. | EEG: provides diagnostic evidence, assists in classifying seizure type |
| Seizure precautions. | Functioning suction equipment Low bed position Padded side rails Additional safety measures (e.g. padded floor) |
| Seizure precautions. | Nursing care: turn pt onto side lying position*, don’t put anything in pt mouth, observe and document details, prevent injuries, support patient physically and psychologically |
| Medical management for Epilepsy. | Individualized for pt needs; focuses on managing, preventing, and controlling (not curing) seizures with minimal side effects Benzodiazepines (-zepam): Clonazepam, diazepam Anti-Epileptic Drugs (AEDs): Lamotrigine |
| Surgical management indications for seizures. | Surgery indicated for epilepsy due to intracranial tumors, abscesses, cysts, or vascular anomalies Also indicated for intractable seizure disorders not responding to medication Removal of the seizure-generating area can produce long-term control |
| Surgical management indications for seizures. | Vagal Nerve Stimulator (RNS): senses and interrupts brainwave activity before seizures occur MRI-guided stereotactic laser interstitial thermal therapy (LiTT):less invasive, for deep epileptogenic lesions |
| Nursing management for seizures. | DURING a seizure: Observation and documentation: sequence of signs before and during seizure Circumstances before seizure (stimuli, disturbances, sleep, hyperventilation) |
| Nursing management for seizures. | DURING a seizure: Occurrence of an aura (premonitory sensation) Initial patient actions, movement onset, gaze position, head position |
| Nursing management for seizures. | DURING a seizure, seizure details: Presence of automatism, incontinence, duration of seizure phases Unconsciousness, paralysis, speech ability, movements at seizure end Postseizure cognitive status (confusion, sleepiness) |
| Nursing management for seizures. | DURING a seizure, seizure details: type of movements, areas involves, pupil size, eye position Prevent injury, support patient physically and psychologically |
| Nursing management for seizures. | AFTER a seizure: Documentation: events leading to, during, and after seizure Seizure precautions Postseizure care: patient may be drowsy, wish to sleep, may not remember events Ensure patient safety and comfort |
| Nursing management for seizures. | AFTER a seizure: Complication prevention: aspiration and injury: Place patience in side-lying position for oral secretion drainage Perform suctioning if needed to maintain airway |
| Assessment for seizures. | Assess: Seizure history Contributing factors to seizures Aura history Observation during seizure to determine seizure type and management Assess effects of seizures on patient lifestyle |
| Risk Evaluation for seizures. | Evaluate risks: Risks for injury Fear Difficulty coping Deficiency knowledge about seizures and medications Medication side effects Status epilepticus |
| Goal of care for seizures. | Prevent injury Control seizures Acquire knowledge about the condition and medication Absence of complications Achieve satisfactory psychosocial adjustment |
| Fear Reduction and Lifestyle Management | Adherence to meds will enhance cooperation, trust, and demonstrate no risk for addiction Identify and manage contributing factors for seizures Encourage a regular and moderate lifestyle, diet, exercise, rest Avoid excessive stimulants and exercise |
| Fear Reduction and Lifestyle Management | Consider ketogenic or modified Atkins diet for treatment-resistant epilepsy Avoid triggers like alcohol and photic stimulation |
| Coping and Psychosocial Support | Counseling Recreational activities Educate about carrying medications and care during a seizure Carry emergency medical ID |
| Monitoring and Complication Management | Status epilepticus Medication toxicity Educate about side effects and overdose signs Regularly monitor medication levels, avoid drug interactions |
| Self-Care and Medication Education | Oral hygiene is essential while on phenytoin to prevent or control gingival hyperplasia Inform all providers about meds to avoid interactions Provide individualized education plans to patients and families |
| Continuing Care and Health Promotion | genetic/preconception care advised for mothers Participate in health promotion activities and screenings |
| Most worrisome complications for seizures/epilepsy? | Status epilepticus Medication side effects (toxicity) Regular monitoring of anticonvulsant medication levels is essential |
| Status epilepticus | Definitions: Seizure lasting 5 mins for generalized tonic-clonic seizures 10 minutes for focal seizures 10 to 15 minutes for absence seizures |
| Status epilepticus | Broadened definition: Continuous clinical or electrical seizures lasting at least 30 minutes Can occur without impairment of consciousness |
| Status epilepticus | **MEDICAL EMERGENCY** Produces cumulative effects Vigorous muscular contractions impose heavy metabolic demand Interferes with respirations, leading to venous congestion and hypoxia |
| Status epilepticus | Potential consequences: Repeated cerebral anoxia and edema Irreversible and fatal brain damage Precipitating factors: Interruption of anticonvulsant medication Fever, concurrent infection, or other illness |
| complications for seizures/epilepsy explained | Medication side effects (toxicity): Educate patients and families about side effects and signs of overdose Regular monitoring of anticonvulsant medication levels is essential: Avoid drug interactions that affect medication effectiveness |
| Nursing care/Patient education for seizures. | Educate about medication adherence/side effects/overdose/toxicity signs Educate to continue medications due to no addiction risk Educate to carry medical ID card, inform all providers of current medications, proper care during a seizure |
| Nursing care/Patient education for seizures. | Reduce fear of seizures by taking meds continuously, identifying risk and contributing factors, encourage a regular/moderate/diet and lifestyle w/o excessive exercise, avoid triggers like alcohol and photic stimulation |
| Nursing care/Patient education for seizures. | Prevent injuries by instilling seizure precautions at home Education about coping mechanisms (recreational activities, counseling) and attitude modification to overcome poor mental health Educate about care during a seizure |
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sleepingbear