Bariatric Surgery pg.105
Match the symptom
Cirrhosis-bleeding
Hepatitis-flu-like symptoms
Pancreatitis-malnutrition
Pancreatic cancer-fatigue and anorexia
Disorders of Musculoskeletal
 Osteoarthritis
o Chronic
o May have unilateral pain
o Pain worsens after activity
 Rheumatoid
o Bilateral joint inflammation
o Morning stiffness
o Pain at rest
 Gout
o Tophi
o Uric acid renal stones
o Excruciating pain with an acute episode
 Nursing interventions (Osteoarthritis and Rheumatoid)
o Ice/heat/rest
o Rom
o NSAIDs
o Acetaminophen
o Steroid
 More for osteoarthritis
o Joint replacement
o Osteoarthritis=glucosamine
o Rheumatoid=DMARDS
 Nurse interventions-GOUT
o Bed rest
o Avoid touch
o Increase fluids
o Diet-no purines
o NSAIDS, steroid injection
 Complications of fractures
o Fat emboli
 Confusion
 Tachypnea
 Tachycardia
 Petechiae
o Compartment syndrome
 pain
 pressure
 pallor
 paresthesia
 paralysis
 pulselessness
ENDOCRINE
 Function of gland
 How does hyposecretion look?
o Meds, radiation
 How does hypersecretion look?
o Med, radiation, removal of the gland
 Posterior pituitary-ADH is the problem
o Hyposecretion=diabetes insipidus
o Hypersecretion=SIADH
DIABETES MELLITUS p.123
 Diet
o Complex carbs
 Common complications
o Retinopathy
o Skin ulcers
o Hypertension
o Neurogenic pain
o Proteinuria
o Heart attack
BLOOD/HEMATOLOGICAL DISORDERS
 Matching Anemia
o Renal diseasedecrease erythropoietin
o Iron deficiency weakness or pallor
o AplasticLow RBC, WBC, Platelets
o Pernicious B12 malabsorption
o Hemolyticpremature RBC destruction
o Sickle Celljoint pain
o Thalassemia facial bone deformities
CARDIAC SYSTEM
 Electrocardiogram
o P wave: atrial depolarization
o QRS: ventricular depolarization
o T wave: ventricular repolarization
 Basics of rhythm strips
o Do you see P wave?
o Do you see QRS after every P wave? (Should be followed by T wave
o What is the rate? Is it normal, too fast, or too slow?
o Is it regular or irregular?
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o What do the P and QRS waves look like?
Cardiac Catheterization
o Pre-procedure
 Informed consent
 Kidney function-dyes
 Allergies
 Metformin?
 Mark distal pulse
 Teach: taste, flush
o Post-procedure
 Positioning
 Immobilize
 Pressure to the insertion site for at least 15 min
 Chest pain
 Vitals
 Extremity
Manifestations of MI
o Pain or discomfort
o Jaw pain
o Arm pain
o Back and abdomen pain
o Occurs without cause
o Not relieved by
o **Women, older clients, and diabetics may not experience chest pain
Initial interventions for MI
o MONA
Heart failure
o Left-sided (LUNGS)
 Dyspnea
 Frothy sputum
 Crackles
 Cough
o Right-sided (REST OF BODY)
 JVD
 Weight gain
 Edema
Oher valve disorders
o Valve disorders
o Aortic aneurysms
o Hypertension (greater than 140/90)
VENOUS OR ARTERIAL?
o Venous
 Painless ulcers
 Lower leg edema
 hyperpigmentation
o Arterial
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Claudication
Delayed CRT
Hair loss on legs
Cyanotic extremities
CABG
o Preop
 Consent
 Education
 Place IVs
 Baseline VS
 Meds that have to be given-antibiotic
o Postop
 CCICU
 May have chest tube or leave chest open
 Vented for first 3-6 hrs
 Sterile dressing changes
 Monitor: for cardiac dysrhythmias
EARLY OR LATE SIGNS OF SHOCK
o Early
 Pallor
 Tachypnea
 Confusion
 tachycardia
o Late
 Cold, moist skin
 Weak thready pulse
 Anuria
 Hypotension
 Metabolic acidosis
Indications for dialysis
o Chronic renal disease
Hemodialysis
o interventions
 Access circulation
 Hold meds?
 Yes and no; a morning dialysis pt you hold morning meds
 If someone has later dialysis you take morning meds but hold
evening
 Weight before and after
 Vitals
 Monitor labs
o Advantages
 More efficient clearance
 Shorter treatment time
o Complications
 Infection
 Closure
 Disequilibrium syndrome
 Hypotension
 Bleeding
 Peritoneal dialysis
o Interventions
 Monitor weight
 Hold meds? No
 Vital signs
 Monitor labs-initial labs and recheck fairly frequently when they first start;
after it may be monthly
o Advantages
 More Mobility
 Fewer hemodynamic complications
o Complications
 Infection
 Poor outflow
 Cold shock
 Bowl perforation
NEUROSENSORY DISORDERS
 Neurosensory diagnostics
 Which tests monitoring for headaches
o Lumbar punction
 Avoid caffeine 8 hrs. prior to the test?
o EEG
 Quickly ID a CVA?
o CT scan
 Requires contrast dye
o Angiography
 Unable to perform is pt has a pacemaker
o MRI
 Cerebrovascular Accidents
o F-face; face droop
o A-arms; equal strength?
o S-speech; has quality changed?
o T-time
CANCER
 Mgmt.
o Assess for signs of infection
o Neutropenic precautions
o Assess for signs of bleeding
o Encourage high energy conservation
BURNS
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Parkland formula
o Administer LR
o Formula: 4mL x kg x % TBSA
o ½ total in first 8 hr
o ½ in the remaining 16 hr
o Deducts any fluids given pre-hospital
OB/PEDS
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Newborn:0-1 (trust vs. mistrust)
o Posterior fontanel closes 2-3 months
o Anterior fontanel closes 8-18 months
Toddler:1-3 (autonomy vs. shame and doubt)
Preschool: 3-5 (initiative vs. guilt
School age: 6-12 (industry vs. inferiority)
Adolescence 12-20 (identity vs. role confusion)
Young adult: 20-35 (intimacy vs. isolation)
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Middle adult: 35-65 (generativity vs. stagnation)
Older adult: 65+ (integrity vs. despair)
Stages of labor
1. 3 phases of dilation
a. Latent: 0-3 cm
b. Active: 4-7 cm
c. Transition: 8-10 cm
2. Pushing stage
3. Delivery of placenta
4. Recovery and bonding
Contractions
 Braxton hicks-false labor
o Increase in 3rd trimester
o Intermittent
o Decrease with
 Change of position
 Walking
o No cervical changes
 True labor
Amniotomy
 Risks
o Prolapsed cord
o Infection
o Committed to delivery
 Interventions
o Assess the station of presenting part
o Assess FHR before and after
o Doc time, amt, color, odor of the fluid
o Monitor temp q2h
C-section
 Indications
o Fetal distress
o Malpresentation
o Multiple gestations
o Genital herpes
 Intervention
o Pre-op: informed consent, labs,
o Post-op: massage fondus
PSYCH