EP7h, Med Surg Certification Review Day 2.pdf
Med Surg Certification Review
Day 2, 2011
Sherry Carter, BSN, RN
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EP7h, Med Surg Certification Review Day 2.pdf
Respiratory System

Anatomy and Physiology
 Respiratory



Tract
Upper: Nose, pharynx, larynx and trachea
Lower: Bronchi, bronchioles and alveoli
Thoracic Cage: Rib cage, intercostal muscles, diaphragm
 Lungs




Structure
Ventilation
Diffusion: High to low pressure (alveolar-capillary)
Acid-Base regulation
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Inspiration & Expiration

Normal Physiology
 Work
of breathing occurs mainly during inspiration:
Diaphragm expands, using energy
 Expiration is passive, no energy expended

COPD
 Work
of breathing occurs during both inspiration
and expiration: Respiratory muscles are unable to
recoil passively
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Respiratory Drive

Normal Physiology
 Presence

of high CO2
COPD
 Areas
sensitive to high CO2 found in ventral
portion of the medulla oblongata malfunction
 Baroceptors in the aorta and carotid arteries
take over and stimulate respiratory drive
based on low O2
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Assessment

Hx
 Dyspnea,
orthopnea, cough, sputum,
allergies, smoking, occupation, nutrition, etc.

Objective
 Palpation

Subcutaneous emphysema
 in patients with pneumothorax, chest tubes, drainage
tubes, trach tubes
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Assessment (cont.)

Objective (cont.)
 Inspection






Color (lips, earlobes mucous membranes)
LOC (hypoxia)
Clubbing of fingers (long term hypoxia)
Dyspnea on exertion (how much to elicit?)
Cough (when? productive?)
Orthopnea (how many pillows?)
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Auscultation

Normal
 Bronchial
 Bronchovesicular
 Vesicular
 http://youtu.be/h7BtrWATfg8
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Auscultation (cont.)

Abnormal
 Crackles
 Rhonchi
 Wheezes

http://youtu.be/5JA6D1Mguh0
 Pleural

Friction Rub
http://youtu.be/t2QE0O_exAQ
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Diagnostic Tests

Radiographic
 CXR,



CT
Pulmonary Function
Sputum
Bronchoscopy
 Biopsy,

thoracentesis
V/Q Scan
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Acid Base Balance

Arterial Blood Gases (ABG)
 pH
 Acidotic
vs. alkalotic
 Compensated vs. uncompensated
 PaCO2
 HCO3
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Respiratory Acidosis

Hypoventilation
 CNS
depression
 Respiratory failure
 Lung disease
 Musculoskeletal disorders
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Respiratory Alkalosis

Hyperventilation
 Anxiety
 Hemorrhage
 Head
injury
 Drug overdose
 Pregnancy
 Liver disease
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Metabolic Acidosis




DKA
Acute/chronic renal failure
Hypoperfusion state
Poisoning
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Metabolic Alkalosis



Diuretic therapy
Excessive antacid use
NGT suction
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Peri-Op Concerns



Respiratory patient is vulnerable to
respiratory complications
First 24 hours most dangerous
Important to get lungs re-expanded
 Get
patient up and moving ASAP
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Prevention Strategies







Smoking Cessation
Adequate nutrition
Adequate fluid intake
Avoid crowds/sick people
Hand hygiene
Flu/pneumonia vaccine
Medication compliance
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COPD

Group of lung disorders caused by flow
limitation:
 Asthma
 Chronic
Bronchitis
 Emphysema
*Evaluate lung volumes via Spirometry
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Asthma

Inflammatory airway constriction
 Episodic


& chronic
Signs & symptoms
Treatment
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Chronic Bronchitis




Definition
Goblet cell hyperplasia
Excess mucus blocks airways
Treatment
 Hydration
 Chest
PT
 Bronchodilators
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Emphysema





Loss of alveolar elasticity-air trapping
leading to barrel-chesting
15-20% people develop this due to genetic
abnormality (never smoked!)
Tri-pod sitting position and pursed-lipped
breathing
O2 dilemma
Treatment
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Mixed


Most patients seen on Med Surg floor
have a combination of the two
Therefore will have symptoms of both and
need to be treated for both
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Other Conditions




Pneumonia
Lung Cancer
Pulmonary Edema
TB
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Pulmonary Emboli



Risk Factors
Virchow’s triad
DVT
 Venous
stasis
 Hypercoagulable state
 Endothelial damage
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Chest Trauma

Principles of chest drainage system
 Uses:





Pnuemothorax
Tension pnuemothorax
Flail chest
Cardiac tamponade
Thoracic surgery
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Chest Drainage






http://www.atriummed.com/EN/chest_drainage/training/
managing-1/index.html
http://www.atriummed.com/EN/chest_drainage/training/
managing-2/index.html
http://www.atriummed.com/EN/chest_drainage/training/
managing-3/index.html
http://www.atriummed.com/EN/chest_drainage/training/
managing-4/index.html
http://www.atriummed.com/EN/chest_drainage/training/
managing-5/index.html
http://www.atriummed.com/EN/chest_drainage/training/
managing-6/index.html
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Respiratory Questions

A.
B.
C.
D.
The inhaled route is preferred for drug
delivery in asthma and COPD because:
Administration by inhalation is easier than by mouth
Onset of action of inhaled drugs is slower than by
ingestion
Inhaled drugs have a longer duration of action than oral
drugs
Side effects are fewer with inhaled compared to oral
meds
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Respiratory Questions

A.
B.
C.
D.
What is the stimulus to the respiratory
system in a patient with longstanding
COPD?
High serum CO2 level
Low Serum O2 level
Low serum CO2 level
High serum O2 level
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Respiratory Questions

A.
B.
C.
D.
The mechanism chiefly responsible for
right heart failure and cor pulmonale in
advanced COPD is vasoconstriction due
to:
Acidosis
Hypercapnia
Hypoxemia
Alkalosis
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Respiratory Questions

A.
B.
C.
D.
The appropriate action for a patient with a
suspected tension pneumothorax is:
Tracheal suctioning
A V/Q scan
Coughing & deep breathing
Emergent evacuation of pleural air
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Respiratory Questions
1.
2.
3.
4.
5.
6.
pH: 7.23
pH: 7.51
pH: 7.12
pH: 7.40
pH: 7.01
pH: 7.36
PaCO2: 32
PaCO2: 26
PaCO2: 29
PaCO2: 37
PaCO2: 61
PaCO2: 55
HCO3: 14
HCO3: 20
HCO3: 11
HCO3: 24
HCO3: 23
HCO3: 32
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Renal /
Genitourinary
Systems

Anatomy and Physiology
 Kidney
 Genitourinary


Female
Male
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Kidneys, Ureters, Bladder and
Urethra

Kidneys
 Retroperitoneal
 4-5”

long
Ureters
 Peristaltic
waves
push fluid


Bladder
Urethra
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Genitourinary

Female
 Hormones


Progesterone
Estrogen
 Menstrual
Cycle
 Menopause
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Genitourinary

Male
 Testes

Produces sperm
and testosterone
 Prostate

Fluid is alkaline95% of ejaculate
 Spermatogenesis

Gender
determination
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Assessment

Urinary:
 Frequency,
urgency,
pain, dribbling,
incontinence,
hesitancy, nocturia and
hematuria
 Objective:

Urine color, odor,
amount, bladder
distention, electrolyte
imbalance
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
Diagnostic Studies:
 Urine pH, creatinine, BUN, GFR
 Cystography
 Angiography
 Biopsy
 Pap
 Pelvic US
 PSA
 BrCA
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Common Pathophysiology

Acute Renal Failure
 Causes

Hypoperfusion
 HF, hypovolemia, obstruction

Drug Toxicity
 NSAIDS, aminoglycosides, radiographic dyes
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
Acute Renal Failure (cont.)
 Stages

Oliguria
 <30 ml/hr
 Duration up to 7 days – longer = worse outcome
 Tx:1500 (+output ) replacement, hourly I&O, dialysis is
routine

Diuretic
 May be >4L/hr
 Duration up to 2 weeks
 Tx: Baseline fluid (+ output), dialysis continues

Recovery
 Duration is one year – renal status is vulnerable
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Common Pathophysiology

Chronic Renal Disease
 Defined
as damage (serum or urine
abnormalities) or GFR <60ml/min/1.732 for
3 months
 Causes


DM (most common)
Glomerulonephritis
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
Chronic Renal Disease (cont.)
 Stages
I.
II.
III.
IV.
V.
GFR 90 and above: diabetic with
microalbuminurea
GFR 60-89: elderly with mild decreased function
GFR 30-59: (moderate) hypertensive with
albuminurea
GFR 15-29: (severe) “formal” renal disease dx
GFR<15: (failure)
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
Chronic Renal Disease (cont.)
 Treatment

(Renal Replacement Therapies)
Hemodialysis
 Assess weight, patency of shunt (Bruit & Thrill)

Peritoneal dialysis
 Assess weight, color and clarity of drainage, catheter site
 Transplant

Lifetime Immunosuppressants
 Meds

Ca, erythropoietin, iron – watch Magnesium doses
 Diet

Low protein (dairy/lean meats), high carb
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Infections

Kidney
 Back/flank
pain (not with urination)
 Pyuria
 Cloudy

urine
Bladder
 Pain
with urination
 Cloudy urine

Treatment
 Fluids,
antibiotics, analgesics (Pyridium)
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Renal Calculi (Stones)

Pain
 Severe
enough to cause shock
 Occurs as ureters push obstruction forward


Morphine and antiemetic may be needed
Treatment
 Straining
of urine (small gravel)
 Calcium phosphate stone – decrease dairy
 Calcium oxalate stone – decrease caffeine
and grains
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Incontinence

Types
 Stress
 Overactive
bladder/urgency
 Overflow
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Incontinence

Diagnosis
 Hx:
Immobility, cognition, meds, obesity,
smoking, environment
 Physical exam: Edema, bladder distention,
mobility, cognition
 Labs: UA, C&S, BUN, creatinine, glucose
 Voiding record: Frequency, time of day
 Stress testing: Cough, Q-tip test, residual
 Urodynamic studies: See handout
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Treatment

Correct underlying problem


Meds



Biofeedback, pelvic floor stimulation, perineometry
Exercises


Stress: Pseudoephedrine, estrogen
Urge: Anticholenergics, antidepressants
Behavioral


Set schedule, surgery (BPH)
Kegel’s
Catheters/urine collection devices

Last resort!
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Benign Prostatic Hyperplasia (BPH)

Assessment
 Hesitancy,
frequency, nocturia, bladder
infections – may have complete blockage and
need catheterization

Treatment
 TURP,
TULP, balloon dilation of ureter
 High fluid intake post-op
 Teach catheter care
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Health Promotion /
Early Detection

Breast Self-Exam
 Monthly
inspection/palpation (at age 20)
 After menses or same day/month postmenopause

Testicular Self-Exam
 Monthly
(at age 15) as this cancer is #1 killer
of young men ages 15-35
 Palpation in shower
 Hx of undescended testes is risk factor
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Renal / Genitourinary Questions

A.
B.
C.
D.
Sean Summers, 22, found a lump in his left
testicle during a shower last week. After a visit to
his MD, he was admitted to the hospital for a left
orchiectomy and lymph node resection. He may
have been at risk for testicular cancer if he had a
hx of:
Smoking
Undescended testicles
Multiple sex partners
Genital trauma
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Renal / Genitourinary Questions

A.
B.
C.
D.
Kathy White has pyelonephritis. The
symptoms you would expect her to exhibit
are:
Burning upon urination, fever, malaise
Pyuria, proteinuria, fatigue
Glucosuria, malaise, +Blood cx
Flank pain, increased WBC, fever
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Renal / Genitourinary Questions

A.
B.
C.
D.
Gus Smith, 85, has chronic renal failure.
He should be taught that his diet should
include:
High carb, moderate fat, low protein
High fat, moderate carb, low protein
High protein, moderate fat, low carb
High fat, moderate carb, no protein
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Musculoskeletal
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Skeleton





206 bones
Body’s framework
Protection of vital organs
Site for hematopoiesis (blood cell formation)
Comprised of calcium phosphate (85%),
calcium carbonate (7%), small amounts
sodium and magnesium
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Soft Tissues

Purpose is to maintain posture, stabilize joints
and facilitate motion

Muscle







Visceral – walls of hollow organs
Skeletal – Voluntary, conscious control
Cardiac – Specialized, striated, short bursts of contractions
over lifetime
Smooth – Specialized to sustain long contractions over
limited time (Uterine)
Cartilage
Tendons
Ligaments
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Assessment





Joint pain, edema, gait, activity & sensory
deficits
Inflammation, crepitus
Equality of movement in UE and LE
Assist devices: Casts, canes, braces
Posture
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Diagnostics






X-ray: Bone density, texture, erosion,
alignment
CT: More detailed
Arthography: Joint contour through
radiopaque dye
Arthroscopy: Direct visualization
Bone scan: Detects bone tumors,
osteomyelitis, aseptic necrosis
Synovial fluid aspiration: relieve pressure
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Degenerative Joint Disease /
Osteoarthritis

Signs and Symptoms
 Joint
pain after exercise
 Stiffness, swelling, limited ROM
 May have deformity or instability
 May be sensitive to temp and humidity
changes
 Nodules or bony prominences, especially at
weight-bearing areas
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Degenerative Joint Disease /
Osteoarthritis

Treatment
 ASA,
NSAIDS
 Analgesics
 Maintenance of functional alignment
 Cold for acute inflammation
 Heat as indicated
 Limit exercise during acute phase
 Add exercise as prescribed
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Pain Differentiation

Osteoarthritis
 Pain
after activity
 Relieved by rest

Rheumatoid arthritis
 Pain
after inactivity
 More likely to develop joint deformity and
loss of function
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Rheumatoid Arthritis



Auto-immune
Also affects surrounding tissues
Treatment includes steroids, chemo,
immunosuppressants as well as NSAIDS
and opioids
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Gout

Uric acid deposits in synovial joints
 Aspiration

to confirm
Treatment
 Acute:
Colchicine
 Chronic



Reduce uric acid: Probenecid or sulfinpyrazone
Block uric acid: Allopurinol
Complication
 Renal

calculi (stones)
Diet: Decrease caffeine, grains, soda – Increase fluids
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Fractures
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Fracture Complications

Fat embolism syndrome
 Hypoxia,
tachypnea, tachycardia, fever
 Change in LOC
 Chest pain, cough, copious thick white
sputum
 CXR reveals “snowstorm”
 Risks


Men 20-30
Long bone fx
 Treatment:
Supportive…Death from ARDS
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Compartment Syndrome

Asymmetric symptoms: Site of injury
 Severe,
unrelenting PAIN
 Cold pale extremity PALLOR
 Diminished sensation/numbness
PARASTHESIA
 Inability to move extremity PARALYSIS
 Absence of pulses below the occlusion
PULSELESSNESS
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Osteomyelitis

Infection
 Secondary

Recent trauma, diabetes, drug abuse
 Localized

symptoms
Redness, swelling, tenderness, fever, malaise,
purulent drainage
 Treatment



IV antibiotics (12 weeks)
I&D of site
Bone graft
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Traction

Skeletal
 Applied

to bone with pins, wires or tongs
Balanced suspension
 Approximation
of femur, tibia or fibula
 Used with skin or skeletal traction
 Patient is NOT the counterforce
 Two people to move patient; one to hold the
weight, one to move the patient
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Traction

Nursing Care
 Clean
pin sites
 Integrity of skin traction
 Body alignment
 Weights hanging freely
 Ropes/pulleys free from interference
 Do not remove/lift weights unless traction is
maintained
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Hip Surgery-Replacement

Pre-op
 Assessment






VS
WBC
CMS
DVT
PE
Pain
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Hip Surgery-Replacement

Post-op
 Assessment
 VS
 WBC
 DVT, PE
 Drainage (dressing/drains)
 Anticoag
 Abduction
 Prevention of flexion >90 degrees
 NO leg crossing
 TEDs
 NO internal/external rotation for 6-12 months
 Crutch/walker/cane as needed
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Musculoskeletal Questions

A.
B.
C.
D.
Justin Lord, a 15 year old who is post-op
following a repair of bilateral femur
fractures is complaining of chest pain,
appears afraid and has a RR of 64. He
may be experiencing:
Anxiety
Fat emboli
Tension pneumothorax
Curling’s (stress) ulcer
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Musculoskeletal Questions

Dorothy is ready to go home and you are
validating her hip precaution education. Which of
the following statements indicates that she has
learned proper hip precautions?
A.
“When I stand up, I will point my feet toward each
other.”
“My toilet at home is fine for me to sit on.”
“It is OK for me to pick up things off the flor when I drop
them.”
“I will use a long-handled reacher to pull up the
blankets over me at night.”
B.
C.
D.
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Integumentary




Epidermis
Dermis
Subcutaneous
Function
 Protection

Appendages
 Hair
 Glands
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History and Diagnostics

History
 Pain,
rash, changes in moles, past sunburns
 Inspection

Color, integrity, moles, old scars, hair growth (legs)
 Palpation

Turgor, moisture, temperature
 Diagnostic

studies
Biopsy, patch test
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Dermatologic Conditions





Psoriasis
Scleroderma
Herpes Zoster (Shingles)
Skin Cancer
Burns
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Common Interventions

Skin grafts
 Autologous,

cadaver
Fasciotomy
 Used
to treat crushing injury-layers are
removed to reduce edema-heals by third
intention

Patient education
 Antibiotics,
wound care, preventing infection
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Wound Healing

Intention
 Primary

Approximated
 Secondary



Infected
NOT Approximated
Granulation healing
 Tertiary


Dehiscence
Two opposing sides
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Integumentary Questions
You are to apply skin cream to a rash on a
patient’s arm. You know you will need to:
A. Apply the cream in the opposite direction
of the hair growth
B. Place a thin rather than thick layer of
cream
C. Make sure you rub it in thoroughly
D. Cover it with a dressing

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Integumentary Questions

A.
B.
C.
D.
Alice Snow, 73, is one day post-op from a
colon resection. She is walking in the
hallway when she states that she believes
her incision has “given way.” You find her
incision has eviscerated and you first:
Apply an abdominal binder
Apply pressure to the incision
Cover the wound with a sterile dressing
Place her in a supine position
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Endocrine System






Regulation of Metabolism
Regulation of Fluids and Electrolytes
Procreation
Glucose Levels
Management of Stress Response
Excretion of Hormones
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Brain


Hypothalamus
Pituitary
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Body




Thyroid
Parathyroid
Pancreas
Adrenals
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Assessment


History
Objective
 Inspection
 Palpation


Lab
ADL’s
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Cushing’s Syndrome

Primary
 Adrenal





Glands (too much)
Excessive cortisol
Sex hormones
Increased aldosterone
Secondary
Secondary
 May
be caused by pituitary dysfunction
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Addison’s

Primary
 Adrenal


cortex (hypofunction)
Low cortisol
Secondary
 Pituitary



Hyposecretion of ACTH
Tumor
Decreased supply vs. increased demand
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Hyperthyroidism


Overactive TSH vs. T3/T4
Signs & symptoms
 Increased
metabolic rate: high BP,
tachycardia, exophthalmoses, weight loss,
tremor, heat intolerance

Management
 Antithyroid
meds
 Radioactive iodine
 Thyroidectomy
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Hypothyroidism


Under secretion of TSH vs. T3/T4
Signs and Symptoms
 Decreased
metabolic rate: Fatigue, weight
gain, cold intolerance, bradycardia,
hypotension, slowed mentation

Management
 Thyroid
replacement
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Diabetes Mellitus
•Defect in insulin secretion, action or both
•Characterized by Hyperglycemia

Type 1






No insulin
Autoimmune
Beta cell destruction
Ketoacidosis
Treatment: Insulin
Type 2





Insulin deficiency
Insulin resistance
Beta cell deficiency
HHNKS
Treatment:
Antidiabetic agents or
Insulin
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Goals


Maintain normal serum glucose level
Mimic normal body response to
glucose/insulin
 Fasting
70-120
 Post-prandial 100-140
 HgB A1C <6.5%
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Complications of DM

Risk for
 Arterial
disease
 CVD
 Chronic
renal disease (Stage I, after dx)
 PVD
 Neuropathies
 Retinopathies
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Treatment / Nursing Implications

Nutrition & Exercise
 Consistency/Balance




Carb, Protein & Fat for meals/snacks
Portion size
4-5 hours between meals
Snack if >5 hours between meals
 HS snack (with insulin)
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Treatment / Nursing
Implications



GOAL: to achieve
normal metabolic
control
Insulin types based on
acting times
Rapid


Lispro
“OG” (novolog, humolog)

Only Give w/meals

Short


Intermediate


Regular
NPH, 70/30 mix
Long acting

Ultralente, lantus
Know onset and
peak!
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Diabetic Ketoacidosis (DKA)

Caused by:






Occurs in type 1
Lack of insulin
Infection/illness
Cell starvation
Ketone production
Acidotic


K+ rises
Hypovolemia

Signs & Symptoms








“Poly’s”
Arrhythmias (K+)
GI discomfort
Muscle irritability
Kussmal resp
Fruity breath
Serum glucose >250
Lethargy/decreased
LOC
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Hyperosmolar Hyperglycemic
Non-Ketotic Syndrome
(HHNKS)




Occurs in type 2
Severe-requires
hospitalization
Serum glucose 8001200
No ketosis due
presence of some
insulin

Same as DKA

Except




No fruity breath
No ketosis
Severe hypovolemia
Mortality high (60-70%)
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Primary Tx for DKA and HHNKS
IV access
1.
Fluid (NS)
•
2.
Insulin bolus
1.
2.
3.
3.
MUST start drip within 10 minutes
Avoids rebound hyperglycemia
Stops catabolic metabolism
Hang insulin drip
1.
Short half-life (10-20 min)
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Hypoglycemia


Serum glucose <50
First Symptoms (CV)


Shakiness, palpitations, diaphoresis, nausea
Second Symptoms (CNS)

Slurred speech, decreased LOC, personality
changes, irritability
Brain needs glucose, NOT insulin
Risk for coma!
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Treatment

15 Grams of liquid carbs
 Juice
(no OJ for renal patients…K+)
 Glucose gel
 If NPO, 25ml D50 IVP

If meal is > 1 hour, add 1 starchy carb + 1
protein
 Juice
followed by milk
 Frosting followed by cheese
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Endocrine System Questions
Brad Scott, 25, has received 10 units of
NPH insulin this morning. You would
expect the peak time to occur at:
A. Lunch
B. Dinner
C. Middle of night
D. Breakfast tomorrow

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Endocrine System Questions

A.
B.
C.
D.
A patient two days post-crani for removal of tumor is
awake and talking with no neurological deficit. BP
110/80, HR 92, RR 22. Urine output has been 60/hr X
two days. The patient has had U.O. of 200-400 ml/hr X
three hours. Spec Gravity is 1.0002, serum glucose 100.
What does the nurse suspect?
DM
SIADH
Acute renal crisis
DI
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Endocrine System Questions

A.
B.
C.
D.
If the previous condition continues, what
would the nurse expect the urine and
serum osmolality to be?
Both up
Both down
Urine down, serum up
Urine up, serum down
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Endocrine System Questions

A.
B.
C.
D.
A 52 year old female is brought to the ED by her
husband. She is lethargic, BP 90/40, HR 52, RR
12. Husband states she has a hx of COPD and
takes 30 mg prednisone 2X/day and abruptly
stopped taking it. The nurse suspects she may
be in adrenal crisis and monitors the patient for:
Hypernatremia, hyperglycemia, hypokalemia
Hyponatremia, hypoglycemia, hypokalemia
Hypernatremia, hyperkalemia, hyperglycemia
Hyponatremia, hyperkalemia, hypoglycemia
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Endocrine System Questions
A 16 year old female with a history of type 1
diabetes is admitted to your unit. Her friend
states that she has had a cold for the last few
days then began vomiting last night. She is now
lethargic. The most likely cause of DKA in this
patient is which of the following?
A. Puberty
B. Insulin omission
C. Infection
D. Dehydration

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Neurologic System

Anatomy and Physiology
 Neuron

Receives and transmits impulses




Cell body
Dendrites
Axons
Myelin Sheath
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Components

Central Nervous System (CNS)
 Brain
and spinal cord
 “Control Center” for the body

Peripheral Nervous System (PNS)
 Cranial
and spinal nerves
 Connect CNS to body via pathways
 “Messenger”
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
Central Nervous System
Protection
 Skull
and vertebral column
 CSF



Clear, colorless, odorless fluid
Acts as cushion, shock absorber
Nutrition delivery/waste removal
 Meninges


Connective tissue
Three layer/three spaces
 Blood-brain

barrier
Selective capillary permeability
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Peripheral Nervous System

Sympathetic
 Releases
norepinephrine (adrenaline)
 “Fight” or “Flight” response

Parasympathetic
 Releases
acetylcholine
 Conservation, restoration and maintenance
 Returns body to normal state
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Increasing ICP

Subtle changes-early signs
 Changes
in LOC
 Loss of detail
 Restlessness
 Papillary changes
 Motor changes/projectile vomiting
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Increasing ICP (cont.)

Late signs
 Widening
pulse pressure
 Bradycardia (<50)
 Abnormal respirations
 Fixed/dilated pupils
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Increasing ICP (cont.)

Treatment
 Osmotic
diuretics
 Loop diuretics
 Corticosteroids
 Anticonvulsants
 Antihypertensives
 Stool softeners
 Surgery
115
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Posturing
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Diagnostic Studies







X-ray
CT
US
MRI
PET scan
EEG
Invasive diagnostic studies
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Meningitis



Inflammation or infection of the meninges
Pathogenic
Inflammatory reaction
 Formation
of exudates
 Exudates obstruct CSF flow  increased ICP
 Congestion/edema form in surrounding tissue
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Treatment and Nursing
Implications








IV antibiotics or antivirals
Fluid & electrolyte balance
Frequent neuro checks
Anticonvulsants
Analgesic/antipyretic
Corticosteroids
Environmental modifications
Respiratory isolation X24 hours
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EP7h, Med Surg Certification Review Day 2.pdf
Spinal Cord Injuries



Edema
Spinal shock
Autonomic dysreflexia

Above the level of injury








Diaphoresis
Nasal congestion
Throbbing HA
Hypertension
Blurred vision
Facial flushing
Bradycardia
Treatment: Remove the stimulus (full bowel, bladder)
120