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Med-Surg HESI TOPICS

Urinary retention assessment, interventions


DKA clinical manifestations/symptoms of great concern; treatment; lab
values to monitor

o Manifestations
dehydration or electrolyte loss: polyuria, polydipsia, polyphagia, weight
loss, dry skin, sunken eyes, soft eyeballs, lethargy and coma
nausea, vomiting, abdominal pain
fruity breath (ketones)
high blood sugar >240 mg/dL
weakness; Hyperkalemia
altered mental status
shock; coma
Ketone levels , buffering of body , blood pH and acidosis occurs.
Kussmaul respiration (ketones) causes respiratory alkalosis to correct
metabolic acidosis by exhaling CO2.
o Priority treatment monitor manifestations of DKA
First assess the airway, LOC, hydration status, electrolytes, and
hypertension and blood glucose level.
pt is dehydrated , closely assess the pt.s fluid status fluid therapy, first
things you need to prioritize in order.
Drug therapy regular insulin by continuous IV infusion continuous
insulin is used instead of SubQ because of 4min half-life of IV insulin and
because of delayed onset of action and prolonged half-life of subQ regular
insulin.
acidosis management
Epigastric pain additional assessment; cause for concern
Carpal tunnel clinical manifestations/symptoms, interventions
Raynauds clinical manifestations/symptoms, interventions
UTI - clinical manifestations/symptoms, assessment, interventions
Complications from flu assessment
Seizures (tonic clonic) interventions
Hypo/hyperthyroidism labs, assessment

o Clinical manifestations
TachyC
tachypnea

Med-Surg HESI TOPICS

insomnia
diaphoresis
double vision
HTN, stroke volume, palpitations
weight loss
irritability
hyperglycemia
heat intolerance
tremors
muscle weakness
exophthalmos
goiter- diff. swallowing
o lab values
T3 and T4 (70-205 ng/dL)
T3RU (24%-34%)
Antibodies to TSH (TSH-RAb) high in graves dz.
TSH Low in graves dz. High in secondary or tertiary hyperthyroidism
Thyroid scan- checks position, size, and function of the thyroid gland.
Radioactive iodine is given by mouth and the uptake of iodine by the
thyroid gland is measured.
Ultrasound- determines the size and general composition of
masses/nodules. painless and quick procedure
ECG- usually shows TachyC. May also show A-fib, dysrhythmias, and
changes in P and T waveforms
o treatment
Monitor v/s
reduce stimulation
anti-thyroid drugs
lithium
beta-adrenergic blockers
thionamides
Radioactive iodine therapy (not used in pregnant women)
Promote comfort- Reducing room temperature
thyroidectomy- total or partial
Monitor V/S q 15 min. postop
Pt. will be on thyroid replacement hormone therapy synthroid for
rest of their life.
hemorrhage
respiratory distress- laryngeal stridor heard in acute resp.
obstruction
Hypocalcemia and tetany- occur if the parathyroid glands are
removed or damaged. Inadequate blood flow to the

Med-Surg HESI TOPICS


parathyroid gland can also cause these. Assess for
tingling around mouth, toes and fingers, muscle twitching
(sign of calcium deficiency).

thyroid storm or thyroid crisis


o complications:
thyroid storm
2. Thyroid storm: Patho, clinical manifestations: pg. 1397
o Patho- life threatening issue caused by uncontrolled hyperthyroidism and is
characterized by high fever and severe HTN. Most often occurs with graves dz.
triggered by stressors like trauma, infection, and DKA and pregnancy.
o clinical manifestation High fever
TachyC
systolic hypertension
GI issues abd. pain, N/V/D
restlessness/ confusion
MONITOR AIRWAY/ ENSURE PATENT AIRWAY- because of
swelling/inflammation d/t goiter causing pressure around trachea.
MONITOR CARDIAC STATUS
o Treatment
antithyroid drugs
reduce stimulation
ENSURE PATENT AIRWAY- #1 priority
thyroidectomy- watch for hypocalcemia indicating damage to parathyroid
gland. pt. will be on thyroid replacement hormone therapy synthroid for
rest of their life.
Graves disease: pg.1399
Patho- Autoimmune disorder, Thyroidstimulating immunoglobulins (TSI) are
made and attach to TSH receptors on tissue. Thyroid responds by increasing
number and size of cells which forms a goiter- increase in size causes diff.
swallowing. need to monitor airway and cardiac status
treatment: same as hyperthyroidism
Cataract removal discharge patient education
Acute glomerulonephritis diet education
Radiation therapy skin care
Addisons disease discharge education, medications

o Patho- life threatening event where cortisol and aldosterone is greater than the
available supply.
o Clinical manifestations

Med-Surg HESI TOPICS

Patchy areas due to decreased pigmentation (primary)


Decreased body hair
Hypoglycemia Fatigue
Muscle weakness
Nausea/vomiting
Menstrual changes
o treatment:
NEUROLOGIC ASSESSMENT AND V/S EVERY HOUR
Focus on promoting fluid & electrolyte balance. Rapid infusion of NS or
D5
Solu-Cortef IV
Hydrocortisone
To manage hyperkalemia administer insulin (20-50 units) with dextrose in
NS
Shifts potassium into cells
Loop diuretics
I&Os
Bacterial meningitis assessment, clinical manifestations/symptoms,
treatment/interventions
PACU (post anesthesia care unit) assessment, priorities in patient care
Preop assessment priorities
Lithotripsy for urolithiasis patient education; complications
Neuropathic pain assessment
Diabetic foot care
Post herpes zoster (shingles) complications
Blood transfusion reactions monitoring; priorities, interventions
Malignant hyperthermia symptoms; treatment
Stable angina (chest pain) basic treatment/patient education
Postop abdominal surgery diet
ABG analysis
Gout medications patient education
Interventions to treat hypovolemia & hypotension
Basics of SBAR communication/report

Med-Surg HESI TOPICS


Inguinal hernia repair assessment, complications & interventions for
Circulation problem of extremity priority assessment
Risks for CAD (cardiovascular disease)
Bone cancer pharmacotherapy treatment
Post facial abscess drained assessment; intervention think about A&P of where
this is located & priorities
Mechanism to support bone remodeling
Causes of eczema
HHNS (hyperkinetic hyperosmolar non-ketotic syndrome) complications of
treatment

o HHNS is end result of osmotic diuresis


o Clinical manifestations altered CNS function with neurologic symptoms confusion to coma;
may have seizures, myoclonic jerking, and reversible paralysis
Dehydration or electrolyte loss polyuria, polydipsia, polyphagia, weight
loss, dry skin, sunken eyes, soft eyeballs, lethargy, coma.
no ketones and blood sugar are very high >600 mg/dL. blood osmolarity
>320 mOsm/L.
o treatment treated in ICU (severe illness)
IV rehydration 1st priority is to increase blood volume. in shock or sever
hypotension give NS. Otherwise, use NS because it more rapidly
corrects the water deficits.
Start by infusing 1 L/hr until BP and urine output are adequate.
then rate is reduced to 100 to 200 ml/hr.
pts. w/ CHF, kidney disease or failure, monitor the central venous
pressure. Assess the patient hourly for signs of cerebral edema
abrupt changes in mental status, abnormal neurologic signs and
coma.
lack of improvement in LOC indicates inadequate rates of fluid
replacement or plasma osmolality.
slow but steady improvement in CNS is the best evidence that fluid
management is satisfactory.
Critical Rescue: for pts being managed for HHNS report changes in
LOC; changes in pupil size, shape or reaction; or seizures.
IV insulin-

Med-Surg HESI TOPICS

Given after adequate fluids are replaced.


monitor pt. closely for indications of hypoK
K+ levels may drop quickly when insulin therapy is started. K+
replacement is stared once urine output is adequate.
Check serum electrolyte every 1-2 hrs. until stable, and the cardiac
rhythm should be monitored continuously for signs of hypoK or
hyperK.

IV fluid administration complications; interventions to correct


Well differentiated cancer cells what does that mean
Heart failure labs to monitor; treatment
Chest tube drainage assessment; interventions for complications
Tracheostomy dressing change safety in completing dressing change
Post TURP discharge education
Interventions for expressive aphasia
Chronic cirrhosis with esophageal varices assessment; complications
SIADH (syndrome of inappropriate antidiuretic hormone) nonpharmacologic
interventions to treat
Viral GI infection assessment
PCP (pneumocystis pneumonia) & AIDS drug therapy and patient education
Postop fracture ORIF (open reduction & internal fixation) surgery assessment,
interventions
Patient fall, possible head injury assessment, interventions
PUD (peptic ulcer disease) - clinical manifestations/symptoms
Bronchoscopy preop care; contraindications for performing
Peripheral venous disease treatment/interventions

Calculations