Med surg final review - Notes from book and class lecture
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Med surg final review - Notes from book and
class lecture allin one for first exam as a study
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Med-Surg final review
1) Graves’ disease
The most common form of hyperthyroidism. Autoimmune disease of antibodies
(immunoglobulins) attacking the thyroid gland. Low TSH levels and high thyroid
hormone levels.
2) N/V/D ... met alkalosis? Metabolic acidosis?
Vomit: metabolic alkalosis because you are vomiting all the hcl
Diarrhea: metabolic acidosis, because you are pooping all the bicarb
3) Acid/Base-what electrolytes do we worry about most?
K, H, CO2, Bicarb
4) Cushing disease
Excessive adrenocortical activity: adrenal cortex (sex hormones and steroids) and
adrenal (epi and norepi) medulla or pituitary are overactive. When “syndrome” the
cause termed is the steroid being taken (drug).
There is an increased in retention of Na and water and decreased K levels due to the
high aldosterone production. HF and HTN.
Manifestations Medical management Nursing management
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, Med surg final review - Notes from book and class lecture
Arrest of growth, obesity, Adrenalectomy Assist w/ ambulation
glucose intolerance,
central type obesity, Watch for s/s of Addison’s Foods high in Ca, vit D,
buffalo hump, heavy trunk, disease post-op: weight, protein, low carb and Na
moon face, thin electrolytes, BG levels
extremities. The skin is thin daily Decrease risk for infection
and fragile, muscle
wasting b/c of increase Bilateral adrenalectomy, Diabetes and peptic ulcer
protein catabolism, teach patient steroid control
osteoporosis, kyphosis, replacement for life
compression fractures, Encourage rest and
acne, oily skin, women moderate activity
have masculine traits
Meticulous skin care: no
tape, reposition q2h
5) Adrenal insufficiency-over active?
Adrenal insufficiency: Addison’s disease or long term corticosteroid use
Adrenal over activity: long term steroid use, Cushing’s disease, pheochromocytoma
6) Teaching, nursing assessment pheochromocytosis
▪ Teaching: avoid foods like coffee, chocolate, tea, aspirin, bananas, vanilla,
tobacco, emotional and physical stress, bed rest and elevated HOB during acute
attacks, monitor BG levels because of the high release of epi and norepi.
o Surgery: remove adrenal glands. Corticosteroid replacement for life and
an increase in Na diet (b/c no aldosterone).
▪ Assessment: BP >250/150. Postural hypotension. The 5 H’s: HTN, HA,
hyperhidrosis, hyper metabolism, hyperglycemia.
▪ Manifestations: HA, diaphoresis, palpitations in the patient with HTN,
hyperglycemia, tremors, and feeling of impending doom.
7) Addison's Disease
Adrenocortical insufficiency. Too much corticosteroids can cause this. Addisonian crisis
happens with slight overexertion, exposure to cold, acute infection, decrease in Na
intake, dehydration, stress, and hypotension
Manifestations Medical management Nursing management
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, Med surg final review - Notes from book and class lecture
Weakness, anorexia, GI Combating circulatory Monitor BP and pulse
symptoms, fatigue, shock, restoring blood when changing positions
emaciation, pigment of skin circulation, fluids and
and mucous membranes, corticosteroids. Increase Asses skin color and turgor
hypotension, low BG, low BG levels with 5%
Na and high K, dehydration dextrose. Abx if stressor Assess daily weight
was infection.
Addisonian crisis: vasopressors Foods high in Na
hypotension, cyanosis,
fever, n/v, classic signs of Supplement intake of Na Fluids and electrolytes,
shock, confusion, when vomiting and especially Na
restlessness diarrhea
Steroids high in dosage
Lifelong corticosteroids during an illness or
infection
Educate on s/s of crisis
and patient should have
emergency kit of steroids
8) Types of anemia’s, causes, s/s
Condition in which the hgb concentration is lower than normal. Low erythrocytes. Limits
oxygen availability to tissues.
• Types
o Hypoproliferative: defect in RBC production
▪ Iron Deficiency
▪ Vit B12 Deficiency (Pernicious Anemia)
▪ Folic Acid Deficiency
▪ Renal dysfunction
▪ Bone marrow dysfunction
o Hemolytic: Premature RBC destruction
▪ Sickle Cell Anemia
▪ High bilirubin levels seen here because of premature destruction of
RBCs
▪ Also, high K levels because RBCs are destroyed
o Bleeding: Loss of RBC
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, Med surg final review - Notes from book and class lecture
• S/S
o Weakness, fatigue, malaise
o Pallor
o Jaundice
o Smooth (Fe) or beefy red (B12) & sore tongue
o Tachycardia, palpitations
o Dyspnea
o Dizziness
o Orthopnea
o
• Physical Findings
o H&H
o CBC
o Iron Studies
o Vit B12
o Folate Levels
o Nutritional assessment (vegetarians low B12)
o Stool and emesis for occult blood
o Active healthy people have more pronounced symptoms
• Nursing interventions
o Manage fatigue ( oxygen and daily activities)
o Nutrition (diet and supplements)
o Adequate perfusion (IV fluids and blood)
o Monitor for potential complications
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