, MEDSURG_HESI_CONCEPTS
1. Teaching-AGN- diet instructions:
a. Acute Glomerulonephritis: Inflammatory injury in the glomerulus caused by
immunological reaction.
b. Cause by streptococcal infection
c. Complications: kidney failure, pulmonary edema, HF
d. Assessment: periorbital and facial edema, decrease urinary output, hematuria,
hypertension, proteinuria (excessive foam in urine), increased BUN and creatinine
e. Risk for fluid volume overload- measuring daily weight and assessing for changes is the
most useful and effective measure for determining fluid balance
f. DIET RESTRICTIONS: restrict sodium intake potassium may be restricted during periods
of oliguria
g. Diuretics are usually administered with edema, antihypertension for hypertension and
antibiotics for infection.
2. NP-Diabetes-Hypoglycemic shock:& altered LOC
a. Hypoglycemic shock signs and symptoms: headache, nausea, sweating, tremors,
lethargy, hunger, confusion, slurred speech, tingling around mouth, anxiety, nightmares,
altered LOC
b. Nursing Action: life threatening, check glucose- may seize if <40. Treat immediately with
complex carbohydrates (CHO): Tube of glucose, Fruit juice, Cola, Hard candy
c. Emergency kit of glucagon for patients with DM should be taught to use only when
notice signs of severe hypoglycemia
d. Check glucose levels, A1c levels if necessary
e. POLYURIA: THINK SHOCK
f. POLYURIA Oliguria Anuria (too much too little can’t produce urine)
3. Teaching-CVA-Visual perception:
a. Cerebral Vascular Accident (CVA): also known as a stroke/Brain attack. Sudden loss of
brain function resulting from a disruption in the blood supply to a part of the brain;
classified as thrombotic or hemorrhagic.
b. CNS involvement related to cause of stroke:
i. Hemorrhagic: caused by a slow or fast hemorrhage into the brain tissue; HTN
ii. Embolic: caused by a clot that has broken away from a vessel and has lodged in
one of the arteries of the brain, blocking the blood supply. It is often related to
atherosclerosis (may occur again)
iii. TROPONIN is the diagnostic test that is most sensitive to MI
c. Risk factors: HTN; pervious ischemic attacks; smoking; diabetes; cardiac disease
d. Findings: Jugular vein distention, Palpable cervical lymph node, Carotid bruit, Nuchal
rigidity, decreased BP, crackles in lungs
, e. Expressive aphasia: communicate with picture boards (visual perception)
f. Be consistent in using the same words each time a question is asked
4. Leadership-Rheumatoid Arthritis-pain diagnosis:
a. Rheumatoid Arthritis: Chronic systematic progressive deterioration of the connective
tissue (SYNOVIUM) of the joints, characterized by inflammation
b. Assessment: fatigue, weakness, weight loss, anorexia, morning stiffness, joint pain
c. Confirmed Lab results: confirmed by Elevated ESR, ASO; positive rheumatoid factor,
presence of antinuclear antibody; abnormal synovial fluid; C-reactive protein
d. Diagnosis: Impaired peripheral mobility relate to join pain
e. Pain management: do not exercise painful swollen joints; do not exercise any joint to
the point of pain, perform exercises slowly and smoothly; avoid jerky movements-
therapeutic exercise daily.
5. Nutrition-Osteomalacia diet:
a. Osteomalacia: softening of the bones due to deficiency of VITAMIN D
b. Risk for injury
c. Increase diet of high calcium and high vitamin D:
i. Fortified milk and cereal
ii. High in vitamin D: oily fish (salmon, mackerel, sardines) and egg yolks
6. NP-Urolithiasis-lithotripsy: (Nephrolithiasis)
a. Urolithiasis: refers to the formation of urinary calculi (kidney stones) form in the ureters
b. May have pain and N/V and WBC in urine
c. Anytime you suspect a kidney stone get a urine specimen ASAP & have it check for RBC
d. If kidney stone are present client will get pain medication immediately
e. Lithotripsy: Removal of kidney stones
i. Ultrasonic wave is aimed at the stone to break into fragments (crushes)- stones
are passed within urine in a few days
ii. Client is taught to watch for signs of urinary obstruction, bleeding, or hematoma
formation
iii. Instruct client to increase fluid intake to flush out the stone fragments
iv. Avoid long periods of remaining in supine position
v. Send stone for analysis
vi. Restrict physical action
vii. WATCH FOR HEMATURIA
7. NP-Thick secretions:
a. Nursing intervention for liquefying or thinning of secretions would be to increase fluid
intake to 3L/day if tolerated. The patient can get secretions out more easily.
b. Tenacious sputum secretions- use bronchodilators
8. NP-Acute Kidney Injury: pyelonephritis (syllabus)
a. Acute Kidney Injury: a potentially reversible disorder, it is a rapid loss of kidney function
accompanied by a rise in serum creatinine and or a reduction in urine output
b. Total normal urine output 1500-2000ml
c. Pyelonephritis: inflammation of the renal pelvis and the parenchyma commonly caused
by bacterial invasion.
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