MED SURG II – MASTER HESI REVIEW
Review Topics Part 1
1) Diabetes Insipidus – page 1161-1162
Caused by a deficiency of production of ADH or a decreased renal response to ADH.
Clinical Manifestations: Polydipsia and Polyuria.
Diagnostic Studies: Water deprivation test (pt deprived of water for 8-12 hrs and then given
desmopressin acetate subcut or nasally), Measure level of ADH after an analog of ADH is
given.
Types of Diabetic Insipidus: Central DI (results from an interference of ADH synthesis,
transport, and release. Ex: brain tumor, head injury, brain surgery, CNS infection), Nephrogenic
DI (results from inadequate renal response to ADH despite presence of adequate ADH. Ex: Drug
therapy, renal damage, hereditary renal disease), Primary DI (Results from excessive water
intake. Ex: Structural lesion in thirst center, psychological disorder).
Nursing Management: Early detection, Maintaining adequate hydration, and patient teaching
for long-term management.
2) Healthcare associated pneumonia
Also known as nosocomial pneumonia, pneumonia in a non-intubated patient that begins 48 hours
or longer after admission to hospital and was not present at the time of admission. Ventilator-
associated pneumonia, also a type of HAP, refers to pneumonia that occurs more than 48 hours
after endotracheal intubation.
Treatment: Antibiotics that can be started as soon as sputum cultures identify the
exact pathogen.
Risks: In treatment of pneumonia, risk of developing multidrug-resistant organisms. Limits the
available antibiotics that can be used as treatment.
3) Diabetes Mellitus long term complications
Stroke
Hypertension
Dermopathy
Atherosclerosis
Nephropathy
Peripheral neuropathy
Neurogenic bladder
Retinopathy, Cataracts, Glaucoma, Blindness
Coronary Artery Disease
Gastroparesis
Islet Cell Loss
Erectile Dysfunction
Peripheral Vascular Atherosclerosis
Gangrene
Infections
Examinations performed Daily, Annually, or when you visit HCP: Funduscopic, Fundus
photography, Urinalysis, Feet Examination, and Stress Tests.
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4) Renal dosing/ issues with drugs – page 1020 Box 44-3
ANTIBIOTICS OTHER DRUGS OTHER AGENTS
Amikacin Captopril Gold
Amphotericin B Cimetidine Heavy Metals
Bacitracin Cisplatin
Cephalosporins Cocaine
Gentamicin Cyclosporine
Neomycin Ethylene Glycol
Polymyxin B Heroin
Streptomycin Lithium
Sulfamidies Methotrexate
Tobramycin Nitrosoureas
Vancomycin NSAIDS
Phenacetin
Quinine
Rifampin
Salicylates
5) Spinal cord injury – page 1419-1437
Classification: (1) Mechanism of Injury, (2) Level of Injury, (3) Degree of Injury.
Clinical Manifestations: Motor and Sensory effects, Respiratory System (decrease in vital
capacity volume), Cardiovascular System (bradycardia, peripheral vasodilation, hypotension),
Urinary System (urinary dysfunction), Gastrointestinal System (incontinence, impaction, ileus,
megacolon, decreased GI secretion) , Integumentary System (skin breakdown, pressure ulcers),
Thermoregulation (Adjustment from body temp to room temp), Peripheral Vascular Problems
(Pain, VTE, PE)
Emergency Management: Table 60-3 Ph. 1425
NURSING ASSESSMENT
o Subjective Date: Health History
o Objective Data: Poikilothermism (unable to regulate body heat)
o Integumentary System: Warm dry skin below level of injury
o Respiratory: Injury at C1-3-Apnea, Inability to cough. Injury at C4-Poor Cough,
diaphragmatic breathing, hypoventilation. Injury at C5-T6- Decreased respiratory
reserve.
o Cardiovascular: Injury above T6-Bradycardia, hypertension, absence of vasomotor tone.
o Gastrointestinal: Decreased or absent bowel sounds, abdominal distension, constipation,
fecal incontinence, fecal impaction.
o Urinary: Retention, flaccid bladder, Spasticity with reflex bladder emptying.
o Reproductive: Priapism, altered sexual function
o Neurologic: Complete-Areflexic, flaccid paralysis, hyperactive deep tendon reflexes,
bilaterally positive Babinski test. Incomplete- Mixed loss of voluntary motor activity
and sensation.
o Musculoskeletal: Muscle atony, Contractures.
o Pain: Neuropathic, musculoskeletal, and/or visceral.
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6) Blood in stool
Melena = black, tarry stools (often foul smelling) caused by digestion of blood in the GI tract.
Black appearance is from the presence of iron.
Occult bleeding = small amounts of blood in gastric secretions, vomitus, or stools not apparent
by appearance. Detectable by guaiac test.
Could be indication of an upper GI bleed
Hemorrhoids are the most common reason for bleeding with defecation
o Focus on pain control and promote wound healing
o Sitz bath 1 to 2 days after surgery and continue for 1 to 2 weeks
o Teach the pt importance of diet, care of the anal area, symptoms of bleeding
complications, and avoidance of constipation and straining
7) CVA (focus on vision issues)
Cerebral vascular accident / Stroke
Treat as medical emergency
Know FAST (Facial drooping, Arm weakness, Speech difficulties, Time)
Sudden trouble seeing in one eye should be reported immediately for indication of a CVA
Women who experience migraine with aura are at an increased risk for stroke.
8) Acute kidney injury
Slight deterioration in function to severe impairment
Rise in serum creatinine and/or a reduction in urine output, and sometimes leads to development
of azotemia (accumulation of nitrogenous waste products in the blood)
Hospitalized patients develop AKI at a high rate and have a high mortality rate
Common causes:
o Prerenal: Hypovolemia, Decreased Cardiac Output, Decreased Peripheral Vascular
Resistance, Decreased Renovascular Blood Flow
o Intrarenal: Nephrotoxic injury, Interstitial Nephritis
o Postrenal: BPH, bladder cancer, calculi formation, trauma
Clinical manifestations:
o Urinary changes – oliguria
o Hypovolemia
o Metabolic Acidosis
o Sodium balance
o Potassium excess
o Hematologic disorders
o Waste product accumulation
o Neurologic disorders
Diagnostic studies:
o H&P
o Identification of precipitating cause
o Serum creatinine and BUN levels
o Electrolytes
o Urinalysis
o Renal Ultrasound
o Renal scan
o CT scan
Primary treatment is to eliminate the cause, manage the signs and symptoms and
prevent complications while the kidneys recover
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9) Abscess
A swollen area within the body tissue, containing an accumulation of pus
The body’s immune system sends WBC to fight the infection
Painful, swollen lump that is filled with pus
S/S = chills, fever, pimples, redness, painful lump, pus, tenderness, swelling, swollen
lymph nodes
Treatment includes draining the abscess and antibiotics
Types mentioned in MedSurg: Anorectal (p. 970), brain (p. 1338), lactational breast (p. 1207),
lung (p. 512), peritonsillar (p. 484)
10) Amyotrophic Lateral Sclerosis (lung issues)
AKA Lou Gehrig’s Disease
A nervous system disease that weakens muscles and impacts physical function.
In this disease, nerve cells break down, which reduces functionality in the muscles they
supply. The cause is unknown.
The main symptom is muscle weakness.
Medication and therapy can slow ALS and reduce discomfort, but there's no cure.
Muscular: muscle weakness, problems with coordination, stiff muscles, loss of muscle,
muscle spasms, or overactive reflexes
Whole body: fatigue or feeling faint
Speech: difficulty speaking or vocal cord spasm
Also common: difficulty swallowing, drooling, lack of restraint, mild cognitive impairment,
severe constipation, severe unintentional weight loss, shortness of breath, or difficulty raising
the foot
Treatment includes:
o Therapies
o Supportive Care
o Medications (glutamate blocker or muscle relaxant)
o Surgery
o Medical procedure
11) Neutropenic precautions
is a blood condition involving low levels of neutrophils, a type of white blood cell. Neutrophils
fight infection by destroying harmful germs. Without enough neutrophils, you’re more likely to
develop infections. Usually, neutropenia occurs after: chemotherapy, radiation therapy or taking
certain medicines. Remember: Gown, Gloves, Mask to protect the patient from catching any
foreign bodies that night cause an infection. If the patient leaves the room, they must have a
mask on before leaving and it must remain on them at all times while they are outside the
room.
12) Asthma (focus on exercise)
that is induced or exacerbated during physical exertion is called exercise induced asthma (EIA)
or exercise induced bronchospasm (EIB). This typically occurs after vigorous exercise, not
during it (jogging, aerobics, climbing stairs). Symptoms of EIA are pronounced during
activities where there is exposure to cold, dry air. Like swimming in an indoor heated
swimming pool is less likely to produce symptoms than downhill skiing. Airway obstruction may
occur due to changes in the airway mucosa caused by hyperventilation during exercise, with
either cooling or rewarming of air and capillary leakage in the airway wall. Characteristics would
include: wheezing, cough, dyspnea and a tight chest.
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