Medsurg-Exam-4 PDF

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Exam 4 GI Assessment: Inspect, auscultate and palpate Imaging: CT, MRI, Endo, KUB(kidney, ureter, and bladder x-ray), US, barium contrast enema(thick contrast: makes pt constipation push fluids and ambulate) GERD: smoking, obesity, diet, stress, NGT insertion, hiatal hernia, medication -S/S: dyspepsia(indigestion), coughing, hoarseness, wheezing(not expected finding-aspiration warning sign) -Complications: erosion, aspiration, cancer, stricture(narrow of the esophagus: food could get stuck) -Tx: PPI, H2, diet changes, lifestyle changes Hiatal Hernia: diaphragm weakness, obesity, lifting, over-eating -S/S: fullness, dyspepsia, GERD S/S, discomfort -Tx: PPI, H2, small freq meals, HOB elevated, sit up after eating, surgery, lifestyle changes Gastritis: inflammation of the stomach -Causes: H. pylori, Aspirins, NSAIDS, smoking, ETOH, poisons -S/S: anorexia, fullness, abdominal pain, melena(dark stool), increase food pain -Tx: antibiotics, PPI, mucosal barriers, lifestyle changes Peptic Ulcer Disease: ulcer in stomach -Causes: stress, smoking, H. pylori, Aspirins, NSAIDS -S/S: N/V, abdomen pain GI bleed, hematemesis(vomiting blood), melena(dark stool) -Gastric: weight loss, food increase pain(30 mins after meals) -Duodenal: well nourished, food decreases pain(2-3 hours after meals) -Tx: antibiotics, PPI, H2, IVF, increase fluids, mucosal barriers, diet, monitor H/H -Hemoglobin: M 14-18, F 12-16 -Hematocrit: M 42-52%, F37-47%

-Complications: GI bleed, coffee ground emesis(CRITICAL CALL MD STAT) Gastric Surgery: -B12 supplement -semi-fowlers position -NGT: surgery(do not manipulate) -measure I&O’s -flush tubing 20-30 mL with water -Stoma: redness and beefy -No good: black, purple, or white -Ileostomy: small bowels -No enteric coated medication Dumping Syndrome: hypertonic chyme dumps -S/S: abdominal cramping, bloating/fullness, diaphoresis, tachycardia, explosive diarrhea, hypovolemia -Tx: self-limiting, limit fluid with meals, decrease carbs/starches, support pt Obstruction: -Mechanical: adhesions, intussusception(gut tunnels back into itself), volvus(twist on itself), hernia -Paralytic: no peristalsis, no bowel sounds, no flatus(farts) -S/S: the quicker the symptoms the higher the obstruction -small bowel: vomiting feces -large bowel: lower abdominal pain -Tx: NPO, NGT, IVF, Antibiotics, surgery Peritonitis: inflammation of peritoneal cavity -S/S: rigid board like abdomen, rebound tenderness, fever, N/V, shock S/S(tachycardia, hypotension), -Tx: surgery, IVF, antibiotics, NGT, NPO, check electrolytes **RISK FOR: DVT, pnemonia

Hepatitis: -AE: bowel(fecal/oral) -B: body fluid(blood, semen, salvia) -C: circulation(blood, semen(safe sex)) -D: co-infection (must have B) -Precautions: STANDARD -Teach: wash hands, safe sex/condoms, prevention(immunization), no ETOH, food prep Gastroenteritis: Inflammation of the GI Tract(entire gut). Impacts small bowel(complication) -S/S: N/V/D, dehydration, electrolyte changes, -Tx: self-limiting, -Home: increase fluids(poweraid), rest -Hospital: IVF, increase PO fluids, I&O’s Cholelithiasis: stones in the gallbladder Cholecystitis: inflammation due to the stones -S/S: RUQ pain and radiate to R shoulder, belching, fatty food increase pain, ghost poop. -Tx: avoid fatty foods, cholecystectomy, ERCP(breaks up stones, must be awake and should not feel pain, return of gag reflex before eating), monitor shock S/S and internal bleeding. -Complications: biliary colic(spasms in nerves in the biliary duct, shows shock S/S) HOB down, stay with patient, and call rapid response team. IBS: bowel cant make up its mind. -S/S: diarrhea or constipation -Tx: treat the symptoms -constipation: increase fiber, increase hydration, Metamucil -diarrhea: increase hydration, Imodium Appendicitis: inflammation of the appendix -S/S: periumbilical cramping, McBurney’s point, N/V, rebound tenderness, fever, RLQ pain. -Warning Signs: pain relief(cough, sneeze, retracting) worried about rupture

-Tx: NPO, surgery, antibiotics, IVF, no laxative/enemas, no excessive palpation. GI Diet Teaching: -increase fiber -increase fluids -grill/baked meats -no fatty/greasy foods -no ETOH/caffeine -limit broccoli/green leafy veggies -limit dairy Ulcerative Colitis: inflammation ulcers in colon/rectum -S/S: large sensation to defecate, blood/mucus in stool, LLQ pain -Tx: increase fluids, measure I&O’s, skin monitoring, steroids(decreases immunity), and antibiotics Potential complication with an GI disease? **Perforation which leads to peritonitis. ** Crohn’s Disease: inflammatory bowel disease -S/S: dry/brittle nails, loud BS, bloating, weight loss, decrease absorption -Tx: diet changes, monoclonal therapy(Infiximab: decrease immunity-avoid crowd people.) -Complications: fistulas-feces in urine, UTI S/S Diverticulitis: inflammation in the colon with pouches -Cause: age, low fiber, and decrease motility -S/S: LLQ pain, bloody stool, constipation, bloating, -Tx: avoid seeds/kernels, increase fiber, no laxative/enemas, decrease straining/lifting -Complications: rupture peritonitis(inflammation lining of the abdominal wall and covering the abdominal organs), obstruction, abscess(formation), hemorrhage Nutrition: -Albumin: 3.5-5.0(2 weeks) -Pre-Albumin: 15-36(2 days)

TPN: -central line -IV pump -Checked off by two RN’s -Change tubing Q24 hours -I&O’s -weaned off -monitor IV site -check electrolytes(labs 6-12 hours) -check glucose(4-6 hours) UTI: Bladder infection. Cystitis(ureters), Urethritis(urethra) -Causes: poor hygiene, DM, antibiotics, dehydration, sex, foley -S/S: extreme pain(costovertebral angle), cloudy urine, hematria, dysuria, increase frequency of urination **ELDERLY=CONFUSION -Teach: cranberries, wipe front to back, pee before and after sex, cotton undies, no bubble baths, increase fluids -Tx: antibiotics-Macrobid, UA/UC, teaching GU Assessment: inspect, palpate(bladder) -Cr 1.5 or higher: NO CONTRAST DYE -Diagnostic: CT, KUB, Bladder Scanner, MRI, UA/UC, CMP Incontinence: -Stress: kegals, no caffeine/ETOH, -Tx: Estrogen -Urge: bladder training, no caffeine/ETOH -Tx: Anticholinergics: Tolterodine Urolithiasis: stones in renal pelvis -Causes: metabolic, GI disease, kidney disease, obesity, DM -S/S: extreme flank pain (controvertible angle), dysuria, hematuria, oliguria/anuria(not expected::PRIORITY PT) -Tx: lithotripsy: bruising on side(monitor S/S shock and hemorrhage), strain urine(want to see the stone)

-Not expected: increase pain, blood, S/S shock -Expected: bruising, tenderness, and awake -Rx: -increase calcium in urine- Thiazide diuretics -increase of oxalic acid: Allopurinol Poly Cystic Kidney: cysts in nephrons -S/S: increase abdominal girth, flank pain, constipation, HTN, -Tx: hemo dialysis until transplant, stool softener, fluids, diet changes, control B/P, no NSAIDS/Aspirins Pyelonephritis: infection within renal pelvis -Acute S/S: fever, chills, N/V, tachycardia, tachypnea, and flank pain -Chronic S/S: HTN, decrease sodium, hyperkalemia -Complications: CKD, ESRD -Tx: Antibiotics, increase fluids PO, IVF, control B/P, diet-decrease K+ Glomerulonephritis: infection damages glomeruli -Causes: strep(10 days after the infection) -S/S: proteinuria, periorbital edema, fluid overload, generalized edema, weight gain, SOB, HTN, risk for hyperkalemia -Tx: diuretics(loops: Furosemide), infection control(tx family), handwashing, antibiotics(take all medication), monitor protein, steroids Benign Prostatic Hyperplasia: increase tissue in prostate -S/S: dribble dribble, hard time starting stream, retention, UTI S/S, -Complications: CKD, hydronephrosis (goes back into the kidneys) -RX: -5 Alphas: Finasteride -Alpha 1: Tamsulosin(Flomax) **SIDE EFFECTS: ORTHOSTATIC HYPOTENSION -take meds a night, position slowly, void with urge

-TURP: -CBI(continuous bladder irrigation 24 hours -expect bleeding/clots: gets lighter over time -burgurdy is bad: call MD -I/O’s: higher output than input -semi fowlers position -risk for DVT: SCD’s -Bladder spasms: Baclofen(smooth muscle relaxer) -Radical Prostatectomy: -Home with foley: clean daily with soap and water, change bag once a week, and no baths, lifting restrictions. Infectious Disease: -Contact: c-diff, VRE, MRSA, scabies -Droplet: pneumonia, influenza, meningitis, RSV, strep -Airborne: varicella, measles, TB, shingles, -Antibiotic Tx: check allergies, monitor S/S of reaction of medication, finish all medications Skin Assessment: document everything head to toe -Teaching: prevention, sunscreen atleast 30 mins prior to exposure, self skin exam

Urticaria: Hives Cellulitis: inflammation in SQ tissue past sight of injury -S/S: red, warm, edema, tenderness, discomfort -Tx: antibiotics, warm compress(vasodilate), elevate to the heart, ambulate, IND(debridement) Herpes Zoster: Airborne, Shingles, extremely painful -Tx: antivirals, pain control, older than 60=Zostavax Psoriasis: autoimmune skin scales -Triggers: stress, obesity, DM, infection -Tx: (NO CURE), topical steroids, biologics, light therapy in MD office, no tanning bed.

Pediculosis: Lice (contact) -Tx/Teaching: RID shampoo, launder everything, Ivermectin(medication) Scabies: Mites/poor hygiene -S/S: intense itching mainly at night in the fingers, palms, and wrists -Tx: scabicides Pressure Ulcers: Q2 TURNS -Stage 1: no break in skin, no blanching -Stage 2: blisters, break in skin, most painful -Stage 3: goes to the fat, increase risk for infection -Stage 4: to the bone/muscle/tendon, could lead to death -Prevention: Q2 turns in bed, Q1 in chair, pad boney areas, lift sheet, barrier products, increase protein intake, hygiene. Risks for skin integrity -age -incontinence -decrease ambulation(elderly, spinal injury) -restraints -obesity -malnourishment -DM-decrease wound healing -ETOH Wound Care: -Wet/Dry: mechanical debridement -Wet/Wet: denature protein(gets rid of slough to help heal) -Teaching: handwashing, sleep alone, keep covered at all times, no contact sports...