Professional Documents
Culture Documents
Parkinsons disease
o S/S tremors at rest, rigidity, bradykinesia, stooped posture, masklike facies, short shuffling steps,
hips and knees slightly flexed, arms flexed at elbows and wrists
o What is said to occur - a progressive degenerative disorder that results in an eventual loss of
coordination and control over involuntary motor movement
o What sort of nursing considerations should we be alert to as far as ADLS Spinal cord Injury (SCI)
o complications
Autonomic dysreflexia - Exaggerated response of autonomic nervous system to noxious
(painful) stimuli
S/S - severe HTN which mad led to SZ or a stoke(increase in BP can stimulate vagus
nerve causing bradycardia, dilation only above the level of injury nasal
congestion, facial flushing, profuse sweating and pounding HA
Causes - noxious (painful) stimuli, fever, kinked, f/c tubing, constipation
Treatment - prevention of triggers
o Triggers include- distended bladder, constipation, renal calculi, ejaculation,
or uterine contractions, but also may be caused by pressure sores, skin rash,
enemas, or even sudden position changes
CVA - Obstruction of blood vessel by atherosclerotic plaque, blood clot, or a combination of the two, or by other
debris released into vessel that impedes blood flow to an area of the brain
o S/S sudden numbness or weakness of the face, arm, or leg, especially on one side of the body,
Sudden confusion trouble speaking or understanding, sudden trouble seeing in one or both eyes,
sudden trouble walking, dizziness loss of balance or coordination, sudden severe HA with no know
cause
o Early interventions - control Bp, overdose with anticoagulants, atherosclerosis, diet and lifestyle
changes
o nursing considerations and the immediate care of these patients
o treatment o who is at higher risk African Americans
o care of the patient in the acute and rehabilitation phase care of the patient and possible complications
Acute 4 major areas to focus Htn, O2, hyperglycemia and hyperthermia; fluids, meds,
sx
Rehab allow pt to participate in there care, personal devices, environmental adaptions,
ADL, nutrition (thickener), gait belts
Recognition of increasing intracranial pressure
o S/S
Early - decreasing LOC : become lethargic, talkative or quiet, or restless and irritable. May
have trouble remembering things, experience a change in personality, or complain of nausea
and vomiting. Symptoms may progress to confusion or diminished responsiveness
Late - increased systolic blood pressure, widened pulse pressure, and slowed heart rate.
Irregular respiratory patterns may develop, and the patient's temperature may rise
o Assessment of these patients LOC ,pupillary characteristics, motor functions, sensory function, v/s
o nursing considerations TIA
o S/S dizziness, momentary confusion, loss of speech, loss of balance, tinnitus, visual disturbances,
ptosis, dysarthria, dysphagia, drooping mouth, weakness and tingling or numbness on one side of
the body
o Causes blood vessels may be occluded by spasms, fragments of plaque or blood clots
Tx - Bacterial infections usually respond to antimicrobial therapy, but no specific drugs effective
against most viral infections and Anticonvulsants used to control seizure activity if necessary
o Precautions isolation precautions
o Testing LP
o patient teaching - immunizations
o nursing priorities - WASH HANDS
ch 36/37/35
congestive heart failure
o Care of the patient- Eliminate unnecessary activities, Help the patient change positons every 2 hrs,
Give a partial bed bath
o S/S SOB, fatigue, weakness, swelling, dysthymias, persistent cough wheezing, ascites, sudden wgt
gain, lack of appetite, chest pain, decreased alertness
o patient teaching Antihypertensive medications know the different classifications that are used:
o ACE inhibitors captopril(Capoten), liniopril (Zestril, Prinivil), enalopril (Vasotec)
Uses -prevents conversion of angiotensin, potent vasoconstrictor
Nursing considerations monitor pt blood cell counts, report changes in urine output
Contraindications renal problems
Pt teaching o Calcium channel blockers diltiazem(Cardizem), isradipine(DynaCirc), nicardipine(Cardene,
nifedipine(Procardia), amlodipine (Norvasc), verapamil (Calan), Caduet
Uses decreases the force of cardiac contraction and dilates the peripheral blood vessels
Nursing considerations monitor pts pulse, elevate legs to reduce edema
Contraindications monitor hypotension, bradycardia and edema
Pt teaching o Beta-blockers
Uses decreases cardiac stimulation
nursing considerations monitor for bradycardia, hypotension, hypoglycemia
contraindications asthma, COPD pts, heart block, or CHF
Pt teaching o Diuretics)
Thiazide agents(chlorothiazide(Diuril), HCTZ) decrease the reabsorption of sodium and water
Potassium sparing( spironolactone(Aldactone) do not promote secretion of potassium into urine
Non-potassium sparing( furosemide (Lasix) allows water and salt to be excreted thru urine
Uses reduces fluid volume, may cause vasodilation, sodium loss
Nursing considerations pts fluid balance, hydration, urine output, mental status and
muscle tone,
Contraindications Pt teaching myocardial infarction
o S/S
Pain
Heavy or constrictive pain located below or behind sternum
May radiate to the arms, back, neck, or jaw
Patient becomes diaphoretic and lightheaded and may experience nausea, vomiting, and
dyspnea
The skin is frequently cold and clammy
Patient experiences great anxiety; feeling of impending doom
o Causes - Begins with occlusion of coronary artery
Period of 4 to 6 hrs. process of ischemia, injury, infarction develops
Ischemia lasting 20 minutes or more is sufficient to produce irreversible damage
o Treatment
o
chronic pain resting ext in dependent position administer analgesic agents as prescribed
impaired skin integrity prevent tissue damage, properly fitted shoes, cut toenails straight across
disturbed body image encourage the pt to express any feelings that results from problems
ineffective peripheral tissue perfusion vasodilator agents and other drugs that improve blood flow as
ordered
o ineffective self-health management adaption to lifestyle changes in essential to good management of
PAD
o risk for infection after sx risk for infection of the surgical incision and the grafts
o decreased cardiac output monitor DW, and inspect dressing for bleeding, decreased urine output,
hypotension
o ineffective peripheral tissue perfusion monitor pulses, warmth and color of the operative extremity and
promptly
o acute pain analgesic agents, positioning and relaxation tech
o impaired physical mobility assess muscle strength and tolerance of activity
Hypertension define it
o Causes - Requires the LV to work harder to overcome increased peripheral resistance. The
increased workload may cause the LV to hypertrophy (enlarge) & may eventually fail
o complications - MI, kidney damage, CVA, TIA, retinal hemorrhages may lead to blindness, and
death
o S/S occipital HA that are more severe on arising, light-headedness and epistaxis
o modifiable and non-modifiable risks o diet
o know your different levels ex: essential
Know your lab value normal of all your electrolytes o
o
o
o
o Sodium(Na) - Major role in regulating body fluid volumes, muscular activity, nerve impulse conduction, and
acid-base balance
Hyper S/S - thirst, flushed skin, dry mm, low urine output, restlessness increased HR convulsions and
postural hypotension
Hypo S/S -
headache, muscle weakness, fatigue, apathy, confusion, abd cramps and orthostatic
hypotension
Values - 136-145mEq/L
Complications o Potassium(K) - Important in maintaining fluid osmolality and volume within the cell, Essential for normal
membrane excitabilitya critical factor in transmitting nerve impulses, Needed for protein synthesis, for the
synthesis and breakdown of glycogen, and to maintain plasma acid-base balance
Hyper S/S explosive diarrhea and vomiting, muscle cramps, weakness and paresthesia, irritability,
anxiety, abd cramps and decreased urine output
Hypo S/S anorexia, abd distention, vomiting, diarrhea, muscle cramps, dysrhythmias, postural
hypotension, dyspnea, shallow resp, confusion, depression, polyuria, nocturia
Hyper S/S nausea, vomiting, dyspepsia and anorexia, lethargy, psychosis, cerebellar ataxia and
possibly coma or death
Hypo S/S fatigue, depression, memory loss, hallucinations and possible seizures or tetany; Early
signs: finger numbness, tingling, burning of extremities and paresthias.
Hyper S/S = bradycardia, flushing, sweating, N/V, low Ca, flaccid paralysis, EKG changes over 15
= respiratory distress and asystole.
Hypo S/S weakness, muscle fasciculation with tremor, tetany, increased reflexes, personality changes,
convulsions, psychosis, come and cardiac arrhythmia. weight loss, reduced appetite, nausea, vomiting, fatty
stool, bloating, muscle pain, irritability, disorientation, confusion, tremor, seizures( severe deficiency),
vertigo, nystagmus, impaired balance.
o
Inderal (propanalol)
o Uses o Contraindications
o patient teaching
o nursing considerations
Hypertensive emergency - life threatening medical emergency
o S/S - Severe headache, blurred vision, nausea, restlessness, and confusion along with very highBP
o Causes make be because pt stop taking his HTN meds, malignant HTN, HTN encephalopathy,
eclampsia, pheochromocytome or CVA
o Treatment rapidly reduce the pressure to non-life threatening level then bring it slowly within normal
range
o Complications cardiac and renal damage, death, CVA, renal failure or cardiac failure
Ch 46
Diabetes type 1 Absence of endogenous insulin
o Causes - autoimmune process, possibly triggered by a viral infection, destroys beta cells, the
development of insulin antibodies, and the production of islet cell antibodies (ICAs)
o s/s - Urinating often, Feeling very thirsty, Feeling very hungry - even though you are eating,
Extreme fatigue, Blurry vision, Cuts/bruises that are slow to heal, Weight loss - even though you are
eating more
o tx - Affected people require exogenous insulin for the rest of their lives
o specific differences - Formerly called juvenile-onset diabetes because it most commonly occurs in
juveniles and young adults
o pt teaching
Diabetes type 2..Inadequate endogenous insulin and bodys inability to properly use insulin
o Causes - Beta cells respond inadequately to hyperglycemia; results in chronically elevated blood
glucose, Continuous high glucose level in the blood desensitizes the beta cells; they become less
responsive to the elevated glucose
o s/s dm 2 have s/s that are mild and may go unnoticedtypical s/s - Urinating often, Feeling
very thirsty, Feeling very hungry - even though you are eating, Extreme fatigue, Blurry vision,
Cuts/bruises that are slow to heal, Tingling, pain, or numbness in the hands/feet
o tx - Controlled by diet and exercise; may require oral hypoglycemic agents or exogenous insulin
o specific differences -More common in adults; increasing in children
o pt teaching Know how to recognize long and short term goals for patients in general (specific when given detailed history)
HHNS - Hyperglycemic Hyperosmolar Nonketotic Syndrome
Patient goes into a coma from extremely high glucose levels (>600 mg/dl)
Causes - Pancreas produces just enough insulin to prevent breakdown of fatty acids & the formation of
ketones but not enough insulin to prevent hyperglycemia
S/S - diuresis, dehydration and hypernatremia, polydipsia, polyuria
assessment of client treatment - iv insulin drip
expected labs - fasting serum blood glucose, random glucose levels, 2 hr postprandial glucose levels
Know the different insulins and their peaks/nursing considerations/diets/interventions and patient teaching
Insulin drips
o when
o why
o how
o nursing considerations
DKA (diabetic ketoacidosis)
o Causes - Life-threatening emergency caused by a relative or absolute deficiency of insulin
o whos is at risk o S/S - As condition progresses, classic symptoms of polydipsia, polyuria, and polyphagia develop
If untreated, patient becomes dehydrated, weak, and lethargic with abdominal pain, nausea,
vomiting, fruity breath, increased respiratory rate, tachycardia, blurred vision, and
hypothermia
Late signs - Air hunger (Kussmaul respirations), coma, and shockdeath can results
without prompt medical care
o early recognition - Anorexia, headache, and fatigue
o Tx - aimed to correct 3 main problems.dehydration, electrolyte imbalance and acidosis
o Complications - coma from extremely high glucose levels (> 600 mg/dl) but no evidence of ketones
o nursing considerations when caring for these clients
Important teaching for diabetics on self- care/diet etc.
o Foot care
Wash & carefully dry the feet every day
Protect from extreme temperatures
Buy shoes that are comfortable & supportive
Keep skin soft & smooth
Wear shoes at all times
o Diet Immediate care of hypoglycemia
Ch 32
Anemia different types/causes in each and patient teaching/treatments/self- care and monitoring while at home
o Pernicious Anemia
Causes lack of intrinsic factor
S/S fatigue, pallor, weakness, a sore tongue, numbness of hands or feet
Tx
Pt teaching/self-care
o Iron Deficiency
Causes From a diet too low in iron or from the body not absorbing enough iron from the
gastrointestinal tract
S/S fatigue,
Tx ferrous sulfate and iron dextran
Pt teaching/self-care - Encourage foods high in iron; liver, oysters,red meats, fish, dried
fruits, legumes, dark green veggies, whole grain cereals/bread
o Aplastic Anemia
Causes Certain drugs (e.g., streptomycin and chloramphenicol) and exposure to toxic
chemicals/radiation cause bone marrow failure
S/S
Tx Transfusion: replace red blood cells and platelets
Antibiotics to prevent or treat infections; corticosteroids also may be given
If bone marrow does not recover, a transplant may be considered if donor can be
found
Pt teaching/self-care -
Hemophilia A
o Causes- certain infections, drug reactions, and certain cancers
o S/S - pallor, extreme fatigue, tachycardia, shortness of breath, and hypotension
Patients may appear jaundiced
High bilirubin levels from all the red blood cells lysed (broken down
o Treatment - identifying and treating the cause
Blood transfusions may be needed to replace red blood cells
Corticosteroids may be administered to the patient
o nursing considerations with care of these cients
Sickle-cell anemia o Causes - Disk-shaped red blood cells become sickle shaped, Misshapen cells more fragile than
normal red blood cells; as a result, the sickled cells easily rupture as they pass through small
capillaries, resulting in a chronic anemia
o who is at risk - almost exclusively in African Americans
o treatment - treatment is symptomatic
Intravenous fluids and pain medication
Red blood cell transfusions correct the anemia and help the body oxygenate tissues
Oxygen therapy
Hydroxyurea
o patient teaching
o prevention of crisis -treating Dehydration and infection, preventing overexertion, cold weather
changes, excessive alcohol consumption, smoking
o why does a crisis occur - Dehydration, infection, overexertion, cold weather changes, excessive
alcohol consumption, smoking
ch 44-45
Patients with adrenal gland problems,
o what is the disease
o S/S
o Labs
o treatment
o what occurs during the illness
Addisons disease adrenal insufficiency
o Interventions o what is it idiopathic atrophy, autoimmune disease , AIDS, TB, hemorrhage rt anticoagulant therapy,
metastatic cancer, adrenalectomy
o what is occurring destructive disease process affecting the adrenal glands that causes deficiencies of
cortisol and aldosterone
DI (diabetes insipidus)
o Causes Neurogenic hypothalamic tumors, head trauma, infection, surgical procedures or metastatic
tumors originating in the lung or breast
Nephrogenic inherited defect; renal tubules of the kidney do not respond to ADH, resulting in
inadequate water reabsorption by the kidneys
o S/S massive diuresis, dehydration, thirst, hypotension, tachycardia, dizziness, decreased skin turgor,
weakness, and fainting episodes