RN ADULT MEDICAL SURGICAL 2019 PROCTOR REMEDIATION
ANTICOAGULANTS HEPARINS
- Therapeutic uses: stroke; PE; DVT; prophylaxis for post-op venous
... [Show More] thrombosis; treatment of DIC
- Heparin toxicity: admin PROTAMINE slowly IV no faster than 20 mg/min or 50 mg in 10 min; do not exceed 100 mg in 2hr; prevent protamine toxicity
- Hemorrhage secondary to heparin toxicity: monitor vitals; observe for bleeding (increased HR; decreased BP, bruising, petechiae, hematomas, black tarry stools); monitor aPTT (keep value 1.5
– 2 x baseline); stop heparin admin
- Epidural/spinal hematoma risk
- Monitor platelet count throughout treatment; stop heparin for platelet count < 100,000 LMW HEPARINS
- Therapeutic uses: DVT prevention and treatment; PE; prevent complications of angina; non-Q wave MI; STEMI
- Enoxaparin
- Hemorrhage: monitor vitals; monitor platelet count; observe for bleeding; avoid aspirin ACTIVATED FACTOR XA INHIBITOR
- Therapeutic uses: DVT and PE prevention postop; acute DVT or PE treatment in conjunction w/ warfarin
- Fondaparinux
- Hemorrhage: monitor vitals; monitor platelet count; monitor for bleeding; avoid aspirin CONTRAINDICATIONS
- Thrombocytopenia
- Use during/following surgeries of eyes/brain/spinal cord/lumbar puncture/regional anesthesia
- Use caution in clients w/ hemophilia; increased capillary permeability; dissecting aneurysm, PUD, severe HTN, hepatic/kidney disease, threatened abortion
INTERACTIONS
- Increased risk of bleeding w/ antiplatelet agents: ASPIRIN; NSAIDS
- Increased risk of bleeding w/ RESVERATROL; SAW PALMETTO; GARLIC; GINGER; GLUCOSAMINE; GINKGO BILOBA
NURSING ADMIN
- Must be given via SUBQ injection or IV infusion
- Rotate sites
- Monitor for indications of bleeding
- Use electric razor
- Use soft toothbrush
VITAMIN K INHIBITORS (COUMARINS) WARFARIN
- Prevention of venous thrombosis and PE
- Prevention of thrombotic events w/ a-fib or prosthetic heart valves
- Reduce risk of recurrent TIA or MI COMPLICATIONS
- Hemorrhage: monitor vitals; observe for bleeding; obtain baseline PT and INR
- Warfarin toxicity: admin vitamin K1
- Hepatitis: monitor liver enzymes; assess for jaundice CONTRAINDICATIONS
- Pregnancy/breastfeeding
- Thrombocytopenia/uncontrollable bleeding
- During/following surgeries of eyes; brain; spinal cord; lumbar puncture; regional anesthesia
- Clients w/ vitamin K deficiencies; liver disorders; alcohol use disorder
- Clients w/ hemophilia; dissecting aneurysm; PUD; severe HTN; threatened abortion INTERACTIONS
- Concurrent use of HEPARIN; ASPIRIN; ACETAMINOPHEN; GLUCOCORTICOIDS; SULFONAMIES; PARENTERAL CEPHALOSPORINS, INCREASES RISK OF BLEEDING
- Concurrent use of PHENOBARBITAL; CARBAMAZEPINE; PHENYTOIN; ORAL CONTRACEPTIVES; VITAMIN K
- Foods high in vitamin K: dark green leafy vegetables, cabbage, broccoli, brussel sprouts, mayo, canola/soybean oil
- RESVERATROL, SAW PALMETTO, FEVERFEW, GARLIC, GINGER, GLUCOSAMINE, GINKGO BILOBA NURSING ADMIN
- Oral, once daily, same time each day
- Baseline vitals
- Monitor PT (18-24 sec); INR (2-3)
- Baseline/monitor CBC, platelet count, Hct
- Have vitamin K for warfarin toxicity
- Wear medical alert bracelet
- Soft bristle toothbrush and electric razor
SKIN CANCER
ABCDE TO EVALUATE MOLES
- Asymmetry
- Borders
- Color
- Diameter
- Evolving
AMPUTATIONS: PROVIDING SUPPORT
- Allow client/family to grieve for loss of body part/change in body image
- Feelings of depression, anger, withdrawal, grief
- Asses psychosocial well-being of client; feelings of altered self-concept/self-esteem; willingness and motivation for rehab
- Supportive environment
BURNS: INDICATIONS OF HYPOVOLEMIC SHOCK
- Inadequate perfusion, confusion, hypotension decreased urine output, increased cap refill time; decreased bowel sounds,
DM MANAGEMENT: MEDICATION TO WITHOLD PRIOR TO CT SCAN W/ CONTRAST MEDIA
- METFORMIN; stop for 24-48 hr before any test w/ contrast dye and restart 48 hr after; can cause lactic acidosis due to acute kidney injury
HEARTH FAILURE AND PULMONARY EDEMA: INTERVENTIONS FOR FLUID VOLUME OVERLOAD
- High fowlers positioning; O2 admin; rapid acting loop diuretics; medications to improve cardiac output; monitor I/O; daily weights; check abgs and electrolytes; restrict fluid intake; slow/discontinue IV fluids
STROKE: ADMIN OF TPA
- Give w/i 4.5 hr of initial manifestations for clients experiencing ischemic stroke due to embolic event as evidenced by CT scan results
GI THERAPEUTIC PROCEDURES: FINDINGS TO REPORT FOR CLIENT RECEIVING TPN
- Metabolic complications: hyperglycemia; hypoglycemia; vitamin deficiencies
- Air embolism: sudden onset of dyspnea; chest pain; anxiety; hypoxemia
- Infection: observe central line insertion site for infection (erythema; tenderness; exudate)
- Fluid imbalance: crackles in lungs/respiratory distress
POST OP NURSING CARE: CARING FOR CLIENT FOLLOWING APPENDECTOMY
- Airway, breathing, circulation
- Vital signs
- Positioning
- Response to anesthesia (sedation, nausea, vomiting)
- Intake/Output
- Surgical wound/incision site/dressing
- Pain
- Mentation
NONINFLAMMATORY BOWEL DISORDERS: FINDINGS TO REPORT
- HERNIA: report redness or swelling at incisional site
- IRITABLE BOWEL SYNDROME: report constipation, fever, increased abdominal pain, fatigue, dark urine, bloody diarrhea, rectal bleeding
- INTESTINAL OBSTRUCTION: Dehydration; persistent vomiting; metabolic disturbances; abdominal distention; absent bowel sounds
LEGAL RESPONSIBILITIES: WITNESSING INFORMED CONSENT
- Ensure provider gave client necessary information; client understood information and is competent to give informed consent; have client sign informed consent document; notify provider if client has more questions or appears not to understand any of the information; document questions client has/notification of provider/reinforcement of teaching/use of interpreter
GI THERAPEUTIC PROCEDURES: DISCHARGE TEACHING FOR CLIENT W/ ILEOSTOMY
- Foods that cause odor: fish, eggs, asparagus, garlic, beans, dark green leafy vegetables
- Foods to decrease odor: buttermilk, cranberry juice, parsley, yogurt
- Foods that cause gas: dark green leafy vegetables, beer, carbonated beverages, dairy products, corn, chewing gum, skipping meals, smoking
- Foods to decrease gas: yogurt, crackers, toast
- Avoid high-fiber foods for the first 2 months after surgery; chew food well; increase fluid intake, and evaluate for evidence of blockage when slowly adding high-fiber foods to diet
- Proper fit and maintenance prevent odor when pouch is not open
- Filters, deodorizers, or breath mint can be placed in pouch to minimize odor while pouch is open
- Discuss feelings about ostomy and concerns about effect on life; look at / touch stoma; ostomy support group
HEMODIALYSIS AND PERITONEAL DIALYSIS: MANIFESTATIONS OF PERITONITIS
- Cloudy/opaque effluent ANEMIAS: MANIFESTATIONS OF ANEMIA
- Pallor, fatigue, somnolence, headache, irritability, numbness/tingling of extremities, dyspnea on exertion, sensitivity to cold, pain/hypoxia (sickle cell crisis)
- Shortness of breath/fatigue on exertion, tachycardia and palpitations, dizziness/syncope on standing or exertion, pallor of nail beds/mucous membranes, nail bed deformities (spoon- shaped nails), smooth/sore/bright-red tongue, paresthesia in hands/feet
CARDIOVASCULAR AND HEMATOLOGIC DISORDERS: DIETARY TEACHING W/ CLIENT WHO HAS HF
- Reduce sodium intake < 3000 mg per day for mild-mod HF, < 2000 mg per day for severe HF
- Monitor fluid intake
- Increase protein intake to 1.12 g/kg
- Use small frequent meals that are soft/easy to chew
HEART FAILURE AND POUMONARY EDEMA: TEACHING ABOUT LEFT-SIDED HF
- Risk factors: hypertension, CAD, angina, MI, valvular disease
- Findings: dyspnea, orthopnea, nocturnal dyspnea, fatigue, displaced apical pulse; S3 (gallop), pulmonary congestion, (dyspnea, cough, bibasilar crackles), frothy sputum, altered mental status, manifestations of organ failure (oliguria), nocturia
HIV/AIDS: PRIORITY CLIENT TEACHING
- Practice good/frequent hand hygiene
- Avoid crowds and travel to countries w/ poor sanitation
- Avoid raw foods/undercooked foods
- Avoid cleaning pet litter boxes (toxoplasmosis)
- Keep home environment clean
- Wash dishes in hot water using dishwasher if available
- Bathe daily using antimicrobial soap
- Adhere to antiretroviral dosing schedules
- Conduct frequent follow up monitoring of CD4 and viral load counts
- Identify primary support systems
- Perform constructive coping mechanisms
- Report manifestations of infection immediately to provider
BRAIN TUMORS: PHARMACOLOGICAL TREATMENT OF DIABETES INSIDPIDUS
- Massive fluid replacement
- Admin of synthetic vasopressin
- Careful attn to lab values
- Replacement of essential nutrients as indicated [Show Less]