Nursing Tips: Med-Surg

The oliguric phase of acute kidney injury (AKI) is marked by urine output less than 400 mL/day. In the diuresis phase of AKI, urine output can reach 4 - 5 L/day.

After a tonic-clonic seizure, a patient enters the "postictal phase," and may exhibit confusion, sleepiness, or agitation.

A patient with atrial fibrillation (A-Fib) experiences rapid but disorganized depolarization of the atria, causing them to quiver instead of fully squeezing. 

A patient with fibrocystic breast changes may experience breast pain and/or movable, tender, rubber-like cysts in the upper outer quadrant of the breast.

A patient with an Abdominal Aortic Aneurysm may have a pulsating abdominal mass with a bruit. Do NOT palpate this due to the risk for rupture!

A patient with sinus bradycardia will likely require no treatment. However, if they are symptomatic, treatment with atropine or a pacemaker may be indicated.

A patient with hyperpituitarism may require surgical treatment with a hypophysectomy. 

A patient with paradoxical pulse and an EKG showing electrical alternans should be evaluated for cardiac tamponade.

A patient with a tension pneumothorax is likely to have tracheal deviation towards the unaffected side. Assess respiratory status in any patient with this finding!

A patient with elevated hBNP (> 100 pg/mL) should be evaluated for Heart Failure.

Calcium (Ca) expected range: 9 - 10.5 mEq/L HINT: California (CA) is due for a big earthquake that may measure 9 - 10.5 on the Richter scale.

A patient who experienced a long-bone fracture is at risk for a fat embolism. Immediately report any dyspnea, confusion, tachypnea, tachycardia, or chest pain to the provider.

A patient with appendicitis is likely to have RLQ pain at McBurney's Point along with rebound tenderness, nausea/vomiting, and fever.

A patient undergoing hemodialysis may have an arteriovenous fistula in the arm. Educate patient that blood pressures, IVs, and blood draws must be done from the arm without the shunt. Also educate patients not to sleep on the arm with the fistula, and perform hand exercises to mature a new fistula.

A patient with asthma who is experiencing airway obstruction unresponsive to usual therapy is experiencing status asthmaticus. Administer oxygen and prepare for emergency intubation!

A patient who experiences prolonged standing (like nurses!) is at risk for developing varicose veins. Educate patients with this risk factor to wear compression stockings and elevate the legs when possible.

A patient reporting a loss of central vision should be evaluated for macular degeneration.

Assess any skin lesions for potential cancerous changes using ABCDE.

Cardiac Enzymes are released in response to cardiac ischemia. They include CK-MB, Myoglobin, Troponin T, and Troponin I. Troponin is the most specific!

A patient presenting with a chancre (ulcer) on the genitals should be evaluated for syphilis. The chancre should be cultured, and a blood test should be done to assess for this sexually transmitted infection.

A patient with Chronic Obstructive Pulmonary Disease (COPD) is likely to have a "barrel chest" appearance, use accessory muscles to breathe, have clubbing of the fingernails, and exhibit hyperresonance upon percussion.

A client experiencing shock is at risk for Disseminated Intravascular Coagulopathy (DIC). Monitor for signs of clotting/bleeding and report any of these findings promptly.

Ostomy patient teaching: 

• Cut opening in skin barrier ≤ 1/8" bigger than the measured stoma size to prevent skin damage from contact with ostomy output.
• Assess stoma regularly - should be pink/moist. Pale/blue stoma indicates ischemia.

A pap test to screen for cervical cancer should be performed every three years starting three years after a patient's first instance of sexual intercourse, or by age 21. 

A negative feedback loop governs most endocrine hormones. In this type of feedback, when the body senses there is not enough of a hormone circulating in the blood, changes are initiated to increase production of that hormone. Once the body senses there is too much of that hormone, changes are initiated to decrease production of that hormone.

A major complication of peptic ulcer disease is perforation of an ulcer. Assess for symptoms of perforation such as severe pain, fever, or a rigid/boardlike abdomen.

A key finding in Huntington's Disease is chorea, which is a type of abnormal and excessive involuntary movement. Tetrabenazine may be given to treat this symptom.

A high pressure alarm from a ventilator could indicate Pulmonary edema, Pneumothorax, Bronchospasm, Biting of the tube, Secretion excess, Coughing, or a Kink in the tubing.

Following a bronchoscopy (visualization of the structures of the airway with sedation), ensure the patient's gag reflex has returned prior to allowing the patient to eat or drink.

For a patient who has suffered a BURN, be sure to assess for inhalation injury. Symptoms: singed eyebrows or nasal hair, and sooty sputum.

For symptoms of compartment syndrome, remember the 5Ps: Paresthesia, Paralysis, Pallor, Pulselessness, Intense Pain

Chest physiotherapy treatments should be included 1 hour before or 2 hours after meals to avoid vomiting.

Best practices for patients with DYSPHAGIA

Dementia vs delirium: Dementia has slow onset, does NOT alter vital signs, and is irreversible. Delirium has rapid onset, can alter vital signs and level of consciousness, and is reversible.

Patients with asthma should monitor their airway with a peak flow meter. 

Diagnosis of meningitis is done by analyzing the patient's CSF (cerebrospinal fluid).

Diabetic foot care teaching: Inspect feet; Apply moisturizer; Wear cotton socks; Cut nails straight across; Don't use OTC products or use heating pads on feet.

With a Urinary Tract Infection (UTI), the urinanalysis may be positive for leukocyte esterase and nitrites.

With Diabetes InSIPidus, you will want to SIP a lot of water. Diabetes Insipidus causes the patient to urinate large quantities of dilute urine, leaving the patient dehydrated and thirsty!

Key labs with Glomerulonephritis: Serum: Positive antistreptolysin-O titer. Urinanalysis: hematuria, proteinuria. Throat culture: Positive for group A beta-hemolytic streptococcus

Chlamydia and Gonorrhea are STDs that can lead to Pelvic Inflammatory Disease (PID) and infertility if not treated promptly.

How to remember that Rheumatoid Arthritis causes swan neck and boutonniere deformities

During a seizure, take these important nursing actions

Innate vs. Acquired Immunity Pathophysiology

Syndrome of Inappropriate ADH (SIADH) causes the excess water to be reabsorbed by the kidneys, resulting in hypervolemia.

Patients with dysphagia (difficulty swallowing) need to have a swallow evaluation by a speech language pathologist.

Expected labs with Rheumatoid Arthritis: Positive Rheumatoid Factor (RF) antibody and Positive ANA titer

Menorrhagia = Excessive menstrual bleeding. This can result in anemia.

If you have menorrhagia, it will make you want to rage!