Nursing Tips: Med-Surg

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

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!

If your patient has a halo traction device in place, make sure wrench/screwdriver are attached to the vest to release patient from the device in the event of an emergency.

Patient teaching for external radiation therapy.

Costovertebral tenderness is a key symptom with Pyelonephritis.

Prevent hip flexion contractures in patients with a BKA (below-the-knee amputation): Have patient lie prone every 3-4 hrs for 20-30 min.

Hormone Replacement therapy can be used to treat the signs/symptoms of menopause. However, it is important to remember that HT increases the risk of embolic events (DVT, MI, stroke) and breast cancer.

Neutropenia and Thrombocytopenia are key symptoms of hematologic cancers (ex: leukemia, multiple myeloma). Key Nursing priority: Prevent infection and bleeding!

With peritoneal dialysis, bloody or cloudy outflow indicates possible infection!

Key feature of Lyme Disease is a ring-shaped, "bullesye" lesion at the site of the tick bite.

When screening a patient for prostate cancer, be sure to obtain the PSA (prostate specific antigen) before performing a DRE (digital rectal exam).

For a patient with urolithiasis (kidney stone), a key nursing intervention is to strain the patient's urine. Send stone for lab analysis!

Key differences in symptoms for Gastric and Duodenal ulcers: Gastric ulcer: Pain 30-60 minutes after meal, worse in DAY, worse with eating. Duodenal ulcer: Pain 1.5-3 hours after meal, worse at NIGHT, better with eating.

Malignant hyperthermia is a life-threatening complication due to certain general anesthesia medications. Symptoms: Muscle rigidity, tachycardia, fever, dysrhythmias, tachypnea, hypotension, cyanosis.

When administering Continuous Bladder Irrigation (CBI) for a patient following a Transurethral Resection of the Prostate (TURP), be sure to increase the CBI rate if outflow is bright red or contains clots. Goal = light pink irrigation outflow.

Key symptom of Herpes Zoster: Painful, unilateral vesicular rash that runs along a dermatome

Mastectomy Care and Patient Teaching:

Nursing Care: Do not administer injections, obtain blood, or take BP in the affected arm.

Patient Teaching: Wear sling when ambulating, wear loose clothing, perform arm/hand exercises to prevent edema and increase ROM.

Patient teaching for GERD: Avoid fatty, fried, citrus, spicy foods. Eat smaller meals. Remain upright after meals. Avoid tight-fitting clothing. Lose weight (if applicable). Quit smoking. Elevate HOB with blocks.

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.

Potassium (K) expected range: 3.5 - 5.0 mEq/L HINT #1: There are ~3.1 miles in a 5K HINT #2: Bananas (high in Potassium!) come in bunches of 3-5.

Magnesium (Mg) expected range: 1.3 - 2.1 mEq/L HINT: MGs are very small British cars - you can only fit 1-2 people in them.

Troponin T and I are key cardiac enzymes that become elevated when there is damage to the heart.

For patients with Diabetes, the goal is to keep their HgbA1C under 7!

One sign of hypocalcemia is a positive Chvostek's sign. HINT: You check for the Chovostek's sign by tapping the patient's cheek (over the area of the facial nerve).