ADULT HEALTH MED SURG STUDY GUIDE AND NOTES 2023

Pan-hysterectomy for Uterine Cancer  Discharge teaching o Educate and inform the client that a Pan-hysterectomy includes the removal of the uterus and the ovaries  Causes Manifestations of Menopause  Hot flashes  Night Sweats  Vaginal Dryness (treatment = use water-based lubricant when having sexual intercourse) Unstable Angina  Nursing consideration o Patients experiencing Unstable Angina will have chest pain lasting longer than 15 minutes Gout and Urolithiasis  How to prevent future uric acid stones o Take allopurinol as prescribed (medication used to reduce uric acid) o Exercise several times a week o Limit intake of foods high in purine  Purine increases the risk of uric acid stone formation: examples  organ meats  poultry (chicken)  fish  red wine  gravy Right-hemispheric stroke  expected neurologic deficits o Visual spatial deficits (loss of depth perception) o Left hemianopsia (blindness in the left half of the visual field) o one-sided neglect Left-hemispheric stroke  expected neurologic deficits o Expressive aphasia (inability to express what one wants to convey) o Right hemiplegia (blindness in the right half of the visual field) Hypertonic Dehydration  Expected finding o Urine specific gravity greater than 1.030 (ex. 1.045 Urine Specific Gravity) o Sodium level greater than 145 mEq/L o Increased respiratory rate Acute Cholecystitis  Expected finding o Tachycardia (priority finding) o Abdominal pain radiating to the right shoulder o Anorexia o Rebound abdominal tenderness Colorectal Cancer  Recommend Dietary Alterations o Consume a diet that is high in high, low in fat, and low in refined carbohydrates  Brassica Vegetables (food that are high in fiber)  Cabbage  Cauliflower  Broccoli Irritable Bowel Syndrome (IBS)  Dietary Consideration o Foods to avoid  Dairy products  Raw fruits  grains that can cause bloating o Safe to consume  Fiber (increase fiber intake to at least 30 g per day)  At least 2 Liters of water daily (to promote regular bowel function) Pancreatitis  Labs below the expected reference range o Calcium (due to fat necrosis) o Magnesium (due to fat necrosis) CT with IV Contrast agent  Risk for reacting to the contrast dye o History of Asthma o Allergies to foods (such as shellfish, eggs, milk, and chocolate) Chronic Glomerulonephritis  Manifestations o Hyperkalemia o Metabolic acidosis o Decreased RBC production o Hyperphosphatemia Frequency of Migraine headaches  Foods to avoid o Foods that contain tyramine (aged cheese, sausage) o Yeast o Chocolate o Smoked fished o Fermented or pickled foods Components of Cushing’s triad  Bradycardia  Hypertension  Irregular respirations  Widen Pulse Pressure Cushing Syndrome (Hypercortisolism)  Expected Finding/Manifestations o Weakness, fatigue, sleep disturbances o Back and joint pain o Altered emotional state (irritability, depression) o Decreased libido Addison’s Disease  Expected Finding/Manifestations o Weight loss o Craving for salt o Hyperpigmentation of the skin and mucous membranes o Weakness and fatigue o Nausea, anorexia, and vomiting o Abdominal pain o Constipation or diarrhea o Dizziness with orthostatic hypotension o Severe Hypotension o Dehydration o Hyponatremia o Hyperkalemia o Hypoglycemia o Hypercalcemia Total Knee Arthroplasty (will most likely be on the final exam)  Nursing consideration o Instruct the patient to flex their foot every hour when awake  Rationale: To reduce the risk for thromboembolism and promote venous return o Avoid placing pillows under the knee to prevent flexion contractures o Instruct client to elevate the leg when sitting in a chair to reduce edema and pain o Instruct the patient to remain their legs in a neutral position when resting in bed to prevent dislocation of the knee Chest Tube/Atrium System  Bubbling in the water seal chamber ceases when the lung re-expands  Nursing Consideration o Instruct the client to perform the Valsalva maneuver during removal o Nurse should provide the client with pain medication prior to the procedure to promote comfort during the removal of the chest tube o The nurse should cover the insertion site with an occlusive dressing to prevent air entry into the pleural space Pressure injury  Nursing consideration o Change position every 1 to 2 hours (to decrease pressure on bony prominences) o Instruct client to keep the skin clean and to dry and to moisturize the skin with a cream or lotion o avoid massaging or rubbing the affected area (can cause further skin breakdown) Hemodialysis  expected findings o increased temperature (ex. 99 degrees)  rationale: caused by the dialysis machine slightly warming the blood o Decrease in blood pressure (ex. 100/70 mm Hg