Category: Med-Surg

Study Tip: Myxedema Coma

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Myxedema coma – a rare life-threatening form of hypothyroidism. It is a disorder characterized by hypoventilation, hypoglycemia, and hypotension. The client with myxedema presents with severe metabolic disorders, generalized nonpitting edema, puffy face, weakness, hypothermia, cardiovascular collapse, and coma.
Diagnostic tests: blood gases, electrolyte levels, ECG, blood sugar, and thyroid hormone levels. Intravenous fluid, electrolyte replacement, intravenous cortisol or other adrenal cortical hormone are used in the treatment. Warm blanket for low body temperature, glucose supplements for hypoglycemia.

Content area: Med-Surg | Endocrine

Study Tip: Thyrotoxicosis

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Thyrotoxicosis (Thyroid Storm) – a form of severe hyperthyroidism that can be precipitated by stress, injury, or infection. It is a life-threatening emergency. Manifestations of thyroid storm include temperature above 102 degrees F (39 degrees C) – with this high temperature, all organ systems will be affected, tachycardia, abdominal pain, systolic hypertension, N/V, confusion, agitation, tremors, and possible seizures. Management of treatment requires careful follow-up by an endocrinologist. Medications include antithyroid medications and radioactive iodine.

Content area: Med-Surg | Endocrine

Study Tip: Status Asthmaticus

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Status Asthmaticus – a severe, life-threatening acute exacerbation of asthma attack that is unresponsive to initial treatments and interventions for asthma attack with bronchodilators. Status Asthmaticus places the client at high risk for respiratory failure. The client has acidosis, hypoxemia, hypoxia, and hypercapnia; all of these together with effects of increase lung volume place the client at risk for pneumothorax and cardiac arrest. Status asthmaticus is considered a medical emergency.

Content Area: Med-Surg – Respiratory

Critical Thinking Question

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Studying, planning and getting ready for your exams. Practice some critical thinking questions as you study; get yourself ready for success!

Complications of Cirrhosis

One of the complications of cirrhosis is Hepatic Encephalopathy. This is a neurological problem resulting from too much ammonia in the blood. Medications for the treatment of Hepatic Encephalopathy include Lactulose and Neomycin.

Question:

A client is undergoing treatment for Hepatic Encephalopathy. What are two main goals (objectives) of therapeutic management for this client?

Leave your answers in the comments

Answer is on Page 2 below

Pages: 1 2

Polycythemia Vera

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Polycythemia vera is a rare disease in which the body makes too many red blood cells. The excess cells make the blood too thick, this thickness causes blood to flow very slowly. It is a slow-growing cancer of the blood.

A person may have this disease and not know, it may be discovered during a blood test for another reason. A rare disease that can occur at any age, but it is common in people over 60 years. Polycythemia vera can be life-threatening if it is not treated quickly. Survival time may be 10 to 15 years with new treatment.

There are two types:

  • Primary which is a chronic myeloproliferative disorder from chromosomal mutation.
  • Secondary polycythemia can be hypoxia driven. Hypoxia stimulates the kidneys to produce more erythropoietin which then stimulates the production of erythrocytes. The need for more oxygen in the secondary type could be due to multiple reasons: cardiovascular disease, pulmonary disease, or tissue hypoxia.

Sign and Symptoms:

  • Hypertension and Hyperviscosity from polycythemia vera are the cause of circulatory manifestations that are seen in this disorder.
  • Polycythemia vera causes headache, vertigo, tinnitus
  • Pruritus which is exacerbated by hot bath may be a confirmatory symptom.
  • Other sign and symptoms include painful fingers and toes, hyperuricemia, weakness, and easy fatigability.

Complications include abnormal blood clots, which can lead to a heart attack or stroke.

Diagnostic tests:

Blood tests – elevated hemoglobin, increased platelets, uric acid, cobalamin levels. Increased histamine levels. Increased RBCs are noted in Bone marrow examination.

Treatment for polycythemia vera includes administering oxygen, radioisotope therapy, or chemotherapy agents for bone marrow suppression. Phlebotomy is the top treatment, to reduce the percentage of hematocrit; during phlebotomy, about 300ml of blood or more may be removed every other day until hematocrit is down to normal level.

Nursing Interventions

  • Maintain adequate oxygenation. This may prevent secondary polycythemia; primary polycythemia is not preventable.
  • Control of pulmonary diseases, teach client to stop smoking.
  • Educate clients to avoid high altitudes
  • Assist with phlebotomy per orders and facility policies during acute exacerbations
  • Monitor client for complications that may result from phlebotomy
  • Monitor hydration therapy closely to avoid fluid overload.
  • Moderate activities, to decrease the risk of clot formation

Reference: Lewis & Heitkemper, Med-Surg Nursing 2007

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Raynaud’s disease

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Raynaud’s disease (Raynaud’s phenomenon)

  • Vasoconstrictive disease.
  • Rare condition that affects the arteries – the blood vessels become narrow.
  • The amount of blood that flows to the body is affected
  • It mainly affects blood flow to fingers and toes.
  • More common in women, triggered by cold temperatures and stress.

Symptoms

  • Vasospasm leads to pain and pallor in affected extremities
  • There may be ulceration of the fingers occasionally
  • Color changes of the affected areas,

Causes

  • Causes of Primary Raynaud’s disease is unknown
  • Secondary Raynaud’s disease is more serious.
  • Caused by other health issues, medications, or injuries
  • Related health issues include – rheumatoid arthritis, scleroderma, Sjögren’s syndrome, or lupus, blood disorders, polycythemia vera, pulmonary hypertension.

Diagnostic tests – Cold stimulation test to trigger an episode

Treatment

  • Medication – Vasodilators (e.g. Nifedipine)

Nursing Interventions

  • Teach client to stay warm, avoid cold
  • Teach to wear gloves, warm but nonconstructive.
  • Encourage the client that smoking cessation is very important.
  • Inform client to contact doctor if any sores or ulcers appear on fingers or toes.

References

Reference: Lewis & Heitkemper, Med-Surg Nursing 2007

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Gout (Gouty Arthritis)

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A form of arthritis characterized by severe burning pain, redness, tenderness and stiffness in joints. Gout is a kind of arthritis caused by uric acid crystals forming in one or more joints.

Symptoms

  • Usually start at night
  • Very common in the big toe joint but can also occur in other joints
  • Affected joint becomes red, feels hot, and painful.
  • Pain increases when the joint is touched.

Causes & Risk Factors

  • Foods that are rich in purines increase the risk for gout – Salmon, sardines, organ meats, asparagus, mushrooms and herring are examples of foods rich in purines.
  • Gout is hereditary.
  • Overweight, Alcohol, High cholesterol, Diabetes, high blood pressure
  • Men develop gout more often than women.

Treatment

  • Rest
  • Pain relievers & anti-inflammatory medications – Motrin, Advil and Naproxen

Patient teaching – Teach patient to

  • Take all medication as prescribed.
  • Inform the MD before taking any aspirin product because aspirin can interfere with other medications
  • Lose weight if patient is overweight.
  • Seek treatment promptly for high blood pressure, high cholesterol or diabetes
  • Follow diet prescribed – low-salt, & low-fat diet.
  • To avoid alcohol and foods that are high in purines.
  • To drink lots of water to help flush uric acid from the body.

Complications

  • When gout is not treated, a gout attack can last for days or even weeks.
  • Prolong attacks for many years may lead to TOPHI – uric acid crystals that form lumps under the skin.
    • Tophi usually form on the toes, fingers, hands and elbows.
  • Gout may also lead to kidney disease or kidney stones from uric acid crystals that collect in the urinary tract.

Reference: Lewis & Heitkemper, Med-Surg Nursing 2007

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Systemic Lupus Erythematosus (SLE)

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What is SLE?

  • SLE is an autoimmune disease that can affect many parts of the body, like the kidneys, skin, the heart, joints, and lungs.
  • Systemic lupus erythematosus (SLE) is the most common and most serious type of lupus.
  • Discoid lupus erythematosus (DLE) also called cutaneous lupus erythematosus. DLE affects the skin. It does not affect other organs.
  • DLE shows up like a red rash or scaly patch, commonly found on the face or scalp, butterfly rash.
  • Leading cause of death in clients with Lupus – Kidney and Cardiac involvement.
  • Another type of lupus is the Drug-induced lupus, this type is caused by reaction to some prescription drugs.

Triggers of Lupus

  • Sunlight – very specific with Lupus
  • Stress
  • Pregnancy
  • Drugs

Assessment Findings – SLE

  • Joint pain and decreased mobility, Photosensitivity, HTN,
  • Fever, Pericarditis, Nephritis, Pleural effusion

Instructions for the client with SLE

  • Instruct client to avoid prolonged exposure to sunlight.
  • Avoid stress and illness
  • Provide instruction about medications – steroids.

Nursing Care –

  • Monitor for Pain, mobility, and fatigue,
  • Vital signs
  • UOP, BUN, & serum creatinine.

Medications –

  • Corticosteroids
  • NSAIDs (not for clients who have renal compromise)
  • Immunosuppressant agents
  • Antimalarial

Complications – Lupus nephritis, Pericarditis and myocarditis

References:
Medical-Surgical Nursing, 9th Edition by Lewis, Heitkemper, et all.
Understanding Medical Surgical Nursing by Paula D Hopper

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