med surg 2 - exam 1

prevention of sickle cell crisis (hydration, avoiding cold temps, avoiding infection - VACCINATION, avoiding low oxygen tension environments, avoiding tight or restrictive clothing, maintaining good dental hygiene)

patho of condition, maintaining ADLs, risk of crisis during pregnancy & fetal complications, genetic counseling

inherited disorder

2 million carriers in the US; 72,000 cases in the US

predominately affects descendants from tropical Africa

myelogenous = myeloid stem cells

lymphocytic = lymphoid stem cells

they may be present for years but eventually degenerate into acute phase or progress to death if untreated

unknown stimulus mutates myeloid or lymphoid stem cells

uncontrolled proliferation of leukemic cell (leukocytosis)

apoptosis does not occur

bone marrow, spleen, & lymph are congested with blasts

swollen or painful lymph nodes, higher risk for infection due to neutropenia, low-grade fever

symptoms of anemia (fatigue, pallor, etc.) due to inability to produce RBCs

bleeding due to inability to produce platelets

chemotherapy, bone marrow transplant

bleeding precautions, neutropenic precautions, manifestations, progression of disease, need for & side effects of chemotherapy, support system, possibility of sterility

primary: prevention (ex: vaccines, avoiding carcinogenic agents)

secondary: screening (ex: colonoscopy)

tertiary: treatment (ex: chemotherapy, radiation)

dietary sources, need for supplementation, reporting clinical manifestations, prenatal teaching (ex: increases demand for b12), radiation for advanced cancers (ex: may increase demand for b12), risk of developing b12 deficiency with use of acid-reducing medications

inheritance pattern, risk with injury, bleeding precautions

replacement of clotting factors through recombinant DNA products, glucocorticoids & splenectomy can also be beneficial

A is factor VIII deficiency

B is factor IX deficiency

VS, fatigue, pallor, SOB, pain, swelling in joints, jaundice, hand-foot syndrome, fever, labs, psychosocial effects

oxygen administration, hydration, pain medication, antipyretics, supportive measures

decreased neutrophils (infection-fighting WBCs)

measures to avoid infection (no fresh flowers, no fresh fruit from the garden, no swimming in the lake, etc.)

hypoxia, fatigue, pallor, tachycardia, spoon-shaped nails, glossitis

increased iron intake & iron supplements

signs of iron overload, dietary sources of iron

side effects of oral iron supplements: GI upset, teeth staining, black tarry stools

hodgkin’s lymphoma has reed-sternberg cells present

chest x-ray, CT, PET, or MRI

definitive diagnosis: lymph node biopsy

red meat, dark green leafy vegetables, beets, dry beans, fortified breakfast cereals

meat, seafood, eggs, dairy products

green leafy vegetables, bran, yeast, legumes

dairy products, orange/grapefruit juice, canned salmon, broccoli, tofu, kale, egg

pernicious anemia

neurological & psychiatric dysfunction (spinal cord degeneration, peripheral neuropathy, altered mental status, depression, visual changes)

tachycardia, SOB, dizziness, fatigue

goals: reduce hyperviscosity & prevent hemorrhage (ex: therapeutic phlebotomy)

actions: obtain routine CBCs, increase fluid intake, ensure adequate rest, elevate lower extremities when sitting, modify cardiovascular risk factors

biphosphonates, radiation therapy, DVT prophylaxis, dexamethasone, autologous stem cell transplantation, chemotherapy

administer medications & therapies as prescribed, encourage fluid intake as tolerated, position patient to facilitate comfort, encourage ambulation as tolerated

fatigue, weakness, bone pain, recurrent infections, weight loss, paresthesia

a factor released by the kidneys to stimulate RBC production

reduce clinical manifestations, topical creams, UV light therapy, systemic medications

discontinue UV light therapy if red or blistered skin presents, proper hand-washing, clinical manifestations, signs of skin infection, limit sunlight exposure

purulent drainage indicates colonization

limit sun exposure, use sunscreen, skin self-examination, wound care

pre-cancerous lesions, can progress to squamous cell carcinoma

presents with multiple skin-colored to reddish brown macules, papules, or plaques from a few millimeters up to cm in sun-exposed areas

cancer from epidermal squamous cells attributed to cumulative exposure to UVB rays over an extended period of time

presents with crusted papules & plaques that can become indurated & ulcerated

can also arise from chronically open wounds, burn scars, or legs ulcers because of chronic inflammation

invades fatty tissue & spreads via lymph nodes

skin cancer arising from the basement membrane of the epidermis

rarely metastatic, can be locally invasive

presents with pearly, translucent, flesh-colored papules, superficial broken blood vessels, & possible rolled edges or ulcerations

most serious of all skin cancers, originating from melanocytes

presentation following ABCDE

rapid metastasis can occur

capitis = scalp; corporis = body; cruris = groin (jock itch); faciei = face; pedis = feet (athlete’s foot); versicolor = upper chest/back/arms; onychomycosis = nails

most are treated with topical antifungals (some also indicate oral antifungals)

2.5 million cases annually

10-18% in acute care facilities

patients who are completely dependent on the nurse

other risks: history of pressure injuries, decrease mobility, increased age, comorbid conditions, use of steroids, impaired blood flow, cognitive impairment, urinary or fecal incontinence, nutritional deficiencies, dehydration, terminal illness

impetigo: contagious, localized, inflammatory skin condition; treat with topical mupirocin ointment

folliculitis: superficial inflammation & infection of hair follicles; treat with moist heat, topical mupirocin ointment, clindamycin, oral antibiotics for MRSA

furuncle: infection of hair follicle extending through dermis & forming a small abscess; treat with moist heat (small), or incision, drainage, & antibiotics (large)

carbuncle: furuncle extending to adjacent follicles; treat with incision, drainage, & antibiotics

cellulitis: diffuse infection of the dermis & subcutaneous tissue; treat with systemic antibiotics

cutaneous abscess: collections of pus with the dermis & subcutaneous tissues; treat with incision, drainage, & antibiotics

acute or chronic pain, impaired tissue integrity, risk for imbalanced fluid volume, risk for infection

administer antibiotics based on culture results, wound care as prescribed, surgical evaluation

teaching: hand washing, wound care, signs of infection

low-risk, smaller lesions

gold standard for non-melanoma skin cancers

not usually needed for localized skin infections (takes a section that contains epidermis, dermis, & upper layers of subcutaneous tissue)

poor surgical candidates because of other comorbidities, or large & multiple lesions

wash hands & apply gloves

select culture swab for anaerobic specimen

rotate swab tip over a 1 cm x 1 cm area of viable tissue at or near center of the wound for 5 seconds, applying sufficient pressure to cause tissue fluid to be expressed

immediately insert the culture swab

repeat to obtain second specimen

redress wound, discard used supplies, & remove gloves & wash hands

label culture specimen & place in biohazard transport bag, send to lab within 2 hours

document

1: non-blanchable redness

2: partial thickness loss

3: full thickness loss, adipose tissue is visible

4: full thickness loss, bone is usually visible

actions of antiviral medications, safe sex practices, considerations in pregnancy

xerosis (dry skin), eczema, psoriasis, herpes zoster (shingles)

signs of hypo/hyperglycemia, insulin administration, medication education, regular BG monitoring, healthy lifestyle

sweating, clamminess, shakiness, irritability, lack of coordination

polyuria, polydipsia, polyphagia

hyper: insulin (or metformin with type 2)

hypo: give the patient juice or dextrose

the patient will require more insulin because of higher BG

there is inadequate insulin, so the body tries to get energy from fat therefore releasing fatty acids which convert to ketones

polydipsia, polyphagia, polyuria, lethargy, stupor, blurred vision, fruity breath, kussmaul’s respirations, N/V, glycosuria

BMI over 26, physical inactivity, HDL less than 35 &/or triglycerides over 250, metabolic syndrome, prediabetes

high BP, high BG, high cholesterol

stroke, cardiovascular disease, MI, type 2 diabetes

basal-bolus delivery system, expenses, responding to BG levels, potential complications, changing the pump, etc.

referral to nutritional professional, individual nutrition guidelines, purpose of nutritional therapy, insulin dose is adjusted based on carb intake, etc.

150 minutes per week, combination of strength & aerobic exercises

depends on weight, activity level, medication, & BG goals

general guideline is 45 to 60 g at each meal & 15 to 20 g at each snack

**one serving is 15 g

wear white socks, don’t put lotion between toes, keep area between toes dry, avoid tight footwear, recommend thermometer system for the bath or shower, refer to podiatry

increased concentration of sodium & glucose, causing water to draw out from organs, which therefore causes profound dehydration & electrolyte imbalance

usually presents in older patients with type 2 diabetes

carries higher mortality rate than DKA

long-acting: glargine, lantus, detemir

intermediate: NPH

short-acting: regular

rapid-acting: aspart, lispro, glulisine

both are increased BG in the morning

dawn is due to natural release of hormones, somogyi is due to excessive insulin at night

micro: retinopathy, periodontal disease, nephropathy, PVD

macro: cardiovascular disease due to altered lipid metabolism

foot complications result from a combination