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TOPIC SUMMARY CONCEPT NURSING INTERVENTION MEDICAL AND PHARMA MANAGEMENT

Loss of • state of depressed cerebral • assess patency of airway
consciousness functioning w unresponsiveness to • maintain patent airway and ventilation
stimulation of sensory and motor fx • suction
• place on semi-fowler’s
OR lateral/semi-prone (allows jaw & tongue to fall forward)
• change client position q2
• maintain NPO until consciousness returns
• provide frequent mouth care
• initiate seizure precautions
• provide ROM exercises (prevent contractures)
• give IV meds SLOWLY (prevent ICP)

migraine • hyperexcitable brain, susceptible to • quiet, dark environment 1. triptans

cortical spreading depression • elevation of head of bed 30 • vasoconstriction, reduce inflamm and pain
(which activates depolarization) • symptomatic t/x • 1st line of t/x
• depolarization activates inflamm 2. ergotamine
• acts on smooth muscle, constriction
3. anticonvulsant agents
4. beta-blockers
5. antidepressants
cluster headaches
1. 100% oxygen by facemask
2. sq sumatriptan
3. i/n zolmitriptan
cranial arteritis
1. corticosteroid
2. analgesics
tension headache
1. local heat or massage
2. analgesic, antidepressants, muscle relaxant
TOPIC SUMMARY CONCEPT NURSING INTERVENTION MEDICAL AND PHARMA MANAGEMENT
Rheumatoid arthritis • chronic, inflammatory • rest joints that are affected, no exercise on area 1. NSAIDS
autoimmune disease, involving • split joint 2. Methotrexate
connective tissue • hot and cold application 3. Analgesics
• destruction and proliferation of • supplement iron, folic acid, vit B12 4. Cyclosporine
synovial membrane • watch for dark, tarry stools 5. Corticosteroids
1. joint destruction • routine ROM, low impact aerobic exercise 6. Immunosuppressants
2. ankylosis • use assistive devices 7. Antidepressants
3. deformity 8. DMARDs
a. DMARDs 1
b. DMARDs (biologic response)
Systemic lupus • immune system develops • avoid exposure to sun, UV; protect w sunscreen, clothing 1. belimumab
erythematosus antibodies against nuclear antigen • offer smoking cessation program • t/x for SLE
1. antibody complexes get • monitor risks for INFECTION • halts production of antibodies
trapped in capillaries • screen for OSTEOPOROSIS [bone mineral density test] 2. corticosteroids (1st line t/x)
2. antibodies destroy host cells • calcium & vit D supplementation daily • SE: osteoporosis, fractures
• weight bearing activities (support bone health) 3. hydroxychloroquine
• routine health screening (monitor organ involvement) • t/x cutaneous, MS, mild systemic
• dietary consultation features of SLE
• provide good skin care and lubrication • Decreases antibodies attacking body,
• avoid powder, drying agents helps control the disease long term
• Doesn’t work immediately (takes couple
of months)
• Take with food to prevent GI problems
• eyes checked regularly if taking long-
term (minimum yearly); retinal damage
4. NSAIDs
• Used in conjunction with corticosteroids
to minimize steroid reqs
• Decreases inflammation
• risk for ulcers and bleeding, take w food
• can affect kidney function
5. immunosuppressive agents
• for serious forms of SLE
6. Cytoxan
• For renal involvement
Systemic sclerosis • collagen overproduction by Care for Raynaud’s phenomenon no standardized treatment for systemic sclerosis
fibroblasts. • Dress warmly, cover head and extrem, keep trunk warm 1. NSAIDs, analgesics
• body begins to overproduce • Protect ulcerated digits, report signs of infection • arthralgias, polyarthritis, and painful
collagen and it accumulates in Care for skin integrity calcinosis
tissues • Avoid use of drying soaps, detergents 2. Proton pump inhibitors – for reflux
• Disease pathogenesis presents • soak ulcers, apply topical antibiotic, use occlusive dressings 3. Antibiotics – for skin ulcers
early microvascular changes with Care for nutrition 4. Antihypertensive agents (enapril), CCBs
endothelial cell dysfunction, • Remain pt upright after 45 to 60 mins after meal 5. topical L-arginine – for Raynaud’s pheno
followed by the activation of • Raise head of bed (avoid reflux) • stimulate formation of nitric oxide
mechanisms promoting their • Provide oral hygiene, promote dental visits
transition into myofibroblasts. • Teach stretching exercises of mouth
Spondyloarthropathies • forms of arthritis that usually strike • maintain good body positioning & alignment 1. NSAIDs
the bones in your spine and nearby • promote ROM w regular exercise • 1st line of t/x
joints • encourage progressive activity thru self-care as tolerated • Cautious w chronic conditions in long-
• administer analgesics or pain medication as prescribed term use
1. ankylosis spondylitis • ask the patient to rate his/her pain 30 minutes to an hour 2. Methotrexate, sulfasalazine, leflunomide
2. reactive arthritis after administering the analgesic • Help w skin & peripheral joint disease
3. psoriatic arthritis • encourage the patient to do deep breathing exercises • Does not prevent spinal changes
3. Corticosteroid injections
1. osteotomy of spine • PO and long term use not recommended
2. total joint replacement 4. Anti-TNF – for psoriatic arthritis
5. Apremilast, ustekinumab
Fibromyalgia • chronic pain syndrome, involves ⭐ PREVENT DECONDITIONING!! 1. NSAIDS, tramadol, opioids
1. chronic fatigue • Exercise should be initiated at a level below the level • relieve pain
2. generalized muscle aching expected for the patient and is gradually increased • treats muscle aching & stiffness
3. stiffness. • Stretching, strength training, and aerobic exercise 2. Low dose tricyclic antidepressants
• CENTRAL SENSITIZATION; • Relaxation training • improve sleep quality and help control
Hypersensitive CNS, increased • Cognitive-behavioral therapy chronic pain and depression
response to painful stimuli 3. Sleep medication
• hypnotic agents and ramelteon
4. Anti-epileptics
• tried for chronic pain control
Jejunogastric • a segment of intestine invaginates or • start IV fluid resuscitation • Surgical reduction
intussusception telescopes into the adjoining • nasogastric decompression ASAP • Laparoscopy
intestinal lumen, causing bowel • NPO for bowel decompression
obstruction. • hydrostatic ENEMAS, with either barium or water-soluble
contrast, or pneumatic, with air insufflation
• Assess for fluid & electro imbalance
• Monitor nutritional status
• Assess for symptoms of resolutions (return of bowel
sounds, passage of flatus or stool, etc)

Below the knee • Preserves joint function • Residual limb measured every 8 to 12 hours (assess edema) Phantom pain
amputation • Apply consistent pressure (reduce edema, shape limb) • Knifelike, cramping pain:
Complications • Assistance provided ONLY when needed anticonvulsants
1. Hemorrhage Physical mobility • Burning, dull sensation: beta blockers
2. Infection • Iie prone 20 to 30 mins, TID (avoid contractures) • Pain, mood: antidepressants
3. Skin irritation • turn side to side then assume prone • Nerve pain: gabaplastin, amitriptyline
4. Phantom limb pain • not to sit for long periods of time
5. Joint contractures • use assistive devices Others
• ROM exercises started EARLY • Opioids – post op pain
• use overhead trapeze (strengthens biceps, change position) • Antibiotics – reduce risk infection
• activities increased gradually (prevent fatigue)
• practice position changes: standing from sitting
• use bandages, limb shrinker, air split to shape limb
• document bleeding, monitor for infection
• wash and dry limb at least BID
JP drain • closed system drain that uses bulb Emptying
suction to prevent wound drainage • unplug → turn bulb upside down → squeeze contents into
from collecting around the surgical measuring cup → clean plug w alcohol → compress bulb →
site. recap bulb → document amount of drainage
• decrease the risk for infection and Milking q4 (prevent clot formation)
allows you to measure how much • use thumb & index finger to secure tubing close to insertion
drainage the wound is draining site → strip down tubing 3 to 4 times
Securing
complications • keep drain secure → lower at insertion site → attach to
1. clot formation secure device
2. catheter falls out ASSESSING!!
3. bulb won’t compress • Assess for redness/warmth, pain, swelling, hardness
Wound care • cleaning, monitoring and promoting • When using a swab/gauze to cleanse a wound, work from • Topical antibiotic
healing in a wound that is closed with the clean area out to the dirtier area (center → periphery)
sutures, clips or staples. • Change the swab and proceed again on either side of the
incision, using a new swab each time.
Wet to dry dressing • When irrigating a wound, warm the solution to room
• to clean dirty/infected wound temperature, preferably to body temperature
• allow the irrigant to flow from the cleanest area to the
wet to wet dressing contaminated area
• to keep wound clean, prevent • Dressing is changed at least 15 minutes after the room has
buildup of exudates been cleaned and avoid meal timings
• If the dressings are adherent to the wound due to drying of
the secretions or blood, wet it with normal saline before it
is removed from the wound
• While dressing, keep the wound edges as near as possible
• Before doing the dressing, inspect the wound for any
complication and measure the amount of discharge
• Apply sterile dressing – apply gauze pieces first and then
the cotton pads
• Apply an ice bag for swelling (if prescribed)
• Report IMMEDIATELY for signs of infection
Grave’s disease • Production of (TSI) thyroid • Monitor HR, BP, EKG, weight (at risk for weight loss and will antithyroid medications
stimulating immunoglobulin) that is need a high calorie, high protein diet) (Methimazole, Propylthiouracil)
producing the same effects on the • Keep patient in a cool, quiet environment • Never stop taking abruptly
body as TSH (thyroid stimulating • Eye care and protection • Take at same time every day
hormone). TSH release causes the • Smoking cessation • Monitor for thyroid storm
thyroid gland to secrete T3 and T4. • Monitor for hypothyroidism (toxicity)
Thyroidectomy • Avoid iodine rich foods or supplement
• Watch for thyroid storm • No Aspirin or Salicylates (increases
• Monitor for parathyroid destruction problems thyroid hormone)
• watch calcium levels Beta-blockers
• Watch for respiratory distress due to the nature of the • blocks peripheral conversion of T3 and
surgical site T4
• decrease HR, BP and heat intolerance
• keep patient in semi-fowler’s (help with swelling and
• contraindicated: asthma, bronchospas
drainage)
• caution in pt with diabetes
• keep at the bedside a trach kit, oxygen, and suction.
radioactive iodine
• destroys the thyroid gland overtime
• permanent cure compared to
medications
• contraindicated: pregnant, lactating
• SE: metal taste, swollen saliva glands
Appendicitis • inflammation of the appendix d/t • Monitor for pain preventing pneumonia
blocking the lumen of the appendix o patient’s pain is suddenly relieved (RUPTURE) which • early ambulation, incentive spirometer,
→ increases pressure inside appendix will be followed by intense abdominal pain DBE, prevent blood clots
• Monitor for peritonitis (intense abd pain, distention, + VS)
appendix: • Maintain nothing by mouth care for rupture appendix
• Stores good bacteria while GI is • No heat application (increases risk of rupture) • IV antibiotics
recovering from diarrhea • No enemas or laxatives (increases risk of rupture)
Pain
• Monitor surgical site for infection
Cause: • Administer pain relief, as prescribed
• Maintain drain after surgery, if present
1. Obstruction • keep the patient on the right side (helps with drainage)
2. Trauma/injury • Maintain NG tube if present. Removed when bowel returns
to normal. Keep NPO till tube is removed
Complications (if not t/x w/in 48-72 hours) • Once PO diet is okay: encourage high fiber diet
• Rupture → abscess, peritonitis • Monitor bowel sounds
• Blot clot → ischemia • NOTIFY doctor if no BM w/in 2 – 3 days after surgery
Peptic ulcer disease • ulcer formation in the lining of the • Assess bowel sounds Antacids
upper GI tract that affects mainly the • Ask patient WHEN is pain experienced • neutralizes the stomach acid
mucosal lining of the stomach, • Assess medical hx: drugs used • Interferes with MANY drugs: always
duodenum or esophagus. • Monitor for GI bleeding (dark/tarry stool, vomited coffee give alone and allow for 1-2 hours
ground-colored blood) before administering other
Causes: • Monitor for peritonitis (intense abd pain, distention, + VS) Sucralfate
1. infection d/t Helicobacter pylori • Monitor for obstruction in pylorus: vomiting, bloating, pain • Protects stomach from acids,enzymes
2. long term use NSAIDS • Monitor for dumping syndrome • Take on empty stomach: hour before
3. Zollinger-Ellison Syndrome • eat many small meals rather than 3 large ones eating
• lie down for 30 minutes after eating • don’t give at same time as antacids or
• eat without drinking fluids….wait 30 minutes after meals H2 blockers
and then consume liquids H2 blockers
• DIET: avoid spicy, fried foods, alcohol, chocolate, caffeine • block histamine; gastric acid secretion
• DIET: consume bland low fiber diet (white rice, banana) decreased.
• Avoid giving at the same time with
surgery antacids or Carafate.
1. Vagotomy • Instead give 30-45 minutes apart.
2. Pyloroplasty Bismuth Subsalicylates
3. Gastric resection • Covers the site of the ulcer and keeps
the stomach acid away
• used with antibiotics, PPIs, or H2
blockers
Proton-pump Inhibitors
• decreases stomach acid; protect lining
antibiotics
• Clarithromycin, Metronidazole,
Tetracycline, Amoxicillin
Diverticulitis • a complication of diverticulosis During initial phase: Diet
• diet will be NP (bowel rest so healing can begin) • PN/IV fluids or fat emulsions
Diverticulosis • monitoring weights/hydration status
• formation of hollow sac cavities • Monitor for peritonitis (intense abd pain, distention, + VS) Avoiding constipation
throughout the intestinal wall • Psyllium
When symptoms decrease • mix in 8 oz water
Diverticulitis • Advance to clear liquids and then low-fiber foods • absorbing water from the intestine →
• inflammation of the [only time a person with diverticulosis needs to consume a makes stool easier to pass
diverticulum…hence the herniate low-fiber diet (Bowel needs to rest and work very little)] • Probiotics
sacs becomes inflamed Once recovered
• Increase fluid intake (2 to 3 L) except for pt with HF and RF Antibiotics

Ileostomy • opening created to bring the small Pre-op • NO enteric coating medications or
intestine to the surface of the • Educate about what to expect, how the stoma will look, and sustained release medication
abdomen, specifically the ileum where it will be on the abdomen.
• will always have liquid stool. • Teach about the pouching system DIET
• 2 to 3 days before surgery soft or semi-liquid diet • 1st 6 weeks: low fiber, small meals
Increased risk for • cleansing solution and laxative may be ordered (clean throughout the day
• dehydration and electrolyte colon) → clear diet prior to surgery • AVOID:
imbalance • presence of profuse diarrhea: IV solution a. Indigestible foods:
• skin break down around the stoma • NPO day of surgery Corn, celery, peas, coleslaw, popcorn,
Post-op nuts and seeds, raisins, skin of fruits,
Ostomies will SHOULD ALWAYS look: pink • Notify MD if stoma is: pale pink (may have a low hgb and raw mushrooms and pineapple
or red and be moist/shiny. hct), dark red or black (compromised circulation to stoma) b. GAS/ODOR causing foods
Patient education beans, onions, eggs, broccoli, cabbage,
• After surgery: drainage is dark green and then turns yellow garlic, alcoholic beverages, fish…high
when patient starts to eat fibrous foods
• Empty pouch when 1/3 to 1/2 full
• Change pouch when gut less active (morning before
breakfast)
• Change pouching system every 3-5 days
• Watch for burning or leaking around skin
• measure the stoma and cut the opening of the skin barrier
to be 1/8” LARGER than the stoma.
Epilepsy • At least 2 unprovoked seizures • Institute seizure precautions ANTICONVULSANT medications
occurring more than 24 hours apart • Encourage pt to follow a regular and moderate routine • DOSE adjusted d/t:
• Uncontrolled, unwanted discharges lifestyle Illness, weight changes, (+) stress
• KETOGENIC DIET (high-protein, low-carbo, high-fat) • SE: allergy, acute toxicity, chronic
1. Primary – Idiopathic (90%) • Wearing of dark glasses (decrease stimulation) toxicity
2. Secondary • Counseling • monitor for agranulocytosis,
leukopenia, thrombocytopenia
• should be taken on routine basis; does
not cause dependence/addiction
Status epilepticus • series of generalized seizures that • Stop seizures as quickly as possible Halt seizures IMMEDIATELY with
occur w/o full recovery of • Ensure adequate cerebral oxygenation • Diazepam, lorazepam, fosphenytoin
consciousness between attacks • Maintain pt in seizure-free state Maintains seizure free state
(lasts 30 mins) • Pt on side-lying position • Phenytoin, phenobarbital
• MEDICAL EMERGENCY • Suction (prevent aspiration) If seizure r/t hypoglycemia
• Vigorous muscle contractions → (+) • IV line closely monitored (risk for dislodgement) • IV infusion dextrose
metabolic demand and interfere w If initial t/x was not successful
respirations → • GA w barbiturate

Anticonvulsant therapy
• Risk for fractures
Transient ischemic • stroke occurs but last only a few • DIET: low-salt, low-fat 1. Antiplatelet drugs
attack minutes to hours and resolves. • Exercise in regular, moderate intensity at least every week 2. Anticoagulants
• warning sign of an impending stroke • Limit alcohol and smoking cessation 3. Antihypertensives
• temporary blockage of blood to brain • Keep pt head elevated, maintain in neutral position 4. Statins
→ brief neurologic impairment • Provide adequate bed rest, maintain quiet environment
• leaves no lasting damage • Avoid activities that cause BP fluctuations (straining, Surgery
sudden changes in position, excessive physical exertion) 1. Carotid endarterectomy
• Encourage consistent physical activity, once the can 2. Angioplasty
tolerate it

Ischemic stroke • Blood supply to brain is BLOCKED or • Monitor blood pressure (BP should be higher than normal) Warfarin
SLOWED • Perform CT SCAN ASAP (w/in 25 mins) • Esp for pt w AF
• Prevent DVT • Anticoagulant
• Assess ability to swallow before giving PO meds *if anticoagulant is contraindicated:
• Do neuro assessment every time when entering room 1. aspirin
2. clopidogrel + aspirin
3. dipyridamole + aspirin
Statins
• Reduces coronary events
Antihypertensives
ACE + diuretics
• Secondary stroke prevention
Recombinant t-PA (SE: bleeding)
• Stimulates fibrinolysis of clot
Hemorrhagic Stroke • RUPTURE of a cerebral blood vessel • Perform CT SCAN ASAP (w/in 25 mins) Phenytoin (Dilantin)
→ allows blood to escape into brain • Do neuro assessment every time when entering room • Treats seizures w/o drowsiness
tissue and not travel beyond point of • Implement aneurysm precautions Antifibrinolytic (epsilon-aminocaproic acid)
rupture o nonstimulating environment, prevent increases in ICP • delay the lysis of the clot
pressure, and prevent further bleeding
• head of the bed is elevated 15 to 30 degrees ventriculoperitoneal shunt
Altered level of consciousness • Avoid activities that cause BP fluctuations (straining, • treat chronic hydrocephalus
• Earliest sign of deterioration sudden changes in position, excessive physical exertion)
• No enemas are permitted, but stool softeners and mild
Complications laxatives are prescribed
1. Vasospasm • Thigh-high elastic compression stockings or sequential
2. Seizures compression boots (prevent DVT)
3. Hydrocephalus
• administers all personal care (prevent any exertion)
4. Rebleeding
• Visitors are restricted
• Reality orientation is provided
• Changes in patient responsiveness are reported
immediately