NSG 223 - Medical-Surgical Nursing II
Exam 3
Question:
Diabetes Insipidus Clinical Manifestations
Answer:
Without the action of ADH on the distal nephron of the kidney, an enormous daily output (greater than 250 mL per hour) of very dilute urine with a specific gravity of 1.001 to 1.005 occurs. The urine contains no abnormal substances such as glucose or albumin. Because of the intense thirst, the patient tends to drink 2 to 20 L of fluid daily and craves cold water. In adults, the onset of DI may be insidious or abrupt. The disease cannot be controlled by limiting fluid intake, because the high-volume loss of urine continues even without fluid replacement. Attempts to restrict fluids cause the patient to experience an insatiable craving for fluid and to develop hypernatremia and severe dehydration.
Peeing non-stop, crystal clear, cannot have concentrated urine Low urine osmolarity (concentration) Serum Osmolality High Hypokalemia & Hypernatremia Polyuria & Polydipsia 1.001-1.005 Urine Specific Gravity (normal for them)
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Question:
Fractures Clinical Manifestations
Answer:
Pain Loss of function Deformity Shortening Crepitus Localized edema andecchymosis
Question:
Medical Management of Fractures
Answer:
Immediately after injury, if a fracture is suspected, the body part must be immobilized before the patient is moved. Adequate splinting is essential.Joints proximal and distal to the fracture also must be immobilized to prevent movement of fracture fragments.Fracture reduction refers to restoration of the fracture fragments to anatomic alignment and positioning. Either closed reduction or open reduction may be used to reduce a fracture. In most instances, closed reduction is accomplished by bringing the bone fragments into anatomic alignment through manipulation and manual traction. The extremity is held in the aligned position while a cast, splint, or other device is applied. Some fractures require open reduction. Through a surgical approach, the fracture fragments are anatomically aligned. Internal fixation devices (metallic pins, wires, screws, plates, nails, or rods) may be used to hold the bone fragments in position until solid bone healing occurs. 2 / 4
Reduction and immobilization are maintained as prescribed to promote bone and soft tissue healing. Edema is controlled by elevating the injured extremity and applying ice as prescribed. Neurovascular status (circulation, motion, and sensation) is monitored routinely, and the primary provider is notified immediately if signs of neurovascular compromise develop
Question:
Fractures and Patient Education
Answer:
Describe ongoing therapeutic regimen, including diet and activities to perform (e.g., exercises) and to limit or avoid (e.g., lifting weights, driving a car, contact sports).Describe approaches to control swelling (e.g., elevate extremity to heart level).Consume a healthy diet to promote bone healing.Observe prescribed weight-bearing and activity limits.Participate in prescribed exercise regimen to maintain the health of unaffected muscles and those muscles now needed for safe transfer, mobility, etc.If indicated, demonstrate safe use of mobility aid, assistive device, immobilizing device and transfer technique.Control pain with pharmacologic and nonpharmacologic interventions.Report pain uncontrolled by elevation and analgesics (may be an indicator of impaired tissue perfusion or compartment syndrome)
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Question:
Compartment Syndrome Clinical Manifestations
Answer:
Compartment syndrome is characterized by the elevation of pressure within an anatomic compartment that is above normal perfusion pressure.Compartment syndrome arises from an increase in compartment volume (e.g., from edema or bleeding), a decrease in compartment size (e.g., from a restrictive cast), or aspects of both.The patient with acute compartment syndrome reports deep, throbbing, unrelenting pain, which is unrelieved by medications, seems disproportional to the injury, and intensifies with passive ROM.Frequent assessment of neurovascular function after a fracture is essential and focuses on the
"five Ps": pain, pallor, pulselessness, paresthesias, and paralysis
Question:
GBS Clinical Manifestations
Answer:
GBS typically begins with muscle weakness and diminished reflexes of the lower extremities. Hyporeflexia and weakness may progress to tetraplegia.Demyelination of the nerves that innervate the diaphragm and intercostal muscles results in neuromuscular respiratory failure. Sensory symptoms include paresthesias of the hands and feet and pain related to the demyelination of sensory fibers.
Ascending Weakness
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