Inflammatory Bowel Disease-think about the pathophysiology of this…

Inflammatory Bowel Disease-think about the pathophysiology of this… Inflammatory Bowel Disease-think about the pathophysiology of this autoimmune disorder with the underlying issue of inflammationWhat are the symptoms and care of the patients with those symptoms?What are the concerns about these patients—due to what is going on in the GI tract, what will the patient with this chronic disease have to deal with?What is treatment for this? RenalUTIKidney stonesPrevention, Symptoms, Care The Cardiac ChaptersReview assessment, complications, care of patients withValvular Disease in general–not specificsValve replacement—what are care guidelines for the person with valve replacement?Heart FailureWhat will the nurse find on assessment?What will the nurse plan for care?HypertensionPeripheral Artery Disease (and the discussed comparison with Coronary artery disease)Intermittent claudication (Angina–same concept)Venous InsufficiencyPeripheral artery and venous disorders are very different–think about what the differences are between what veins and arteries do and what you would see if they were not working as they should.  What is the difference between caring for a patient with PAD and venous insufficiency?The cardiac chapters are an excellent example of learning a concept versus a specific disorder.Coronary artery disease is related to problems with perfusion of the heartPeripheral arterial disease is related to problems perfusing tissues in the extremitiesCommon conceptsUnderlying problem is atherosclerosisIt causes narrowing of the arteriesIn the heart–decreased arterial blood flow to the heart–decreased oxygen to the heart muscle–oh no!In the lower extremities–decreased arterial blood flow to the lower extremities means what?  What would you expect on assessment.  When you check a pulse, what are you feeling for?  Arterial blood flow!  If the arteries are narrowed, how would the assessment be affected?  This is how you MUST look at this material–what will I see and then what will I do? Respiratory exemplars are pulmonary embolus and asthmaReview the assessment findings and plan of care for these patientsHow do we as nurse’s reduce risk?How is it diagnosed and treated?Review resp assessment. DiabetesWhat it is, care of the diabetic patient in generalFoot careMedicationDietHigh and low Blood sugarDiagnosisTreatmentHHS and DKAa/w hyperglycemiatype 1 DM NO insulin productiontype 2 DM decreased insulin and/or decreased response to insulinDiabetic ketoacidosisà occurs only in type 1 DMWithout insulin, fat is broken down to be used as energyKetones, which are acids are formedKetoacidosis (metabolic) HHS/HHNK Hyperosmolar hyperglycemiaIn type 2 diabetes, usually a/w infectionOlderNo acidosis Hyperglycemiaà sugar enters the urine and pulls fluid out of the body—polyuriaPolydipsia=thirstPolyphagia=cells are hungry Dehydration Fluids to replace lost fluidsInsulin infusion to lower the blood sugarInsulin does what to potassiumHypokalemiaPut on cardiac monitor   HematologyOur exemplars are leukemia, iron-def anemia, B12 and folic acid def anemias, thrombocytopenia, and neutropenia.Review the pathophysiology of leukemia because it will help you understand the assessment findings and complications of leukemiaBecause the bone marrow is busy making abnormal WBC’s (that do not do the job WBC’s are supposed to do) the patient will have anemia and thrombocytopenia–what would the nurse see and what would the nurse be concerned about? Treatment is usually with chemotherapy–review care of the patient receiving chemotherapy for leukemia and care of the patient with leukemia in general What is important about the anemias?  How are they different?  What do we have to know to decide on treatment?  How would we care for them?  Review blood transfusion basics Thrombocytopenia—what are our concerns when caring for a patient with low platelet levels? INTEGUMENTARYReview Skin cancers–risks and health promotionSkin care in general with the goal of reducing skin breakdown Immune system–the hypersensitivities and the immune systemPassive immunity—immunity made by someone elseActive immunity—immunity made by the disease or immunization Wound healing/Inflammation (again, a concept that is involved in many disorders–an allergic reaction results in inflammation, an injury results in inflammation, an infection results in inflammation and the underlying process does not change)   Acid-base and fluid and electrolytes–yes, you are expected to be able to recognize acid-base and fluid and electrolyte imbalances, because these can occur in the patient with diabetes, respiratory disorders, heart failure, so consider how these might play a part in the care of these patients. Example– A patient with a high blood sugar will be dehydrated because the sugar in the urine will pull water with it and the tissues will then be dehydrated.  Additionally, if the patient uses fat for energy, ketones will be produced and the patient can become acidotic (metabolic acidosis) and the nurse may see low levels of potassium and Kussmaul’s respirations.  So, while these chapters were a study unto themselves, you can now see how they fit in with the diseases we have studied this term. Normal pHNormal CO2Normal bicarb Is it normal, acidosis or alkalosis?Was is caused by the resp system?  If not, it is metabolic CO2 combines with water to make acidHigh CO2à acidosisLow CO2à alkalosisResp pH down and CO2 upResp pH up and the cO2 down Stress, Pain are a part of most patients’ experience with disease and hospitalization, so like delegation and prioritization, you need to consider these in relation to any disease process we cover.Nurses will always have patients who are experiencing stress. What are the options for reducing stress at the bedside?  What is the foundation of stress reduction techniques?  What effect of stress will the nurse see? (Think fight or flight and release of cortisol) Pain assessment and treatment.  Assessment of acute pain is often done using pain scales with a goal number.  Chronic pain tends to affect the patient’s ability to live a quality of life and the real goals tend to be the patient’s ability to do the things that they value—play with grandchildren, be able to take a walk with less pain, be able to sleep and get adequate rest. Health Science Science Nursing NSG 240 Share QuestionEmailCopy linkComments (0)

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