Cushing’s syndrome results in an increased secretion of cortisol. Cortisol stimulates the secretion of gastric acid, and this can result in the development of peptic ulcers and gastrointestinal bleeding. The client should be encouraged to eat potassium-rich foods to correct hypokalemia that occurs in this disorder. Aspirin can increase the risk for gastric bleeding and skin bruising. Cushing’s syndrome does not affect temperature changes in lower extremities.
pironolactone (Aldactone) is a potassium-sparing diuretic. If the client was taking potassium chloride or another potassium supplement, the risk for hyperkalemia exists. Potassium doses would need to be adjusted while on this medication.
Congenital hypothyroidism is the most common preventable cause of mental retardation. Neonatal screening is the only means of early diagnosis and subsequent prevention of mental retardation. Newborn infants are screened for congenital hypothyroidism before discharge from the nursery and before 7 days of life. Treatment is begun immediately if necessary.
Glycosylated hemoglobin is a measure of glucose control during the past 6 to 8 weeks before the test. It is a reliable measure to determine the degree of glucose control in diabetic clients over a period of time and is not influenced by good glucose or dietary management a day or two before the test is done. The HbA1c should be 7.5% or less, with elevated levels indicating poor glucose control.
Insulin reactions are most likely to occur during the peak time of the insulin, when the medication is at its maximum action. Peak action depends on type of insulin, amount administered, injection site, and other factors.
The client is taught that tension needs to be avoided on the suture line; otherwise, hemorrhage may develop. One way of reducing incisional tension is to teach the client how to support the neck when coughing or being repositioned. Likewise, during the postoperative period, the client should avoid any unnecessary movement of the neck. That is why sandbags and pillows are frequently used to support the head and neck. Removal of the thyroid does not mean that the client will be taking antithyroid medications postoperatively. If a client experiences tingling in the fingers, toes, and lips, it is probably a result of injury to the parathyroid gland during surgery resulting in hypocalcemia. These signs and symptoms need to be reported immediately.
Deep breathing and coughing exercises and use of incentive spirometry should be practiced for 6 to 8 weeks after the client is discharged from the hospital in order to keep the alveoli expanded and promote the removal of lung secretions. If the entire regimen of antibiotics is not taken, the client may suffer a relapse. Adequate rest is needed to maintain progress toward recovery. The period of convalescence with pneumonia is often lengthy, and it may be weeks before the client feels a sense of well-being.
The best time to perform BSE is after (not during) the monthly period, when the breasts are not tender and swollen
It is not necessary for a client with Bell’s palsy to stay on a liquid diet. The client should be encouraged to chew on the unaffected side.
Chronic irritation of the fifth cranial nerve results in trigeminal neuralgia and is characterized by intermittent episodes of intense pain of sudden onset on the affected side of the face. The pain is rarely relieved by analgesics. It is recommended that clients chew on the unaffected side and use warm mouthwash for oral hygiene. Medications such as carbamazepine (Tegretol) help control the pain of trigeminal neuralgia.
Glucose tablets are taken if a hypoglycemic reaction occurs. Glucagon is administered subcutaneously or intramuscularly if the client loses consciousness and is unable to take glucose by mouth. Glucagon releases glycogen stores and raises blood glucose levels in hypoglycemia. Family members can be taught to administer this medication and possibly prevent an emergency room visit. The nurse would not instruct a client to omit insulin. Acetone in the urine may indicate hyperglycemia. Although signs of hypoglycemia need to be taught to the client, drowsiness and coma are not the initial and key signs of this complication.
Precipitate labor is defined as that which lasts 3 or fewer hours for the entire labor and delivery. It usually has an abrupt, not a gradual onset. Induction, particularly with an oxytocic agent, is contraindicated because of the enhanced stimulatory effects on the uterine muscle and an increased risk for fetal hypoxia.
Risks for preterm labor include dehydration. A client should not restrict fluids (except for those containing alcohol and caffeine). A sign of preterm labor may be pelvic pressure, without the perception of a contraction. A decrease in activity and bed rest is often prescribed in an attempt to decrease pressure on the cervix and increase uterine blood flow. Mechanical stimulation of the cervix during intercourse can stimulate contractions.
Rebounding of cerebral edema is a side effect of dexamethasone sodium phosphate (Decadron) withdrawal if done abruptly. Dexamethasone sodium phosphate decreases inflammation not infection. Facial edema is a common side effect that disappears when the medication is discontinued.
A client with a C-5 spinal cord injury results in quadriplegia with no sensation below the clavicle, including most of the arms and hands. The client maintains partial movement of the shoulders and elbows. Maintaining intact skin is an outcome for spinal cord injury clients.
After arthroscopy, the client can usually walk carefully on the leg once sensation has returned. The client is instructed to avoid strenuous exercise for at least a few days. The client may resume the usual diet. Signs and symptoms of infection should be reported to the physician.
Allopurinol (Zyloprim) helps prevent an attack of gouty arthritis, but it does not relieve the pain. Therefore, another medication such as colchicine or an NSAID must be added if an acute attack occurs. Because acute attacks may occur more frequently early in the course of therapy with allopurinol, some physicians recommend taking the two products concurrently during the first 3 to 6 months.
Live or attenuated vaccines have their virulence (potency) diminished so as to not produce a full-blown clinical illness. In response to vaccination, the body produces antibodies and causes immunity to be established
Toxoids are baterial toxins that have been made inactive by either chemical or heat.
Killed or inactived vaccines are vaccines that contain pathogens made inactive by either chemicals or heat.
Cough is a frequent side effect of therapy with any of the angiotensin-converting enzyme (ACE) inhibitors.
Lithium replaces sodium ions in the cells and induces excretion of sodium and potassium from the body. Client teaching includes maintenance of sodium intake in the daily diet and increased fluid intake (at least 1 to 1 1/2 liters per day) during maintenance therapy. Lithium is stored at room temperature and protected from light and moisture.
Pseudoparkinsonism is a common extrapyramidal side effect of antipsychotic medications. This condition is characterized by a stooped posture, shuffling gait, masklike facial appearance, drooling, tremors, and pill-rolling motions of the fingers. Hyperpyrexia is characteristic of another extrapyramidal side effect, neuroleptic malignant syndrome (NMS). Aphasia is not characteristic of pseudoparkinsonism.
Foot care for the client with vascular disease is the same as for clients who have diabetes mellitus. This includes daily cleansing of the feet; drying well especially between the toes; applying lotion to dry areas; wearing shoes that fit well without pressure areas; and keeping the toenails trimmed short. The client is also instructed to avoid crossing the legs at the knees or ankles to prevent vasoconstriction.
The client with a peptic ulcer is taught to eat smaller, more frequent meals to help keep the gastric secretions neutralized. The client should eat slowly and chew thoroughly to prevent excess gastric acid secretion. The client should consume fluids of 6 to 8 glasses of water per day to dilute gastric acid. The use of aspirin is avoided, because it is irritating to gastric mucosa.
Caffeine in the diet can contribute to bladder spasms and reflex incontinence. This should be eliminated in the diet of the client with a spinal cord injury.
Treatment for Raynaud’s disease includes avoidance of precipitating factors such as cold or damp weather, stress, and cigarettes. The client should get sufficient rest and sleep, protect the extremities by wearing protective clothing, and stop activity during vasospasm.
To lower the risk of heart disease, the diet should be low in saturated fat with the appropriate number of total calories. The diet should include fewer red meats and more white meat, with the skin removed. Dairy products used should be low in fat, and foods with high amounts of empty calories should be avoided.
Sodium should be avoided by the client with hypertension. Fresh fruits and vegetables are naturally low in sodium. Hypertensive clients are also advised to keep fat intake to less than 30% of total calories as part of prudent heart living.
The client should avoid taking iron with milk or antacids, because these items decrease absorption of iron. The client should also avoid taking iron with food if possible. The client should increase natural sources of iron, such as meats, fish, and poultry. Finally, the client should take in sufficient fiber and fluids to prevent constipation as a side effect of iron therapy.
Foods that help eliminate odor with a colostomy include yogurt, buttermilk, spinach, beet greens, and parsley. Foods that cause odor are many, and include alcohol, beans, turnips, radishes, asparagus, onions, cucumbers, mushrooms, cabbage, asparagus, eggs, and fish.
The size of the opening for the appliance is generally cut 1/8 inch larger than the size of the client’s stoma. This minimizes the amount of exposed skin, but does not cause pressure on the stoma.
Symptoms of autonomic dysreflexia include headache, congestion, flushed skin above the injury and cold skin below it, diaphoresis, nausea, and anxiety.
Female spinal cord trauma clients remain fertile in their reproductive years. Contraception is necessary for these clients who are sexually active. Oral contraceptives may increase the risk for thrombophlebitis. Clients with paralysis should avoid dairy products to control the formation of urinary calculi. Clients who lack bladder control are taught to self-catheterize using clean technique. Meals should be eaten at the same time every day and include fiber and warm solid and liquid foods to promote and maintain regular evacuation of the bowel.
Haloperidol is a neuroleptic medication that may cause the client to experience EPS. Antiparkinsonian medications such as benztropine (Cogentine) may be administered concurrently to decrease the symptoms of EPS.
Chlorpromazine is an antipsychotic medication often used in the treatment of psychosis. Photosensitivity is sometimes a side effect of the phenothiazine class of antipsychotic medications to which chlorpromazine (Thorazine) belongs.
A client with hepatitis has tremendous metabolic demands that lead to fatigue and interfere with activities of daily living (ADLs). The nurse encourages ADLs unless they cause excessive fatigue. The client is advised to plan rest periods after activities, such as meals. Activities should be spaced throughout the day with frequent planned rest periods. Clients who engage in excessive activity too early in the recovery stage may experience a relapse.
In a client with multiple sclerosis, Because fatigue can be precipitated by warm temperatures, the client is instructed to take cool baths and maintain a cool environmental temperature. A high-fiber diet and an adequate fluid intake of 2000 mL daily is encouraged to prevent alterations in elimination and bowel patterns. The client should not be told to avoid pregnancy, but the nurse should assist the client to make informed decisions regarding pregnancy.
The metal frame is never used or pulled on for turning or lifting. Pin care should be performed at least once a day using soap and water with cotton-tipped swabs or with alcohol swabs. The bolts should never be loosened except in an emergency. In fact, the physician should be notified if the bolts loosen. The client is instructed to carry the correct size wrench in case of an emergency requiring cardiopulmonary resuscitation (CPR). In such a situation, the anterior portion of the vest, including the anterior bolts, will need to be loosened, and the posterior portion should remain in place to provide stability for the spine during CPR.
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