Care of Common Medical-Surgical Complications

1. Care of Common Medical-Surgical Complications Unit 6 Med-Surg 1

2. Introduction • Know those terms! • There are many things which can occur to complicate the hospital stay for a patient. Med-Surg 1

3. Hemorrhage A condition of excessive blood loss • Signs and Symptoms • Apprehension/restless • Thirst • Cold, moist skin • Reduced body temperature and BP • Changes in LOC • Decreased capillary refill • Shock Med-Surg 1

4. Hemorrhage • External • Visible bleeding • Rapid, thready pulse • Deep, rapid respirations • Internal • Bleeding is hidden • Distension and/or tenderness of soft tissues • Rapid, thready pulse • Treatment

5. Shock Shock is a problem with oxygen supply to and from the tissues…inadequate tissue perfusion • Hypovolemic – decreased fluid volume • Cardiogenic – cardiac failure • Neurogenic – blood pools in dilated vessels • Septic – caused by infection

6. Shock • Signs and symptoms • Hypotension with narrowed pulse pressure • Cold, clammy skin (warm and flushed in neurogenic shock) • Rapid, weak pulse (slow, weak pulse in neurogenic shock) • Deep, rapid respirations • Thirst • Apprehension and changes in LOC TREATMENT

7. Pulmonary embolism PE is a condition in which a blood clot or other abnormality lodges in a vessel in the lungs • Signs and symptoms • Dyspnea • Tachypnea, and tachycardia • Cyanosis or pallor • Sharp, sudden chest pain • Rales • Productive cough with hemoptysis • Anxiety and restlessness TREATMENT Med-Surg 1

8. Medications • Anticoagulants • Heparin • Coumadin • Related blood tests • Side effects Med-Surg 1

9. Fluid Imbalance Fluid imbalance refers to the state in which water and its solutes are in abnormal proportion and concentration • The role of sodium (Na) • Hypernatremia • Hyponatremia • Fluid deficit – loss of body fluid • Fluid excess – gain of body fluid Med-Surg 1

10. Fluid Imbalance • S and Sx of FVD • Thirst • Dry skin with poor turgor • Dry lips • Dry, coated tongue • Sunken, soft eyeballs • Muscle atony • Weight loss • Shrunken fontanels in babies • Electrolyte imbalance • Anorexia, dyspepsia, and constipation Med-Surg 1

11. Fluid Imbalance • S and Sx of FVO or FVE • Edema • Confusion • Lack of coordination • Convulsions • Hyperventilation • Sudden weight gain • Warm, moist skin • Rales or crackles • Apathy, sleepiness, anorexia, nausea, vomiting, and coma Med-Surg 1

12. Fluid Imbalance • What are your interventions? • A patient shows signs of fluid imbalance. What do you need to do to correct the following symptoms? • Apprehension, anxiety, confusion • Abdominal cramps, diarrhea • Weak, rapid pulse • Cold, clammy skin • Disorientation • Scanty urine output Med-Surg 1

13. Hemorrhage • Let’s do another… • A patient has developed postoperative hemorrhage. What are you going to do to overcome these symptoms? • Bleeding from the wound • Restlessness • Thirst • Rapid, thready pulse • Rapid, labored respirations Med-Surg 1

14. Infection Infections occur when pathogens invade the body • Surgical infection with S and Sx • Urinary infection with S and Sx • Respiratory infection with S and Sx Med-Surg 1

15. Treatment Prescribed antipyretics Clean and irrigate wound Oral and IV fluids Reposition Oxygen Prescribed expectorants and analgesia TCDB Humidity to inspired air Good nutrition I and O Aseptic technique Promote personal hygiene Universal precautions/prevent microorganism spread Handwashing Catheter care VS Patient safety Infection

16. Let’s Review • How do we give a tepid sponge bath? • How do we identify a pathogenic organism? • Terminology • Antiinfective vs. Antimicrobial vs. Antibiotic • Bacteriostatic • Bacteriocidal ??? Med-Surg 1

17. Medications • Anti-infectives • Penicillins • Aminoglycosides • Cephalosporins • Chloramphenicol • Macrolides • Quinolones • Tetracyclines • Sulfonamides • Antifungals • Antivirals Med-Surg 1

18. Thrombophlebitis Thrombophlebitis is an inflammation of the wall of a vein with blood clot formation. Several factors may contribute to this • Injury to interior lining of vein • Excessive and abnormal blood clotting (hypercoagulability) • Reduced or stopped blood flow (stasis) • Tell me the signs and symptoms… Med-Surg 1

19. Treatment Anticoagulant therapy Bedrest Elevate the part to the level of the heart Avoid massage Apply external heat if prescribed TED hose Analgesia as prescribed Assess Homan’s Assess swelling, warmth, redness, pain VS Patient safety Thrombophlebitis

20. Inflammation Inflammation results from cell injury and is part of the body’s natural defense system • Signs and Symptoms • Redness and heat due to increased blood supply to the area • Swelling due to accumulation of tissue fluid at the site • Pain due to pressure from swelling irritating nerves and prostaglandin release • Loss of function due to pain and swelling Med-Surg 1

21. Treatment Bedrest Elevate the extremity Warm, moist heat as prescribed Assess area frequently Analgesia as prescribed Assess patient condition VS I and O Patient safety Finished with unit 6! Inflammation