Introduction to Adult Health Nurse By Dr. Dereje pdf

Chapter 1: Introduction and essential concepts
Dereje Chala
11/12/2023 Adult Health Nursing I 1

Contents of the chapter
1.Introduction to adult health nursing
2.Initial assessment of acutely ill patient
3.Care of patient with sepsis and infectious disease
(MERSA)
4.Fluid and electrolyte imbalances

Introduction to adult health nursing
• Definition: it is providing nursing care or comprehensive nursing
services to patients from the age of 18 and above.
Your roles
• Take a health history
• Conduct P/E

Components of health history
• Biographical data
• Chief complaint
• Present health history/illness
• Past health history
• Family history
• Review of systems
• Patient profile

Components of physical examination
•Initial observations- initial inspection
• Introducing oneself and shaking hand
• Posture
• Body movements
• Nutritional status
• Speech pattern
• V/S and pain assessments
•Focused assessment

Focused assessment
• Skin Head and neck
• Thorax and lungs
• Breasts
• Cardiovascular system
• Abdomen Rectum
• Genitalia
• Neurologic system
• Musculoskeletal system

Techniques of P/E
• Inspection
• Palpation
• Percussion
• Auscultation

Initial assessment of acutely ill patient

Care pathway

Care of patient with sepsis and infectious disease (MERSA)
• Sepsis is a serious condition that happens when the body’s
immune system has an extreme response to an infection.
• The body’s reaction causes damage to its own tissues and
organs.
• 48.9 million cases and 11 million sepsis-related deaths
worldwide, which accounted for almost 20% of all global
deaths (2017).

Prevalence
• Almost half of all global sepsis cases occurred among
children, with an estimated 20 million cases and 2.9 million
global deaths in children under 5 years of age (2017).
• Approximately 85% of sepsis cases and sepsis-related
deaths worldwide occurred in low- and middle-income
countries

Who is at risk?
• Anyone affected by an infection, severe injury, or
serious non-communicable disease can progress to
sepsis but vulnerable populations are at higher risk:
• older persons,
• pregnant or recently pregnant women,
• neonates,
• hospitalized patients,
• patients in intensive care units,
• people with weakened immune systems (e.g. HIV, cancer)
• people with chronic medical conditions (e.g. kidney disease,
cirrhosis).

Causes
• Sepsis is usually caused by bacterial infections
• May be the result of other infections such as viruses,
parasites or fungi.
• All age
• diarrhoeal diseases (9.2 to 15 million annual cases)
• lower respiratory infections (1.8–2.8 million annually)
• Death increased when underlying conditions present (chronic
illness or injury)

Common signs and symptoms
Sepsis is a medical emergency
• Common signs and symptoms include:
• fever or low temperature and shivering
• confusion
• difficulty breathing
• clammy and sweaty skin
• extreme body pain or discomfort
• high heart rate, weak pulse or low blood pressure
• low urine output.

Symptoms in children include:
• fast breathing
• convulsions
• pale skin
• lethargy
• difficulty waking up
• feeling cold to the touch.
• In children under 5 years old, it can cause difficulty feeding,
frequent vomiting or lack of urination.

Management
• antimicrobials, intravenous fluids and careful monitoring

Preventive strategies in reducing sepsis
• good hygiene practices
• ensuring access to vaccination programmes
• improved sanitation and water quality and availability,
• other infection prevention and control best practices both in
the community and health care settings.

Methicillin-resistant Staphylococcus aureus
(MRSA)
• It is caused by a type of staph bacteria that's become
resistant to many antibiotics used to treat ordinary staph
infections.
• occur in people who've been in hospitals or other healthcare
settings, such as nursing homes and dialysis centers.
• Healthcare-associated Staph resistant- common after
invasive therapies, surgeries, artificial joints.
• Community-associated – occur among healthy people
• Resistant to methicillin, oxacillin, penicillin, amoxicillin and
cephalosporins

Symptoms
• Staph skin infections
• swollen, painful red bumps that might look like pimples
or spider bites
• Warm to the touch
• Full of pus or other drainage
• Accompanied by a fever

Skin infections

Complication
• Bloodstream
• Lungs
• Heart
• Bones
• Joints

Prevention
• Washing hands
• Keep wounds covered
• Keep personal items personal.
• Shower after athletic games or practices.
• Sanitize linens.

Management
• Boils or abscesses may require incision and drainage while
antibiotics may be prescribed if indicated.
• Vancomycin
• Ofloxacin

Seminar presentation
You will perform the presentation individually.
1.Care of unconscious patients
2.Safety in acute care setting in nursing practice
3.Lifesaving and nursing practice
4.Perioperative nursing care

Fluid and electrolyte balances
•Depend upon dynamic processes that are crucial for
life and homeostasis.
•Disorder to F and E can occur in every setting, with
every disorder, and with a variety of changes that
affect healthy people
• e.g., increased fluid and sodium loss with strenuous
exercise and high environmental temperature,
inadequate intake of fluid and electrolytes as well as
those who are ill.

Fluid and electrolyte content of our body

Fluids
• There should be balance in ICF and ECF.
• Change in urine output ( decreased)
• Evidence of FVD
• increased heart rate,
• decreased blood pressure
• decreased central venous pressure
• Edema
• increased body weight and
• imbalances in fluid intake and output (I&O).

Fluid gain and output

Electrolytes
• Electrolytes in body fluids are active chemicals (cations
that carry positive charges and anions that carry negative
charges).
• The major cations in body fluid are
• sodium, potassium, calcium, magnesium, and hydrogen ions.
• The major anions are
• chloride, bicarbonate, phosphate, sulfate, and proteinate ions.
• Even though electrolytes are available in ICF and ECF, it is
usual practice to measure electrolyte concentration from
plasma.

Concentration of electrolytes

How fluid regulated between IC and EC?
•Osmosis – the movement of fluids from the region
of low solute concentration to the region of high
solute concentration until the solutions are of equal
concentration.
•Diffusion
•Filtration
•Sodium-potassium pump

Osmosis
•Osmotic pressure is the amount of hydrostatic
pressure needed to stop the flow of water by
osmosis. It is primarily determined by the
concentration of solutes.
•Oncotic pressure is the osmotic pressure exerted by
proteins (e.g., albumin).
•Osmotic diuresis is the increase in urine output
caused by the excretion of substances, such as
glucose, mannitol, or contrast agents in the urine.

Diffusion
• is the natural tendency of a substance to move from an area of higher
concentration to one of lower concentration.
Example
• The exchange of oxygen and carbon dioxide (CO2) between the
pulmonary capillaries and alveoli and the tendency of sodium to
move from the ECF compartment, where the sodium concentration is
high, to the ICF, where its concentration is low.

Filtration
• Movement of water and solutes occurs from an area of
high hydrostatic pressure to an area of low hydrostatic
pressure.
Example
• The kidneys filter approximately 180L of plasma per day.
• The passage of water and electrolytes from the arterial
capillary bed to the interstitial fluid; in this instance, the
hydrostatic pressure results from the pumping action of
the heart.

Osmosis and diffusion

Sodium-potassium pump
•The sodium concentration is greater in the ECF than
in the ICF; because of this, sodium tends to enter
the cell by diffusion.
•This tendency is offset by the sodium–potassium
pump that is maintained by the cell membrane and
actively moves sodium from the cell into the ECF.
• Conversely, the high intracellular potassium
concentration is maintained by pumping potassium
into the cell.

Laboratory tests for evaluating fluid status
• Osmolality is the concentration of fluid that affects the movement
of water between fluid compartments by osmosis.
• Osmolality measures the solute concentration per kilogram in
blood and urine.
• It is also a measure of a solution’s ability to create osmotic
pressure and affect the movement of water.
• Serum osmolality primarily reflects the concentration of sodium,
although blood urea nitrogen (BUN) and glucose also play a major
role in determining serum osmolality.
• Urine osmolality is determined by urea, creatinine, and uric acid.
When measured with serum osmolality, urine osmolality is the
most reliable indicator of urine concentration.
• Osmolality is reported as milliosmoles per kilogram of water

Normal range
• 275 to 290 mOsm/kg
• Osmolarity is the concentration of solutions, is measured
in milliosmoles per liter (mOsm/L).

Factors affecting osmolality and osmolarity

Urine-specific gravity
• Urine-specific gravity measures the kidneys’ ability to
excrete or conserve water.
• The specific gravity of urine is compared to the weight of
distilled water, which has a specific gravity of 1.000.
• The normal range of urine specific gravity is 1.010 to 1.025.

BUN
• It is an end product of the metabolism of protein (from both
muscle and dietary intake) by the liver.
• Amino acid breakdown produces large amounts of ammonia
molecules, which are absorbed into the bloodstream.
• Ammonia molecules are converted to urea and excreted in the
urine.
• The normal BUN is 10 to 20 mg/dL (3.6 to 7.2 mmol/L).
• The BUN level varies with urine output; may be affected by
decreased renal function, GI bleeding, dehydration, increased
protein intake, fever, and sepsis (decrease). Those that decrease
BUN include end-stage liver disease, a low-protein diet, starvation,
and any condition that results in expanded fluid volume (e.g.,
pregnancy).

Creatinine
• is the end product of muscle metabolism.
• It is a better indicator of renal function than BUN because
it does not vary with protein intake and metabolic state.
• The normal serum creatinine is approximately 0.7 to 1.4
mg/dL (62 to 124 mmol/L); its concentration depends on
lean body mass and varies from person to person.
• levels increase when renal function decreases.

Hematocrit
• Hematocrit measures the volume percentage of red blood
cells (erythrocytes) in whole blood and normally ranges
from 42% to 52% for men and 35% to 47% for women.
• Factors that increase the hematocrit value are dehydration
and polycythemia, and those that decrease hematocrit are
overhydration and anemia.

Urine sodium
• The values change with sodium intake and the status of fluid
volume: As sodium intake increases, excretion increases; as
the circulating fluid volume decreases, sodium is conserved.
• Normal urine sodium levels range from 75 to 200 mEq/24 hours
(75 to 200 mmol/24 hours).
• A random specimen usually contains more than 40 mEq/L of
sodium.
• Urine sodium levels are used to assess volume status and are
useful in the diagnosis of hyponatremia and acute kidney
injury.

Fluid volume disturbances
A) Hypovolemia
• FVD, or hypovolemia, occurs when loss of ECF volume
exceeds the intake of fluid.
• It occurs when water and electrolytes are lost in the same
proportion as they exist in normal body fluids; thus, the
ratio of serum electrolytes to water remains the same.
• FVD and dehydration are not the same.

Pathophysiology
• FVD results from loss of body fluids and occurs more rapidly when
coupled with decreased fluid intake.
• FVD can also develop with a prolonged period of inadequate intake.
• Causes of FVD include
• abnormal fluid losses (vomiting, diarrhea, GI suctioning, and sweating)
• decreased intake (as in nausea or lack of access to fluids)
• third-space fluid shifts, or the movement of fluid from the vascular
system to other body spaces (e.g., with edema formation in burns,
ascites with liver dysfunction).
• diabetes insipidus (a decreased ability to concentrate urine owing to a
defect in the kidney tubules that interferes with water reabsorption)
• adrenal insufficiency, osmotic diuresis, hemorrhage, and coma.

Clinical manifestations

Lab findings
• BUN: Serum creatinine (normal ration is 10:1). In FVD, the ratio will
be increased (20:1).
• Hematocrit – increase due to decrease plasma volume.
• Serum electrolyte - Potassium and sodium levels can be reduced
(hypokalemia, hyponatremia) or elevated (hyperkalemia,
hypernatremia).
• Hypokalemia occurs with GI and renal losses.
• Hyperkalemia occurs with adrenal insufficiency.
• Hyponatremia occurs with increased thirst and ADH release.
• Hypernatremia results from increased insensible losses and diabetes
insipidus

Medical management
• Maintain Fluid volume and other factors that could affect FV.
• Oral fluids – if not severe
• IV fluid – if hypovolemia is acute or severe. Usually start with
Isotonic electrolyte solutions (e.g., lactated Ringer solution, 0.9%
sodium chloride), if normotensive provide a hypotonic electrolyte
solution (e.g., 0.45% sodium chloride).
• Assess frequently for I and O, weight, vital signs, central venous
pressure, level of consciousness, breath sounds, and skin color – to
monitor overload.
• Check for oligouria

Fluid management

Nursing management
• Monitors and measures fluid I&O at least every 8 hours, and sometimes
hourly.
• Daily body weights are monitored; an acute loss of 0.5 kg (1.1 lb)
represents a fluid loss of approximately 500 mL (1 L of fluid weighs
approximately 1 kg, or 2.2 lb).
• Monitor V/S.
• Monitor Skin and tongue turgor.
• Assess for mental function – delirium due to decreased cerebral
perfusion.
• Prevent hypovolemia- how?
• Correct hypovolemia-how?

Hypervolemia (FVE)
• It is an isotonic expansion of the ECF caused by the
abnormal retention of water and sodium in approximately
the same proportions in which they normally exist in the
ECF.
• It is most often secondary to an increase in the total-body
sodium content, which, in turn, leads to an increase in
total-body water.
• Because there is isotonic retention of body substances,
the serum sodium concentration remains essentially
normal.

Pathophysiology
• FVE may be related to simple fluid overload or diminished function
of the homeostatic mechanisms responsible for regulating fluid
balance.
• It happens due to heart failure, kidney injury, and cirrhosis of the
liver, consumption of excessive amounts of table or other sodium
salts.
• Excessive administration of sodium-containing fluids in a patient
with impaired regulatory mechanisms may predispose to a serious
FVE.

• edema, distended neck veins, and crackles (abnormal lung sounds).
• For more C/Ms, please refer to table 13-4.
Lab findings
• BUN and Hematocrit – decrease due to dilution, low protein intake
and anemia.
• Urine sodium – increase – due to conservation by kidney.
• CXR - may reveal pulmonary congestion.
• Hypervolemia occurs when aldosterone is chronically stimulated
(i.e., cirrhosis, heart failure, and nephrotic syndrome). Therefore,
the urine sodium level does not increase in these conditions.

Medical management
• Manage the cause
• Discontinue the infusion when needed.
• Administering diuretics and restricting fluids and sodium- to treat
symptoms.
• Diuretics – when dietary sodium restrictions alone are not effective.
• The choice of diuretic is based on the severity of the hypervolemic state,
the degree of impairment of renal function, and the potency of the
diuretic.
• Thiazide diuretics block sodium reabsorption in the distal tubule, where
only 5% to 10% of filtered sodium is reabsorbed.
• Loop diuretics, such as furosemide (Lasix) or torsemide (Demadex), can
cause a greater loss of both sodium and water because they block
sodium reabsorption in the ascending limb of Henle loop, where 20% to
30% of filtered sodium is normally reabsorbed.
• Generally, thiazide diuretics, such as hydrochlorothiazide (Microzide),
are prescribed for mild to moderate hypervolemia and loop diuretics for

•Don’t forget for diuretics side effects- electrolyte
imbalances. Consider potassium supplementations.
•Dialysis
• to remove sodium and fluid from the body
• Hemodialysis or peritoneal dialysis may be used to
remove nitrogenous wastes and control potassium and
acid–base balance, and to remove sodium and fluid.
• Continuous renal replacement therapy may also be
required

• Nutritional therapy
• dietary restriction of sodium
• may range from a mild restriction to as little as 250 mg
of sodium per day, depending on the patient’s needs.
• Use substitute of salt like lemon juice, onions, and garlic

Nursing management
• measures I&O at regular intervals to identify excessive fluid
retention.
• An acute weight gain of 1 kg (2.2 lb) is equivalent to a gain of
approximately 1 L of fluid.
• Monitor degree of edema and Pitting edema.

Electrolyte imbalances
• Common in clinical practice and may need to be corrected
based on history, physical examination findings, and
laboratory values (with comparison to previous values).

Sodium imbalances
• the most abundant electrolyte in the ECF.
• the primary determinant of ECF volume and osmolality.
• major role in controlling water distribution throughout the body,
• it does not easily cross the cell wall membrane
• its abundance and high concentration in the body.
• Sodium is regulated by ADH, thirst, and the renin–angiotensin–
aldosterone system.
• A loss or gain of sodium is usually accompanied by a loss or gain of
water.
• Sodium also functions in establishing the electrochemical state
necessary for muscle contraction and the transmission of nerve
impulses.

Sodium Deficit (Hyponatremia)
• a serum sodium level that is less than 135 mEq/L (135 mmol/L).
• Acute hyponatremia - the result of a fluid overload in a surgical
patient.
• Chronic hyponatremia is seen more frequently in patients outside
the hospital setting, has a longer duration, and has less serious
neurological sequelae (>48 hrs)
• Exercised-associated hyponatremia - occur during extreme
temperatures, because of excessive fluid intake before exercise, or
prolonged exercise that results in a decrease in serum sodium.

Pathophysiology
• primarily occurs due to an imbalance of water rather than sodium.
• Low urine sodium occurs as the kidney retains sodium to
compensate for nonrenal fluid loss (i.e., vomiting, diarrhea,
sweating).
• High urine sodium concentration is associated with renal salt
wasting (i.e., diuretic use).
• In dilutional hyponatremia, the ECF volume is increased without
any edema.
• Deficiency of aldosterone- predisposes to sodium deficiency.
• Certain medications – eg. Anticonvulsants

• Poor skin turgor
• Dry Mucosa
• Headache
• Decreased saliva production
• Orthostatic fall in blood pressure
• Nausea, vomiting, and abdominal cramping
• Altered mental status, status epilepticus, and coma – due to
cerebral edema and cellular swelling

• anorexia, muscle cramps, and a feeling of exhaustion –
due to sodium loss and water gain.
• Signs of increasing intracranial pressure, such as lethargy,
confusion, muscle twitching, focal weakness, hemiparesis,
papilledema, seizures, and death, may occur due to severe
loss of sodium (115 mEq/L).

Investigations
• Hx and P/E
• identification of current IV fluids, If applicable.
• Serum osmolarity – decrease
• Serum sodium- decrease
• Specific urine – low-due primarily to sodium loss (< 20m Eq/L urine
sodium level)

Medical management
• Treat underlying conditions
• Administer sodium- PO, NGT and parenteral
• Administer lactated Ringer solution or isotonic saline (0.9% sodium
chloride) solution
• Alert: too rapid administration is risk for neurologic problems
(dyemyelination)- should not exceed 140 mEq/L rapidly- 12 mEq/L
over 24 hrs.
• Water restriction
• Pharmacologic interventions - AVP receptor antagonists eg.
conivaptan hydrochloride (Vaprisol), Tolvaptan (Samsca)

Nursing management
• identify and monitor patients at risk for hyponatremia
• monitors I&O as well as daily body weight
• Early detection and treatment are necessary to prevent serious
consequences.
• Salt tablets –for athletes
• When administering fluids to patients with cardiovascular disease,
the nurse assesses for signs of circulatory overload (e.g., cough,
dyspnea, puffy eyelids, dependent edema, excess weight gain in 24
hours). The lungs are auscultated for crackles.
• If the patient is taking lithium- look for lithium toxicity

Sodium Excess (Hypernatremia)
• a serum sodium level higher than 145 mEq/L (145 mmol/L)
• Caused by: a gain of sodium in excess of water or by a loss of water
in excess of sodium.
• With a water loss, the patient loses more water than sodium; as a
result, the serum sodium concentration increases and the
increased concentration pulls fluid out of the cell.
• the patient ingests or retains more sodium than water.

Pathophysiology
• Common cause- fluid deprivation
• Administration of hypertonic enteral feedings without adequate water
supplements leads to hypernatremia, as does watery diarrhea and greatly
increased insensible water loss (e.g., hyperventilation, burns).
• Diabetes insipidus – if no response to excessive thirst or fluid restriction.
• Less common cause
• heat stroke, near drowning in seawater
• malfunction of hemodialysis or peritoneal dialysis systems.
• IV administration of hypertonic saline or excessive use of sodium
bicarbonate

• Dehydration
• Mild increase in body temperature
• Thirst
• For more details, see table 13-6.

Investigations
• Serum sodium level - exceeds 145 mEq/L (145 mmol/L) and
the serum osmolality exceeds 300 mOsm/kg (300 mmol/L).
• Urine specific gravity and serum osmolarity- increase - as
the kidneys attempt to conserve water (provided the
water loss is from a route other than the kidneys).

Medical management
• e infusion of a hypotonic electrolyte solution (e.g., 0.3% sodium
chloride) or an isotonic nonsaline solution (e.g., dextrose 5% in
water [D5W])- gradually
• Rapid reduction- may cause cerebral edema –by decreasing plasma
osmolality than fluids in the brain tissue.
• The serum sodium level is reduced at a rate no faster than 0.5 to 1
mEq/L/h to allow sufficient time for readjustment through diffusion
across fluid compartments (general rule, no exact rate).
• Desmopressin acetate, a synthetic ADH, may be prescribed to treat
diabetes insipidus if it is the cause of hypernatremia.

Nursing management
• Monitor fluid losses and gains
• Assess for abnormal losses of water or low water intake and for
large gains of sodium.
• Prevent hypernatremia – provide oral fluids at regular intervals,
particularly in patients who are unable to perceive or respond to
thirst.
• water intake – if diabetes insipidus
• Correct hypernatremia- fluid therapy

Potassium imbalances
• Major ICF, 98% of the body’s potassium is inside the cells.
• Perform the neuromuscular function. Potassium influences
both skeletal and cardiac muscle activity- sodium-
potassium pump.
• Renal system plays important role.
• Aldosterone also increases the excretion of potassium by
the kidney.

Potassium Deficit (Hypokalemia)
• serum potassium level below 3.5 mEq/L [3.5 mmol/L]
• Pathophysiology
• Potassium-losing diuretics, such as the thiazides and loop diuretics
• Corticosteroids, sodium penicillin, and amphotericin B.
• GI loss of potassium
• Acid–base imbalance (respiratory or metabolic alkalosis)
• Hyperaldosteronism increases renal potassium wasting and can lead to
severe potassium depletion.
• poor intake, people with bulimia frequently suffer increased potassium
loss through self-induced vomiting and misuse of laxatives, diuretics, and
enemas
• Magnesium depletion causes renal potassium loss

• Severe hypokalemia can cause death through cardiac or respiratory
arrest.
• Clinical signs develop when the potassium level decreases to less
than 3 mEq/L (3 mmol/L).
• If prolonged, hypokalemia can lead to an inability of the kidneys to
concentrate urine, causing dilute urine (resulting in polyuria,
nocturia) and excessive thirst.
• Potassium depletion suppresses the release of insulin and results in
glucose intolerance.
• See table 13-7.

Investigations
• Changes in ECG
• Urinary potassium excretion exceeding 20 mEq/day with
hypokalemia suggests that renal potassium loss is the
cause.
• Metabolic alkalosis

Medical management
• increased intake in the daily diet or by oral potassium
supplements- most fruits and vegetables, legumes, whole
grains, milk, and meat.
• IV supplementation.
• Potassium loss must be corrected daily; administration of
40 to 80 mEq/day of potassium is adequate in the adult if
there are no abnormal losses of potassium.

Nursing management
• monitored closely for signs of digitalis toxicity-if patient is taking
potassium.
• monitor for its early presence in patients at risk.
• Prevent hypokalemia
• encourage the patient at risk to eat foods rich in potassium (when the diet
allows).
• Consumption of foods high in potassium should be encouraged; examples
include bananas, melon, citrus fruits, fresh and frozen vegetables, lean
meats, milk, and whole grains.
• Careful monitoring of fluid I&O

Treating hypokalaemia
• Oral potassium supplements can produce small bowel lesions;
therefore, the patient must be assessed for and cautioned about
abdominal distention, pain, or GI bleeding.
• Potassium should be given only after adequate urine output
• Potassium is never given by IV push or intramuscularly to avoid
replacing potassium too quickly.
• IV potassium must be given using an infusion pump
• Renal function should be monitored through BUN and creatinine
levels and urine output

Potassium Excess (Hyperkalemia)
• serum potassium level greater than 5 mEq/L [5 mmol/L].
• Pathophysiology
• decreased renal excretion of potassium, rapid administration of
potassium, and movement of potassium from the ICF
compartment to the ECF compartment.
• With kidney injury, particularly those in whom potassium levels
increase as a result of infection or excessive intake of potassium
in food or medications
• Patients with hypoaldosteronism or Addison disease
• Medications - KCl, heparin, ACE inhibitors, NSAIDs, beta
blockers, cyclosporine (Neoral), tacrolimus (Prograf), and
potassium-sparing diuretics.

• Elevated serum potassium – myocardium – at the level of 8
mEq/L (8 mmol/L) or greater.
• Dysrhythmias and cardiac arrest – see Table 13-7.
Investigations
• Serum potassium levels and ECG changes
• Arterial blood gas analysis may reveal both a metabolic
and a respiratory acidosis.

Medical management
• Take ECG immediately – may show shortened repolarization and peaked
T wave.
• Restriction of dietary potassium and potassium containing medications.
• Administration, either orally or by retention enema, of cation exchange
resins (e.g., sodium polystyrene sulfonate [Kayexalate]).
• In emergency, administer IV calcium gluconate.
• Monitoring the blood pressure
• IV administration of sodium bicarbonate – to correct metabolic acidosis
• IV administration of regular insulin and a hypertonic dextrose solution
causes a temporary shift of potassium into the cells.
• Beta-2 agonists, such as albuterol (Proventil, Ventolin), are highly
effective in decreasing potassium.

Nursing management
• Identify and monitor kidney diseases
• Monitor I&O and observes for signs of muscle weakness and
dysrhythmias.
• Monitor V/S – take an apical pulse.
• Monitor serum potassium levels, as well as BUN, creatinine, glucose, and
arterial blood gas values.
• Potassium-rich foods to be avoided include many fruits and vegetables,
legumes, whole-grain breads, lean meat, milk, eggs, coffee, tea, and
cocoa
• Foods with minimal potassium content include butter, margarine,
cranberry juice or sauce, ginger ale, gumdrops or jellybeans, hard candy,
root beer, sugar, and honey –should be taken

Home take assignment
• Read
• Calcium imbalances
• Magnesium imbalances
• Phosphorus imbalances
• Chloride imbalances
• Acid-base imbalances

Chapter 2: Geriatric Considerations
• Geriatrics: a field of practice that focuses on the physiology, pathology,
diagnosis, and management of the disorders and diseases of older adults
• Geriatric syndromes: common conditions found in older adults that tend to
be multifactorial and do not fall under discrete disease categories; these
conditions include falls, delirium, frailty, dizziness, and urinary incontinence
• Gerontologic/geriatric nursing: the field of nursing that relates to the
assessment, planning, implementation, and evaluation of older adults in all
environments, including acute, intermediate, and skilled care, as well as
within the community
• Gerontology: the combined biologic, psychological, and sociologic study of
older adults within their environment

Demographics of Aging
• As the older adult population increases, the number of people who
live to a very old age is also dramatically increasing.
• The greatest growth in the older adult population is for those aged 85
years and older.
• Life expectancy—the average number of years that a person can
expect to live —varies by gender and race, with women living longer
than men and white women having the longest life expectancy – has
risen in Ethiopia.

Health status of the older people

Theories of aging
• Aging is defined as chronologically by the passing of time—
subjectively, as in how a person feels, and functionally, as in changes
in physical or mental capabilities.
• No universally accepted theory.
• The theories include
• Biological
• Psychological
• Developmental
• sociologic theories of aging
• Functional consequences theory

Theories of aging

Age-related changes
• The well-being of older adults depends on physical, psychosocial,
mental, social, economic, and environmental factors.
• A total assessment includes an evaluation of all major body systems,
social and mental status, and the person’s ability to function
independently (Weber & Kelley, 2014).

Pharmacology of aging
• Because an increasing number of chronic conditions affect older
adults, they use more medications than any other age group.
• Although medications improve health and well-being by relieving pain
and discomfort, treating chronic illnesses, and curing infectious
processes, adverse drug reactions are common because of
medication interactions, multiple medication effects, incorrect
dosages, and the use of multiple medications.
• Polypharmacy is the prescription, use, or administration of more
medications than is clinically indicated.

Pharmacologic aspects of aging

Nursing Strategies for Improving Medication
Management and Adherence
• The following strategies can help patients manage their medications
and improve adherence:
• Assess self-management abilities, psychomotor skills, and current
medication knowledge.
• Explain the purpose, adverse effects, and dosage of each medication,
particularly those that are newly prescribed.
• Provide the medication schedule in writing. Encourage the use of
standard containers without safety lids (if there are no children in the
household)

• Suggest the use of a multiple-day, multiple-dose medication
dispenser to help the patient adhere to the medication schedule.
• Destroy or remove old, unused medications.
• Encourage the patient to inform the primary provider about the use
of over-the-counter medications and herbal agents, alcohol, and
recreational drugs.
• Encourage the patient to keep a current list of all medications,
including over-the-counter and herbal medications, in their purse or
wallet to share with the primary provider at each visit and in case of
an emergency

• Reconcile medication schedule upon discharge from hospital or
rehabilitation facility. Recommend using one supplier for
prescriptions; pharmacies frequently track patients and are likely to
notice a prescription problem such as duplication or contraindications
in the medication regimen.
• If the patient’s competence is doubtful, identify a reliable family
member or friend who might assist the patient with adherence.

Common mental health in older adult
• Depression
• Substance abuse
• Dementia
• Alzheimer’s Disease
• Vascular dementia

Chapter 3:Management of Patients With
Oncologic Disorders
• Cancer is a large group of disorders with different causes,
manifestations, treatments, and prognoses.
• Oncology nursing?
• Cancer is a disease process that begins when a cell is transformed by
genetic mutations of the cellular deoxyribonucleic acid (DNA).
• Genetic mutations may be inherited and/or acquired, leading to
abnormal cell behavior.

Classification of cancer by tissue origin

Diagnosis of ca
(1) determine the presence and extent of cancer,
(2) identify possible disease metastasis,
(3) evaluate the function of involved and uninvolved body
systems and organs, and
(4) obtain tissue and cells for analysis, including evaluation
of tumor stage and grade.

Diagnostic evaluations of ca may include
• a review of systems
• physical examination
• imaging studies
• laboratory tests of blood, urine, and other body fluids
• procedures; and pathologic analysis.

Tumor staging and grading
• Staging determines the size of the tumor, the existence of local
invasion, lymph node involvement, and distant metastasis.
• Several systems exist for classifying the anatomic extent of
disease.
• The tumor, nodes, and metastasis (TNM) system.
• Grading is the pathologic classification of tumor cells. Grading
systems seek to define the type of tissue from which the tumor
originated and the degree to which the tumor cells retain the
functional and histologic characteristics of the tissue of origin
(differentiation).

• Samples for gradings include tissue scrapings, body fluids, secretions,
washings, biopsy, or surgical excision.

Management of cancer
• Treatment options offered to patients with cancer are
based on treatment goals for each specific type, stage,
and grade of cancer.
• The range of possible treatment goals includes complete
eradication of malignant disease (cure), prolonged survival
and containment of cancer cell growth (control), or relief
of symptoms associated with the disease and
improvement of quality of life (palliation).

Cancer-care tragectory

Surgery
• Surgical removal of the entire cancer remains the ideal and
most frequently used treatment method.
• Surgery may be the primary method of treatment, or it
may be prophylactic, palliative, or reconstructive.
• Diagnostic Surgery or biopsy, is performed to obtain a
tissue sample for histologic analysis of cells suspected to
be malignant.

Nursing management
• Surgical care is individualized according to age, organ
impairment, specific deficits, comorbidities, cultural
implications, and altered immunity.
• completes a thorough preoperative assessment
• provides the patient and family with verbal and written
information about the surgical procedure as well as other
interventions that may take place intraoperatively.

Radiation therapy

Chemotherapy
• the use of antineoplastic drugs in an attempt to destroy cancer
cells by interfering with cellular functions, including replication and
DNA repair.
• Used primarily to treat systemic disease rather than localized
lesions that are amenable to surgery or radiation.
• Chemotherapy may be combined with surgery, radiation therapy,
or both to reduce tumor size preoperatively (neoadjuvant), to
destroy any remaining tumor cells postoperatively (adjuvant), or to
treat some forms of leukemia or lymphoma (primary).

Adjunct Chemotherapeutic Agents
• In certain regimens, additional medications are given with
chemotherapy agents to enhance activity or protect normal cells
from injury.
• e.g. leucovorin (Wellcovorin) is often given with fluorouracil (5-FU)
to treat colorectal cancer.
• Leucovorin, a compound similar to folic acid, helps fluorouracil
bind with an enzyme inside of cancer cells and enhances the ability
of fluorouracil to remain in the intracellular environment.
• Significant toxicity, including severe bone marrow suppression,
mucositis, diarrhea and liver, and lung and kidney damage, can
occur. Leucovorin helps to prevent or lessen these toxicities.

Administration of Chemotherapeutic
Agents
• The route of administration depends on the type of agent; the
required dose; and the type, location, and extent of malignant
disease being treated.
• The dosage of chemotherapeutic agents is based primarily on the
patient’s total body surface area, weight, previous exposure and
response to chemotherapy or radiation therapy, and function of
major organ systems.
• Chemotherapy treatment regimens include standard-dose therapy,
dose-dense regimens (giving chemotherapy more frequently than
standard treatment regimens), and myeloablative therapy.

Potential Long-Term Complications of
Cancer Chemotherapy
• Abnormalities in senses of taste, smell, and touch
• Abnormal balance, tremors, or weakness
• Avascular necrosis
• Cardiovascular toxicity (coronary artery disease, myocardial infarction,
congestive heart failure, valvular heart disease, peripheral arterial
disease)
• Decreased libido
• Dental caries
• Dry mouth
• Dysphagia
• Dyspnea on exertion
• Growth retardation in children Herpes infections (zoster and varicella)
• Hypothyroidism Immune dysfunction

Safety in Handling Chemotherapy for
Health Care Providers
•When preparing (compounding, reconstituting)
chemotherapy for administration, use the following
safety equipment to prevent exposure through
inhalation, direct contact, and ingestion:
• Class II or III biological safety cabinet (BSC)
• Closed system transfer devices
• Puncture and leak-proof containers,
• IV bags Needleless systems (i.e., IV tubing and syringes)

•If BSC is not available when preparing
chemotherapy for administration, use the following
safety equipment to minimize exposure:
• Surgical N-95 respirator to provide respiratory and
splash protection
• Eye and face protection (both face shield and goggles)
working at or above eye level or cleaning a spill

Safety measures
• When preparing or administering chemotherapy or
handling linens and other materials contaminated with
chemotherapy or blood and body fluids of patients
receiving chemotherapy, wear the following for personal
protection:
• Double layer of powder-free gloves specifically designated for
chemotherapy handling (the inner glove is worn under the
gown cuff and the outer glove is worn over the cuff)
• Long sleeve, disposable gowns (without seams or closures that
can allow drugs to pass through) made of polyethylene-coated
polypropylene or other laminate materials

Introduction to Adult Health Nurse By Dr. Dereje pdf

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