Lippincott Manual of Nursing Practice, 9th Edition () (PDF) by S. M. Nettina - UnitedVRG.Lippincott Manual of Nursing Practice Series: Alarming Signs and Symptoms - PDF Drive

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This hernia is quite common in neonates but also occurs in women who are obese or who have had several pregnancies. Because most umbilical hernias in infants close spontaneously, surgery is warranted only if the hernia persists for more than 4 or 5 years. Taping or binding the affected area or supporting it with a truss may relieve symptoms until the hernia closes. A severe congenital umbilical hernia, which allows the abdominal viscera to protrude outside the body, must be repaired immediately.

Incisional Incisional ventral hernia develops at the site of previous surgery, usually along vertical incisions. This hernia may result from a weakness in the abdominal wall, caused by an infection, impaired wound healing, inadequate nutrition, extreme abdominal distention, or obesity. Palpation of an incisional hernia may reveal several defects in the surgical scar.

An indirect inguinal hernia causes the abdominal viscera to protrude through the inguinal ring and follow the spermatic cord in males or round ligament in females. A direct inguinal hernia results from a weakness in the fascial floor of the inguinal canal.

Femoral Femoral hernia occurs where the femoral artery passes into the femoral canal. Typically, a fatty deposit within the femoral canal enlarges and eventually creates a hole big enough to accommodate part of the peritoneum and bladder. A femoral hernia appears as a swelling or bulge at the pulse point of the large femoral artery.

To detect a hernia in a male patient, ask the patient to stand with his ipsilateral leg slightly flexed and his weight resting on the other leg. Tell the patient to cough. If pressure is felt against the finger- tip, an indirect hernia exists; if pressure is felt against the side of the finger, a direct hernia exists.

See How a herniated disk develops, page Physical stress from severe trauma or strain or joint degeneration may cause herniation of an intervertebral disk, as shown below. Nucleus pulposus Anulus fibrosus. ALERT During conservative treatment, watch for a de- terioration in neurologic status, especially during the first 24 hours after admission, which may indicate an urgent need for surgery.

Physical therapy may also be needed to strengthen muscles. Follow-up with home physical therapy re- ferral to determine home safety. Teach the patient the home exercise program. ALERT After surgery, assess the patient for complications, such as deep vein thrombosis, pulmonary embolus, and hip dislocation.

Use normal saline or bicar- bonate mouthwash for daily oral rinsing. Make sure his schedule includes time for exercise and rest. See Clinical effects of hypercalcemia. It also figures prominently in nerve im- pulse conduction, acid-base balance, enzyme action, and cell membrane function. See Clinical ef- fects of hyperkalemia. If the sample was drawn using poor technique, the results may be falsely high.

To avoid falsely high re- sults consider the following causes: — drawing the sample above an I. CO is increased by conditions that increase heart rate, stroke volume, or both. TPR is increased by factors that increase blood viscosity or reduce the lumen size of vessels, especially the arterioles.

Decreased blood flow Increased TPR. See Under- standing hypertension. See Clinical effects of hypokalemia, page See Understanding leukemia, page A rapidly progressing disease, acute leukemia is characterized by the malignant proliferation of WBC precursors blasts in bone marrow or lymph tissue and by their accumulation in peripheral blood, bone marrow, and body tissues.

In chronic forms of leukemia, disease onset occurs more insidiously, commonly with no symptoms. Platelet Red blood cell Lymphocyte agranulocyte. ALERT If aspirate is dry or free from leukemic cells but the patient has other typical signs of leukemia, a bone marrow biopsy, usually of the posterior superior iliac spine, must be per- formed.

Others originate in the intrahepatic bile ducts cholan- giomas. Cells metastasize to gallbladder, mesentery, peritoneum, and diaphragm by direct extension. See How lung cancer develops, page Although the exact cause of such change remains unclear, some lung cancers originating in the bronchi may be more vulnerable to injuries from carcinogens. As the tumor grows, it can partially or completely obstruct the airway, result- ing in lobar collapse distal to the tumor. Early metastasis may occur to other tho- racic structures as well.

Metastasis to hilar lymph nodes. Bronchus Tumor projecting into bronchi. Metastasis to carinal lymph nodes. Tumor projecting into bronchi. The other diseases produce more general- ized and disabling symptoms; also, patients lack evidence of joint inflammation, have normal neurologic tests, and have a greater degree of anxiety and depres- sion than patients with Lyme disease.

However, it may be more useful in later disease stages, when sensitivity and speci- ficity of the test are improved. These strains may also resist cephalosporins, aminogly- cosides, erythromycin, tetracycline, and clindamycin. The groin, armpits, and intestines are less common colonization sites. See Understanding mitral stenosis. Narrowing of the valve by valvular abnormalities, fibrosis, or calcification ob- structs blood flow from the left atrium to the left ventricle.

Left atrial volume and pressure rise and the chamber dilates. Greater resistance to blood flow causes pulmonary hypertension, right ventricular hypertrophy, and right-sided heart fail- ure. Inadequate filling of the left ventricle results in low cardiac output. See How myelin breaks down.

Myelin speeds electrical impulses to the brain for interpretation. Its high electrical resistance and low capacitance allow the myelin to conduct nerve impulses from one node of Ranvier to the next. The sheath becomes inflamed, and the membrane layers break down into smaller components that become well-circumscribed plaques filled with microglial elements, macroglia, and lym- phocytes.

This process is Axon called demyelination. The partial loss or dispersion of the action potential causes neurologic dysfunction. Node of Ranvier Myelin Plaque sheath. This injured tissue is potentially viable and may be salvaged if cir- culation is restored, or it may progress to necrosis. Tro- ponin levels increase within 4 to 6 hours of myocardial injury and may remain elevated for 5 to 11 days.

Record the severity, location, type, and duration of pain. Avoid I. Watch for bleeding. Keep the leg with the sheath insertion site immobile. Maintain strict bed rest. Check peripheral pulses in the affected leg frequently. ALERT Watch for crackles, cough, tachypnea, and edema, which may indicate impending left-sided heart failure. A physical trainer may also be consulted, if not contraindicated by comorbid condi- tions. Record the measurement in skin with your thumb and forefin- centimeters.

Cylinder cells arise in ducts and degenerate into cysts; large, fatty, granular cells arise in parenchyma. Dopamine deficiency prevents affected brain cells from performing their normal inhibitory function. Other nondopamin- ergic receptors may be affected, possibly contributing to depression and other nonmotor symptoms. It may signal splenic infarction, renal calculus formation, or ab- dominal organ thrombosis. Stay alert for tachycar- dia, clamminess, and complaints of vertigo.

If these effects occur, the pro- cedure should be stopped. Give 24 oz ml of juice or water. ALERT Elderly patients may require fluid replacement with normal saline solution after phlebotomy to decrease the risk of orthostatic hypertension. Personnel who administer radioactive phosphorus should take radiation precautions to prevent contamination. The patient with advanced stages of a pressure ulcer may also benefit from hyperbaric therapy.

Home care services and infusion therapy may also be required upon discharge from the hospital. This staging system reflects the depth and extent of tissue involvement. Stage I An area of skin that develops observ- able, pressure-related changes that include persistent redness in patients with light skin or persistent red, blue, or purple in patients with darker skin.

Other indicators include pain, itching, warmth, edema or hardness at the site. Stage II Superficial partial-thickness wound that appears as an abrasion, blister, or shal- low crater involving the epidermis, der- mis, or both. Stage III Full-thickness wound with tissue dam- age or necrosis of subcutaneous tissue that can extend down to, but not through, underlying fasciae.

The wound appears as a deep crater that may or may not undermine to neighboring tis- sue. Stage IV Full-thickness wound with extensive damage, tissue necrosis, or damage to muscle, bone, or structures, such as joints and tendons.

The wound may undermine to neighboring tissues and develop sinus tracts. See How prostate cancer develops. Prostate cancer commonly a form of adenocarcinoma grows slowly. When pri- mary lesions metastasize beyond the prostate, they invade the prostate capsule and spread along the ejaculatory ducts in the space between the seminal vesi- cles.

Seminal vesicle. Malignant tumor prostatic carcinoma. Sphincter Membranous urethra urethrae. Erythrodermic psoriasis This type is marked by extensive flushing all over the body, which may result in scaling. The rash may develop rapidly, signaling new psoriasis or gradually in chronic psoriasis.

Sometimes the rash occurs as an adverse drug reaction. Guttate psoriasis This type typically affects children and young adults. Erupting in drop-sized plaques over the trunk, arms, legs and, sometimes, the scalp, this rash general- izes in several days. Inverse psoriasis Smooth, dry, bright red plaques characterize inverse psoriasis.

Located in skin folds armpits and groin, for example , the plaques fissure easily. Psoriasis vulgaris This psoriasis type is the most common. It begins with red, dotlike lesions that gradually enlarge and produce dry, silvery scales. The plaques usually appear symmetrically on the knees, elbows, extremities, genitalia, scalp, and nails. Pustular psoriasis This type features an eruption of local or extensive small, raised, pus-filled plaques. Possible triggers include emotional stress, sweating, infections, and adverse drug reactions.

Charged atoms or ions form and react with other atoms to cause cell damage. High- ly differentiated cells are more resistant to radiation. Watch for signs of shock, infection, and respiratory difficulties. See Understanding rheumatoid arthritis. Infiltration by lymphocytes, macrophages, and neutrophils continues the local inflammatory response. These cells, as well as fibroblast- like synovial cells, produce enzymes that help degrade bone and cartilage. Bone atrophy and misalignment cause visible defor- mities and disrupt the articulation of opposing bones, resulting in muscle atrophy and imbalance and, possibly, partial dislocations subluxations.

Swelling Joint space narrowing Erosion of bone. See Classifying rheumatoid arthritis. Later, they help determine the extent of cartilage and bone de- struction, erosion, subluxations, and deformities and show the character- istic pattern of these abnormalities. A physical therapy program, including range-of- motion exercises and carefully individualized therapeutic exercises, forestalls loss of joint function.

An occupational therapy program helps maintain independence. Watch for and im- mediately report any inability to rotate the hip or bear weight on it, in- creased pain, or a leg that appears shorter.

See What happens in car- diogenic shock. The blood backs up behind the weakened left ventricle, increasing preload and causing pulmonary congestion.

In addition, to compensate for the drop in stroke volume, the heart rate increases to maintain cardiac output. As a result of the diminished stroke volume, coronary artery per- fusion and collateral blood flow decrease. The result is myocardial hypoxia, further decreased cardiac output, and a triggering of compensatory mechanisms to prevent decompensation and death. Left ventricular dilation and backup Decreased coronary artery of blood perfusion and collateral blood flow.

Report signs of hemodynamic de- cline promptly. Item is exactly as described. PDF version is all I needed so it worked for me. I made 2 Purchases so far , eBook comes with Good quality , Instant access i even receive them on my email. Take advantage of these practical features that will improve your eBook experience: The ability to download the eBook on multiple devices at one time—providing a seamless reading experience online or offline Easily convert to audiobook, powering your content with natural language text-to-speech Powerful search tools and smart navigation cross-links that allow you to search within this book, or across your entire library of VitalSource eBooks About the Author Sandra M.

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