Diseases and Disorders: A Nursing Therapeutics Manual by Marilyn Sawyer Sommers PhD RN FAAN, Ehriel Fannin PhD(c)

By Marilyn Sawyer Sommers PhD RN FAAN, Ehriel Fannin PhD(c) RN CNL

Everything you want to learn about taking care of patients—in one transportable "must have" handbook!

Clear, yet complete discussions of pathophysiology, with rationales within the medicinal drugs and laboratory sections, explain the scientific foundation for the nursing care.

Thoroughly revised and up-to-date all through, the fifth version contains the newest clinical advances and the perform of nursing today.

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Approximately 50% of patients who are diagnosed with a threatened abortion carry their pregnancies to term. Inevitable and incomplete abortions are considered obstetric emergencies. Intravenous (IV) fluids are started immediately for fluid replacement, and narcotic analgesics are administered to decrease the pain. Oxytocics, when given IV, help decrease the bleeding. With any type of abortion, it is critical to determine the patient’s blood Rh status. Any patient who is Rh-negative is given an injection of an Rho(D) immune globulin (RhoGAM) to prevent Rh isoimmunization in future pregnancies, but there is little evidence that RhoGAM administration is necessary for first-trimester losses.

Note a flushed appearance. Assess the patient’s breathing pattern for Kussmaul’s respirations, a compensatory mechanism that the body uses to attempt to balance the pH by blowing off carbon dioxide. Check for an increased heart rate caused by stimulation of the sympathetic nervous system. To detect changes in cardiac performance, use a cardiac monitor for patients with a pH less than 7 and a potassium level greater than 5 mEq/L. Assess for changes in heart rate, ventricular ectopics, T-wave configuration, QRS, and P-R intervals.

Surgical intervention is needed for specific injuries to organs. Diaphragmatic tears are repaired surgically to prevent visceral herniation in later years. Esophageal injury is often managed with gastric decompression with a nasogastric tube, antibiotic therapy, and surgical repair of the esophageal tear. Gastric injury is managed similarly to esophageal injury, although a partial gastrectomy may be needed if extensive injury has occurred. Liver injury may be managed nonoperatively or operatively, depending on the degree of injury and the amount of bleeding.

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