Diseases & Disorders - A Nursing Therapeutic Manual : a by Marilyn Sommers

By Marilyn Sommers

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PHYSICAL EXAMINATION Metabolic Acidosis. Inspect the patient’s skin, noting if it feels warm. 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.

It can occur during the prenatal or intrapartum period. In a marginal abruption, separation begins at the periphery and bleeding accumulates between the membranes and the uterus and eventually passes through the cervix, becoming an external hemorrhage. In a central abruption, the separation occurs in the middle, and bleeding is trapped between the detached placenta and the uterus, concealing the hemorrhage. Frank vaginal bleeding also does not occur if the fetal head is tightly engaged. Since bleeding can be concealed, note that the apparent bleeding does not always indicate actual blood loss.

Common symptoms include night sweats, lymphadenopathy, fever, weight loss, fatigue, and rash. Gastrointestinal (GI) disturbances such as nausea, vomiting, diarrhea, and anorexia are common. The patient may describe neurological manifestations, including headache, lightheadedness, memory loss, word-finding difficulty, inability to concentrate, and mood swings. Patients may notice gait disturbance, a “stiff” neck and pain, burning, numbness, and tingling in the extremities. A history of infections such as tuberculosis, herpes, hepatitis B, fungal infections, or STIs is common in the HIV and AIDS population.

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