COMMON MEDICAL – SURGICAL CASES/ DISORDER

A. FLUID AND ELECTROLYTE IMBALANCES

What are electrolyte disorders?

An electrolyte disorder occurs when the levels of electrolytes in your body are
either too high or too low. Electrolytes are naturally occurring elements and
compounds in the body. They control important physiologic functions.

Examples of electrolytes include:

 calcium

 chloride

 magnesium

 phosphate

 potassium

 sodium

 These substances are present in your blood, bodily fluids, and urine.
They’re also ingested with food, drinks, and supplements.
 Electrolytes need to be maintained in an even balance for your body to
function properly. Otherwise, vital body systems can be affected. Severe
electrolyte imbalances can cause serious problems like coma, seizures, and
cardiac arrest.

Symptoms of electrolyte disorders

Mild forms of electrolyte disorders may not cause any symptoms. Such disorders
can go undetected until they are discovered during a routine blood test.
Symptoms usually start to appear once a particular disorder becomes more
severe.

Not all electrolyte imbalances cause the same symptoms, but many share similar
symptoms.

Common symptoms of an electrolyte disorder include:

 irregular heartbeat
 fast heart rate
 fatigue
 lethargy
 convulsions or seizures
 nausea
 vomiting
 diarrhea or constipation
 abdominal cramping
 muscle weakness
 muscle cramping
 irritability
 confusion
 headaches
 numbness and tingling

Causes of electrolyte disorders

Electrolyte disorders are most often caused by a loss of bodily fluids through
prolonged vomiting, diarrhea, or sweating. They may also develop due to fluid
loss related to burns. Certain medications can cause electrolyte disorders as well.
In some cases, underlying diseases are to blame.

The exact cause may vary depending on the specific type of electrolyte disorder.

Types of electrolyte disorders

Elevated levels of an electrolyte are indicated with the prefix “hyper-.” Depleted
levels of an electrolyte are indicated with “hypo-.”

Conditions caused by electrolyte level imbalances include:

 calcium: hypercalcemia and hypocalcemia

 chloride: hyperchloremia and hypochloremia

 magnesium: hypermagnesemia and hypomagnesemia

 phosphate: hyperphosphatemia or hypophosphatemia

 potassium: hyperkalemia and hypokalemia

 sodium: hypernatremia and hyponatremia

Calcium

Calcium is a vital mineral that your body uses to stabilize blood pressure and
control skeletal muscle contraction. It’s also used to build strong bones and
teeth.
Hypercalcemia is when you have too much calcium in the blood. This usually
happens due to:

 hyperparathyroidism

 kidney disease

 thyroid disorders

 lung diseases, such as tuberculosis or sarcoidosis

 certain types of cancer, including lung and breast cancers

 excessive use of antacids and calcium or vitamin D supplements

 medications like lithium, theophylline, or certain water pills

Hypocalcemia is a lack of adequate calcium in the bloodstream. Causes can

include:

 kidney failure

 hypoparathyroidism

 vitamin D deficiency

 pancreatitis

 prostate cancer

 malabsorption

 certain medications, including heparin, osteoporosis medicine, and

antiepileptic drugs

Chloride

Chloride is necessary for maintaining the proper balance of bodily fluids.

Hyperchloremia occurs when there is too much chloride in the body. This can
happen as a result of:

 severe dehydration

 kidney failure

 dialysis
Hypochloremia develops when there is too little chloride in the body. This is
often caused by sodium or potassium problems, as discussed below. Other
causes can include:

 cystic fibrosis

 eating disorders, such as anorexia

 scorpion stings

Magnesium

Magnesium is a critical mineral that regulates many important functions, such

as:

 muscle contraction

 heart rhythm

 nerve function

Hypermagnesemia means excess amounts of magnesium. This is a disorder that

primarily affects people with Addison’s disease and end-stage kidney disease.

Hypomagnesemia means having too little magnesium in the body. Common

causes include:

 alcohol use disorder

 malnutrition

 malabsorption

 chronic diarrhea

 excessive sweating

 heart failure

 certain medications, including some diuretics and antibiotics

Potassium

Potassium is particularly important for regulating heart function. It also helps

maintain healthy nerves and muscles.
Hyperkalemia may develop due to high levels of potassium. This condition can
be fatal if left undiagnosed and untreated. It’s typically triggered by:

 severe dehydration

 severe acidosis, including diabetic ketoacidosis

 certain medications, including some blood pressure medications and

diuretics

 adrenal insufficiency, which is when your cortisol levels are too low

Hypokalemia occurs when potassium levels are too low. This often happens as a
result of:

 eating disorders

 severe vomiting or diarrhea

 dehydration

 certain medications, including laxatives, diuretics, and corticosteroids

Sodium

Sodium is needed in the body to maintain fluid balance and is critical for normal
body function. It also helps to regulate nerve function and muscle contraction.

Hypernatremia happens when there is too much sodium in the blood.

Abnormally high levels of sodium may occur due to:

 inadequate water consumption

 severe dehydration

 excessive loss of bodily fluids as a result of prolonged vomiting, diarrhea,

sweating, or respiratory illness

 certain medications, including corticosteroids

Hyponatremia develops when there is too little sodium. Common causes of low
sodium levels include:

 excessive fluid loss through the skin from sweating or burns

 vomiting or diarrhea
 poor nutrition

 alcohol use disorder

 overhydration

 thyroid, hypothalamic, or adrenal disorders

 liver, heart, or kidney failure

 certain medications, including diuretics and seizure medications

 syndrome of inappropriate secretion of antidiuretic hormone (SIADH)

Phosphate

The kidneys, bones, and intestines work to balance phosphate levels in the body.
Phosphate is necessary for a wide variety of functions and interacts closely with
calcium.

Hyperphosphatemia can occur due to:

 low calcium levels

 chronic kidney disease

 severe breathing difficulties

 underactive parathyroid glands

 severe muscle injury

 tumor lysis syndrome, a result of cancer treatment

 excessive use of phosphate-containing laxatives

Low levels of phosphate, or hypophosphatemia, can be seen in:

 acute alcohol abuse

 severe burns

 starvation

 vitamin D deficiency

 overactive parathyroid glands

 certain medication use, such as intravenous (IV) iron treatment, niacin,

and some antacids
B. NEUROLOGIC DISORDERS
An expert neurologist will state that neurological diseases primarily disturb the
functioning of the spinal cord, nerves, brain, and nervous system. If these
components stop working properly, then it can result in difficulties like
speaking, swallowing, moving, breathing, and learning problems.

STROKE:
A sudden stroke attack occurs when the blood flow to the brain stops which
further damages the brain cells. There are two kinds of stroke attacks,
Hemorrhagic and Ischemic. They are caused due to blood clots or blocking of
the blood vessel. Some of the symptoms of stroke are –
 Dizziness, weakness or sudden numbness of the arm, face or leg
 Severe headache without any reason
 Trouble in understanding or speaking
 Problem in walking, loss of balance and coordination

MIGRAINE:
It is characterized as a chronic neurological disorder where the patient complains
of frequent headaches. Intensity of the headaches can be moderate to severe and
often last for two days or more. The associated symptoms are –
 Frequent vomiting and nausea
 Trouble in vision with complains of seeing spots or flashing lights
 Sensitivity to sound, light and smells
 Speech problems

BRAIN TUMORS:
Such tumors are the result of the rapid growth of abnormal cells in the brain
tissues. Brain tumors can either be malignant i.e. cancerous or benign. The
common signs are –
 Trouble with memory, thinking and poor cognitive abilities
 Seizures and headache
 Problem in walking, talking, seeing and hearing
 Mood swings, weakness and nausea

MULTIPLE SCLEROSIS:
This disease affects the brain and spinal cord nerve cells which are integral for
the proper functioning of the nervous system. The damage done to the myelin
sheath or protective layer surrounding the nerve cells affects the brain. A neuro
care specialist will mention the following symptoms –
 Weakness of muscles
 Sensations ranging from prickling to numbness
 Trouble with thinking and memory
 Visual disturbances
 SPINAL CORD DISORDERS:
Injuries are one of the prevailing reasons for spinal cord disorders. Some other
reasons include blocked blood supply, compressions of the spinal cord by a
tumor or fractured bone and infections. An expert neurologist will tell you to be
aware of the following signs –
 Change in reflexes
 Loss of bladder or bowel control
 Partial or complete paralysis
 Severe back pain and weakness
C. Cardiovascular disease

Cardiovascular disease is a term that refers to more than one disease of the
circulatory system including the heart and blood vessels, whether the blood
vessels are affecting the lungs, the brain, kidneys or other parts of the body.
Cardiovascular diseases are the leading cause of death in adult Canadian men and
women.
The following six types of cardiovascular disease are highlighted below:

1. Ischemic heart disease is the most common type of cardiovascular

disease in Canada and other industrialized countries around the world. It refers
to problems with the circulation of blood to the heart muscle. A partial blockage
of one or more of the coronary arteries can result in a lack of enough oxygenated
blood (ischemia) thus causing symptoms such as angina (chest pain) and
dyspnea (shortness of breath). A complete blockage of an artery causes necrosis
(damage to the tissues) or a myocardial infarction, commonly known as a heart
attack.

2. Cerebrovascular disease (Stroke) refers to a problem with the

circulation of blood in the blood vessels of the brain. A blockage with effects
lasting less than 24 hours is referred to as a transient ischemic attack. A
complete blockage with long-term effects is referred to as a cerebrovascular
thrombosis (clot) or accident or a stroke. Sometimes, a blood vessel in the brain
can burst resulting in long term effects.

3. Peripheral vascular disease affects the circulation primarily in the legs].

Patients with this disease typically complain of pain in their calves especially
when walking.
4. Heart failure occurs when the pumping action of the heart cannot provide
enough blood to the rest of the body as it is needed. This can happen as a result
of damage to the heart muscle, for example from a heart attack, or from
excessive consumption of alcohol, or because of a heart muscle disease also
called a cardiomyopathy. Patients with heart failure usually suffer from
shortness of breath and swelling of the legs.
5. Rheumatic heart disease once common in Canada is a major problem in
many poor countries. This disease begins with a bacterial infection in childhood,
affecting joints and heart valves. The heart problems appear many years later.
Often the valves have to be replaced by an operation.
Other infections can occur attacking the inner tissues of the heart including the
valves (endocarditis) and the outer tissue overlying the heart (pericarditis).

6. Congenital heart disease is a problem with the structure of the heart

arising because of a birth defect. These anatomical defects can be as simple as a
small hole in one of the inside walls of the heart or they can be very complex,
affecting the way blood flows through the heart and lungs. Some congenital
heart problems result in death unless immediately corrected by surgical
intervention. Others cause disability to varying degrees and are treated by
surgery later in life with correction of the problem sometimes requiring more
than a single operation.

D. RESPIRATORY DISORDER
Respiratory illness is a common problem in the United States. Many times,
people are genetically more likely to get respiratory conditions, but your work
place or environmental exposures could also play a big role. One thing is for
sure, smoking is the most common cause of respiratory disease.

Asthma
Asthma is defined as a common, chronic respiratory condition that causes
difficulty breathing due to inflammation of the airways. Asthma symptoms
include dry cough, wheezing, chest tightness and shortness of breath.

Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease is an umbrella term that encompasses
several respiratory illnesses that cause breathlessness, or the inability to exhale
normally. People usually experience symptoms, including shortness of breath,
and normally cough up sputum (mucus from the lungs), especially in the
morning. COPD can be tricky for some people to identify, because symptoms
are often mistaken for the gradual aging process and body deterioration. In fact,
COPD can develop over the course of several years without any signs of
shortness of breath. For that reason, Dr. Meyer says COPD often goes
undetected for far too long. He says the disease usually begins while people are
in their 30s or 40s and then peaks during their 50s, 60s and 70s.

Treatment includes smoking cessation, bronchodilator therapy (medication that

opens the airways) and pulmonary rehabilitation, which is a supervised exercise
program for people with COPD. Unlike asthma, COPD is not reversible.

Chronic Bronchitis
Chronic bronchitis is a form of COPD emphasized by a chronic cough. Usually
people cough up sputum (mucus from the lungs), especially in the morning.

Since chronic bronchitis is a form of COPD, it’s treated the same way. People
can also develop acute bronchitis, which is not a long-term disease but rather an
infectious problem. It develops from a viral or bacterial infection and can be
treated with antibiotics. Symptoms associated with acute bronchitis will
subside once the infection has resolved.
Emphysema
Emphysema is a serious respiratory disease, which is another form of COPD.
The most common cause is smoking. Those who suffer from emphysema have
trouble exhaling air from their lungs. Cigarette smoke damages the air sacs in
the lungs to a point where they can no longer repair themselves.

E. URINARY DISORDERS

Kidney failure, also called renal failure, partial or complete loss

of kidney function. Kidney failure is classified as acute (when the onset is
sudden) or chronic.

Kidney stone, also called renal calculus, plural renal calculi, concretion of
minerals and organic matter that forms in the kidneys. Such stones may
become so large as to impair normal renal function. Urine contains many
salts in solution, and if the concentration of mineral salts becomes excessive,
the excess salt precipitates as crystals that may enlarge to become visible,
solid particles called stones. Kidney stones are classified as primary if they
form without apparent cause, such as an infection or obstruction. They are
classified as secondary if they develop after a renal infection or disorder.

F. HEMATOLOGIC DISORDER

Anemia

An anemia is a decrease in number of red blood cells (RBCs) or less than the
normal quantity of hemoglobin in the blood. However, it can include decreased
oxygen-binding ability of each hemoglobin molecule due to deformity or lack in
numerical development as in some other types of hemoglobin deficiency.
Anemia is the most common disorder of the blood. There are several kinds of
anemia, produced by a variety of underlying causes. Anemia can be classified in
a variety of ways, based on the morphology of RBCs, underlying etiologic
mechanisms, and discernible clinical spectra, to mention a few. The three main
classes of anemia include excessive blood loss (acutely such as a hemorrhage or
chronically through low-volume loss), excessive blood cell destruction
(hemolysis) or deficient red blood cell production (ineffective hematopoiesis).
Based on 2005-2006 estimates, the Centers for Disease Control and
Prevention has stated that approximately 5.5 million Americans a year are either
admitted to a hospital or seen by a physician, with some form of anemia as their
primary diagnosis.
G. GASTROINTESTINAL DISORDERS

Gastroesophageal Reflux Disease (GERD)

When stomach acid backs up into your esophagus — a condition called acid
reflux — you may feel a burning pain in the middle of your chest

Gallstones

Gallstones are hard deposits that form in your gallbladder — a small, pear-
shaped sack that stores and secretes bile for digestion
Celiac Disease a serious sensitivity to gluten, which is a protein found in wheat,
rye, and barley. Eat gluten, and your immune system goes on the attack: It
damages your villi, the finger-like protrusions in your small intestines that help
you absorb nutrients from the foods you eat. Symptoms of celiac disease in
children include abdominal pain and bloating, diarrhea, constipation, vomiting,
and weight loss. Symptoms in adults can also include anemia, fatigue, bone
loss, depression, and seizures.

H. Liver, biliary tract, exocrine pancreatic Disorders

Hepatitis A is the most common and the most infectious, spreading easily
from person to person like most other viruses. It affects millions around the
world and is responsible for more than 2 million deaths a year.

Hepatitis B is acquired through exposure to infected blood, vaginal fluids,

or semen. It's estimated that about 300,000 Canadians have hepatitis B.

Hepatitis C affects about 3.5 million North Americans. About 15% of those
with hepatitis C may have been exposed to infected blood products before
widespread blood testing began.

Hepatitis D is unique because it can only affect those that already have
hepatitis B.

I. METABOLIC DISORDERS

Tay-Sachs

Tay-Sachs is a disease that causes a progressive deterioration of the body's brain

and neurological system. The condition can lead to eventual deafness, blindness
or paralysis. Most instances of Tay-Sachs disease are diagnosed by the time a
child is 6 months old, although the condition can remain latent until adolescence
or adulthood. One common symptom of Tay-Sachs is a red dot in the back of the
eyes. A diagnosis usually is confirmed by a DNA test for the gene.

Wilson's Disease

Wilson's disease often goes undiagnosed, because symptoms don't appear until it
is too late to treat. Wilson's disease causes an overabundance of copper to
accumulate in the liver. The buildup eventually causes liver damage, cirrhosis
and liver failure. Copper also can be released into other body systems and cause
damage to the brain, eyes or red blood cells. Urinary and blood tests are used to
diagnose the condition, confirmed by genetic DNA testing. People who are born
with Wilson's disease receive an abnormal gene from both parents who may or
may not have mild liver disorder symptoms. Wilson's disease is treated with
dietary changes and medication. A liver transplant is required if damage causes
liver failure.
J. Emergency nursing

In addition to addressing these "true emergencies," emergency nurses

increasingly care for people who are unwilling or unable to get primary medical
care elsewhere and come to emergency departments for help.
Besides heart attacks, strokes, gunshot wounds and car accidents, emergency
nurses also tend to patients with acute alcohol and/or drug intoxication,
psychiatric and behavioral problems and those who have been raped.
They must be adept at working with patients of many different backgrounds,
cultures, religions, ages and types of disabilities. Emergency nurses must also
have a good working knowledge of the many legal issues impacting health care
such as consent, handling of evidence, mandatory reporting of child and elder
abuse and involuntary psychiatric holds.
In their role as patient educators, they must have a thorough knowledge of
anatomy, physiology, pharmacology and psychology and be able to
communicate effectively with patients and their families.
An emergency nurse is typically assigned to triage patients as they arrive in
the emergency department and as such are the first professional patients see.
Therefore, the emergency nurse must be skilled at rapid, accurate physical
examination, early recognition of life-threatening conditions. In some cases,
emergency nurses may order certain tests and medications following
"collaborative practice guidelines" or "standing orders" set out by the hospital's
emergency physician staff.