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statpearls_NBK430685\nurse-article-35872_1 | Acute Scrotum Pain (Nursing) -- Introduction | The acute scrotum is defined as “the constellation of new onset pain, swelling, and/or tenderness of the intrascrotal contents.” Patients may describe the onset of symptoms as rapidly as occurring within minutes or up to 1 to 2 days dependent on the etiology. The acute scrotum is an umbrella term that includes a wide variety of unique disease processes. Rapid evaluation and diagnostics are necessary due to the time dependency of certain morbid but reversible conditions, such as acute testicular torsion. | Acute Scrotum Pain (Nursing) -- Introduction. The acute scrotum is defined as “the constellation of new onset pain, swelling, and/or tenderness of the intrascrotal contents.” Patients may describe the onset of symptoms as rapidly as occurring within minutes or up to 1 to 2 days dependent on the etiology. The acute scrotum is an umbrella term that includes a wide variety of unique disease processes. Rapid evaluation and diagnostics are necessary due to the time dependency of certain morbid but reversible conditions, such as acute testicular torsion. |
statpearls_NBK430685\nurse-article-35872_2 | Acute Scrotum Pain (Nursing) -- Introduction | Knowledge of the relevant anatomy is essential to understanding the differential diagnosis and subsequent steps in the evaluation. The testes are ovoid-shaped organs roughly 3 cm to 5 cm by 3 cm by 3 cm and vertically-oriented. The tunica albuginea envelops them with continuous internal septations converging into a mediastinum testis which acts as the structural support for the organ. This, in turn, is enveloped by the tunica vaginalis. Posterolateral to the testis is the epididymis, a curved structure roughly 6 cm to 7 cm in its longest dimension. Its efferent ductules converge to form the ductus epididymis and eventually the vas deferens. | Acute Scrotum Pain (Nursing) -- Introduction. Knowledge of the relevant anatomy is essential to understanding the differential diagnosis and subsequent steps in the evaluation. The testes are ovoid-shaped organs roughly 3 cm to 5 cm by 3 cm by 3 cm and vertically-oriented. The tunica albuginea envelops them with continuous internal septations converging into a mediastinum testis which acts as the structural support for the organ. This, in turn, is enveloped by the tunica vaginalis. Posterolateral to the testis is the epididymis, a curved structure roughly 6 cm to 7 cm in its longest dimension. Its efferent ductules converge to form the ductus epididymis and eventually the vas deferens. |
statpearls_NBK430685\nurse-article-35872_3 | Acute Scrotum Pain (Nursing) -- Introduction | The vascular anatomy of the scrotal contents is also important to review. The testes receive a joint supply of blood from the testicular artery, deferential artery, and the cremasteric artery. While the deferential artery and the cremasteric artery are branches of the inferior vesical and inferior epigastric artery, respectively, the testicular artery branches directly from the abdominal aorta. The testes are drained via small branching veins forming the pampiniform plexus and ultimately the testicular vein. Notably, the testicular vein drains directly into the inferior vena cava on the right while it drains into the left renal vein contralaterally. | Acute Scrotum Pain (Nursing) -- Introduction. The vascular anatomy of the scrotal contents is also important to review. The testes receive a joint supply of blood from the testicular artery, deferential artery, and the cremasteric artery. While the deferential artery and the cremasteric artery are branches of the inferior vesical and inferior epigastric artery, respectively, the testicular artery branches directly from the abdominal aorta. The testes are drained via small branching veins forming the pampiniform plexus and ultimately the testicular vein. Notably, the testicular vein drains directly into the inferior vena cava on the right while it drains into the left renal vein contralaterally. |
statpearls_NBK430685\nurse-article-35872_4 | Acute Scrotum Pain (Nursing) -- Introduction | The vascular structures, vas deferens, and nerves are all bound within the spermatic cord, a conduit allowing passage from the peritoneum to the scrotum via the inguinal canal. The cremaster muscle is also found within the spermatic cord. The tunica vaginalis usually surrounds only part of the testis and epididymis and then attaches posteriorly to the scrotal wall. However, when the tunica vaginally surrounds the testis and part of the spermatic cord, the testicle is no longer fixed to the scrotal wall and able to twist freely. This is known as the Bell-Clapper deformity and has an incidence of up to 12%. [1] [2] [3] | Acute Scrotum Pain (Nursing) -- Introduction. The vascular structures, vas deferens, and nerves are all bound within the spermatic cord, a conduit allowing passage from the peritoneum to the scrotum via the inguinal canal. The cremaster muscle is also found within the spermatic cord. The tunica vaginalis usually surrounds only part of the testis and epididymis and then attaches posteriorly to the scrotal wall. However, when the tunica vaginally surrounds the testis and part of the spermatic cord, the testicle is no longer fixed to the scrotal wall and able to twist freely. This is known as the Bell-Clapper deformity and has an incidence of up to 12%. [1] [2] [3] |
statpearls_NBK430685\nurse-article-35872_5 | Acute Scrotum Pain (Nursing) -- Nursing Diagnosis | Scrotal pain Testicular torsion Epididymitis Anxiety | Acute Scrotum Pain (Nursing) -- Nursing Diagnosis. Scrotal pain Testicular torsion Epididymitis Anxiety |
statpearls_NBK430685\nurse-article-35872_6 | Acute Scrotum Pain (Nursing) -- Causes | The causative etiologies of an acute scrotum are broad include those who are ischemic, traumatic, infectious, inflammatory, neuropathic, acute or chronic, or idiopathic. Given the nature of these, an acute scrotum should be considered analogous to patients presenting with an acute abdomen. By far the most common causes are epididymitis/epididymal-orchitis, testicular appendage torsion, spermatic cord torsion (commonly referred to as testicular torsion), varicoceles, and inguinal hernias. The incidence and frequency of these etiologies are highly variable by age groups. Acute scrotal pain in children is much more likely to represent torsion of the spermatic cord or testicular appendages whereas patient older than 25 are much more likely to have epididymitis. A complete differential diagnosis is discussed later. [4] [5] [6] | Acute Scrotum Pain (Nursing) -- Causes. The causative etiologies of an acute scrotum are broad include those who are ischemic, traumatic, infectious, inflammatory, neuropathic, acute or chronic, or idiopathic. Given the nature of these, an acute scrotum should be considered analogous to patients presenting with an acute abdomen. By far the most common causes are epididymitis/epididymal-orchitis, testicular appendage torsion, spermatic cord torsion (commonly referred to as testicular torsion), varicoceles, and inguinal hernias. The incidence and frequency of these etiologies are highly variable by age groups. Acute scrotal pain in children is much more likely to represent torsion of the spermatic cord or testicular appendages whereas patient older than 25 are much more likely to have epididymitis. A complete differential diagnosis is discussed later. [4] [5] [6] |
statpearls_NBK430685\nurse-article-35872_7 | Acute Scrotum Pain (Nursing) -- Risk Factors | There is little data which specifically reports the incidence of the acute scrotum as a presenting complaint, but male genitourinary complaints are estimated at between 0.5% and 2.5% of all emergency department visits. The annual incidence of testicular torsion, however, is estimated 1 in 4000. This means however that an estimated 1 in every 160 men will experience spermatic cord torsion within their first 25 years of life. Although it is possible to occur at any age, the incidence drops off dramatically in the adult years. Even among children, however, the most common cause of acute scrotal pain is torsion of the appendix testis rather than that of the spermatic cord. | Acute Scrotum Pain (Nursing) -- Risk Factors. There is little data which specifically reports the incidence of the acute scrotum as a presenting complaint, but male genitourinary complaints are estimated at between 0.5% and 2.5% of all emergency department visits. The annual incidence of testicular torsion, however, is estimated 1 in 4000. This means however that an estimated 1 in every 160 men will experience spermatic cord torsion within their first 25 years of life. Although it is possible to occur at any age, the incidence drops off dramatically in the adult years. Even among children, however, the most common cause of acute scrotal pain is torsion of the appendix testis rather than that of the spermatic cord. |
statpearls_NBK430685\nurse-article-35872_8 | Acute Scrotum Pain (Nursing) -- Risk Factors | Epididymitis is the most common cause of acute scrotal pain in adults. It is estimated that over 600,000 cases are diagnosed in United States (US) emergency departments each year, and this condition was responsible for 1 out of every 144 outpatient visits for men between 18 and 50 years of age. The condition tends to have a bimodal age incidence due to differing microbiological etiologies and risk factors. [7] [8] | Acute Scrotum Pain (Nursing) -- Risk Factors. Epididymitis is the most common cause of acute scrotal pain in adults. It is estimated that over 600,000 cases are diagnosed in United States (US) emergency departments each year, and this condition was responsible for 1 out of every 144 outpatient visits for men between 18 and 50 years of age. The condition tends to have a bimodal age incidence due to differing microbiological etiologies and risk factors. [7] [8] |
statpearls_NBK430685\nurse-article-35872_9 | Acute Scrotum Pain (Nursing) -- Assessment | A focused history and physical examination are essential in the evaluation of the acute scrotum. A patient should be interviewed and asked about the onset and duration of symptoms as well as whether they have been continuous or intermittent. The clinical should ask about the history of increased activity, physical exertion, heavy lifting, or direct trauma as well as any objective external signs such as swelling, urethral discharge, erythema, rash, or skin color changes. Associated symptoms such as fevers, dysuria, frequency, urgency, hematospermia, abdominal pain, back pain, or weight loss should be required. It is also important to ask about relevant comorbid conditions including diabetes, congestive heart failure or any immunocompromised state. A sexual history should also be reviewed including number and gender of sexual partners, use of barrier contraceptives (condoms), and history of diagnosis of or treatment for sexually transmitted illnesses. | Acute Scrotum Pain (Nursing) -- Assessment. A focused history and physical examination are essential in the evaluation of the acute scrotum. A patient should be interviewed and asked about the onset and duration of symptoms as well as whether they have been continuous or intermittent. The clinical should ask about the history of increased activity, physical exertion, heavy lifting, or direct trauma as well as any objective external signs such as swelling, urethral discharge, erythema, rash, or skin color changes. Associated symptoms such as fevers, dysuria, frequency, urgency, hematospermia, abdominal pain, back pain, or weight loss should be required. It is also important to ask about relevant comorbid conditions including diabetes, congestive heart failure or any immunocompromised state. A sexual history should also be reviewed including number and gender of sexual partners, use of barrier contraceptives (condoms), and history of diagnosis of or treatment for sexually transmitted illnesses. |
statpearls_NBK430685\nurse-article-35872_10 | Acute Scrotum Pain (Nursing) -- Assessment | Physical examination should include a visual inspection of the fully exposed abdomen, groins, penis, and scrotum. Care should be taken to note any rashes, ulcers, abnormal scrotal asymmetry (it is normal for the left hemiscrotum to hang slightly lower) or horizontal position of a testicle. The scrotum, perineum, and thighs should be palpated to feel for the presence of crepitance or subcutaneous emphysema. The scrotal contents should be palpated to compare the relative sizes of the testes, detect any obvious intratesticular masses, or other scrotal contents such as hernias. The urethra should be inspected for discharge. Finally, the clinician should investigate bilaterally for the presence of a cremasteric reflex. | Acute Scrotum Pain (Nursing) -- Assessment. Physical examination should include a visual inspection of the fully exposed abdomen, groins, penis, and scrotum. Care should be taken to note any rashes, ulcers, abnormal scrotal asymmetry (it is normal for the left hemiscrotum to hang slightly lower) or horizontal position of a testicle. The scrotum, perineum, and thighs should be palpated to feel for the presence of crepitance or subcutaneous emphysema. The scrotal contents should be palpated to compare the relative sizes of the testes, detect any obvious intratesticular masses, or other scrotal contents such as hernias. The urethra should be inspected for discharge. Finally, the clinician should investigate bilaterally for the presence of a cremasteric reflex. |
statpearls_NBK430685\nurse-article-35872_11 | Acute Scrotum Pain (Nursing) -- Assessment | A “high-riding” asymmetrical testicle with an abnormal lay and loss of ipsilateral cremasteric reflex is historically described as the classic presentation of acute testicular torsion. However, this dogmatic description of the classic presentation is not universally observed in all cases and may lead to misdiagnosis or delay in definitive treatment. The cremasteric reflex is fickle and may be absent in up to 30% of normal males without any pathology. Conversely, several case series report patients with surgically confirmed testicular torsion may still have preserved cremasteric reflexes anywhere from 8% to 30% of the time. Other scrotal pathology such as epididymo-orchitis may also result in loss of a normal reflex. | Acute Scrotum Pain (Nursing) -- Assessment. A “high-riding” asymmetrical testicle with an abnormal lay and loss of ipsilateral cremasteric reflex is historically described as the classic presentation of acute testicular torsion. However, this dogmatic description of the classic presentation is not universally observed in all cases and may lead to misdiagnosis or delay in definitive treatment. The cremasteric reflex is fickle and may be absent in up to 30% of normal males without any pathology. Conversely, several case series report patients with surgically confirmed testicular torsion may still have preserved cremasteric reflexes anywhere from 8% to 30% of the time. Other scrotal pathology such as epididymo-orchitis may also result in loss of a normal reflex. |
statpearls_NBK430685\nurse-article-35872_12 | Acute Scrotum Pain (Nursing) -- Evaluation | Evaluation first begins with a history and physical examination. If the diagnosis of spermatic cord torsion is strongly suspected, then an emergency surgical consultation is warranted without further delay. The “classic” cutoff for salvage of testicular torsion is surgical exploration and detorsion within six hours of symptoms onset. This does not mean however that prompt evaluation and definitive surgical exploration be delayed for patients in whom symptoms have been present for greater than 6 hours. The salvage rates do drop to between 80% to 88%% at 12 hours, 31% at 24 hours, and only 2.6% at 48 hours. This may be due to variable degrees or torsion (incomplete torsion) or torsion-detorsion phenomena. | Acute Scrotum Pain (Nursing) -- Evaluation. Evaluation first begins with a history and physical examination. If the diagnosis of spermatic cord torsion is strongly suspected, then an emergency surgical consultation is warranted without further delay. The “classic” cutoff for salvage of testicular torsion is surgical exploration and detorsion within six hours of symptoms onset. This does not mean however that prompt evaluation and definitive surgical exploration be delayed for patients in whom symptoms have been present for greater than 6 hours. The salvage rates do drop to between 80% to 88%% at 12 hours, 31% at 24 hours, and only 2.6% at 48 hours. This may be due to variable degrees or torsion (incomplete torsion) or torsion-detorsion phenomena. |
statpearls_NBK430685\nurse-article-35872_13 | Acute Scrotum Pain (Nursing) -- Evaluation | Provided it does not delay definitive surgical consultation, additional studies which may be useful include complete blood counts, urinalysis with microscopy, urine culture, and urethral swabs for gonorrhea and chlamydia. For systemically ill patients or those presenting with sepsis, blood cultures, inflammatory markers, and cross-sectional imaging of the pelvis through the mid-thighs may be considered. | Acute Scrotum Pain (Nursing) -- Evaluation. Provided it does not delay definitive surgical consultation, additional studies which may be useful include complete blood counts, urinalysis with microscopy, urine culture, and urethral swabs for gonorrhea and chlamydia. For systemically ill patients or those presenting with sepsis, blood cultures, inflammatory markers, and cross-sectional imaging of the pelvis through the mid-thighs may be considered. |
statpearls_NBK430685\nurse-article-35872_14 | Acute Scrotum Pain (Nursing) -- Evaluation | Doppler ultrasonography is the most appropriate imaging modality for evaluation of the acute scrotum when it does not delay definitive surgical consultation in cases of presumed torsion. The sensitivity of color Doppler ultrasound is reported to range between 96% to 100% with a specificity of between 84% to 95%. A body of literature exists which also supports the role of point-of-care ultrasound by the treatment provider for the evaluation of the acute scrotum. A detailed review of this technique is beyond the scope of this article, but findings on ultrasound suggestive of testicular torsion include an enlarged, homogenous, hypoechoic testicle with absent color flow or spectral Doppler waveforms suggesting increased vascular resistive index. The spermatic cord torsion may also be directly observed with ultrasound; a finding described as the “whirlpool” or “snail” sign. | Acute Scrotum Pain (Nursing) -- Evaluation. Doppler ultrasonography is the most appropriate imaging modality for evaluation of the acute scrotum when it does not delay definitive surgical consultation in cases of presumed torsion. The sensitivity of color Doppler ultrasound is reported to range between 96% to 100% with a specificity of between 84% to 95%. A body of literature exists which also supports the role of point-of-care ultrasound by the treatment provider for the evaluation of the acute scrotum. A detailed review of this technique is beyond the scope of this article, but findings on ultrasound suggestive of testicular torsion include an enlarged, homogenous, hypoechoic testicle with absent color flow or spectral Doppler waveforms suggesting increased vascular resistive index. The spermatic cord torsion may also be directly observed with ultrasound; a finding described as the “whirlpool” or “snail” sign. |
statpearls_NBK430685\nurse-article-35872_15 | Acute Scrotum Pain (Nursing) -- Evaluation | Conversely, infectious etiologies of the acute scrotum cause an increase in blood flow to the testicle or epididymis, which is apparent of Doppler imaging. Resistive indices of the testicle may be abnormally low, and the testicle or epididymis will again be larger than the asymmetry side. Abscesses may also be identified, as well as the presence of subcutaneous gas within the scrotal wall. | Acute Scrotum Pain (Nursing) -- Evaluation. Conversely, infectious etiologies of the acute scrotum cause an increase in blood flow to the testicle or epididymis, which is apparent of Doppler imaging. Resistive indices of the testicle may be abnormally low, and the testicle or epididymis will again be larger than the asymmetry side. Abscesses may also be identified, as well as the presence of subcutaneous gas within the scrotal wall. |
statpearls_NBK430685\nurse-article-35872_16 | Acute Scrotum Pain (Nursing) -- Evaluation | Other imaging modalities are also available. Radionuclide scrotal imaging (RNSI) was at one point the primary modality since its implementation in the 1970s. In the differentiation of testicular torsion and epididymo-orchitis, there is a reported sensitivity range of 89% to 98% and specificity of 90% to 100%. However, this modality is prone to false positives particularly in cases of spermatocele, hydrocele, and inguinal hernias and may lead to unnecessary surgical exploration when compared to modern ultrasonography. MRI had 93% sensitivity and 100% specificity for diagnosing torsion; however, availability and length of time required to complete may limit its appropriateness. CT imaging is useful when there is a concern for necrotizing skin and soft tissue infections and Fournier’s gangrene. [9] [10] [11] | Acute Scrotum Pain (Nursing) -- Evaluation. Other imaging modalities are also available. Radionuclide scrotal imaging (RNSI) was at one point the primary modality since its implementation in the 1970s. In the differentiation of testicular torsion and epididymo-orchitis, there is a reported sensitivity range of 89% to 98% and specificity of 90% to 100%. However, this modality is prone to false positives particularly in cases of spermatocele, hydrocele, and inguinal hernias and may lead to unnecessary surgical exploration when compared to modern ultrasonography. MRI had 93% sensitivity and 100% specificity for diagnosing torsion; however, availability and length of time required to complete may limit its appropriateness. CT imaging is useful when there is a concern for necrotizing skin and soft tissue infections and Fournier’s gangrene. [9] [10] [11] |
statpearls_NBK430685\nurse-article-35872_17 | Acute Scrotum Pain (Nursing) -- Medical Management | The definitive treatment of testicular torsion is surgical exploration and detorsion, usually followed by orchiopexy to prevent recurrent torsion. Manual detorsion can and often should be attempted at the bedside although its success rate is widely variable and has been reported to range from 25% to 80%. In patients with testicular torsion, the affected testicle is rotated medially. Therefore, manual detorsion should be attempted first from a medial-to-lateral direction (“opening of the book”) and may require 180 to 720 more degrees. Specifically, this requires a counterclockwise rotation of the patient's right testicle or a clockwise rotation of the patient's left testicle, similar to the action of opening the spine of a book. Manual detorsion is contraindicated if pain and/or suspected torsion have been present for longer than 6 hours. Point-of-care ultrasound may be usefully in evaluating the direction and effectiveness of this maneuver. Successful manual detorsion should result in near immediate relief of pain. Surgical exploration is still mandated even in the event manual detorsion is successful. | Acute Scrotum Pain (Nursing) -- Medical Management. The definitive treatment of testicular torsion is surgical exploration and detorsion, usually followed by orchiopexy to prevent recurrent torsion. Manual detorsion can and often should be attempted at the bedside although its success rate is widely variable and has been reported to range from 25% to 80%. In patients with testicular torsion, the affected testicle is rotated medially. Therefore, manual detorsion should be attempted first from a medial-to-lateral direction (“opening of the book”) and may require 180 to 720 more degrees. Specifically, this requires a counterclockwise rotation of the patient's right testicle or a clockwise rotation of the patient's left testicle, similar to the action of opening the spine of a book. Manual detorsion is contraindicated if pain and/or suspected torsion have been present for longer than 6 hours. Point-of-care ultrasound may be usefully in evaluating the direction and effectiveness of this maneuver. Successful manual detorsion should result in near immediate relief of pain. Surgical exploration is still mandated even in the event manual detorsion is successful. |
statpearls_NBK430685\nurse-article-35872_18 | Acute Scrotum Pain (Nursing) -- Medical Management | Treatment of epididymitis is discussed in detail in its respective article with antimicrobial therapy directed toward the most likely causative organism. [12] [11] | Acute Scrotum Pain (Nursing) -- Medical Management. Treatment of epididymitis is discussed in detail in its respective article with antimicrobial therapy directed toward the most likely causative organism. [12] [11] |
statpearls_NBK430685\nurse-article-35872_19 | Acute Scrotum Pain (Nursing) -- Nursing Management | Pain relief Antibiotics for acute epididymitis Keep patient NPO if testicular torsion IV fluids if patient going for surgery Wound check Urine output Manage anxiety | Acute Scrotum Pain (Nursing) -- Nursing Management. Pain relief Antibiotics for acute epididymitis Keep patient NPO if testicular torsion IV fluids if patient going for surgery Wound check Urine output Manage anxiety |
statpearls_NBK430685\nurse-article-35872_20 | Acute Scrotum Pain (Nursing) -- When To Seek Help | If scrotal pain worsens High fever Unstable hemodynamics Inability to void Persistent nausea and vomiting | Acute Scrotum Pain (Nursing) -- When To Seek Help. If scrotal pain worsens High fever Unstable hemodynamics Inability to void Persistent nausea and vomiting |
statpearls_NBK430685\nurse-article-35872_21 | Acute Scrotum Pain (Nursing) -- Coordination of Care | The majority of people with acute scrotal pain initially present to the emergency department, and thus, the triage nurse should be fully aware of causes that are urgent and demand immediate medical attention and those that are elective. In many cases, the urologist will need to be consulted to determine the final diagnosis. The role of the radiologist is vital as some type of imaging study is usually required to confirm the diagnosis. The nurse is also important for educating the patient on scrotal disorders like epididymitis which may be associated with sexual activity. Patients who have been diagnosed with torsion should be told to avoid sporting activities unless cleared by the urologist, as there is a small risk of recurrence. [13] [14] (Level III) Only by having an integrated pathway of best practices can one make the diagnosis of urological disorders and lower the morbidity. | Acute Scrotum Pain (Nursing) -- Coordination of Care. The majority of people with acute scrotal pain initially present to the emergency department, and thus, the triage nurse should be fully aware of causes that are urgent and demand immediate medical attention and those that are elective. In many cases, the urologist will need to be consulted to determine the final diagnosis. The role of the radiologist is vital as some type of imaging study is usually required to confirm the diagnosis. The nurse is also important for educating the patient on scrotal disorders like epididymitis which may be associated with sexual activity. Patients who have been diagnosed with torsion should be told to avoid sporting activities unless cleared by the urologist, as there is a small risk of recurrence. [13] [14] (Level III) Only by having an integrated pathway of best practices can one make the diagnosis of urological disorders and lower the morbidity. |
statpearls_NBK430685\nurse-article-35872_22 | Acute Scrotum Pain (Nursing) -- Coordination of Care -- Outcomes | The prognosis of acute scrotal pain depends on the cause. In patients with epididymitis, pain improves within several days of treatment, but the induration may last weeks or months. Some diabetics may develop an abscess and sepsis is a potential consequence. In patients who developed epididymitis secondary to sexual activity, the partner needs to be referred and treated, to stop the cycle of transmission. For patients with a diagnosis of testicular torsion, the diagnosis depends on early diagnosis and treatment. If the treatment is delayed by 12-24 hours, the risk of losing testis and infertility is high. [15] [16] [17] (Level V) | Acute Scrotum Pain (Nursing) -- Coordination of Care -- Outcomes. The prognosis of acute scrotal pain depends on the cause. In patients with epididymitis, pain improves within several days of treatment, but the induration may last weeks or months. Some diabetics may develop an abscess and sepsis is a potential consequence. In patients who developed epididymitis secondary to sexual activity, the partner needs to be referred and treated, to stop the cycle of transmission. For patients with a diagnosis of testicular torsion, the diagnosis depends on early diagnosis and treatment. If the treatment is delayed by 12-24 hours, the risk of losing testis and infertility is high. [15] [16] [17] (Level V) |
statpearls_NBK430685\nurse-article-35872_23 | Acute Scrotum Pain (Nursing) -- Health Teaching and Health Promotion | Educate patient on surgery for testicular torsion Educate patient on management of acute epididymitis Hand washing and prevention of infection Safe sex practices | Acute Scrotum Pain (Nursing) -- Health Teaching and Health Promotion. Educate patient on surgery for testicular torsion Educate patient on management of acute epididymitis Hand washing and prevention of infection Safe sex practices |
statpearls_NBK430685\nurse-article-35872_24 | Acute Scrotum Pain (Nursing) -- Pearls and Other issues | Points to remember: The acute scrotum should be approached similarly to the acute abdomen. The differential diagnosis is broad but may be narrowed based on the patient’s demographics, risk factors, history and physical examination. The most common etiology of acute scrotal pain in adults is epididymitis/epididymo-orchitis. Suspected testicular torsion is a time-dependent surgical emergency and consultation should be not delayed. The most appropriate imaging modality is usually Doppler ultrasound. Despite “classic” presentations, a cremasteric reflex does not definitively confirm nor exclude torsion, and the testicle may be salvageable long after the 6-hour window. | Acute Scrotum Pain (Nursing) -- Pearls and Other issues. Points to remember: The acute scrotum should be approached similarly to the acute abdomen. The differential diagnosis is broad but may be narrowed based on the patient’s demographics, risk factors, history and physical examination. The most common etiology of acute scrotal pain in adults is epididymitis/epididymo-orchitis. Suspected testicular torsion is a time-dependent surgical emergency and consultation should be not delayed. The most appropriate imaging modality is usually Doppler ultrasound. Despite “classic” presentations, a cremasteric reflex does not definitively confirm nor exclude torsion, and the testicle may be salvageable long after the 6-hour window. |
statpearls_NBK430685\nurse-article-35872_25 | Acute Scrotum Pain (Nursing) -- Review Questions | Access free multiple choice questions on this topic. Comment on this article. | Acute Scrotum Pain (Nursing) -- Review Questions. Access free multiple choice questions on this topic. Comment on this article. |
statpearls_NBK430685\nurse-article-36052_0 | Type 2 Diabetes (Nursing) -- Learning Outcome | Identify appropriate nursing diagnoses for patients with type 2 diabetes mellitus Describe medical management of type 2 diabetes mellitus Discuss nursing management of type 2 diabetes mellitus | Type 2 Diabetes (Nursing) -- Learning Outcome. Identify appropriate nursing diagnoses for patients with type 2 diabetes mellitus Describe medical management of type 2 diabetes mellitus Discuss nursing management of type 2 diabetes mellitus |
statpearls_NBK430685\nurse-article-36052_1 | Type 2 Diabetes (Nursing) -- Introduction | Diabetes mellitus is an increasingly prevalent condition. [1] [2] This condition is characterized by hyperglycemia. The two main types of diabetes are type 1 diabetes mellitus and type 2 diabetes mellitus, with type 2 diabetes accounting for 90% of all cases. Other types of diabetes mellitus include gestational diabetes, drug-induced diabetes, and monogenic diabetes. Complications of diabetes mellitus affect all body systems and can include lethal consequences. The purpose of this article is to review nursing diagnoses, causes, risk factors, assessment, evaluation, medical management, nursing management, and other aspects of importance to nurses. | Type 2 Diabetes (Nursing) -- Introduction. Diabetes mellitus is an increasingly prevalent condition. [1] [2] This condition is characterized by hyperglycemia. The two main types of diabetes are type 1 diabetes mellitus and type 2 diabetes mellitus, with type 2 diabetes accounting for 90% of all cases. Other types of diabetes mellitus include gestational diabetes, drug-induced diabetes, and monogenic diabetes. Complications of diabetes mellitus affect all body systems and can include lethal consequences. The purpose of this article is to review nursing diagnoses, causes, risk factors, assessment, evaluation, medical management, nursing management, and other aspects of importance to nurses. |
statpearls_NBK430685\nurse-article-36052_2 | Type 2 Diabetes (Nursing) -- Nursing Diagnosis | Some nursing diagnoses which might be appropriate for patients with a medical diagnosis of diabetes mellitus include impaired skin integrity if a superficial rash is present, impaired tissue integrity if a wound is present, deficient knowledge, imbalanced nutrition, and ineffective health maintenance. If the disease is not properly managed, this can result in hospitalization, fluid volume deficit with extreme hyperglycemia such s diabetic ketoacidosis, risk for falls in the presence of dizziness, peripheral neuropathy, or vision alterations (i.e., blurred vision or diabetic retinopathy), risk for infection with chronic hyperglycemia especially in the presence of an open wound, risk for injury if there is nerve damage such as peripheral neuropathy, and risk for unstable blood glucose if the blood glucose fluctuates significantly from hyperglycemia to hypoglycemia within a short time frame. | Type 2 Diabetes (Nursing) -- Nursing Diagnosis. Some nursing diagnoses which might be appropriate for patients with a medical diagnosis of diabetes mellitus include impaired skin integrity if a superficial rash is present, impaired tissue integrity if a wound is present, deficient knowledge, imbalanced nutrition, and ineffective health maintenance. If the disease is not properly managed, this can result in hospitalization, fluid volume deficit with extreme hyperglycemia such s diabetic ketoacidosis, risk for falls in the presence of dizziness, peripheral neuropathy, or vision alterations (i.e., blurred vision or diabetic retinopathy), risk for infection with chronic hyperglycemia especially in the presence of an open wound, risk for injury if there is nerve damage such as peripheral neuropathy, and risk for unstable blood glucose if the blood glucose fluctuates significantly from hyperglycemia to hypoglycemia within a short time frame. |
statpearls_NBK430685\nurse-article-36052_3 | Type 2 Diabetes (Nursing) -- Causes | Type 1 diabetes mellitus involves an autoimmune process whereby the body destroys the islets of Langerhans, which are pancreatic cells responsible for producing insulin; therefore, the body lacks the ability to produce insulin altogether. In type 2 diabetes mellitus, the body cannot properly utilize insulin, commonly referred to as “insulin resistance.” Insulin production can eventually decrease. Drug-induced diabetes can occur in patients who receive corticosteroids. Sometimes the patient’s diabetes resolves once the corticosteroids are discontinued; however, sometimes, the patient’s diabetes persists despite discontinuation of the corticosteroids. | Type 2 Diabetes (Nursing) -- Causes. Type 1 diabetes mellitus involves an autoimmune process whereby the body destroys the islets of Langerhans, which are pancreatic cells responsible for producing insulin; therefore, the body lacks the ability to produce insulin altogether. In type 2 diabetes mellitus, the body cannot properly utilize insulin, commonly referred to as “insulin resistance.” Insulin production can eventually decrease. Drug-induced diabetes can occur in patients who receive corticosteroids. Sometimes the patient’s diabetes resolves once the corticosteroids are discontinued; however, sometimes, the patient’s diabetes persists despite discontinuation of the corticosteroids. |
statpearls_NBK430685\nurse-article-36052_4 | Type 2 Diabetes (Nursing) -- Risk Factors | Multiple factors increase the risk of developing diabetes mellitus. Risk factors for type 2 diabetes mellitus include belonging to a certain ethnic group (Native American, African American, Hispanic, Asian American, Pacific Islander), being increased in age, being overweight or obese, family history of diabetes, history of heart disease, or hypertension, hyperlipidemia, and history of gestational diabetes. | Type 2 Diabetes (Nursing) -- Risk Factors. Multiple factors increase the risk of developing diabetes mellitus. Risk factors for type 2 diabetes mellitus include belonging to a certain ethnic group (Native American, African American, Hispanic, Asian American, Pacific Islander), being increased in age, being overweight or obese, family history of diabetes, history of heart disease, or hypertension, hyperlipidemia, and history of gestational diabetes. |
statpearls_NBK430685\nurse-article-36052_5 | Type 2 Diabetes (Nursing) -- Assessment | Various tools designed to assess the risk of cardiac disease are available for categorizing risk. [3] A patient’s history will include an assessment for risk factors such as a family history of diabetes, ethnicity, and increased age (>40 years old). A physical assessment will involve calculating the body mass index and possibly a visual inspection for acanthosis nigricans in pediatric patients. [4] [5] [6] A medical history combined with physical assessment findings (such as having a body mass index >25 kg/m2) may trigger the healthcare provider to screen the patient for diabetes mellitus with laboratory testing. | Type 2 Diabetes (Nursing) -- Assessment. Various tools designed to assess the risk of cardiac disease are available for categorizing risk. [3] A patient’s history will include an assessment for risk factors such as a family history of diabetes, ethnicity, and increased age (>40 years old). A physical assessment will involve calculating the body mass index and possibly a visual inspection for acanthosis nigricans in pediatric patients. [4] [5] [6] A medical history combined with physical assessment findings (such as having a body mass index >25 kg/m2) may trigger the healthcare provider to screen the patient for diabetes mellitus with laboratory testing. |
statpearls_NBK430685\nurse-article-36052_6 | Type 2 Diabetes (Nursing) -- Assessment | For patients already diagnosed with type 2 diabetes mellitus, a physical assessment may involve inspecting the skin for wounds, examining the eyes with an ophthalmoscope to determine retinal damage, and performing microfilament testing to determine the presence of peripheral neuropathy. | Type 2 Diabetes (Nursing) -- Assessment. For patients already diagnosed with type 2 diabetes mellitus, a physical assessment may involve inspecting the skin for wounds, examining the eyes with an ophthalmoscope to determine retinal damage, and performing microfilament testing to determine the presence of peripheral neuropathy. |
statpearls_NBK430685\nurse-article-36052_7 | Type 2 Diabetes (Nursing) -- Evaluation | Any patient who is at least 40 years old, has a body mass index greater than 25 kg/m2, or has multiple risk factors for diabetes will be screened with laboratory testing. A fasting blood glucose level is a common component of routine laboratory testing. A level of 126 mg/dL or greater is diagnostic of diabetes mellitus. Glycosylated hemoglobin or “hemoglobin A1c” is the standard laboratory test used for screening, diagnosing, and evaluating treatment regimens because it provides the average blood glucose over the past 3 months. A result of 5.7 to 6.4% indicates prediabetes, while a result of 6.5% or higher is diagnostic of diabetes. [7] | Type 2 Diabetes (Nursing) -- Evaluation. Any patient who is at least 40 years old, has a body mass index greater than 25 kg/m2, or has multiple risk factors for diabetes will be screened with laboratory testing. A fasting blood glucose level is a common component of routine laboratory testing. A level of 126 mg/dL or greater is diagnostic of diabetes mellitus. Glycosylated hemoglobin or “hemoglobin A1c” is the standard laboratory test used for screening, diagnosing, and evaluating treatment regimens because it provides the average blood glucose over the past 3 months. A result of 5.7 to 6.4% indicates prediabetes, while a result of 6.5% or higher is diagnostic of diabetes. [7] |
statpearls_NBK430685\nurse-article-36052_8 | Type 2 Diabetes (Nursing) -- Medical Management | When lifestyle modification fails to achieve the targeted blood glucose levels, the first-line medication prescribed is metformin. [7] Various types of oral anti-diabetic agents are available as adjunct therapy. Insulin is a major treatment for diabetes mellitus. [8] Insulin can be categorized as rapid-acting, short-acting, intermediate-acting, and long-acting. Furthermore, if the patient with diabetes mellitus has developed complications, medications might also be prescribed to ameliorate those conditions. | Type 2 Diabetes (Nursing) -- Medical Management. When lifestyle modification fails to achieve the targeted blood glucose levels, the first-line medication prescribed is metformin. [7] Various types of oral anti-diabetic agents are available as adjunct therapy. Insulin is a major treatment for diabetes mellitus. [8] Insulin can be categorized as rapid-acting, short-acting, intermediate-acting, and long-acting. Furthermore, if the patient with diabetes mellitus has developed complications, medications might also be prescribed to ameliorate those conditions. |
statpearls_NBK430685\nurse-article-36052_9 | Type 2 Diabetes (Nursing) -- Nursing Management | Hypoglycemia is the most common life-threatening condition which requires immediate nursing management. [7] Extreme hyperglycemia is less common but another possibility. Therefore, nurses must recognize the clinical manifestations of altered blood glucose levels in patients and integrate blood glucose monitoring into the plan of care. Nursing management also includes assessing the patient for complications of type 2 diabetes mellitus and providing patient education relating to the plan of care as well as healthy dietary intake, activity recommendations, and the prescribed medication regimen as needed. | Type 2 Diabetes (Nursing) -- Nursing Management. Hypoglycemia is the most common life-threatening condition which requires immediate nursing management. [7] Extreme hyperglycemia is less common but another possibility. Therefore, nurses must recognize the clinical manifestations of altered blood glucose levels in patients and integrate blood glucose monitoring into the plan of care. Nursing management also includes assessing the patient for complications of type 2 diabetes mellitus and providing patient education relating to the plan of care as well as healthy dietary intake, activity recommendations, and the prescribed medication regimen as needed. |
statpearls_NBK430685\nurse-article-36052_10 | Type 2 Diabetes (Nursing) -- When To Seek Help | Hypoglycemia is the most common emergency requiring the nurse to intervene and consult healthcare team members. If, upon assessment, the nurse finds a patient with diabetes who has signs and symptoms of hypoglycemia (such as diminished level of consciousness), the nurse should assess for additional clinical manifestations of hypoglycemia such as cool, clammy (moist) skin and perform blood glucose testing. Most in-patient clinical facilities provide automatically generated treatment protocols for hypoglycemia. These protocols might include providing orange juice for conscious patients with the ability to swallow. Otherwise, if the patient is lethargic and providing oral intake would pose an aspiration risk, the protocol might include intravenous administration of dextrose 50% or a glucagon injection followed by retesting the blood glucose in 10 to 15 minutes and notifying the healthcare provider so that the patient’s medication regimen can be adjusted appropriately. [8] Another emergency in patients with diabetes is extreme hyperglycemia. If the patient with diabetes is experiencing tachypnea and extreme hyperglycemia (such as a blood glucose level greater than 600 mg/dL), the nurse should notify the healthcare provider immediately. Anticipated orders might include transferring the patient to an intensive care unit, administering insulin intravenously, administering potassium intravenously, and infusing intravenous fluids. [9] Additionally, the nurse should seek help from the respiratory therapist who might obtain blood sampling for arterial blood gases. | Type 2 Diabetes (Nursing) -- When To Seek Help. Hypoglycemia is the most common emergency requiring the nurse to intervene and consult healthcare team members. If, upon assessment, the nurse finds a patient with diabetes who has signs and symptoms of hypoglycemia (such as diminished level of consciousness), the nurse should assess for additional clinical manifestations of hypoglycemia such as cool, clammy (moist) skin and perform blood glucose testing. Most in-patient clinical facilities provide automatically generated treatment protocols for hypoglycemia. These protocols might include providing orange juice for conscious patients with the ability to swallow. Otherwise, if the patient is lethargic and providing oral intake would pose an aspiration risk, the protocol might include intravenous administration of dextrose 50% or a glucagon injection followed by retesting the blood glucose in 10 to 15 minutes and notifying the healthcare provider so that the patient’s medication regimen can be adjusted appropriately. [8] Another emergency in patients with diabetes is extreme hyperglycemia. If the patient with diabetes is experiencing tachypnea and extreme hyperglycemia (such as a blood glucose level greater than 600 mg/dL), the nurse should notify the healthcare provider immediately. Anticipated orders might include transferring the patient to an intensive care unit, administering insulin intravenously, administering potassium intravenously, and infusing intravenous fluids. [9] Additionally, the nurse should seek help from the respiratory therapist who might obtain blood sampling for arterial blood gases. |
statpearls_NBK430685\nurse-article-36052_11 | Type 2 Diabetes (Nursing) -- Outcome Identification | Expected outcomes for patients with diabetes depend on the patient’s admitting medical diagnosis. For example, for patients with diabetes experiencing the complication of myocardial infarction, the expected outcomes are that the patient will have no reports of chest pain, demonstrate stable vital signs, and maintain a stable cardiac rhythm on telemetry. On the other hand, for patients with diabetes experiencing the complication of osteomyelitis, the expected outcomes are that the patient will exhibit wound healing (absence of purulent drainage, presence of granulation tissue, normal white blood cell count) and maintain stable vital signs remaining afebrile. | Type 2 Diabetes (Nursing) -- Outcome Identification. Expected outcomes for patients with diabetes depend on the patient’s admitting medical diagnosis. For example, for patients with diabetes experiencing the complication of myocardial infarction, the expected outcomes are that the patient will have no reports of chest pain, demonstrate stable vital signs, and maintain a stable cardiac rhythm on telemetry. On the other hand, for patients with diabetes experiencing the complication of osteomyelitis, the expected outcomes are that the patient will exhibit wound healing (absence of purulent drainage, presence of granulation tissue, normal white blood cell count) and maintain stable vital signs remaining afebrile. |
statpearls_NBK430685\nurse-article-36052_12 | Type 2 Diabetes (Nursing) -- Monitoring | Performing blood glucose testing is a routine component of nursing care for patients with diabetes mellitus. Individuals with diabetes mellitus perform routine self-monitoring of blood glucose as outpatients. | Type 2 Diabetes (Nursing) -- Monitoring. Performing blood glucose testing is a routine component of nursing care for patients with diabetes mellitus. Individuals with diabetes mellitus perform routine self-monitoring of blood glucose as outpatients. |
statpearls_NBK430685\nurse-article-36052_13 | Type 2 Diabetes (Nursing) -- Coordination of Care | Collaboration among healthcare team members has demonstrated improved outcomes for patients with type 2 diabetes mellitus. [10] Besides the healthcare providers and nurses, other interdisciplinary team members who might be involved in the plan of care for patients with diabetes include pharmacists, endocrinologists, nurses with specialty training and certification in wound care, registered dieticians, and diabetes educators. Diabetes educators are an invaluable resource since they are equipped with the knowledge to provide teaching on various aspects of diabetes care and management. Depending on which complications of diabetes are present, neurologists, cardiologists, pulmonologists, nephrologists, infectious disease specialists, and podiatrists might also serve on the team. Physical therapists, occupational therapists, and speech therapists can assist when patients experience certain complications of diabetes (i.e., cerebrovascular accident, foot amputation). Social workers and case managers can address psychosocial or financial issues along with needs for special equipment. On an outpatient basis, ophthalmologists play an important role in screening and maintaining eye health. | Type 2 Diabetes (Nursing) -- Coordination of Care. Collaboration among healthcare team members has demonstrated improved outcomes for patients with type 2 diabetes mellitus. [10] Besides the healthcare providers and nurses, other interdisciplinary team members who might be involved in the plan of care for patients with diabetes include pharmacists, endocrinologists, nurses with specialty training and certification in wound care, registered dieticians, and diabetes educators. Diabetes educators are an invaluable resource since they are equipped with the knowledge to provide teaching on various aspects of diabetes care and management. Depending on which complications of diabetes are present, neurologists, cardiologists, pulmonologists, nephrologists, infectious disease specialists, and podiatrists might also serve on the team. Physical therapists, occupational therapists, and speech therapists can assist when patients experience certain complications of diabetes (i.e., cerebrovascular accident, foot amputation). Social workers and case managers can address psychosocial or financial issues along with needs for special equipment. On an outpatient basis, ophthalmologists play an important role in screening and maintaining eye health. |
statpearls_NBK430685\nurse-article-36052_14 | Type 2 Diabetes (Nursing) -- Health Teaching and Health Promotion | Equipping patients with the proper knowledge to mitigate their risk of developing diabetes mellitus or the associated complications is critical. [11] [12] Nurses should assess the patient’s knowledge related to diabetes care and provide education regarding dietary intake (such as limiting carbohydrate intake), exercise, and medications since these factors influence blood glucose levels. While providing patient education, the nurse should also assess for any potential barriers such as limited access to healthy foods in the community, limited income, or language barriers. Nurses are also responsible for teaching certain skills such as conducting self-monitoring of blood glucose and how to administer insulin injections. Since pneumonia and influenza pose a higher risk of mortality to patients with diabetes, nurses should encourage patients to remain up-to-date with pneumonia and influenza vaccinations. Furthermore, the nurse should encourage self-monitoring of blood glucose, daily foot inspections, and regular eye exams. Smoking cessation is another key lifestyle modification to prevent complications. | Type 2 Diabetes (Nursing) -- Health Teaching and Health Promotion. Equipping patients with the proper knowledge to mitigate their risk of developing diabetes mellitus or the associated complications is critical. [11] [12] Nurses should assess the patient’s knowledge related to diabetes care and provide education regarding dietary intake (such as limiting carbohydrate intake), exercise, and medications since these factors influence blood glucose levels. While providing patient education, the nurse should also assess for any potential barriers such as limited access to healthy foods in the community, limited income, or language barriers. Nurses are also responsible for teaching certain skills such as conducting self-monitoring of blood glucose and how to administer insulin injections. Since pneumonia and influenza pose a higher risk of mortality to patients with diabetes, nurses should encourage patients to remain up-to-date with pneumonia and influenza vaccinations. Furthermore, the nurse should encourage self-monitoring of blood glucose, daily foot inspections, and regular eye exams. Smoking cessation is another key lifestyle modification to prevent complications. |
statpearls_NBK430685\nurse-article-36052_15 | Type 2 Diabetes (Nursing) -- Risk Management | Providing for patient safety is critical. When providing patient teaching, it is imperative that the nurse considers obstacles that have the potential to lead to unsafe patient outcomes. For example, teaching a patient who has diabetes mellitus and a severe vision impairment how to self-inject insulin has the potential for lethal results and poses significant liability risk. | Type 2 Diabetes (Nursing) -- Risk Management. Providing for patient safety is critical. When providing patient teaching, it is imperative that the nurse considers obstacles that have the potential to lead to unsafe patient outcomes. For example, teaching a patient who has diabetes mellitus and a severe vision impairment how to self-inject insulin has the potential for lethal results and poses significant liability risk. |
statpearls_NBK430685\nurse-article-36052_16 | Type 2 Diabetes (Nursing) -- Discharge Planning | As with all patients, it is essential to review the prescribed medication regimen for each patient with diabetes upon discharge. Additionally, the nurse should provide patient education encompassing health promotion and review when to follow-up with the healthcare provider after discharge. | Type 2 Diabetes (Nursing) -- Discharge Planning. As with all patients, it is essential to review the prescribed medication regimen for each patient with diabetes upon discharge. Additionally, the nurse should provide patient education encompassing health promotion and review when to follow-up with the healthcare provider after discharge. |
statpearls_NBK430685\nurse-article-36052_17 | Type 2 Diabetes (Nursing) -- Evidence-Based Issues | Implementation of lifestyle modification programs that improve outcomes among patients diagnosed with type 2 diabetes mellitus is supported by research. [11] [12] [11] [13] [14] [15] [16] Many programs to improve the outcomes of patients with type 2 diabetes mellitus involve patient education. [11] [12] [11] [17] Since one of the responsibilities of nurses is to provide patient education, the nurse plays a central role in teaching those diagnosed with type 2 diabetes mellitus. | Type 2 Diabetes (Nursing) -- Evidence-Based Issues. Implementation of lifestyle modification programs that improve outcomes among patients diagnosed with type 2 diabetes mellitus is supported by research. [11] [12] [11] [13] [14] [15] [16] Many programs to improve the outcomes of patients with type 2 diabetes mellitus involve patient education. [11] [12] [11] [17] Since one of the responsibilities of nurses is to provide patient education, the nurse plays a central role in teaching those diagnosed with type 2 diabetes mellitus. |
statpearls_NBK430685\nurse-article-36052_18 | Type 2 Diabetes (Nursing) -- Pearls and Other issues | Diabetes mellitus can be type 1, type 2, gestational, or medication-induced. Risk factors for developing type 2 diabetes mellitus include being of certain ethnicities, increased age, obesity, sedentary lifestyle, and family history of the disease. The main diagnostic test for diabetes mellitus is glycosylated hemoglobin or hemoglobin A1c. Medical management for type 2 diabetes mellitus usually involves oral anti-diabetic agents and/or insulin administration. Lifestyle modification plays a key role in blood glucose control. Patients should consult with their healthcare provider to determine how often to perform self-monitoring of blood glucose as outpatients. Eating only sugar-free foods will not control blood glucose since carbohydrate intake influences blood glucose. | Type 2 Diabetes (Nursing) -- Pearls and Other issues. Diabetes mellitus can be type 1, type 2, gestational, or medication-induced. Risk factors for developing type 2 diabetes mellitus include being of certain ethnicities, increased age, obesity, sedentary lifestyle, and family history of the disease. The main diagnostic test for diabetes mellitus is glycosylated hemoglobin or hemoglobin A1c. Medical management for type 2 diabetes mellitus usually involves oral anti-diabetic agents and/or insulin administration. Lifestyle modification plays a key role in blood glucose control. Patients should consult with their healthcare provider to determine how often to perform self-monitoring of blood glucose as outpatients. Eating only sugar-free foods will not control blood glucose since carbohydrate intake influences blood glucose. |
statpearls_NBK430685\nurse-article-36052_19 | Type 2 Diabetes (Nursing) -- Review Questions | Access free multiple choice questions on this topic. Comment on this article. | Type 2 Diabetes (Nursing) -- Review Questions. Access free multiple choice questions on this topic. Comment on this article. |
statpearls_NBK430685\nurse-article-36638_0 | Spinal Shock (Nursing) -- Learning Outcome | List the causes of spinal shock. Describe the presentation of spinal shock. Summarize the treatment of spinal shock. Recall the nursing management role in spinal shock. | Spinal Shock (Nursing) -- Learning Outcome. List the causes of spinal shock. Describe the presentation of spinal shock. Summarize the treatment of spinal shock. Recall the nursing management role in spinal shock. |
statpearls_NBK430685\nurse-article-36638_1 | Spinal Shock (Nursing) -- Introduction | Spinal shock is a result of severe spinal cord injury. Spinal shock refers to the spinal cord impairment below the level of injury, including paralysis, loss of reflexes, anal sphincter tone, bowel and bladder control, as well as persistent penile erection (priapism) that can occur following a spinal cord trauma. Spinal cord injury can be associated with spinal fractures, dislocations, tearing of ligaments, rotational distraction, and tearing of the disc space. If the spinal shock is not associated with significant spinal column injury, the prognosis is more favorable. The treatment of patients with significant spinal shock and injury presents a challenge. Aggressive medical management and nursing care can reduce spinal shock effects on the overall functionality of the patient. This chapter review is designed to provide a concise introduction to the care of these patients. [1] [2] | Spinal Shock (Nursing) -- Introduction. Spinal shock is a result of severe spinal cord injury. Spinal shock refers to the spinal cord impairment below the level of injury, including paralysis, loss of reflexes, anal sphincter tone, bowel and bladder control, as well as persistent penile erection (priapism) that can occur following a spinal cord trauma. Spinal cord injury can be associated with spinal fractures, dislocations, tearing of ligaments, rotational distraction, and tearing of the disc space. If the spinal shock is not associated with significant spinal column injury, the prognosis is more favorable. The treatment of patients with significant spinal shock and injury presents a challenge. Aggressive medical management and nursing care can reduce spinal shock effects on the overall functionality of the patient. This chapter review is designed to provide a concise introduction to the care of these patients. [1] [2] |
statpearls_NBK430685\nurse-article-36638_2 | Spinal Shock (Nursing) -- Nursing Diagnosis | Inadequate tissue perfusion Inadequate breathing Anxiety Insufficient knowledge Imbalance in body fluids Inability to control bowel or bladder Immobility | Spinal Shock (Nursing) -- Nursing Diagnosis. Inadequate tissue perfusion Inadequate breathing Anxiety Insufficient knowledge Imbalance in body fluids Inability to control bowel or bladder Immobility |
statpearls_NBK430685\nurse-article-36638_3 | Spinal Shock (Nursing) -- Causes | The primary cause of spinal shock is accidental high-impact, direct spinal cord trauma, with motor vehicle collisions causing half of all spinal cord injuries. The most commonly involved area of spinal cord injury is the cervical spine. Decreased blood flow to the spinal cord can also produce spinal shock. For instance, a hypotensive patient in the medical intensive care unit (ICU) or a postangiography patient with an occlusion of the spinal cord arteries can have the same presentation. Secondary causes of spinal shock include mechanical cord compression, hypotension, hypoxia, fever, and hyperglycemia. [3] These issues are best treated in the ICU by an interprofessional team and specially trained nurses. | Spinal Shock (Nursing) -- Causes. The primary cause of spinal shock is accidental high-impact, direct spinal cord trauma, with motor vehicle collisions causing half of all spinal cord injuries. The most commonly involved area of spinal cord injury is the cervical spine. Decreased blood flow to the spinal cord can also produce spinal shock. For instance, a hypotensive patient in the medical intensive care unit (ICU) or a postangiography patient with an occlusion of the spinal cord arteries can have the same presentation. Secondary causes of spinal shock include mechanical cord compression, hypotension, hypoxia, fever, and hyperglycemia. [3] These issues are best treated in the ICU by an interprofessional team and specially trained nurses. |
statpearls_NBK430685\nurse-article-36638_4 | Spinal Shock (Nursing) -- Risk Factors | Men ages 20 to 29 years are prone to spinal cord injury and clinical diagnosis of spinal shock. According to the Centers for Disease Control fact sheet, among cases of spinal shock, 45% are due to motor vehicle collisions, 34% are due to domestic injuries such as falls, 15% are due to sporting injuries, and 6% are secondary to self-harm injuries. A similar distribution among causes of spinal cord injury is seen in international data. [4] Intoxication due to alcohol or other drugs plays a significant role in traumatic spinal cord injury; often, the initial neurological exam is not accurate due to intoxication. The cost of care for these patients is extraordinarily high since they require long-term care, which most families can not afford. | Spinal Shock (Nursing) -- Risk Factors. Men ages 20 to 29 years are prone to spinal cord injury and clinical diagnosis of spinal shock. According to the Centers for Disease Control fact sheet, among cases of spinal shock, 45% are due to motor vehicle collisions, 34% are due to domestic injuries such as falls, 15% are due to sporting injuries, and 6% are secondary to self-harm injuries. A similar distribution among causes of spinal cord injury is seen in international data. [4] Intoxication due to alcohol or other drugs plays a significant role in traumatic spinal cord injury; often, the initial neurological exam is not accurate due to intoxication. The cost of care for these patients is extraordinarily high since they require long-term care, which most families can not afford. |
statpearls_NBK430685\nurse-article-36638_5 | Spinal Shock (Nursing) -- Assessment | Healthcare practitioners should obtain a detailed history of the accident as factors such as a rollover crash, ejection outside the car, or seat belt usage can give significant information on the severity and nature of spinal cord injury. The presence of intoxication is essential information as it may confuse the physical exam findings on presentation. Because the energy necessary to produce a spinal cord injury during a traumatic event is very high, patients should be thoroughly examined for other tissue and organ injuries. A complete spinal examination should include a motor and a sensory exam, with findings including decreased motor activity, muscle strength, and organ dysfunction (eg, constipation and urinary retention) being common findings with spinal shock. Recording an American Spinal Injury Association (ASIA) score is essential for prognosis; long-term expectations can be made relatively accurately before discussing with the family and the patient. While evaluating the patient, clinicians should assume spinal instability, taking all necessary precautions to keep the spine stable until final imaging is obtained and stability is established. | Spinal Shock (Nursing) -- Assessment. Healthcare practitioners should obtain a detailed history of the accident as factors such as a rollover crash, ejection outside the car, or seat belt usage can give significant information on the severity and nature of spinal cord injury. The presence of intoxication is essential information as it may confuse the physical exam findings on presentation. Because the energy necessary to produce a spinal cord injury during a traumatic event is very high, patients should be thoroughly examined for other tissue and organ injuries. A complete spinal examination should include a motor and a sensory exam, with findings including decreased motor activity, muscle strength, and organ dysfunction (eg, constipation and urinary retention) being common findings with spinal shock. Recording an American Spinal Injury Association (ASIA) score is essential for prognosis; long-term expectations can be made relatively accurately before discussing with the family and the patient. While evaluating the patient, clinicians should assume spinal instability, taking all necessary precautions to keep the spine stable until final imaging is obtained and stability is established. |
statpearls_NBK430685\nurse-article-36638_6 | Spinal Shock (Nursing) -- Assessment | Usually, high spinal cord injuries result in transient spinal shock, with an absence of all spinal reflexes and muscle tone. In the recovery phase of the injury, however, reflexes recover and increase in amplitude, reaching a hyper-reflexive state. Other clinical features likely to be present during the assessment of patients with spinal shock include autonomic dysfunction. This autonomic dysfunction is called neurogenic shock, which is a component of spinal shock. A reduction in sympathetic tone in the blood vessels is noted with spinal shock, resulting in a profound drop in blood pressure. The parasympathetic system remains functioning, leading to an unopposed parasympathetic drive, which results in notable bradycardia. When the heart rate is slow enough to compromise cardiac output, intravenous atropine or glycopyrronium should be administered. [5] | Spinal Shock (Nursing) -- Assessment. Usually, high spinal cord injuries result in transient spinal shock, with an absence of all spinal reflexes and muscle tone. In the recovery phase of the injury, however, reflexes recover and increase in amplitude, reaching a hyper-reflexive state. Other clinical features likely to be present during the assessment of patients with spinal shock include autonomic dysfunction. This autonomic dysfunction is called neurogenic shock, which is a component of spinal shock. A reduction in sympathetic tone in the blood vessels is noted with spinal shock, resulting in a profound drop in blood pressure. The parasympathetic system remains functioning, leading to an unopposed parasympathetic drive, which results in notable bradycardia. When the heart rate is slow enough to compromise cardiac output, intravenous atropine or glycopyrronium should be administered. [5] |
statpearls_NBK430685\nurse-article-36638_7 | Spinal Shock (Nursing) -- Evaluation | Patients with spinal cord injury need to be assessed in a timely fashion to minimize poor outcomes. Preferably, these patients should be evaluated at a level 1 trauma center due to the extent of injuries. Spinal immobilization, airway, breathing, and hemodynamic stability evaluation should be established first. Clinicians should utilize the basic airway, breathing, and circulation approach to the trauma patient for the initial review. In-line cervical spine immobilization should be maintained during the assessment, ensuring the spine does not sustain extra movement. [6] The current British National Institute for Health and Care Excellence (NICE) guidelines recommend utilizing a cervical collar, a spine board, and head immobilization between sandbags or foam wedges to prevent unintentional movement. [7] | Spinal Shock (Nursing) -- Evaluation. Patients with spinal cord injury need to be assessed in a timely fashion to minimize poor outcomes. Preferably, these patients should be evaluated at a level 1 trauma center due to the extent of injuries. Spinal immobilization, airway, breathing, and hemodynamic stability evaluation should be established first. Clinicians should utilize the basic airway, breathing, and circulation approach to the trauma patient for the initial review. In-line cervical spine immobilization should be maintained during the assessment, ensuring the spine does not sustain extra movement. [6] The current British National Institute for Health and Care Excellence (NICE) guidelines recommend utilizing a cervical collar, a spine board, and head immobilization between sandbags or foam wedges to prevent unintentional movement. [7] |
statpearls_NBK430685\nurse-article-36638_8 | Spinal Shock (Nursing) -- Evaluation | After this initial assessment, further evaluation is necessary to determine the location of the injury, if possible. A complete neurological examination should be carried out using the American Spinal Injuries Association (ASIA) grading scale. This is a universal classification tool for spinal cord injuries, which helps determine the sensory and motor level of injury for each side of the body. [8] Motor and sensory loss from an injury can either be complete or incomplete. A complete cord injury will present with motor paralysis and sensory loss below the cord injury level. Complete cord injury often results in spinal and neurogenic shock. [5] Once the initial evaluation is completed, a complete spinal computed tomogram (CT) should be the initial imaging obtained. Magnetic resonance imaging (MRI) of the spine may be helpful but should not be the initial imaging modality. | Spinal Shock (Nursing) -- Evaluation. After this initial assessment, further evaluation is necessary to determine the location of the injury, if possible. A complete neurological examination should be carried out using the American Spinal Injuries Association (ASIA) grading scale. This is a universal classification tool for spinal cord injuries, which helps determine the sensory and motor level of injury for each side of the body. [8] Motor and sensory loss from an injury can either be complete or incomplete. A complete cord injury will present with motor paralysis and sensory loss below the cord injury level. Complete cord injury often results in spinal and neurogenic shock. [5] Once the initial evaluation is completed, a complete spinal computed tomogram (CT) should be the initial imaging obtained. Magnetic resonance imaging (MRI) of the spine may be helpful but should not be the initial imaging modality. |
statpearls_NBK430685\nurse-article-36638_9 | Spinal Shock (Nursing) -- Medical Management -- Overview | Spinal shock patients should be treated in an ICU setting, as many complications can arise due to the injury. Neurogenic shock is different than spinal shock and usually occurs with higher spinal column injuries (ie, above the T6 level). Neurogenic shock is the loss of sympathetic tone and unopposed parasympathetic signals. The blood vessels have diminished constriction, and bradycardia occurs without sympathetic signals. [3] Generally, fluids and inotropes are used for initial treatment. With high cervical injuries, the diaphragmatic function will be compromised, and these patients will usually require early tracheotomy since they will likely be ventilator-dependent. Deep vein thrombosis risk is high in these patients; therefore, prophylaxis should be initiated immediately. Because approximately 60% of these patients will require spine stabilization with surgical intervention, neurosurgery or orthopedic clinicians should be consulted early. Since the cord is not usually completely destroyed in spinal cord injury, recovery usually occurs, although the duration and degree of recovery vary. [9] [10] | Spinal Shock (Nursing) -- Medical Management -- Overview. Spinal shock patients should be treated in an ICU setting, as many complications can arise due to the injury. Neurogenic shock is different than spinal shock and usually occurs with higher spinal column injuries (ie, above the T6 level). Neurogenic shock is the loss of sympathetic tone and unopposed parasympathetic signals. The blood vessels have diminished constriction, and bradycardia occurs without sympathetic signals. [3] Generally, fluids and inotropes are used for initial treatment. With high cervical injuries, the diaphragmatic function will be compromised, and these patients will usually require early tracheotomy since they will likely be ventilator-dependent. Deep vein thrombosis risk is high in these patients; therefore, prophylaxis should be initiated immediately. Because approximately 60% of these patients will require spine stabilization with surgical intervention, neurosurgery or orthopedic clinicians should be consulted early. Since the cord is not usually completely destroyed in spinal cord injury, recovery usually occurs, although the duration and degree of recovery vary. [9] [10] |
statpearls_NBK430685\nurse-article-36638_10 | Spinal Shock (Nursing) -- Medical Management -- Initial Treatment of Spinal Cord Injury | Promptly treat circulatory collapse and shock; immediately establish large-bore (ie, 14-gauge or 16-gauge) IV lines. Immediately start a crystalloid fluid bolus upon the patient's arrival. If there is no response to fluid bolus, inotropic therapy is required; however, repetitive fluid boluses should not be given in established spinal shock as this may lead to fluid overload. Use atropine for isolated and clinically significant bradycardia, which is a common feature of spinal shock. Monitor the patient's temperature, as patients are frequently hypothermic. [5] | Spinal Shock (Nursing) -- Medical Management -- Initial Treatment of Spinal Cord Injury. Promptly treat circulatory collapse and shock; immediately establish large-bore (ie, 14-gauge or 16-gauge) IV lines. Immediately start a crystalloid fluid bolus upon the patient's arrival. If there is no response to fluid bolus, inotropic therapy is required; however, repetitive fluid boluses should not be given in established spinal shock as this may lead to fluid overload. Use atropine for isolated and clinically significant bradycardia, which is a common feature of spinal shock. Monitor the patient's temperature, as patients are frequently hypothermic. [5] |
statpearls_NBK430685\nurse-article-36638_11 | Spinal Shock (Nursing) -- Medical Management -- Management of Spinal Shock | Corticosteroids are administered to decrease tissue edema and ischemia after injury in some cases. | Spinal Shock (Nursing) -- Medical Management -- Management of Spinal Shock. Corticosteroids are administered to decrease tissue edema and ischemia after injury in some cases. |
statpearls_NBK430685\nurse-article-36638_12 | Spinal Shock (Nursing) -- Medical Management -- Management of Spinal Shock | Nursing procedures that cause vagal stimulation (ie, oral or tracheal suctioning) can exacerbate bradycardia in these patients; therefore, hyperoxygenation with the administration of 100% oxygen for 2 minutes before nursing procedures is recommended. | Spinal Shock (Nursing) -- Medical Management -- Management of Spinal Shock. Nursing procedures that cause vagal stimulation (ie, oral or tracheal suctioning) can exacerbate bradycardia in these patients; therefore, hyperoxygenation with the administration of 100% oxygen for 2 minutes before nursing procedures is recommended. |
statpearls_NBK430685\nurse-article-36638_13 | Spinal Shock (Nursing) -- Medical Management -- Management of Spinal Shock | Due to autonomic nervous system dysfunction, patients with spinal cord injuries may lose the ability to self-regulate body temperature; therefore, temperature regulation and monitoring with invasive devices to obtain accurate core body temperature are essential. | Spinal Shock (Nursing) -- Medical Management -- Management of Spinal Shock. Due to autonomic nervous system dysfunction, patients with spinal cord injuries may lose the ability to self-regulate body temperature; therefore, temperature regulation and monitoring with invasive devices to obtain accurate core body temperature are essential. |
statpearls_NBK430685\nurse-article-36638_14 | Spinal Shock (Nursing) -- Medical Management -- Management of Spinal Shock | Due to expected urinary retention, a urinary catheter should be maintained and discontinued after 72 hours of injury. Intermittent catheterization should be used to minimize the risk of urinary tract infections. | Spinal Shock (Nursing) -- Medical Management -- Management of Spinal Shock. Due to expected urinary retention, a urinary catheter should be maintained and discontinued after 72 hours of injury. Intermittent catheterization should be used to minimize the risk of urinary tract infections. |
statpearls_NBK430685\nurse-article-36638_15 | Spinal Shock (Nursing) -- Medical Management -- Management of Spinal Shock | Constipation is common in patients with spinal cord injury; to prevent complications, patients with spinal shock should be maintained on a laxative bowel regimen. | Spinal Shock (Nursing) -- Medical Management -- Management of Spinal Shock. Constipation is common in patients with spinal cord injury; to prevent complications, patients with spinal shock should be maintained on a laxative bowel regimen. |
statpearls_NBK430685\nurse-article-36638_16 | Spinal Shock (Nursing) -- Medical Management -- Management of Spinal Shock | Patients with spinal shock will require enteral nutrition; therefore, a nasogastric tube capable of suction should be maintained because, in the initial phase of the injury, patients often develop paralytic ileus requiring suctioning to decompress the stomach and bowel. | Spinal Shock (Nursing) -- Medical Management -- Management of Spinal Shock. Patients with spinal shock will require enteral nutrition; therefore, a nasogastric tube capable of suction should be maintained because, in the initial phase of the injury, patients often develop paralytic ileus requiring suctioning to decompress the stomach and bowel. |
statpearls_NBK430685\nurse-article-36638_17 | Spinal Shock (Nursing) -- Medical Management -- Management of Spinal Shock | Patients should be frequently assessed and treated for the presence of pain. | Spinal Shock (Nursing) -- Medical Management -- Management of Spinal Shock. Patients should be frequently assessed and treated for the presence of pain. |
statpearls_NBK430685\nurse-article-36638_18 | Spinal Shock (Nursing) -- Medical Management -- Management of Spinal Shock | Occupational and physiotherapy should be started as soon as possible to optimize functional recovery, prevent contractures, and minimize muscle atrophy. [5] | Spinal Shock (Nursing) -- Medical Management -- Management of Spinal Shock. Occupational and physiotherapy should be started as soon as possible to optimize functional recovery, prevent contractures, and minimize muscle atrophy. [5] |
statpearls_NBK430685\nurse-article-36638_19 | Spinal Shock (Nursing) -- Medical Management -- Prevention of Complications | Patients with spinal injury are at an extremely high risk of developing pressure ulcers, which can occur within hours in immobilized patients. [11] Skincare with protocol-based turning and positioning (ie, log-roll) is recommended in all patients with spinal cord injury and shock. Backboards should be discontinued as soon as possible as they increase the risk of pressure ulcers. The use of airflow or dynamic alternating mattresses is contraindicated in these patients when spine stabilization has not occurred. Initially, a standard mattress or full-support mattress is recommended. [5] | Spinal Shock (Nursing) -- Medical Management -- Prevention of Complications. Patients with spinal injury are at an extremely high risk of developing pressure ulcers, which can occur within hours in immobilized patients. [11] Skincare with protocol-based turning and positioning (ie, log-roll) is recommended in all patients with spinal cord injury and shock. Backboards should be discontinued as soon as possible as they increase the risk of pressure ulcers. The use of airflow or dynamic alternating mattresses is contraindicated in these patients when spine stabilization has not occurred. Initially, a standard mattress or full-support mattress is recommended. [5] |
statpearls_NBK430685\nurse-article-36638_20 | Spinal Shock (Nursing) -- Medical Management -- Prevention of Complications | Prevent catheter-associated urinary tract infections and central line-associated bloodstream infections by following sterile placement techniques and protocol-based dressing care. | Spinal Shock (Nursing) -- Medical Management -- Prevention of Complications. Prevent catheter-associated urinary tract infections and central line-associated bloodstream infections by following sterile placement techniques and protocol-based dressing care. |
statpearls_NBK430685\nurse-article-36638_21 | Spinal Shock (Nursing) -- Medical Management -- Prevention of Complications | Prevent further injury to the spine with appropriate lifting and handling of the patient. Log-rolling is recommended to maintain the alignment of the whole spine. | Spinal Shock (Nursing) -- Medical Management -- Prevention of Complications. Prevent further injury to the spine with appropriate lifting and handling of the patient. Log-rolling is recommended to maintain the alignment of the whole spine. |
statpearls_NBK430685\nurse-article-36638_22 | Spinal Shock (Nursing) -- Medical Management -- Prevention of Complications | Standard venous thromboembolism (VTE) prophylaxis is indicated in all patients with spinal cord injury because VTE and pulmonary embolism can occur within 72 hours of admission in these patients who do not receive appropriate prophylaxis. [12] | Spinal Shock (Nursing) -- Medical Management -- Prevention of Complications. Standard venous thromboembolism (VTE) prophylaxis is indicated in all patients with spinal cord injury because VTE and pulmonary embolism can occur within 72 hours of admission in these patients who do not receive appropriate prophylaxis. [12] |
statpearls_NBK430685\nurse-article-36638_23 | Spinal Shock (Nursing) -- Medical Management -- Prevention of Complications | All patients with spinal shock should receive gastric stress ulcer prophylaxis for four weeks with a proton-pump inhibitor. [13] | Spinal Shock (Nursing) -- Medical Management -- Prevention of Complications. All patients with spinal shock should receive gastric stress ulcer prophylaxis for four weeks with a proton-pump inhibitor. [13] |
statpearls_NBK430685\nurse-article-36638_24 | Spinal Shock (Nursing) -- Nursing Management | Assess hemodynamics. Assess sensory and motor deficits. Assess the patient's pain. Provide DVT and gastric ulcer prophylaxis. Prevent pressure ulcers. Ensure adequate oxygenation and ventilation. Educate the patient about the disorder. Elevate the head of the bed to avoid aspiration. Encourage the patient to cough and use the incentive spirometer. Optimize interventions for neurogenic bowel and bladder. Consult with a dietitian regarding nutrition. Consult with physical therapy for early mobilization. Provide resources for anticipated grief. | Spinal Shock (Nursing) -- Nursing Management. Assess hemodynamics. Assess sensory and motor deficits. Assess the patient's pain. Provide DVT and gastric ulcer prophylaxis. Prevent pressure ulcers. Ensure adequate oxygenation and ventilation. Educate the patient about the disorder. Elevate the head of the bed to avoid aspiration. Encourage the patient to cough and use the incentive spirometer. Optimize interventions for neurogenic bowel and bladder. Consult with a dietitian regarding nutrition. Consult with physical therapy for early mobilization. Provide resources for anticipated grief. |
statpearls_NBK430685\nurse-article-36638_25 | Spinal Shock (Nursing) -- When To Seek Help | Changes in the level of consciousness Urinary and fecal retention Unstable hemodynamics resulting from autonomic dysfunction, which may present as: Bradycardia Hypotension Hypertension Temperature dysregulation Fever | Spinal Shock (Nursing) -- When To Seek Help. Changes in the level of consciousness Urinary and fecal retention Unstable hemodynamics resulting from autonomic dysfunction, which may present as: Bradycardia Hypotension Hypertension Temperature dysregulation Fever |
statpearls_NBK430685\nurse-article-36638_26 | Spinal Shock (Nursing) -- Outcome Identification | The outcomes for most patients depend on the severity of neurological deficits present on admission. The prognosis is good for those who respond to initial resuscitation, but those who fail to respond usually have a protracted ICU course and prolonged recovery phase. [3] [14] | Spinal Shock (Nursing) -- Outcome Identification. The outcomes for most patients depend on the severity of neurological deficits present on admission. The prognosis is good for those who respond to initial resuscitation, but those who fail to respond usually have a protracted ICU course and prolonged recovery phase. [3] [14] |
statpearls_NBK430685\nurse-article-36638_27 | Spinal Shock (Nursing) -- Monitoring | Monitoring for the following is an essential part of nursing care for patients with spinal shock: Blood pressure Heart rate Temperature Urinary output Bowel movements Skin integrity Enteral feed delivery Neurologic examination to ensure deficits are not worsening | Spinal Shock (Nursing) -- Monitoring. Monitoring for the following is an essential part of nursing care for patients with spinal shock: Blood pressure Heart rate Temperature Urinary output Bowel movements Skin integrity Enteral feed delivery Neurologic examination to ensure deficits are not worsening |
statpearls_NBK430685\nurse-article-36638_28 | Spinal Shock (Nursing) -- Coordination of Care | Spinal shock carries very high morbidity. Clinical outcomes are worse if patients do not receive comprehensive care managed by an interprofessional team. An interprofessional team caring for patients with spinal shock should include emergency and trauma teams, neurosurgery, and rehabilitation services, as well as anticipatory guidance from case managers, social workers, and spiritual care. The registered nurse is important in the care and education of the patient and the family. These patients should be admitted to the ICU and closely monitored. These patients are vulnerable to complications and require deep vein thrombosis (DVT) prophylaxis, pressure sore prevention, bowel and bladder management, safety maintenance, anticipatory guidance, and adequate nutrition. [15] [16] | Spinal Shock (Nursing) -- Coordination of Care. Spinal shock carries very high morbidity. Clinical outcomes are worse if patients do not receive comprehensive care managed by an interprofessional team. An interprofessional team caring for patients with spinal shock should include emergency and trauma teams, neurosurgery, and rehabilitation services, as well as anticipatory guidance from case managers, social workers, and spiritual care. The registered nurse is important in the care and education of the patient and the family. These patients should be admitted to the ICU and closely monitored. These patients are vulnerable to complications and require deep vein thrombosis (DVT) prophylaxis, pressure sore prevention, bowel and bladder management, safety maintenance, anticipatory guidance, and adequate nutrition. [15] [16] |
statpearls_NBK430685\nurse-article-36638_29 | Spinal Shock (Nursing) -- Health Teaching and Health Promotion | Neurogenic bladder Neurogenic bowel Spinal cord injury Accident prevention Nutrition Skin Care Fall precautions | Spinal Shock (Nursing) -- Health Teaching and Health Promotion. Neurogenic bladder Neurogenic bowel Spinal cord injury Accident prevention Nutrition Skin Care Fall precautions |
statpearls_NBK430685\nurse-article-36638_30 | Spinal Shock (Nursing) -- Discharge Planning | Spinal cord rehabilitation Alterations in a private home (eg, ramps, assistive devices) Mental health resources Assistance with activities of daily living (eg, ADL) | Spinal Shock (Nursing) -- Discharge Planning. Spinal cord rehabilitation Alterations in a private home (eg, ramps, assistive devices) Mental health resources Assistance with activities of daily living (eg, ADL) |
statpearls_NBK430685\nurse-article-36638_31 | Spinal Shock (Nursing) -- Evidence-Based Issues | Current guidelines on managing spinal cord injury: Immobilize with an appropriate collar. Resuscitate and evaluate at a level 1 trauma facility. Perform imaging studies. Prevent hypoxemia and hypotension. Perform DVT prophylaxis. Perform neurogenic bladder and bowel management. Initiate pain management. Implement nutrition management. | Spinal Shock (Nursing) -- Evidence-Based Issues. Current guidelines on managing spinal cord injury: Immobilize with an appropriate collar. Resuscitate and evaluate at a level 1 trauma facility. Perform imaging studies. Prevent hypoxemia and hypotension. Perform DVT prophylaxis. Perform neurogenic bladder and bowel management. Initiate pain management. Implement nutrition management. |
statpearls_NBK430685\nurse-article-36638_32 | Spinal Shock (Nursing) -- Review Questions | Access free multiple choice questions on this topic. Comment on this article. | Spinal Shock (Nursing) -- Review Questions. Access free multiple choice questions on this topic. Comment on this article. |
statpearls_NBK430685\nurse-article-36720_0 | Atrioventricular Block (Nursing) -- Learning Outcome | List the causes of heart block Describe the presentation of heart block Recall the types of heart block Summarize the treatment of heart block | Atrioventricular Block (Nursing) -- Learning Outcome. List the causes of heart block Describe the presentation of heart block Recall the types of heart block Summarize the treatment of heart block |
statpearls_NBK430685\nurse-article-36720_1 | Atrioventricular Block (Nursing) -- Introduction | Atrioventricular (AV) conduction is evaluated by assessing the relationship between the P waves and QRS complexes. Normally, there is a P wave that precedes each QRS complex by a fixed PR interval of 120 to 200 milliseconds. AV block represents a delayed electrical impulse from the atria to the ventricles. This can be due to an anatomical or functional impairment in the heart’s conduction system. This disruption in normal electrical activity can be transient or permanent. In general, there are three degrees of AV nodal blocks: first degree, second degree (Mobitz type 1 or 2), and third-degree. [1] [2] [3] | Atrioventricular Block (Nursing) -- Introduction. Atrioventricular (AV) conduction is evaluated by assessing the relationship between the P waves and QRS complexes. Normally, there is a P wave that precedes each QRS complex by a fixed PR interval of 120 to 200 milliseconds. AV block represents a delayed electrical impulse from the atria to the ventricles. This can be due to an anatomical or functional impairment in the heart’s conduction system. This disruption in normal electrical activity can be transient or permanent. In general, there are three degrees of AV nodal blocks: first degree, second degree (Mobitz type 1 or 2), and third-degree. [1] [2] [3] |
statpearls_NBK430685\nurse-article-36720_2 | Atrioventricular Block (Nursing) -- Introduction | At this time, there is no well-characterized large study about the relationship between different types of AV block with age, race, or gender. AV block is sometimes seen in athletes and in patients with congenital heart disorders. | Atrioventricular Block (Nursing) -- Introduction. At this time, there is no well-characterized large study about the relationship between different types of AV block with age, race, or gender. AV block is sometimes seen in athletes and in patients with congenital heart disorders. |
statpearls_NBK430685\nurse-article-36720_3 | Atrioventricular Block (Nursing) -- Nursing Diagnosis | Ineffective tissue perfusion Risk for falls Impaired cardiac function Anxiety | Atrioventricular Block (Nursing) -- Nursing Diagnosis. Ineffective tissue perfusion Risk for falls Impaired cardiac function Anxiety |
statpearls_NBK430685\nurse-article-36720_4 | Atrioventricular Block (Nursing) -- Causes | Higher degrees of AV block often suggest some underlying pathology. This is known as a pathophysiologic AV block. About half of such cases are a result of chronic idiopathic fibrosis and sclerosis of the conduction system. Another common source is ischemic heart disease which is responsible for around 40 percent of cases of AV block [4] . | Atrioventricular Block (Nursing) -- Causes. Higher degrees of AV block often suggest some underlying pathology. This is known as a pathophysiologic AV block. About half of such cases are a result of chronic idiopathic fibrosis and sclerosis of the conduction system. Another common source is ischemic heart disease which is responsible for around 40 percent of cases of AV block [4] . |
statpearls_NBK430685\nurse-article-36720_5 | Atrioventricular Block (Nursing) -- Causes | AV block is also associated with cardiomyopathies, including hypertrophic obstructive cardiomyopathy and infiltrative conditions such as sarcoidosis and amyloidosis. Infectious causes such as Lyme disease, rheumatic fever, endocarditis, viruses as well as autoimmune disease such as systemic lupus erythematosus should also be explored [5] [6] [7] [8] . Other potential triggers include cardiac surgery, medications, and inherited conditions [9] . | Atrioventricular Block (Nursing) -- Causes. AV block is also associated with cardiomyopathies, including hypertrophic obstructive cardiomyopathy and infiltrative conditions such as sarcoidosis and amyloidosis. Infectious causes such as Lyme disease, rheumatic fever, endocarditis, viruses as well as autoimmune disease such as systemic lupus erythematosus should also be explored [5] [6] [7] [8] . Other potential triggers include cardiac surgery, medications, and inherited conditions [9] . |
statpearls_NBK430685\nurse-article-36720_6 | Atrioventricular Block (Nursing) -- Risk Factors | First-degree AV block can originate from various locations within the conduction system. The levels of conduction delay include the atrium, AV node (most common in first-degree heart block), Bundle of His, bundle branches, fascicles, Purkinje system. Mobitz type I second-degree AV block usually occurs within the AV node, while Mobitz type II second-degree AV block mainly originates from conduction system disease below the level of the AV node (in the bundle of His and in the bundle branches). In third-degree AV block, no atrial impulses reach the ventricle- it can occur in the AV node or in the infranodal specialized conduction system. [10] The following medications can affect different levels of conduction delay: | Atrioventricular Block (Nursing) -- Risk Factors. First-degree AV block can originate from various locations within the conduction system. The levels of conduction delay include the atrium, AV node (most common in first-degree heart block), Bundle of His, bundle branches, fascicles, Purkinje system. Mobitz type I second-degree AV block usually occurs within the AV node, while Mobitz type II second-degree AV block mainly originates from conduction system disease below the level of the AV node (in the bundle of His and in the bundle branches). In third-degree AV block, no atrial impulses reach the ventricle- it can occur in the AV node or in the infranodal specialized conduction system. [10] The following medications can affect different levels of conduction delay: |
statpearls_NBK430685\nurse-article-36720_7 | Atrioventricular Block (Nursing) -- Risk Factors | Increased parasympathetic tone, digoxin (which upgrades vagotonic action), calcium channel blockers (which obstruct the inward calcium current responsible for depolarization), and beta-blockers can affect the AV node Medications such as procainamide, quinidine, and disopyramide can block sodium channels and delay conduction in the bundle of His Similarly, though rarely, medications such as procainamide, quinidine, and disopyramide can also delay infra-Hisian conduction system | Atrioventricular Block (Nursing) -- Risk Factors. Increased parasympathetic tone, digoxin (which upgrades vagotonic action), calcium channel blockers (which obstruct the inward calcium current responsible for depolarization), and beta-blockers can affect the AV node Medications such as procainamide, quinidine, and disopyramide can block sodium channels and delay conduction in the bundle of His Similarly, though rarely, medications such as procainamide, quinidine, and disopyramide can also delay infra-Hisian conduction system |
statpearls_NBK430685\nurse-article-36720_8 | Atrioventricular Block (Nursing) -- Assessment | History taking for patients with concerns for AV block should include: History of heart disease, both congenital and acquired Full list of medications and dosing. Particular drugs of interest include beta-blockers, calcium channel blockers, antiarrhythmic drugs, digoxin Recent cardiac procedure Signs and symptoms associated with other systemic diseases associated with heart block (amyloidosis, sarcoidosis) Baseline exercise capacity Potential exposure to tick bites The following symptoms should raise concerns: Dyspnea Fatigue Chest pain Presyncope or syncope Sudden cardiac arrest | Atrioventricular Block (Nursing) -- Assessment. History taking for patients with concerns for AV block should include: History of heart disease, both congenital and acquired Full list of medications and dosing. Particular drugs of interest include beta-blockers, calcium channel blockers, antiarrhythmic drugs, digoxin Recent cardiac procedure Signs and symptoms associated with other systemic diseases associated with heart block (amyloidosis, sarcoidosis) Baseline exercise capacity Potential exposure to tick bites The following symptoms should raise concerns: Dyspnea Fatigue Chest pain Presyncope or syncope Sudden cardiac arrest |
statpearls_NBK430685\nurse-article-36720_9 | Atrioventricular Block (Nursing) -- Evaluation | First degree. In first-degree AV block, the P waves always precede the QRS complexes, but there is a prolongation of the PR interval. The PR interval will be greater than 200 milliseconds in duration without any dropped beats. There is a delay, without interruption, in conduction from the atrium to the ventricle. All atrial activation is eventually transmitted to the ventricles. The delay is typically due to a minor AV conduction defect occurring at or below the AV node. Causes. There are multiple causes of first-degree AV block, including simply being a normal variant. Other causes include inferior myocardial infarction (MI), increased vagal tone (e.g., athletes), status post-cardiac surgery, myocarditis, hyperkalemia, or even medication-induced (e.g., beta-blockers, non-dihydropyridine calcium channel blocks, adenosine, digitalis, and amiodarone). Clinical significance. This is benign and does not result in any hemodynamic instability. No specific treatment is required. | Atrioventricular Block (Nursing) -- Evaluation. First degree. In first-degree AV block, the P waves always precede the QRS complexes, but there is a prolongation of the PR interval. The PR interval will be greater than 200 milliseconds in duration without any dropped beats. There is a delay, without interruption, in conduction from the atrium to the ventricle. All atrial activation is eventually transmitted to the ventricles. The delay is typically due to a minor AV conduction defect occurring at or below the AV node. Causes. There are multiple causes of first-degree AV block, including simply being a normal variant. Other causes include inferior myocardial infarction (MI), increased vagal tone (e.g., athletes), status post-cardiac surgery, myocarditis, hyperkalemia, or even medication-induced (e.g., beta-blockers, non-dihydropyridine calcium channel blocks, adenosine, digitalis, and amiodarone). Clinical significance. This is benign and does not result in any hemodynamic instability. No specific treatment is required. |
statpearls_NBK430685\nurse-article-36720_10 | Atrioventricular Block (Nursing) -- Evaluation | Second degree, Mobitz type 1 (Wenckebach). In second-degree Mobitz type 1 AV block, there is a progressive prolongation of the PR interval, which eventually culminates in a non-conducting P wave. The PR interval continues to prolong with each beat of the cycle, and the subsequent PR lengthening is progressively shorter. The PR interval before the dropped beat is the longest of the cycle, and the PR interval after the dropped beat is the shortest as the cycle starts over. | Atrioventricular Block (Nursing) -- Evaluation. Second degree, Mobitz type 1 (Wenckebach). In second-degree Mobitz type 1 AV block, there is a progressive prolongation of the PR interval, which eventually culminates in a non-conducting P wave. The PR interval continues to prolong with each beat of the cycle, and the subsequent PR lengthening is progressively shorter. The PR interval before the dropped beat is the longest of the cycle, and the PR interval after the dropped beat is the shortest as the cycle starts over. |
statpearls_NBK430685\nurse-article-36720_11 | Atrioventricular Block (Nursing) -- Evaluation | Mechanism. This is usually a result of a reversible conduction block at the level of the AV node. There is typically a functional suppression of AV conduction. The AV nodal cells seem to progressively fatigue until they fail to conduct an impulse to the ventricles and a dropped beat occurs. | Atrioventricular Block (Nursing) -- Evaluation. Mechanism. This is usually a result of a reversible conduction block at the level of the AV node. There is typically a functional suppression of AV conduction. The AV nodal cells seem to progressively fatigue until they fail to conduct an impulse to the ventricles and a dropped beat occurs. |
statpearls_NBK430685\nurse-article-36720_12 | Atrioventricular Block (Nursing) -- Evaluation | Causes. There are multiple causes of second-degree Mobitz type 1 (Wenckebach) AV block, including reversible ischemia, myocarditis, increased vagal tone, status post-cardiac surgery, or even medications that slow AV nodal conduction (e.g., beta-blockers, non-dihydropyridine calcium channel blocks, adenosine, digitalis, and amiodarone). | Atrioventricular Block (Nursing) -- Evaluation. Causes. There are multiple causes of second-degree Mobitz type 1 (Wenckebach) AV block, including reversible ischemia, myocarditis, increased vagal tone, status post-cardiac surgery, or even medications that slow AV nodal conduction (e.g., beta-blockers, non-dihydropyridine calcium channel blocks, adenosine, digitalis, and amiodarone). |
statpearls_NBK430685\nurse-article-36720_13 | Atrioventricular Block (Nursing) -- Evaluation | Clinical significance. Differentiating between second-degree Mobitz type 1 (Wenckebach) and Mobitz type 2 AV blocks is important as the management and treatment are different. Mobitz type 1 is often a benign rhythm. Most patients are asymptomatic, and there tends to be a minimal hemodynamic disturbance. Patients that are asymptomatic do not require treatment and can be monitored on an outpatient basis. Patients that are symptomatic typically respond to atropine and rarely require permanent cardiac pacing. Medication-induced impairment of AV conduction is often reversible after stopping the offending agent. | Atrioventricular Block (Nursing) -- Evaluation. Clinical significance. Differentiating between second-degree Mobitz type 1 (Wenckebach) and Mobitz type 2 AV blocks is important as the management and treatment are different. Mobitz type 1 is often a benign rhythm. Most patients are asymptomatic, and there tends to be a minimal hemodynamic disturbance. Patients that are asymptomatic do not require treatment and can be monitored on an outpatient basis. Patients that are symptomatic typically respond to atropine and rarely require permanent cardiac pacing. Medication-induced impairment of AV conduction is often reversible after stopping the offending agent. |
statpearls_NBK430685\nurse-article-36720_14 | Atrioventricular Block (Nursing) -- Evaluation | Second degree, Mobitz type 2. In second-degree Mobitz type 2 AV block, there are intermittent non-conducted P waves without warning. Unlike Mobitz type 1 (Wenckebach), there is no progressive prolongation of the PR interval; instead, the PR interval remains constant, and the P waves occur at a constant rate with unchanged P-P intervals. Because the P waves continue to occur at normal intervals, the R-R interval surrounding the dropped beat is simply a multiple of the preceding R-R interval and remains unchanged. | Atrioventricular Block (Nursing) -- Evaluation. Second degree, Mobitz type 2. In second-degree Mobitz type 2 AV block, there are intermittent non-conducted P waves without warning. Unlike Mobitz type 1 (Wenckebach), there is no progressive prolongation of the PR interval; instead, the PR interval remains constant, and the P waves occur at a constant rate with unchanged P-P intervals. Because the P waves continue to occur at normal intervals, the R-R interval surrounding the dropped beat is simply a multiple of the preceding R-R interval and remains unchanged. |
statpearls_NBK430685\nurse-article-36720_15 | Atrioventricular Block (Nursing) -- Evaluation | Mechanism. In Mobitz type 2, the block occurs farther along the electrical conduction system below the AV node. | Atrioventricular Block (Nursing) -- Evaluation. Mechanism. In Mobitz type 2, the block occurs farther along the electrical conduction system below the AV node. |
statpearls_NBK430685\nurse-article-36720_16 | Atrioventricular Block (Nursing) -- Evaluation | In this case, the cells abruptly and unpredictably fail to conduct an impulse from the atria to the ventricles. This is often the result of structural damage to the conduction system. | Atrioventricular Block (Nursing) -- Evaluation. In this case, the cells abruptly and unpredictably fail to conduct an impulse from the atria to the ventricles. This is often the result of structural damage to the conduction system. |
statpearls_NBK430685\nurse-article-36720_17 | Atrioventricular Block (Nursing) -- Evaluation | Because the defect occurs below the AV node and often times distal to the His Bundle, it produces wide, bizarre-appearing QRS complexes. In the remaining cases, the defect is located within the Bundle of His, resulting in the normal, narrow QRS complexes. There can be a fixed P:QRS relationship (e.g., 2:1, 3:1) or no pattern at all. | Atrioventricular Block (Nursing) -- Evaluation. Because the defect occurs below the AV node and often times distal to the His Bundle, it produces wide, bizarre-appearing QRS complexes. In the remaining cases, the defect is located within the Bundle of His, resulting in the normal, narrow QRS complexes. There can be a fixed P:QRS relationship (e.g., 2:1, 3:1) or no pattern at all. |
statpearls_NBK430685\nurse-article-36720_18 | Atrioventricular Block (Nursing) -- Evaluation | Causes. Common causes of second-degree Mobitz type 2 AV block include anterior MI, causing septal infarction of the bundle branches. Other causes include idiopathic fibrosis of the conducting system, autoimmune (e.g., systemic sclerosis or systemic lupus erythematosus) or inflammatory (e.g., myocarditis, Lyme disease, or rheumatic fever) conditions, infiltrative myocardial disease (hemochromatosis, sarcoidosis, or amyloidosis), electrolyte imbalance (e.g., hyperkalemia), medication-induced (e.g., beta-blockers, non-dihydropyridine calcium channel blockers, digitalis, adenosine, or amiodarone), or status post-cardiac surgery (e.g., mitral valve repair). | Atrioventricular Block (Nursing) -- Evaluation. Causes. Common causes of second-degree Mobitz type 2 AV block include anterior MI, causing septal infarction of the bundle branches. Other causes include idiopathic fibrosis of the conducting system, autoimmune (e.g., systemic sclerosis or systemic lupus erythematosus) or inflammatory (e.g., myocarditis, Lyme disease, or rheumatic fever) conditions, infiltrative myocardial disease (hemochromatosis, sarcoidosis, or amyloidosis), electrolyte imbalance (e.g., hyperkalemia), medication-induced (e.g., beta-blockers, non-dihydropyridine calcium channel blockers, digitalis, adenosine, or amiodarone), or status post-cardiac surgery (e.g., mitral valve repair). |
statpearls_NBK430685\nurse-article-36720_19 | Atrioventricular Block (Nursing) -- Evaluation | Clinical significance. Mobitz type 2 AV block can be associated with severe bradycardia and hemodynamic instability. It has a greater risk of progressing to third-degree (complete) heart block or asystole. Because the onset of dropped beats can occur abruptly and unexpectedly, hemodynamic instability and the consequential syncope and potentially sudden cardiac death can occur at any moment. Thus, patients require a permanent pacemaker. While Mobitz type 1 can improve with atropine, giving atropine in the setting of Mobitz type 2 can worsen the block and increase the risk of complete heart block or asystole. | Atrioventricular Block (Nursing) -- Evaluation. Clinical significance. Mobitz type 2 AV block can be associated with severe bradycardia and hemodynamic instability. It has a greater risk of progressing to third-degree (complete) heart block or asystole. Because the onset of dropped beats can occur abruptly and unexpectedly, hemodynamic instability and the consequential syncope and potentially sudden cardiac death can occur at any moment. Thus, patients require a permanent pacemaker. While Mobitz type 1 can improve with atropine, giving atropine in the setting of Mobitz type 2 can worsen the block and increase the risk of complete heart block or asystole. |
statpearls_NBK430685\nurse-article-36720_20 | Atrioventricular Block (Nursing) -- Evaluation | Third-degree (complete). In third-degree, or complete, heart block there is an absence of AV nodal conduction, and the P waves are never related to the QRS complexes. If ventricular conduction occurs, it is maintained by a junctional or ventricular escape rhythm. There is a complete dissociation between the atria and ventricles and they conduct independently of each other. The P waves (atrial activity) are said to “march through” the QRS complexes at their regular, faster rate. The QRS complexes (ventricular activity) also occur at a regular, but slower rate. There are two independent rhythms occurring simultaneously. | Atrioventricular Block (Nursing) -- Evaluation. Third-degree (complete). In third-degree, or complete, heart block there is an absence of AV nodal conduction, and the P waves are never related to the QRS complexes. If ventricular conduction occurs, it is maintained by a junctional or ventricular escape rhythm. There is a complete dissociation between the atria and ventricles and they conduct independently of each other. The P waves (atrial activity) are said to “march through” the QRS complexes at their regular, faster rate. The QRS complexes (ventricular activity) also occur at a regular, but slower rate. There are two independent rhythms occurring simultaneously. |
statpearls_NBK430685\nurse-article-36720_21 | Atrioventricular Block (Nursing) -- Evaluation | Mechanism. Third-degree heart block is the end result of progressively worsening second-degree AV block. Because a third-degree heart block can occur above or below the AV node, two different rhythms can take over. If it occurs above or at the crest of the AV node, a junctional rhythm will take over and drive the ventricles. The resulting QRS complexes will be narrow and occur at the intrinsic rate of the AV node (40 to 55 beats/minute). Whereas if the block occurs below the AV node, a ventricular pacemaker must take over. In such cases, the QRS complexes will be wide and at the intrinsic rate of the ventricular pacemaker (20 to 40 beats/minute). | Atrioventricular Block (Nursing) -- Evaluation. Mechanism. Third-degree heart block is the end result of progressively worsening second-degree AV block. Because a third-degree heart block can occur above or below the AV node, two different rhythms can take over. If it occurs above or at the crest of the AV node, a junctional rhythm will take over and drive the ventricles. The resulting QRS complexes will be narrow and occur at the intrinsic rate of the AV node (40 to 55 beats/minute). Whereas if the block occurs below the AV node, a ventricular pacemaker must take over. In such cases, the QRS complexes will be wide and at the intrinsic rate of the ventricular pacemaker (20 to 40 beats/minute). |
Subsets and Splits