Download Nursing Study Guide: Key Concepts and Clinical Applications and more Study notes Nursing in PDF only on Docsity!
MED SURG FINAL REVIEW TOPICS
*=SATA
1. A ppen di ci ti s → w h at w i ll g et you w orri ed?
a. You should start to worry when the patient’s pain is suddenly GONE which would indicate a RUPTURE
2. H em odi alysi s → w h at are S/S of di sequi libri um syn drom e?
a. Early → headache, nausea, disorientation, restlessness, blurred vision b. Late → confusion, seizure, com a, death
3. AKI a. Acute kidney injury b. Clinically diagnosed by an abrupt rise in serum creatinine c. Common causes: ATN (acute tubular necrosis) d. Dx: acute reduction in UOP and/ or elevation in serum creatinine e. Reversible f. Cause of death: Infection 4. Hyperkalemia (treatment) a. Sodium polystyrene sulfonate 5. What is the MAX DOSE for APAP a. 4000 mg/ 4 g 6. Ketorolac a. Can take it for 5 days b. E.g. if taken on Tuesday morning, you can take until Sunday morning 7. Opioid toxicity triad a. Pinpoint pupils b. Respiratory Depression c. ALOC (Coma) *8. Difference between S/S of PAD vs Venous Insufficiency a. PAD i. Absent pulses (absent hair (shiny) cool legs) ii. Round, red sores (blood pooling) iii. Toes and feet pale (or black eschar) *Sores that don’t heal (usually in the toes) iv. Sharp calf pain (intermittent claudication) / hypoxia during exercise/activity (burning / pain) v. Pain relieved by rest and placing in dependent position vi. Decreased cap refills & pulses vii. Thick nasty toenails viii. Dependent rubor of the extremity NOTE the color can change due to the position from pale to red to blue/purple b. Venous Insufficiency i. Voluptuous pulses → warm legs ii. No sharp pain iii. weak/ non-functioning valves in the veins; blood flows backwards
iv. Varicose veins v. Brownish-red color vi. Hemosiderin in the blood vii. Chronic dermatitis viii. Stasi s ulcers → m edi al m alleolus (i rreg ular sores) ix. Edema
9. Rovsing’s Sign a. Push down in the pt’s LLQ and you feel pain in the RLQ that indicates Appendicitis 10. Kehr’s Sign a. When there is pain felt at the tip of the left shoulder this is an indication of a ruptured spleen 11. S/S Hypothyroidism a. think everything is down except for weight b. Lethargy c. Intolerance to cold d. Late clinical manifestations i. Subnormal temp ii. Bradycardia iii. Decreased LOC iv. Thickened skin v. Weight gain vi. Cardiac complications 12. S/S Hyperthyroidism a. think everything is up except for weight b. Intolerance to heat c. Bulging eyes (exophthalmos) d. Tachycardia e. Increased systolic BP f. Weight loss 13. Levothyroxine a. Aka synthroid b. Treats hypothyroidism c. Admin: 30-60 minutes in the AM before breakfast d. PT: full effect of medication takes 4-8 weeks; DO NOT stop abruptly; HOLD is HR > 110, notify the MD if S/S of hyperthyroidism occurs e. AE: S/S of hyperthyroidism 14. T reatm en t for H yperth yroi di sm → I odi n e 131 R A I (radi ation precauti on s i n th e
hospital, for the patient and for w hen the patient goes home) a. Delayed response 2-3 months; Peaks around 4-6 months b. CI: X!; no young children/breastfeeding/shellfish or sulfate allergy c. Admin: d. PT: Do not use the same toilet as others for 2 weeks; male clients should sit down to urinate e. Flush toilet 2-3 times after use
21. *M etaboli c syn drom e → w h at w ere th e 4 th i n g s th at w ere con si sten t w i th th ese
patients? a. B P meds or HIGH BP (over 130) b. B lood sugar meds or high BG (100+) c. O beses waist size (F 35+; M 40+) d. L ipids (Tri >150; HDL F <50; HDL M <40)
22. S/S Hyperglycemia a. BG is elevated >115 & HgbA1c > 6. b. Flushing - hot dry skin c. 3 P’s d. Irritable e. Headache f. NV g. Difficulty concentrating h. Fruity breath **i. Test for ketones
- S/S Hypoglycemia** a. BG < b. Tachycardia c. Diaphoresis d. Hungry e. Irritable f. Headache g. Dizzy h. Weakness and fatigue i. Anxious and trembling j. Blurred vision
- S/S DM II 25. Cholesterol Panel results (HDL, LDL, Total, Triglycerides GOALS) a. HDL > b. LDL < c. Total < d. Triglycerides < 26. S/S DKA vs. HHNS a. DKA i. Usually in DM I ii. BG > iii. Ketones iv. Acetone-like breath (fruity breath) v. Kussmaul breathing (deep-rapid breathing) vi. NV vii. Abdominal pain viii. Hyperkalemia b. HHNS
i. Usually in DM II ii. No ketones, acidosis, Kussmaul breathing iii. 3 P’s possibly with seizures or paralysis, OH, dizziness, extreme dehydration with neurological manifestations
27. Treatment for Status Asthmaticus a. IV Methylprednisolone b. Terbutaline c. Epinephrine d. Isoproterenol 28. What drugs can cause an asthma attack (asthma exacerbation) a. ASA, NSAIDS, BB, Cholinergics 29. BAM SLAM (know which ones are bronchodilators/anti-inflammatory & drug names) a. Bronchodilators i. Albuterol & Levalbuterol ii. Salmeterol, Vilanterol b. Anticholinergics i. Ipratropium, tiotropium, Glycopyrrolate c. Methylxanthines i. Theophylline, Aminophylline, Theobromine d. Steroids (glucocorticoids) e. Leukotriene Modifiers f. Mast Cell 30. What would we do with a patient who has COPD with high CO a. Don’t administer high O2 for it can shut off their hypoxic drive b. You want to keep their SpO2 between 88-92% 31. S/S COPD a. Generalized i. Easily fatigued ii. Use of accessory muscles iii. Orthopneic iv. Cor Pulmonale v. Thin in appearance vi. Wheezing vii. Pursed lip breathing viii. Chronic cough ix. Barrel chest x. Dyspnea xi. Prolonged expiratory time xii. Bronchitis → increased sputum xiii. Digital clubbing b. Emphysema (pink puffer) i. Pink skin & pursed lip breathing ii. Barrel chest (increased chest) iii. No chronic cough
ii. Vision problems iii. Individual’s behavior is quick and overly curious iv. Memory loss
36. APETM locations a. Aortic → right of the sternal border 2nd intercostal space b. Pulmonic →left of the sternal border 2nd intercostal space c. Erb’s point →left of the sternal border 3rd intercostal space d. T ricuspid →left of the sternal border 4th intercostal space e. Mitral →5th intercostal space midclavicular line 37. AE of Furosemide a. AE: Dehydration, Drop in BP , Hyponatremia, Hypokalemia, Hypocalcemia, Hypomagnesemia, Hyperglycemia, Hyperuricemia, Ototoxicity/Tinnitus 38. AE BB medications a. AE: Bradycardia, Hypotension/OH, Decreased CO, AV block, rebound excitation, bronchoconstriction, hypoglycemia 39. Stable Angina vs Unstable Angina vs STEMI a. Stable angina i. “Predictable” 1. E.g if you increase activity you will increase the pain ii. Caused by exercise or emotional distress iii. Relieved by rest or NTG b. Unstable angina i. Occurs with exercise OR with rest ii. Increases frequency, severity, and duration over time c. STEMI (MI) 40. Different ways to do a stress test on a cardiac patient --what meds do we use? a. Exercise stress test → for unstable angina b. Chemical stress test i. For pts who are too weak, sick, or feeble to walk on the treadmill ii. Given a chemical to stimulate the heart iii. Called Lexican (Regadenoson) 41. What are S/S that would indicate the patient is bleeding post cath lab angioplasty? a. Cardiac tamponade (bleeding around the heart) i. Beck’s triad: Hypotension, JVD, Muffled heart sounds b. Retroperitoneal Bleeding i. Hypotension, Flank Pain, Grey Turner’s sign, Cullen’s sign, SOB 42. LH F vs R H F (di astoli c vs systoli c) → w h i ch i s m ore con si sten t w i th di lated
cardiomyopathy vs hypertrophic cardiomyopathy
a.
*43. S/S of LHF a. Crackles b. Pink frothy sputum c. Paroxysmal (intermittent) nocturnal dyspnea d. “X” pillow orthopnea e. SOB *44. S/S of RHF a. Fatigue b. Enlarged liver & spleen (hepatomegaly & splenomegaly) c. May be secondary to chronic pulmonary problems d. JVD e. Dependent edema 45. Causes of LHF & RHF
i. Infusing sterile dialyzing fluid through catheter implanted in abdominal cavity ii. Dialysate fluid bathes peritoneal membrane that:
- Covers abdominal organs
- Overlies capillary beds iii. COMPLICATIONS
- Infection (peritonitis)
- Pain
- Exit site and tunnel infections
- Dialysate leakage
- Hyperglycemia *50. S/S Parkinson’s Disease a. MOTOR i. Tremor ii. Muscle rigidity iii. Bradykinesia iv. Postural Instability b. NON-MOTOR i. Insomnia ii. Constipation iii. anxiety/depression iv. Dementia v. Fatigue vi. hyposmia/anosmia vii. Weight loss viii. Drooling ix. Urinary urgency or hesitancy x. Libido drop 51. PT for Levodopa-Carbidopa a. AE: Dyskinesias, OH, tachycardia, palpitations, psychosis (visual hallucinations, nightmares, paranoia), pee changes color (dark brown or red) b. PT: eat protein in small portions throughout the day; avoid foods containing pyridoxine (wheat germ, green veggies, whole-grains, liver, legumes) c. RN: Avoid use in clients who have skin lesions that haven’t been dx; expect a 2nd generation antipsychotic medication to decrease Psych AE 52. What is the drug we give for drooling a. Glycopyrrolate (anticholinergics) 53. MS interventions a. Encourage fluid to prevent UTI b. Perform crede’s maneuver to help with retention c. Bladder training to help with incontinence, and should be done 1-2 hours d. If cognitive decline, promote cognitive function i. Frequency, reorient to place, objects used in daily routine places, set a similar daily schedule (meals and bedtime) e. For dysarthria → use a communication board
f. For diplopia use an eye patch, rotate eye every few hours & teach the pt to scan from side to side to help with eye strength / fatigue g. For general fatigue → en courag e pt to plan to h ave rest periods
*54. Types of kidney stones & causes associated with each kidney stone a. Cysteine i. Genetic DO b. Calcium (most common) i. Hypercalcemia of bone cancer c. Uric Acid i. gout/ chemotherapy/tumor lysis syndrome d. Struvite i. UTI
- Gouty arthritis vs osteoarthritis vs rheumatoid arthritis & different treatment options for each a. Gouty arthritis b. Osteoarthritis c. Rheumatoid arthritis 56. BPH treatments & PT for the treatments (drugs and surgery) a. Medications i. 5-alpha reductase inhibitors (5-ARI) 1. Finasteride, Dutasteride a. Takes 6 months to start working b. Can cause impotence, loss of libido c. Wear gloves - especially female RN d. Wear condoms ii. Alpha-Adrenergic Blockers 1. Tamsulosin a. Works fast in 48 hours b. Really bad OH c. Rebound tachycardia
- Urine pink, red, or tea colored = myoglobinuria ii. Foamy urine (proteinuria)
- Due to excess protein in the urine
- 24 hour collection for urine protein iii. Edema in the face, eyes, ankles, feet, legs or abdomen iv. HTN 58. Expected findings with ESRD a. A (acid - base → w orks w /lungs) i. Metabolic acidosis b. B (blood pressure (RAAS system)) i. HTN c. C (calcium absorption) i. Hypocalcemia d. D (vitamin D activation) i. Osteoporosis & hypocalcemia e. E (EPO → RBC production and excrete waste) i. Activity intolerance d/t anemia f. F (fluid and electrolyte balance (ADH)) i. Overload, hyperkalemia, hyperphosphatemia g. Little to no GFR aka dialysis dependent; loss of ⅞ filtration capacity h. Irreversible 59. EKG alterations with Hypokalemia vs Hyperkalemia a. Hypokalemia i. U waves, ST Depression, muscle weakness, shallow breathing, ileus b. Hyperkalemia i. Peaked T waves, arrhythmias, Wide QRS, Hyperactive bowel sounds, V-fib, Hypotension 60. PT for Nitroglycerin a. Stop activity, sit down b. Take first pill c. If pain does not subside in 5 minutes then call 911, take the next dose d. A MAX of 3 doses can be taken
- S/S of STEMI/MI 62. S/S of hypoxia a. Early signs: anxiety, confusion, restlessness b. Late signs: cyanosis, hypotension 63. Different causes of renal failure (causes of pre, intra and post renal) a. Prerenal i. Dehydration ii. HF iii. Low BP (bleeding) b. Intrarenal i. Infection ii. Drugs
iii. DM iv. Acute Glomerulonephritis c. Postrenal i. Stones ii. BPH iii. Cancer tumor
