Final Study Guide Med surg

NURS120- MED SURG FINAL STUDY GUIDE Diagnostic - determines origin and cause of disorder Curative - resolves health problem by repairing/removing cause Restorative - improves patients’ functional ability Palliative - relieves symptoms of disease process, but does not cure Cosmetic - alters/enhances personal appearance Informed consent - surgeon obtains signed consent Preoperative Fasting - NPO 8 hrs prior to surgery, decreases risk for aspiration Malignant Hyperthermia - may be genetic, increased metabolism, leads to acidosis, high temp, muscle rigidity, dysrhythmias (reversal: dantrolene) Endoscopy - tube through mouth to small intestine Normal finding- delayed swallow response Abnormal finding- blood sputum, hoarseness, inability to speak Colonoscopy - use go lightly (day before, encourage high fluid intake b/c will lose lots of fluids), tube in rectum to large intestine Malignant Hyperthermia in Acute phase* Abnormal finding- dark tarry (upper GI), bright red (lower GI) GERD Triggers- fatty foods, chocolate, peppermint, coffee, tea, milk, late/large meals S/S- pyrosis (heartburn), regurgitation Treatment- avoid aggravating factors, small frequent meals, last meal 3 hrs prior to bed, lose weight, drugs (H2 Antihistamine, PPI, Sucralfate) RN- lifestyle changes, elevate 30 degrees, not supine 2-3 hrs after meal, fluids Complication- Barrett’s esophagus, PNA, bronchitis, asthma (due to gastric secretions) IBD- lost of meds needed Crohns - any part of GI tract Risk factors- genetic, environmental (smog), immune system abnormalities S/S- fever, weight loss, malabsorption Treatment- bowel rest, drugs Comp- Fistulas, strictures, anal abscess, perforation UC - starts at rectum to colon S/S- rectal bleeding (pink/frothy), rectal pain (tenesmus) Treatment- Colectomy Comp- perforation PUD Risk factor- H.Pylori, NSAID use, high alcohol intake, smoking, stress, coffee S/S- burning/gaseous pain 1-5 hrs after meals, bleed, dehydration, feeling of fullness, NV Tests- Stool/Breath test Treatment- avoid spicy food, caffeine, pepper, broth, NG tube, rehydrate, bowel rest, drugs (H2 Antihistamine, PPI, ABX, Antacids) Complication- Hemorrhage, perforation (tight/rigidty), high HR, weak pulse, high RR Gastritis Risk factor- smoking, diet, NSAIDs, H.Pylori S/S- loss of IF, anorexia, anemia Closed reduction - nonsurgical, manual realignment of bone fragments to their anatomical position Open reduction - correction of bone alignment through surgical incision, screws/wires/pins/plates Traction - application of a pulling force to an injured/diseased body part Bucks Traction - 24-48 hrs before surgery to relieve painful muscle spasms, alignment of the bone assess skin/pressure points Q2-4hrs Skin Traction - removable, complication of weight falling & constant readjustment (do not touch) Skeletal Traction - holding different areas, tissue damage RICE - rest, ice, compress, elevate Hypoglycemia - sweat, pallor, hunger, shaky, tired, dizzy, palpitations,

NURS120- MED SURG FINAL STUDY GUIDE lack of coordination Treat- 15g carb, IV dextrose Hyperglycemia - dry mouth, thirst, weak, headache, blurred vision, frequent urination (3 P’s) Treat- insulin, fluids DKA - ketones, fruity breath, SOB, confusion, coma, abd pain Treat- insulin drip, 5% dextrose, fluids Hypovolemia - fluid volume deficit, decrease BP, decrease O2 Risk for Orthostatic Hypotension, increase sodium Nutrition for wound healing Vit C - collagen prod Vit A - epithelization Protein - synth of immune factors Carb - metabolic, energy Compartment Syndrome Early signs- pain unmanageable, Late-6 P’s (pain, pressure, paresthesia, pallor, paralysis, pulselessness) relieve source of pressure, cut cast/low weight Pulselessness/Paralysis- amputation may be needed! (fasciotomy- surgical decompression where it is left open for adequate soft tissue decompression) RN- do not elevate legs/apply cold, vasoconstriction occurs and worsens it! VTE - esp after hip fracture • Anticoagulant drugs given for 10-14 days (warfarin/heparin/aspirin/factor Xa inhibitor) • Wear compression gradient stockings, Intermittent pneumatic compression devices • Dorsiflex/plantar flex/ROM exercises on unaffected leg FES • Symptoms occur 24-48 hrs after injury, after S/S fluid+O2 admin • FE in lungs- hemorrhage, ARDs, chest pain, tachypnea, cyanosis, dyspnea, tachycardia, hypoxic S/S- sudden chest pain URGENT, petechiae RN- reposition patient as little as possible before fracture immobilization/stabilization TB Risk factors- poor, crowded cities, traveled countries • Airborne, granulomas (hallmark signs) S/S- crackles, rhonchi, night sweats, weight loss, bloody sputum Treatment- RIPE meds, meds are harsh to live (watch ALT/AST) RIF (urine orange), INH (tingling hands/feet), PYRAZINAMIDE (increase uric acid), ETHAMBUTOL (vision changes) • DOT therapy if patient does not adhere to med regime • Mantoux test (skin test), BCG vaccine always test positive PE • Blood clot, fat, air in lungs

NURS120- MED SURG FINAL STUDY GUIDE • Reflux of urine from ureter back to kidney, obstruction, catheterization Interstitial Cystitis • Painful bladder syndrome (PBS)/ mini ulcers • Pain relieved by bladder emptying • NEGATIVE culture (no bacteria), often misdiagnosed Treatment- eliminate irritants (sodas, spicy foods), stress mgmt, catheter (bladder rest) Incontinence Urge - can’t hold urine Functional - can’t get to bathroom in time Stress - pressure from coughing/laughing HTN stages Pre HTN- 120-129/ <80 Stage 1- 130-139/ 80-89 Stage 2- 140/90 or higher HTN Crisis- 180/120 or higher HTN Urgency- oral antihypertensives (-pril, -lol, -dipine) HTN ER- cerebral edema, IV Na Nitroprusside • Nicotine contained tobacco products cause vasoconstriction and increase BP S/S- silent killer.. later stages- fatigue, dizzy, palpitations, angina, dyspnea, NV (women) Treatment- weight, salt, DASH (omega 3 fatty foods- tuna, tofu walnuts, veggies, fruits, whole grain, fish, poultry, beans, nuts), physical activity, stress mgmt., smoking, limit alcohol Drugs- diuretics, angiotensin, Ca channel blockers CAD - Clot turns CAD -> MI Risk factors- increase 4x after menopause, stressful states S/S- HTN, ischemia, Angina Treatment- modifiable (smoking, drinking, stress), anti-lipids (-statins), low dose aspirin MI - thrombus S/S- severe angina (radiates), NV, fever, initial HTN, tachycardia Treatment- MONA therapy (nitro 3 max doses, 5 mins in between, aspirin- baby 325mg) • Cardiac catheter- assess bleeding, bed rest in acute phases, iodine allergy • Troponin- biomarker for MI AFIB • Absence of P-waves S/S- SOB, chest pain, hypoxia (reposition patient), palpitations Treatment- Diltiazem, Metroprolol, Amiodarone, Digoxin PAD - occlusion to arteries, pallor/cyanosis, do not elevate PVD - problem w venous return, edema/red/warmth, elevate, do not massage/ambulate Chest pain Mgmt: 1) Administer supplemental oxygen, position patient in upright position unless CI 2) Assess vital signs 3) Obtain a 12-lead ECG 4) Provide prompt pain relief first with a nitrate followed by an opioid analgesic 5) Auscultate heart sounds Iron Deficiency - Low Hgb, poor iron intake/blood loss/hemolysis Risk factor- young, women, poor diet S/S- pallor, cheilitis, fatigue, sensitivity to cold, brittle nails Treatment- Foods high in iron, iron supp (take on empty stomach, w/ Vit C), transfusion Nutrition- lean beef, white meats, fish, legumes, leafy greens, whole grains, cereal, beans Pernicious Anemia - Low Vit B12, absence of IF, RBC abnormal shape • Decreased sensitivity to pain/heat due to neurologic impairment Risk factors- high alcohol intake, hot tea, smoking, long term use H2+PPI, strict vegetarians, genetic S/S- anorexia, ataxia, abdominal pain, confusion

NURS120- MED SURG FINAL STUDY GUIDE Treatment- parenteral/intranasal B12, IV B12 (if not die in 1-3 years) Nutrition- meat, eggs, enriched grains, milk & dairy foods, fish (salmon) Sickle Cell Anemia • Heterogenous Risk factors for crisis- infection, hydration, oxygenation S/S- crisis (SOB, pain, jaundice, gallstones, HTN, fever, chest pain) Treatment- HOP (hydration, oxygen, pain mgmt.) Transfusion- Fresh plasma within 24 hrs, Prime with 0.9% NS, completed by 4 hrs Brain - Left (cognition), Right (memory/awareness) CVA - brain attack/stroke S/S- decreased motor function (test cranial nerves), intellectual function (repeat after me, what obj) Communication (inability to express, speech slurred), decreased pupillary response Diagnosis- CT/MRI/lumbar puncture, BE (balance, eyes) FAST (face, arms, speech, time) ISCHEMIC - decreased blood flow to brain (blockage) Risk factors- overweight, high BP+cholestrol, sleep apnea, CVD, DM Treatment- tPA within 3-4.5 hrs LKWT, aspirin first then anticoag once stabilized to prevent, surgical extraction of clots HEMORRHAGIC - bleeding (risk for seizures due to increase ICP) Treatment- NO anticoags, manage HTN, hypoglycemia (confusion), surgical resec (Gamma Knife) TIA - mini stroke, S/S for few mins-24 hrs, self-resolve but precursor to stroke, nutrition (protein/hydration) Seizures Cause- idiopathic, trauma, infection, tumors, electrolyte imbalance, fever, congenital (down syndrome) Partial- simple (does not affect consciousness), complex (affects consciousness), secondary (spreads) Generalized- absence (starring spell), myoclonic (brief muscle), clonic (jerk), tonic (stiffness), tonic-clonic (grand mal), atonic (muscle limp, no tone) Stages Prodromal - subtle changes (mood) Aura - sensory changes (tinnitus, visual, taste/smell terrible) Ictal - seizing (give Ativan to stop) Post - ictal - drooling, slow to respond, contracted (hyperoxygenate, left side lay) EPILEPTIC Diagnostic EEG - quiet environment, figuring out triggers, no stimulants, pad side rails, press button Blood test - underlying pathology (electrolye imbalance/sepsis) CT / MRI - changes in brain structure (tumor) Lumbar puncture - ICP off, CSF leaking (treat by blood patching) Treatment - Keto diet (no bread/sugar/milk/corn/beans/rice)- meats, eggs/dairy, oils, greens, nuts, berries AEDs - reduce excessive electrical activity, Clonazepam (acute), Barbi/lacosamide (maintenance) Vagus Nerve Stimulator - magnet across chest to stop seizing (late defense) Surgery - remove portion of brain causing it (last line defense) RN - side lying, airway, pad rails, clear area, suction avail, dim lights, loosen clothing, vitals Q 30 mins, neuro checks, meds STATUS EPILEPTICUS (medical ER)- seizing > 5 mins, 2 nd seizure without post-ictal phase, repeated > 30 mins RN- oxygen/support breathing, IV fluids, AEDs (benzo, Ativan, versed, Valium), anesthetics