Advanced med-surg final essay topic questions

Describe how triage is performed during a disaster and how it differs from triage within the emergency department

triage in the ED--> prioritizes patients based on their level of illness/severity and the goal is the help patients with life-threatening conditions first

performed by: rapid assessment and color-coded based on condition (red, yellow, green) (may take several minutes per patient

resources: usually abundant (enough staff/beds etc.)

triage in MCI cases--> prioritizes patients based on the likelihood of survival and the goal is to do the greatest good for the greatest number of people

performed by: assessment of airway/circulation/mental status then color-coded based on findings (seconds to 1 minute per patient only for assessment)

resources: limited resources

Differentiate between Addison's disease and Cushing's syndrome and associated plans

Addison's disease--> (Add the cortisol/salt/sugar)

S/S: low cortisol/aldosterone levels, low BP, hyponatremia/hyperkalemia, weight loss, hypoglycemia

INTERVENTIONS: primary goal is to replace hormones with hydrocortisone, and correct electrolyte imbalances, monitor vitals/BS/fluid status, and prevent addisonian crisis (teach about dosing during stress etc.)

Cushing's--> (cushioned with cortisol/salt/sugar)

S/S: high cortisol levels, round/moon face, HTN, hypernatremia, hypokalemia, weight gain, hyperglycemia

INTERVENTIONS: primary goal is to reduce cortisol levels through treating cause, meds, and/or surgery, and preventing hypertension/ correcting electrolyte imbalances

Discuss the care plan for a patient suffering from DKA and HHS:

Assessment: vitals, neuro status, fluid status, kussmals respirations in DKA patients, blood glucose levels, BUN/creatinine, ABGS and presence of ketones

Interventions: fluid replacement (IV 0.9% NS), regular insulin IV, electrolyte management (treat hypokalemia) and determine underlying triggers/cause

Describe differences for use of a lobectomy versus liver transplants in patients with liver failure:

Lobectomy:

-Surgical removal of a lobe of the liver, usually performed to treat localized liver disease, such as a tumor or severe localized injury

-Does not replace the entire liver—the remaining liver regenerates if healthy.

-for primary or metastatic liver tumors confined to one lobe, severe trauma or abscess localized to a single lobe, and certain cases of hepatic cysts or benign masses

-Requires adequate remaining liver function; not suitable in generalized liver failure (e.g., cirrhosis)

Liver Transplant:

-Surgical replacement of the entire diseased liver with a healthy donor liver

-End-stage liver disease / liver failure

-Completely replaces liver function

-Requires life-long immunosuppressive therapy to prevent rejection

List 3 types of shock and at least one cause for each type

1) hypovolemic shock --> hemorrhage or severe dehydration

2) septic shock --> severe systemic infections (fungal, bacterial, or viral)

3) neurogenic shock--> spinal cord injuries or traumatic brain injury

Discuss primary and secondary brain trauma

primary--> The immediate injury to brain tissue that occurs at the moment of trauma

examples: concussion, contusion, lacerations, and skull fractures

secondary --> Brain injury that occurs after the initial trauma, caused by physiologic and biochemical processes that worsen the primary injury

examples: increased ICP/cerebral edema

What is Frank Starling's Law?

Starling's Law: The stroke volume of the heart increases in response to an increase in the volume of blood filling the heart, when all other factors remain constant

simplified = The more the heart fills with blood, the more it stretches, and the stronger it pumps — up to a point. So, stroke volume (blood pumped per beat) depends on how full the heart is before it contracts

Discuss the components of frank starling's law and how they affect cardiac output

Key Components & Effects on Cardiac Output

Preload (how full the heart is before it beats)

Think: Stretch of the heart fibers like a rubber band.

Effect:

↑ Preload = ↑ stroke volume → ↑ CO

↓ Preload = ↓ stroke volume → ↓ CO

Contractility (how strong the heart can squeeze)

Think: The “muscle power” of the heart.

Effect:

↑ Contractility = heart squeezes harder → ↑ stroke volume → ↑ CO

↓ Contractility = weaker squeeze → ↓ stroke volume → ↓ CO

Afterload (resistance the heart has to pump against)

Think: Like pumping water through a narrow hose.

Effect:

↑ Afterload = heart works harder → stroke volume ↓ → CO ↓

↓ Afterload = easier to pump → stroke volume ↑ → CO ↑

Acute phase of ARDs:

-Damage to alveolar–capillary membrane

-Fluid leaks into alveoli → pulmonary edema

-Decreased surfactant → alveoli collapse (atelectasis)

-Respiratory alkalosis early (from tachypnea)

S/S: tachypnea, crackles, restlessness, use of accessory muscles, hypoxemia, and increased labored breathing

PLAN OF CARE: Improve oxygenation, prevent further lung injury, high-flow oxygen, intubation and mechanical ventilation early if severe, use PEEP to keep alveoli open, and monitor ABGs

Proliferative phase of ARDs:

-lungs begin repairing

-slight improvement in gas exchange

S/S: persistent hypoxemia, decreased lung compliance, hypercapnia, and tachypnea

PLAN OF CARE: Continue lung-protective ventilation,

avoid fluid overload, optimize nutrition, physical therapy, early mobility if stable, monitor for organ dysfunction, and prevention of complications (pressure injuries, DVTs)

Late/fibrotic phase of ARDs:

-Lung tissue becomes scarred and fibrotic

-Decreased lung compliance (very stiff lungs)

-Permanent damage possible

S/S: severe hypoxemia, fatigue, very stiff lungs, worsening C02 retention, and in severe cases, multi-organ failure

PLAN OF CARE: Continue mechanical ventilation, may require high PEEP, monitor for right-sided HF, possible long-term oxygen needs, evaluate for tracheostomy if prolonged ventilation, and palliative support if poor prognosis

Discuss the rationale for early enteral feeding in relation to prevention of GI microbial translocation

Microbial translocation = when bacteria or toxins from the GI tract cross the intestinal barrier and enter the bloodstream → can lead to sepsis, SIRS, and worsening organ failure

Early enteral feeding (providing nutrition through the gut within 24–48 hours) protects the intestinal lining and prevents this from happening

-when patient is NPO, intestinal lining can thin and bacteria can leak out

-enteral feedings stimulate peristalsis, preventing bacterial overgrowth

-maintains normal gut pH

Level 1 Disaster

Small-scale event that can be managed completely by local resources

ex: house fires or minor flooding

-local EMS responds, local fire/police and local hospitals

Level 2 disaster

Moderate disaster. Local resources are overwhelmed and state-level support is needed

ex: wildfires, moderate hurricane damage, flooding affecting multiple towns

-state national guard or state emergency operations may be needed

-state-level Red Cross

Level 3 disaster

Large-scale or catastrophic disasters that overwhelm local and state resources → federal government steps in

ex: major hurricanes like Katrina, large earthquakes, pandemics, terrorism

-U.S public health gets involved, federal agencies such as CDC or national guard may be needed to get involved

-federal emergency management agency

-may even need international aid