med surg 4

Cutaneous manifestations of thrombocytopenia

Petechiae, ecchymosis, and purpura =

Key nursing precautions for a patient with thrombocytopenia = Use soft toothbrush, electric razor only, no IM injections

rectal temps, and implement fall precautions =

What is Polycythemia Vera

a rare bone marrow disorder in which the body overproduces RBCs causing the blood to become unusally thing (hyperviscous) =

Hallmark symptom of Polycythemia Vera triggered by heat

Pruritus (generalized itching) after a warm bath or shower =

Primary medical treatment for Polycythemia Vera to reduce hematocrit

Therapeutic phlebotomy (removal of 300-500 mL of blood) =

Target Hematocrit percentage for Polycythemia Vera management

Maintain hematocrit below 45% =

What is sickle cell crisis

a severe, acute complication of sickle cell disease where abnormally shaped, rigid RBC obstruct microvascular blood flow causing tissue hypoxia and extreme pain =

Patho of sickle cell crisis

• trigger (hypoxia, dehydration, cold, stress)

• RBCs sick and become rigid

• clumping of RBCs and vascular obstruction

• ischemia and tissue hypoxia

• severe pain, organ damage and inflammation =

The "HOP" priority protocol for Sickle Cell Crisis

Hydration, Oxygenation, and Pain management (IV opioids) =

Why is keeping a Sickle Cell patient warm a priority?

Cold causes vasoconstriction, which triggers or worsens the sickling process =

What is the rule of 9s

• head (ant 4.5, post 4.5)

• chest (ant 9, post 9)

• abd (ant 9, post 9)

• one arm (ant 4.5, post 4.5)

• one leg (ant 9, post 9)

• genitalia (1%) =

Parkland Formula equation for 24-hour fluid resuscitation

4 mL x weight (kg) x %TBSA burned =

Fluid administration schedule for the Parkland Formula

50% of total volume in first 8 hours (from time of injury); 50% over the next 16 hours =

Most critical assessment sign of an inhalation burn injury

Stridor, hoarseness, or brassy cough (indicates impending airway obstruction) =

Priority nursing action for suspected inhalation injury

Secure airway

Normal range for Intracranial Pressure (ICP)

5 to 15 mmHg =

Equation to calculate Cerebral Perfusion Pressure (CPP) = CPP -- Mean Arterial Pressure (MAP) - ICP =

Normal range for Cerebral Perfusion Pressure (CPP)

80 to 100 mmHg (Minimum of 60 required for perfusion) =

The very first sign of increased ICP

Altered mental status or change in Level of Consciousness (restlessness

Components of Cushing's Triad (Late sign of ICP)

Systolic hypertension (widened pulse pressure), Bradycardia, and Irregular respirations =

Arterial gas levels that cause cerebral vasodilation (raising ICP)

PaCO2 > 45 mmHg (Hypercapnia) and PaO2 < 50 mmHg (Hypoxia) =

Recommended Head of Bed (HOB) position for increased ICP

30 to 45 degrees with head

Preferred IV fluid for neuro patients (and why)

0.9% Normal Saline; avoid hypotonic fluids (D5W

Mechanism of Mannitol (20%) in neuro care

Osmotic diuretic that pulls fluid from brain tissue into blood vessels to lower ICP =

"Halo Sign" assessment for Basilar Skull Fracture

Clear

Positive Kernig Sign description

Pain

Priority position after a Lumbar Puncture

Flat or supine for 4 to 8 hours to prevent CSF leak and spinal headache =

The "Clinical Triad" of Neurogenic Shock

Hypotension, Bradycardia, and Hypothermia (with warm, dry skin) =

First priority management for Autonomic Dysreflexia

Immediately sit the patient upright (90 degrees) to lower blood pressure =

Most common trigger for Autonomic Dysreflexia

Bladder distension (blocked or kinked urinary catheter) =

Physical finding of BPH during a Digital Rectal Exam (DRE)

Symmetrically enlarged, smooth, firm, and rubbery prostate =

Difference between Tamsulosin and Finasteride for BPH

Tamsulosin relaxes smooth muscle (immediate flow improvement); Finasteride shrinks the prostate (takes 3-6 months) =

Critical safety education for Alpha-1 Blockers (Tamsulosin

Terazosin)

Safety precaution for Finasteride (5-Alpha Reductase Inhibitor)

Pregnant women must not handle crushed or broken tablets (teratogenic) =

Expected color of CBI drainage in the first 24 hours after TURP

Bright red with small clots =

Priority action if a TURP patient has bladder spasms and decreased output

Check CBI tubing for kinks or clots; perform manual irrigation if obstructed =

Goal of catheter traction (tension) after a TURP

To apply pressure to the operative site and prevent internal hemorrhage =