N162B- Med Surg B Final Review

Chvostek Sign

Tapping the cheek over the facial nerve causes twitching of the facial muscles on that side; a positive sign indicating hypocalcemia

Trousseau Sign

Inflating a blood pressure cuff above the systolic baseline for at least 3 minutes causes carpopedal spasms in the arm; a positive sign indicating hypocalcemia

Post Thyroidectomy and Hypocalcemia

The parathyroid glands may be removed or may atrophy, reducing PTH secretion. PTH is responsible for calcium resorption, and its loss can lead to hypocalcemia. The patient may present with positive Chvostek and Trousseau signs

Sodium Imbalances and the Brain

Both hyponatremia and hypernatremia cause fluid shifts between the intracellular fluid (ICF) and extracellular fluid (ECF). These shifts are especially dangerous in the brain, making seizure precautions a priority nursing intervention

Normal Sodium Level

135 to 145 mEq/L

Normal Potassium Level

3.5 to 5 mEq/L

Hyperkalemia: Causes

Renal failure is a primary cause. Since potassium is mostly excreted through the kidneys, renal failure prevents adequate excretion and causes a dangerous buildup of potassium in the blood

Hypokalemia: Causes

Thiazide diuretics, loop diuretics, laxatives, and prolonged nasogastric tube drainage can all cause hypokalemia

Hyperkalemia: EKG Changes

Peaked (tall, tent shaped) T waves, widened QRS complex, and in severe cases a sine wave pattern; these changes indicate dangerously elevated potassium levels

Hypokalemia: EKG Changes

Flattened or inverted T waves, the presence of U waves (a small wave appearing after the T wave), and possible ST segment depression

EKG in Potassium Imbalances: Nursing Action

In both hypokalemia and hyperkalemia, an essential nursing intervention is to obtain an EKG and promptly report the results to the physician

Cholelithiasis

The presence of gallstones in the gallbladder. A key lifestyle modification to manage symptoms is decreasing fat consumption

Ascites

Abnormal accumulation of fluid within the peritoneal cavity; commonly associated with liver disease and cirrhosis

Paracentesis: Goal in Ascites Treatment

A primary goal of paracentesis is to relieve respiratory distress caused by excess abdominal fluid pressing upward against the diaphragm

Elevated Ammonia and its Effects on the Body

Elevated blood ammonia (60 to 80 umol/L or higher) is a risk factor for hepatic encephalopathy. Ammonia acts as a toxin in the CNS, causing the patient to become increasingly lethargic with a declining level of consciousness. The specific threshold varies by individual and underlying liver condition

Neomycin Sulfate and Ammonia

Neomycin sulfate is used to reduce ammonia forming bacteria in the gut, which lowers serum ammonia levels. As ammonia decreases, the patient shows improvement in level of consciousness

Hepatitis: Types with Vaccines

Hepatitis A and Hepatitis B have available vaccines

Hepatitis: Types that Can Become Chronic

Hepatitis B and Hepatitis C are the types that can progress to chronic infection

Hepatitis A: Transmission

Spread through the fecal to oral route, commonly through contaminated food or water

Hepatitis B: Transmission

Spread through blood, sexual contact, and from mother to child during childbirth (perinatal transmission)

Hepatitis C: Transmission

Spread primarily through blood to blood contact, such as sharing needles or contaminated medical equipment

Hepatitis E: Transmission and Pregnancy Risk

Spread through the fecal to oral route via contaminated water. Associated with high maternal mortality

Hepatitis B: Post Exposure Prophylaxis

Administer Hepatitis B Immune Globulin (HBIG) and initiate the Hepatitis B vaccine series as soon as possible after exposure

Dehydration: Lab Changes

Dehydration causes hemoconcentration, which leads to elevated hematocrit levels along with hypernatremia

Pancreatitis: Dietary and Lifestyle Precautions

Patients with pancreatitis must avoid all alcohol consumption. They should also avoid even the smell of food, as this can trigger overexcretion of pancreatic enzymes

Steatorrhea

Fatty, frothy, and foul smelling stools caused by the inability of lipase to be released into the intestines to help digest fat; a common sign of pancreatitis

Cullen Sign

Periumbilical ecchymosis, meaning bruising or discoloration around the belly button; a clinical finding that may be present in acute pancreatitis. Named after physician Thomas Stephen Cullen

Acute Pancreatitis: Common Causes

Gallstones and chronic alcohol use are the most common causes. Other causes include medications, trauma, and hyperlipidemia

Fluid Volume Deficit

Insufficient fluid in the body caused by hemorrhage, burns, vomiting, diarrhea, or excessive sweating. Signs include tachycardia, hypotension, dry mucous membranes, decreased urine output, and elevated hematocrit

Fluid Volume Excess

Too much fluid in the body. Signs include edema, crackles in the lungs, elevated blood pressure, bounding pulse, and sudden weight gain

Jaundice and Bilirubin

Occurs when the liver cannot conjugate bilirubin, causing it to accumulate in the blood and tissues. The skin and sclera become yellow and stools may become clay colored. The nurse should assess the sclera and oral mucosa, particularly in darker skinned patients

T Tube After Open Cholecystectomy

A T tube may be placed during open cholecystectomy to assist with bile drainage from the common bile duct during the healing period

Post Hip Replacement Flexion Precaution

Patients must not flex the hip beyond 90 degrees, such as by sitting low in a chair and reaching below waist level. This position places the joint at risk for dislocation

RICE for Soft Tissue Injuries

Rest, Ice, Compression, and Elevation; the standard treatment approach for sprains and other soft tissue injuries

Homans Sign

Pain in the calf upon dorsiflexion of the foot; historically associated with deep vein thrombosis (DVT)

Burns Emergent Phase: Hematocrit Changes

Massive fluid shifts from the vascular space to the interstitial space cause hemoconcentration, which results in elevated hematocrit levels

Large Burns and Fluid Loss

Burns covering more than 30 percent of total body surface area cause massive fluid loss; this is the priority nursing concern in large burn patients

Inhalation Injury in Burn Patients

Coughing during the immediate post burn phase may indicate an inhalation injury, which is a major predictor of mortality in burn patients

GERD Pathophysiology

Gastroesophageal reflux disease occurs when stomach acid flows back into the esophagus, causing irritation and inflammation of the esophageal lining. Over time this can lead to complications such as esophageal erosion

GERD Treatment: Antacid Patient Education

Should not take other medications for at least 2 hours before or after the dose, because some medications require an acidic environment for proper absorption

Escharotomy

A surgical incision made through burn eschar to relieve pressure and prevent burn induced compartment syndrome, used specifically in circumferential burns

Post Burn Pain Management

Administered via the intravenous route to ensure a rapid and reliable therapeutic effect

Compartment Syndrome

A condition in which increasing pressure within a fascial compartment compromises blood flow and nerve function. The fascia does not expand, so any buildup of pressure from bleeding or swelling will compress circulation and nerves. A hallmark sign is pain unrelieved by appropriate medication. The nurse monitors for the 6 Ps: Pain, Pallor, Paralysis, Paresthesia, Pulselessness (late sign), and Poikilothermia

Cast Care During Drying

The cast must always be repositioned using the palms of the hands and never the fingertips during the drying period. Fingertip pressure creates dents in the cast that can lead to the formation of pressure ulcers under the skin

Severe Anemia: Compensatory Responses

The heart develops compensatory tachycardia, increasing its rate to pump more blood and compensate for the lack of oxygen carrying cells. The patient also experiences dyspnea for the same reason

Pagophagia and Pica

Craving to eat ice (pagophagia) or clay (pica) are characteristic signs of iron deficiency anemia

Hospice Care

A type of care offered to patients with a life expectancy of 6 months or less. It focuses on comfort and support rather than curative treatment, emphasizing quality of life for both the patient and their family

Radiation Therapy: Skin and Rest Education

Monitor their skin closely for the effects of external radiation beams, and prioritize getting adequate rest throughout their course of treatment

Diabetes Type I vs Type II Pathophysiology

Type I is an autoimmune disease in which the pancreas produces little or no insulin. Type II involves insulin resistance or insufficient insulin production. Both result in elevated blood glucose but through different underlying mechanisms

Diabetic Ketoacidosis (DKA)

A life threatening complication primarily of Type 1 Diabetes. Severe insulin deficiency causes the body to break down fat for energy, producing ketones that lead to metabolic acidosis. Characterized by hyperglycemia, ketones in blood and urine, and acidosis

Hyperosmolar Hyperglycemic

A serious complication primarily of Type 2 Diabetes characterized by extremely high blood glucose, severe dehydration, and hyperosmolarity without significant ketoacidosis. Often triggered by illness or infection

Hypoglycemia

Abnormally low blood glucose; a complication seen in both types of diabetes, often caused by excess insulin, inadequate food intake, or excessive exercise. Symptoms include shakiness, diaphoresis, confusion, and palpitations

Addison Disease

Primary adrenal insufficiency in which the adrenal glands do not produce adequate cortisol and aldosterone. Treatment requires lifelong corticosteroid replacement therapy

Cushing Syndrome

A condition caused by prolonged excess cortisol exposure. Treatments aim to identify and reduce or eliminate the source of excess cortisol, such as surgical removal of a causative tumor or tapering of exogenous steroids

Glucocorticoid Tapering

When weaning a patient off glucocorticoids such as prednisone, the dose must always be reduced gradually and must never be stopped abruptly. Abrupt discontinuation can trigger an adrenal crisis because the adrenal glands have been suppressed by long term steroid use

Hypothyroidism Presentation

Caused by underproduction of thyroid hormones leading to a slowed metabolism. Signs include fatigue, weight gain, cold intolerance, constipation, bradycardia, dry skin, and hair loss

Hyperthyroidism Presentation

Caused by overproduction of thyroid hormones leading to an accelerated metabolism. Signs include weight loss, heat intolerance, tachycardia, increased appetite, anxiety, and diaphoresis

Graves Disease

The most common autoimmune cause of hyperthyroidism. Distinct signs include exophthalmos (protruding eyes), goiter, heat intolerance, weight loss, tachycardia, and anxiety

Glasgow Coma Scale

A neurological assessment tool that evaluates level of consciousness across three categories: Eye Opening, Verbal Response, and Motor Response. Normal flexion in the motor category means the patient withdraws from pain. An eye score of 2 means the patient opens eyes only to painful stimuli

Cushing Triad

Three classic signs of increased intracranial pressure: Hypertension with widening pulse pressure (rising systolic BP), Bradycardia, and Irregular respirations such as Cheyne Stokes breathing

Embolic Stroke

A type of ischemic stroke caused by a blood clot or debris that forms elsewhere in the body and travels to the brain, obstructing a cerebral artery. Common sources include atrial fibrillation and cardiac thrombi

Ischemic Stroke

The most common type of stroke; caused by a blockage of a cerebral artery that reduces blood flow to brain tissue. The blockage may be caused by a local thrombus or an embolus traveling from elsewhere in the body

Myasthenia Gravis

A chronic autoimmune neuromuscular disorder characterized by weakness and fatigability of skeletal muscles. The Tensilon (edrophonium) test can be helpful in diagnosing this condition

Amyotrophic Lateral Sclerosis

A progressive neurodegenerative disease affecting motor neurons in the brain and spinal cord. There is no definitive diagnostic test; diagnosis is based on patient history, neurological exam, signs and symptoms, and lab tests that rule out metabolic conditions

Multiple Sclerosis

A chronic autoimmune neurological disease in which the immune system attacks the myelin sheath in the central nervous system, disrupting nerve signal transmission. There is currently no cure for MS

Severe Hyponatremia: Priority Nursing Intervention

Patients must be placed on seizure precautions and side rails must be padded. Severe hyponatremia causes fluid to shift into brain cells, significantly increasing the risk of seizures

Dementia

A general term for the progressive loss of the ability to remember, think, and make judgments that interferes with daily activities. Alzheimer disease is the most frequent form. It is not a normal part of aging, although it often affects older people

Delirium

An acute state of confusion that develops over hours to days. The patient has decreased ability to direct, focus, sustain, and shift attention and awareness. Deficits in memory, orientation, language, visuospatial ability, or perception may be present. The patient may be hypoactive or hyperactive. Treating the underlying cause can reverse it

Delirium vs Dementia

Delirium develops acutely over hours to days and can often be reversed by treating its underlying cause. Dementia develops gradually over time and is generally not reversible

Delirium: Nursing Management

Identify and treat the underlying cause, administer the Confusion Assessment Method (CAM), check comorbidities and diagnostic tests, reorient patient to person, place, time and purpose, use distraction for agitated behavior, manage fever, pain and nausea, encourage early mobility, encourage use of sensory aids such as eyeglasses and hearing aids, implement measures to promote sleep, provide a safe environment, and teach the patient and caregivers about causes and manifestations of delirium

Electrolytes

Active chemicals that carry positive (cations) or negative (anions) electrical charges when dissolved in water. Major cations: sodium, potassium, calcium, magnesium, and hydrogen ions. Major anions: chloride, bicarbonate, phosphate, sulfate, and albumin. Concentration is expressed in mEq/L and differs between fluid compartments