MedSurg 2 Exam 1

- Afib and diabetes on atenolol: beta blocker masks hypoglycemia monitor blood glucose, monitor BP, and apical pulse rate - High cholesterol labs: high HDL and low LDL - Female client with suspected MI: indigestion, anxiety, nausea and vomiting, pain down arm, neck pain. - HTN emergency vs HTN urgency: - Emerg: target organ damage - Urgency: potential target organ damage, pt. May have been non-compliant with meds and HTN tx. More managed than emergency - Acute coronary syndrome: fatigue, dyspnea, syncope - MI lab: troponin, CK-MB, myoglobin - Cardiac and exercise: 30 min/day for 5 days a week. Have to think about the stability of pt. And age - Grapht: great saphenous vein - DASH diet: grilled foods, whole grains, low sodium and high fiber, fruits/veggies - Limit full fat dairy, red meat, seeds and nuts (because of the oil) - Stable angina: alleviate with rest and nitro - Aspirin to pt. With hx. Of MI: to prevent platelet aggregation. - Concern with CAD pt. Who smokes: vasoconstriction, poor blood supply. Increases blood carbon monoxide level, decreases blood O2, and increases platelet adhesion. Increases BP and HR - Modifiable risk factors with Coronary artery disease: HTN, stop smoking, control diabetes, lifestyle changes (decrease cholesterol, increase exercise) - Causative factor of rheumatic endocarditis: strep - Complications of infective endocarditis: - Painful nodules: osler nodes - rash/redness: jane way lesions - Splintered hemorrhage in eyes: roth spots - Complications of pacemaker: displacement of leads, due to raising arms/movement of extremity. Educate pt. To limit activity - Exacerbation of pulmonary edema and pt. Has SOB: sit pt. In high fowlers and give them O2. - Difference between cardioversion and defib: - Cardioversion: match the patient's rhythm. Pt. has a pulse - Defib: resets the HR/rhythm. Pt. is pulses. Shock them into rhythm. - Sinus brady and is symptomatic: pt. Is not responding to atropine, next prepare to give pt. A pacemaker - Mechanical valve replacement education: long term anticoagulants - Mitral valve prolapse (the valve stays open) Clinical manifestations: palpitations, dizziness, SOB, fatigue, anxious - Clinical manifestations Mitral valve regurgitation (backflow of blood): dyspnea on exertion, fatigue and weakness, cough - Pt. post MI develops S/S of HF what is discharge med: statin, aspirin, ACE inhibitor (this is prescribed because of the HF - concern of ACE is coughing, ARB is given is ACE symptoms are intolerable) - What is causative factor for infective endocarditis: staph - Pt. has a.fib and does not respond well to meds what are they admitted for and next tx in line: elective cardioversion Older adult with HF and has oral diuretics: take in the morning to prevent peeing at night, worried about orthostatic HTN (get up slowly), electrolyte imbalance (K is the main concern) - Pt. diagnosed with HTN and cardiac hx. They are put on beta blockers: asthma (bronchospasm) - IV adenosine: treats sinus tachy - Pt. with new ICD (implantable cardioversion device) education post op: incisional care, S/S of infection, it notifies you if there are any irreg rhythms (tell Dr,), emergency preparedness (CPR for family and caregivers) - Who is at high risk for HF: >65 years - What meds for sinus brady: atropine IV (look at the dosing in the notes) - Client complaining of itching with lines/webs on fingers: scabies (can be under skin folds) - What type of kaposi sarcoma post organ transplant: Iatrogenic kaposi sarcoma - Pemphigus vulgaris: blistering disease, common in mediterranean/jewish. Ulcers that start in the mouth, characteristic odor, spreads and ooze, treat them like a burn victim - Infection - fluid/electrolyte balance - Skin surrounding wounds - Nursing care for pemphigus vulgaris nursing dx: - Disturbed body image - Risk for infection - Acute pain - Impaired skin integrity - How does herpes zoster occur (shingles): chicken pox, lays dormant in the spinal cord. Manifests from stress, infection, and trauma. Look at the different phases - Age related changes of skin: thinning, decreased elasticity, wrinkles, moles, uneven pigmentation - Pt. presents with elevated blue/black lesions in ear: melanoma - What med is best to used within 24-48 hours of eruption of herpes zoster acyclovir - What typically presents with honey crusted lesions: impetigo, children at high risk, hygiene is a big concern. Bactroban (ATB) is used topically - WEAR GLOVES. Treatment is 5-7 days - Lice: found at nape of neck and behind the ears, everyone needs to be treated, wash linens - Scabies: apply from the neck down, usually one application is good and repeat in a week. Takes 4 weeks to see reinfection or infection in people who have been close to pt. - Precaution for C-diff: contact - Tb: airborne Droplet: is used for flu, chicken pox - Gonorrhea: also treat them for chlamydia - Early clinical manifestation of dehydration: thirst is the first sign - HIV lab value: - Western blot: indicated HIV, priority test to look at - Picture of staging wounds - Chronic heart failure - pt states they are suffocating: paroxysmal nocturnal dyspnea - Vaccines: whooping cough and pertussis