MedSurg Final Flashcards

GERD positioning – lying on the left side

If someone is on fluid restriction – have them make a list of their favorite beverages

Lice (pediculosis) - wash the children’s clothes and toys with hot water

Teaching on glaucoma – glaucoma can cause blindness overtime

If a patient has Urolithiasis (kidney stones) - they should drink 3L of water

Herpes Zoster (Shingles)

-            Is not contagious. Can't be spread to others

-            The nurse should be prepared to treat with acyclovir

Sign of end stage kidney failure – increased BUN levels

Lupus exacerbation – is NOT caused by exercise

To see if a fistula is working – listen for bruits

MRI – teach the patient to wear earplugs

Sign of infection at the pin site – fever

Treatment of DKA – 0.9% sodium chloride

Raynaud's

-            Do anything to reduce stress

-            Wear gloves when reaching into the freezer

Client that should be assessed first – the patient with shortness of breath

Hip replacement - abduction

Preop

-            Consent - patient needs to understand. Can be done months in advance

-            Blood thinner - ask the doctor before

-            Pain post operative – teach the 0-10 pain scale

Intraop

-            Hypothermia – old 80, pound person

Postop

-            AIRWAYS assessment

-            Nausea – prn meds (Zofran)

-            JP drain – compress for it to work. Check for kinks

Hematological

Anemias

-            Check RBS and hemoglobin, HCT

Iron deficiency – iron supplements

B12 – B12, leafy greens

-            Check issues with absorption. PUD and gastritis in the stomach lining

Megoblastic anemia – large red blood cells, will clog the vessels

-            Red blood cells group up and cause JAUNDICE

Causes fatigue – fall risk

Vitals – low oxygen

FOBT – could be bleeding out in the GI

Sickle Cell – deformed red blood cells

-            Pain, clotting, clogging, THROMBOSIS

Polycythemia – increased RBS

Neutropenia – low WBC

-            Bands: increased number when INFECTION (baby neutrophils) LEFT SHIFT

-            Immunocompromised = wash hands, isolation

Thrombocytopenia – low platelets and thin blood. Risk for bleeding

-            Sit up straight with nosebleed

Blood transfusion

-            18 gauge.

-            Done in 4 hours

-            Vitals every 15 min. Temp every 5 minutes

-            First sign of a reaction is increased heart rate—and then fever

Bone marrow biopsy – iliac crest and sternum

-            apply pressure to the biopsy sight

Respiratory Function

Pulmonary Function Test – 6 to 8 hours

Laryngitis – inflammation of the vocal cords

-            Stop smoking, rest voice,

Sinusitis – inflammation of the sinuses. Palpate the sinuses.

Pharyngitis – sore throat. Caused by strep.

Sleep apnea – lose weight

-            s/s: not getting sleep, headaches, really loud snoring

Integument

Skin lesions

-            Macule – flat, less than one cm

-            Vesicle – raised, fluid filled

Impetigo – vesicle

Herpes – vesicle ‘

-            Simplex – cold sores

-            Zoster (shingles) - previous exposure to chickenpox. PAIN and itchy

o   Don't scratch, warm shower, apply corticosteroids and acyclovir

Pediculosis (lice) - bugs that lay KNITS

-            Wash everything with hot water

Scabies – bug. The home looks like a macule. Contagious. Itchy. Wear mittens.

-            Take and scabicide

-            Take a warm shower

Sensory

Cataracts – can be fixed with surgery. SURGERY

Glaucoma – you have it for the rest of your life. EYEDROPS

-            Educate on eye drops – have them demonstrate

Retinal detachment – no pain. s/s curtain, flashing lights, floaters

Meniere's disease – fluid in the ear. Monitor for falls – can cause vertigo

Weber test – tuning fork to forehead. Hear it in both ears = normal finding

Rhine test – tuning for to the back of the ear until they can't hear it. Then move it forward to ear should hear it 2 times longer. AIR is longer than BONE = normal

Fluid and Electrolytes

Potassium – cardiac arrythmias

Calcium

-            Chevocks sign = spasms = low calcium

Sodium – irritable

ABGs

-            Vomiting = alkalosis

-            Diarrhea = acidosis

Dehydration

-            Low BP, increased HR, tenting

-            Urine – dark, low urine output, test urine specific gravity (normal is 1.005)

o   Higher urine specific gravity means dehydration

Fluid volume excess

-            High BP, high HR, edema, crackles, high respirations

Kidney and Urinary Tract Function

Urinalysis bad results – do a bacterial culture to know what bacteria to treat

KUB – kidney, ureter, bladder Xray – done for kidney stones

RAAS – renin-angiotensin-aldosterone

-            CONTROLS BP through the kidneys

UTI – urinary tract

-            Drink lots of fluids

Bladder – sistitus

Kidney – pyelonephritis

Glomerulonephritis – CAUSED BY STREP

Urinary caliculi – kidney stones

-            Drink 3L water, lithotripsy = strain the urine. Pink urine is normal after a stone.

-            Should not smell = infection

Incontinence

-            Kegels – suck in the perineal muscles

Retention – retaining urine

-            BPH – enlarged prostate makes it harder to pee for men

-            Check for kinks, make sure bag is lower

Acute Kidney Injury

-            Fluid excess. Give diuretics, watch weights, restrict fluids

Dialysis

-            They must a fistula – listen for a bruit first, no BP on the arm, check pulses (not at the same time)

-            Don't give meds before, they will wash right out of them

-            Worried about dehydration and low electrolytes (hypos)

-            Peritoneal dialysis – watch for hyperglycemia (hypers)

o   Should not be cloudy – call the doctor

Metabolic

Insulin (know the insulin types)

-            Rapid (aspart) = 5 min

-            Regular = 30 min

DKA – diabetic ketoacidosis TYPE 1, hyperglycemia

-            FLUIDS

-            IV regular insulin

Hypoglycemia s/s - sweating, chills, confusion

-            Talk and walk – give them a snack. 15 grams

Macrovascular – heart attack and stroke

Microvascular – retinopathy, neuropathy

Sick day rules for diabetics

-            Still take insulin

-            Check blood sugar constantly

-            Use the sliding scale to give insulin

Cardiovascular

Left heart failure - lungs

Right heart failure – organs JVD

Aortic disruptions

-            AAA = abdominal aortic aneurysm – worried about rupture, pulsating mass, CT scan, back and stomach pain, normal bowel sounds-bowel sounds go around it

PAD s/s

-            Do not elevate the legs. Dangle.

-            Hair loss and thick toenails

Venous disease s/s

-            Edema – elevate and compression hose

Raynaud’s - wear gloves and decrease stress and smoking and caffeine

-            No meds for the disease

-            Ineffective tissue perfusion

Gastrointestinal

Order of assessment – inspect, auscultate, palpate, percuss

Colonoscopy – enemas, NPO, clear liquids

-            Looking for clear/yellow liquid return, should not be brown

C. diff – contact precautions, antibiotics

H. Pylori – increased acid production causes PUD

- worried about perforation = board like abdomen means bleeding. Low BP high HR

Ulcerative colitis – has blood. Do not increase the fiber

Chrons – has no blood and don't eat fiber

Neurological Function

Seizures

-            Protect from injury

-            Turn on side

-            Maintain airway and maintain IV access

-            Time

MS

-            Spasms, lack of movement

-            Fatigue

-            Double vision

-            Take lots of rests

Parkinsons

-            Decreased dopamine

-            TRAP – tremors, rigid, akinesia (brady), postural instability

Strokes

-            Hemorrhagic (bleeding) and ischemic (TPA)

-            Left side stroke = akinesia and left sided paralysis

-            Right side stroke = vision problems and right paralysis

-            CT and 2^nd would be MRI

o   MRI: wear earplugs, no pacemaker, takes long

Rheumatic Disorders

-            ANA and ESR and RF for inflammation lab tests

-            Rheumatoid arthritis – joints

-            Lupus – organs = confused and agitated, trouble breathing, chest pain

o   Butterfly rash

-            Gout – buildup of uric acid

o   Low purines (organs and shellfish) and don't drink alcohol

-            Fibromyalgia – chronic pain

o   Not inflammation

o   Stress

o   CHRONIC FATIGUE – don't drink caffeine to increase rest

o   Antidepressants why? For pain?

Musculoskeletal

-            Acute vs chronic = 3 months

-            Know the body mechanics

-            Osteoarthritis – exercise to minimize the symptoms

o   Both-use heat before ice though

o   Tylenol (not NSAIDS)

-            Osteoporosis – age, women, calcium breakdown

o   Kyphosis

o   Raloxaphine (preventative, take for risk factors) and Calcitonin (once you get it)

-            Osteomyelitis – bone infection

o   Surgery, diabetes, injury

o   Increased temp, red, warmth, check WBC

o   Antibiotics IV

-            Traction

o   skeletal – checks pins for infection and check fever. Check neurovascular

o   bucks – foot drop plate

-            Amputation

o   Figure 8

o   Phantom pain – will go away eventually

o   Keep it dry

-            Fractures

o   Cast – check for compartment syndrome

§  Circulation

o   NEUROVACULAR

§  Cap refill, sensation, pulses