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Med/Surg Final

Based on Test Map

Informed Consent? an active, shared decision-making process between the health care provider and the recipient of care.
Malignant Hyperthermia? rare disorder characterized by hyperthermia with rigidity of skeletal muscles that can result in death. Occurs when exposed to certain anesthetic agents.
Patient Controlled Analgesic(PCA)? alternative approaches for pain control. its to provide immediate analgesia and to maintain a constant, steady blood level of the analgesic agent. the route is IV.
Glasgow Coma Scale(GCS)? Eye Opening, Verbal Response and Motor Response. Highest score is 15, Lowest is 3 and anything <8 is Coma.
Positioning of pt with increase ICP? Maintain the pt in head up position, prevent extreme neck flexion. Decorticate(palms are up ) or decerebrate(palms are down) is a reflex response.
Spinal Cord Injury? Nursing Dx? caused by trauma or damage to the spinal cord. DX: Ineffective breathing, impaired skin integrity, constipation, risk for autonomic Dysreflexia.
Spinal Shock? decrease reflexes, loss of sensation and flaccid paralysis below the level of injury.
Neurogenic Shock? due to loss of vasomotor tone caused by injury. characterized by hypotension and bradycardia.
Incomplete Spinal Cord Injury Syndrome?(3) 1.Central Cord: damage to central cord cause weakness/sensory loss in upper/lower extremities. 2.Anterior Cord: compromised blood flow to ant. cord due to damage to ant.artery. 3.Brown-Sequard:damage to 1/2 of cord cause vasomotor paralysis.
Incomplete Spinal Cord Injury Syndrome?(3) 4.Posterior Cord: damage/compression to post. spinal artery. cause proprioception loss. 5.Conus Medullaris: damage to low cord. cause paralysis to lower limbs, bladder/bowel. 6.Cauda Equina: damage to lumbar and sacral roots. cause paralysis.
Neurogenic Bladder/Bowel? voluntary control of bladder/bowel is lost.
Fracture? Classes?(6) disruption or break in the continuity of the structure of bone. Types: Open, Closed, Complete(break runs completely through), Incomplete, Displaced(out normal position), Nondisplaced.
Fracture Break Types?(6) Transverse: line across bone. Spiral: spiral direction. Greenstick: splinted piece. Comminuted: shattered. Oblique: Slant break. Pathologic: spontaneous fracture at the site of a bone disease.
Fracture Healing Complications?(4) Delayed Union, Nonunion, Angulation(heals in abnormal position), Refracture(new fracture)
Open Reduction Internal Fixation?(ORIF) wires, screws, pins, plates, intramedullary rods or nails to correct the alignment through surgical incision.
Types of Fractures? Colle's: fracture of the distal radius and is one of the most common. Humerus, Pelvis, Hip, Femoral shaft, and Tiba.
Amputation? Phantom Limb Sensation? Position? Removal of body extremity by trauma or surgery. Phantom:feel like pain in still present in removed limb. tx by pain meds and mirror therapy. Position: place prone with hip in extension for 30mins 3-4xday.
Herniated Disc? Back Surgery Postop Assessments? Disc: slipped disc. Assess: proper alignment, pain management, CSF leakage/severe headache, neurologic sings, movement of arms/legs/sensation, extremity circulation, bowel sounds, stool softeners, adequate bladder emptying and incontinence.
Hip replacement? Postop Teaching? Precaution? use of a prosthesis to replace fractured hip. Teach: pillows between legs, hip in neutral straight position, no higher than 90degrees. no adduction, internal rotation or crossing of legs. Caution: neurovascular impairment, assess extremity.
Fracture Complications? Infections, Compartment Syndrome(swelling compromises blood flow, nerves and tendons), Venous Thromboembolism, Fat Embolism Syndrome(fat globules in the tissues pass into the lungs causing resp. failure.)
GERD? S/S? Surgical TX? chronic symptom mucosal damage caused by reflux of stomach acid into the lower esophagus. S/S: Heartburn, Dyspepsia, Regurgitation, Hypersalivation, Chest Pain and Resp.symptoms. TX:Nissen/Toupet Fundoplication surgery.
GERD Tx Meds? PPI:decrease acid secretion. names(Nexium, Dexilant, Preacid, Prilosec,Protonix, AcipHex). H2-Receptors: block action of histamine. names(Tagamet, Pepcid, Axid, Zantac). Antacids: neutralizes HCL acid. names(Tums, Magox, Alka-Seltzer)
Hiatal Hernia? Hernia: portion of the stomach into the esophagus through hiatus in the diaphragm.
Bowel Obstruction? S/S? TX? when intestinal contents cannot pass through the GI tract. Occurs when fluid, gas, and intestinal contents accumulate above the obstruction. S/S: Vomiting, pain, bowel movement and abdominal distention. TX: NPO, NG tube, IV fluids/Lactated Ringer's.
Emergency TX for Bowel Obstruction? Nursing Assessment? Nursing Diagnosis? if strangulated. Assess: prevent fluid/electrolyte deficiencies, measure abdominal girth, monitor I/Os, any changes in VS, DX: acute pain, deficient fluid volume.
Hernia? Types? TX? Prevention? protrusion of viscus through an abnormal opening or a weakened area in the wall of the cavity. Type: Sliding, Reducible, Incarcerated, Strangulated(resection surgery). TX: Herniorrhaphy. Prevent: healthy wt, exercise, not lifting or straining body.
Cirrhosis? Nutritional Therapy? chronic progressive disease of the liver that degenerates and destroys the liver cells. Nutritional: High in calories(3000cal/day, quick bread, oatmeal,) with high carbohydrate(sugar, cereal, bread, potatoes) and low levels of fat.
Esophageal Varices? TX? complex of tortuous veins at the lower end of the esophagus, which are enlarged and swollen. TX: goal is to prevent bleeding. Band Ligation or Sclerotherapy may be used to prevent rebleeding. Balloon tamponade is used for hemorrhage that's uncontrollable
Paracentesis? needle puncture of the abdominal cavity. before have pt void to prevent a puncture of the bladder. pt is placed in high fowlers position. monitor for Tachycardia, Hypotension, electrolyte imbalances and check the dressing for bleeding and leakage
Hepatic Encephalopathy? TX? neuropsychiatric symptom of liver disease including a neurotoxic effects of ammonia. due to the liver not being able to convert ammonia to urea. Tx: removed through feces by trapping ammonia through gut. Neomycin destroys ammonia in gut.
Acute/Chronic Pancreatitis? Acute/Chronic S/S? Acute: reversible, autodigestion of the pancreas. Chronic: irreversible cellular damage with decrease exocrine function. S/S: Acute(positive Turner/Cullen's sign, low fever, pleural effusions, high amylase). Chronic(wt loss, steatorrhea, high lipase)
Pancreatitis Labs? Positioning for pain? Nutritional Therapy? Lab: CT Scan is the most valuable test. serum amylase/lipase. Position: Knee-Chest/Fetal position or side-lying position(with head elevated) Nutritional: NPO, Jejunal feeding tube, high carbohydrate of small frequent feedings, fat-soluble vit.
Acute hemorrhagic Pancreatitis? inflammation of the pancreas accompanied by the formation of necrotic areas on the surface of the pancreas and in the omentum and frequently also accompanied by hemorrhages into the substance of the gland.
Acute and Chronic Cholecystitis/ Cholelithiasis/ Choldocholithiasis? S/S of these. inflammation of the GB/ gallstones in the GB/ gallstones in the common bile duct(med emergency). S/S: pain, fever, tachycardia, diaphoresis, jaundice, tender RUQ, pain that radiates to the shoulder, hx of fat intolerance, heartburn.
GB Diagnostic? Nutritional Therapy? Ultrasonography(dx gallstones), ERCP(visualizes), Cholangiography(shows bile flow), Serum Enzymes(alkaline phosphate, ALT, AST). Nutritional: small frequent meals, low-fat diet(some fat to empty bile). level of fat consumption is based on pts tolerance.
Jaundice? yellowish discoloration of body tissues, results from derangement of liver cells and compression of bile ducts by connective tissue overgrowth. occurs with decreased ability to conjugate and excrete bilirubin. shown a rise in CBC/WBC.
T-tube? ensures patency of the duct and allows excess bile to drain to adjust the intestines on receiving continuous flow of bile.
Headache Types? Tension-Type: stress headache, dull pressure, photophobia/phonophobia. Migraine: recurring, aura, associated with seizures, anxiety, MI. Cluster: repeated HA that occur for wks-mths at a time, most severe forms intense.
Amyotrophic Lateral Sclerosis(ALS)? Rare progressive neurological disorder by loss of motor neurons. leads to death 2-6yrs after dx. the motor neurons in the brainstem and spinal cord gradually degenerate. S/S: weakness of upper extremities, dysarthria, dysphagia.
Guillain-Barre Syndrome? post infection ascending polyneurofatal form of polyneuritis. Paralysis that affects cranial nerves and peripheral nervous system affects males than females.
Myasthenia Gravis(MG)? Autoimmune disorder of the neuromuscular junction characterized by the fluctuating weakness of certain skeletal muscle groups. the antibodies attack the ACh receptors to decrease the # of receptors with thymus enlargement.
Multiple Sclerosis(MS)? S/S? Nursing Diagnosis Progressive disorder of CNS with damage to myelination sheath due to inflammation. S/S: motor weakness/paralysis of the limbs, numbness/tingling and Nystagmus and emotional state. DX: impaired physical mobility.
MS TX? Drugs? Care? TX:no cure, focused on tx the disease process and symptomatic relief. Drugs:Immunomodulators: modify the disease process(Rebif), Immunosuppressants: for more active aggressive forms. Care:exercise/water PT helps with muscles to improve daily function.
MS Nursing Implementation? Teaching? Implement:be aware of triggers(infection), deal with anxiety, focus on preventing major complications of immobility, such as respiratory/Urinary tract infection. Teach:balance exercise, rest and meals. food high in Fiber, and life style changes.
Myasthenia Gravis(MG)? S/S? Nursing Dx? autoimmune disease of the neuromuscular junction by fluctuating weakness of certain skeletal muscle groups. S/S:motor loss, but reflexes remain normal, improves with rest. DX: ineffective airway clearance, impaired verbal, activity intolerance.
Tensilon Test? MG TX? in pts with MG, it reveals muscle contractility after the IV injection of Anticholinesterase agent. reserved by Atropine. TX:Anticholinesterase(Neostigmine), Corticosteroids, Immunosuppressants.
Seizures? Epilepsy? Types? Seizure: uncontrolled electrical discharge of neurons in the brain. Epilepsy: spontaneous recurring seizures caused by underlying condition. Types: Generalized and Partial/Focal Seizures.
Generalized Seizures? Both sides of the brain LOC 1.Tonic-Clonic:Grand Mal, loc, 5.tonic(stiff), 6.clonic(jerking,LOC), cyanosis, incontinence, fatigue, no memory. 2.Abscence:petit mal(children),brief spell 100xday. 3.Myclonic:jerk in body. 4.Atonic: drop attack.
Partial/ Focal Seizures? irritations on one side of the brain. 1.Simple:motor(jacksonian march)/sensory(tingling/numbness) phenomena, no loc, changes in HR. 2.Complex:behavioral/emotional and cog. functions, postictal confusion, slight loc partakes in repetitive movements.
Status Epileptics? TX? continuous seizures activity, neurological emergency. cerebral anoxia(ABGS), aspiration, retardation, dementia, death. TX: Atican/Valium immediately followed by Dilantin(Phenytonin) and Phenobarbital, Glucose, o2, hydration, suction.
Seizure Assessment? Nursing DX? TX? Assess: what preceded, when, how long ,what occured during the seizure, and postictial loc. DX:Ineffective breathing pattern, self-health management. TX: antiseizure drugs, surgery an psychosocial counseling.
Created by: aneshia