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MedSurg II
Hondros College LPN Med Surge II full term
| Question | Answer |
|---|---|
| How often to check VS after surgery | Every 15 minutes |
| Signs of shock | Increased HR, thready pulse, BP decreased, cool/clammy skin, urine output decreased |
| signs/symptoms of pulmonary embolism | Sudden chest pain, dyspnea, tachycardia, cyanosis, diaphoresis, and hypotension |
| Interventions for pulmonary embolism | HOB at 45 degrees, administer oxygen, notify dr |
| How often to inspect surgical dressings? | every 2 to 4 hours for the first 24 hours |
| How much drainage in 24 hours? | More than 300 ml should be treated as abnormal |
| Define: diplopia, strasmus, nystagmus. | Diplopia: double vision. Strabismus: lazy eye. Nystagmus: jerky eyes. |
| What do the pons regulate? What does the cerebellum regulate? | Pons: Respirations Cerebellum: Balance |
| What are the 3 meninges? | Dura, arachnid, and pia |
| What to remember about cerebral angiography | 1)Allery to iodine (shellfish) 2) NPO after midnight 3)bed rest for 12 to 24 hours 4)force fluids |
| What to remember about lumbar puncture | 1)Patient should be well hydrated 2) Inserted between l3/l4 or l4/l5 3)must lie flat for 6 to 12 hours afterwards. |
| Increased Intracranial Pressure causes changes in: | 1)LOC 2)Pupil response 3)Speech 4)Motor function 5)Vitals |
| Degenerative disorder with demyelination of brain stem and nerves (CNS) | Multiple sclerosis |
| Neuromuscular disorder - nerve impulses fail at the myoneural junction, causing weakness | Myasthenia gravis |
| motor neurons in the brain degenerate - messages do not reach the muscles | ALS/Lou Gehrigs - results in death 2 to 5 years after onset |
| Overactivity of dopamine; genetically transmitted | Huntingtons |
| Cardinal symptom is chorea | Huntingtons |
| Degeneration of the trigeminal nerve | Trigeminal neuralgia |
| Cardinal symptom of trigeminal neuralgia | excruciating, burning facial pain |
| Cranial nerves in Bells and Trigeminal neuralgia | VII and V. |
| Cardinal symptom of Bells Palsy | Unilateral facial paralysis |
| Upward progressing paralysis preceded by an infection | Guilllain Barre Syndrome |
| Cardinal sign of meningitis | Stiff neck and headache. (Kernigs and Brudzinksis signs for diagnosis). |
| Exaggerated sympathetic response at the T6 level - triggered by full bladder or impaction | Autonomic Dysreflexia |
| Labyrinthitis | Inflammation of the labryinthine canals in the inner ear - usually caused by a URI |
| Chronic, progressive deafness due to formation of spongy bone | Otosclerosis |
| Increase in the endolymph fluid - chronic disease of inner ear and 8th cranial nerve | Meniere's disease |
| Cardinal sign of Menieres | Recurrent attacks of vertigo accompanied by tinnitus or deafness. The vertigo is severe - rotational, may cause them to be unable to stand |
| Abnormally low blood volume due to blood loss | Hypovolemic anemia| 1000 ml loss can cause severe complications | Manifested by hypotension, tachy, hemoglobin less than 10g, hematocrit less than 40% |
| Absence of intrinsic factor, loss of vitamin B12 | Pernicious anemia | Deficiency of B12 affects growth of all cells and myelination of of nerves |
| Manifestations of pernicious anemia | Cardinal: Sore tongue, dysphagia, neurological issues |
| Decrease of bone marrow function | aplastic anemia | Primary = congenital, Secondary = viral, medications, chemicals |
| Manifestations and interventions of aplastic anemia | pancytopenia, fatigue, palpitations | splenectomy, platelet transfusion, bone marrow transplant |
| WBC less than 200/mm3 & causes | Agranulocytosis | Caused by medications, chemo, neoplastic disease, viral/bacterial infections |
| Manifestations & interventions of agranulocytosis | ulcerations of mucous membranes, pneumonia, UTI. | Interventions - remove cause, prevent infections - strict asepsis. |
| Malignant neoplastic immunodeficiency of the bone marrow (+manifestations) | Myeloma. Bone pain, fractures, hypercalcemia (which causes renal failure) |
| Inflammation of lymphatic vessels - name of disease, alternate name, and cardinal sign. | Lymphangitis; blood poisoning; fine red streaks from affected area. |
| What do helper T's / CD4 cells do? | initiate immune response |
| Barrier between the body and outside world againt microorganisms | Innate immunity. |
| Composed of the thymus, spleen, bone marrow, blood, and lymph, provides a specific reaction to an antigen. | adaptive/acquired immunity. |
| This immunity is a result of the development and presence of circulating antibodies and is divided into active and passive. | Humoral immunity. |
| Types of hypersensitivity | Level I - pollens, insects, food allergies | Level II - Blood transfusions | III - Autoimmune | IV - delayed response to an exposure (transplants or TB test) |
| CD4 levels | 600 to 1200 = normal | 200-499 minor immune problems | below 200 severe problems |
| Pathophysiology of HIV | kills CD4 cells, then reproduces in the lymphatic system, eventually spilling over into the blood. |
| Early symptomatic HIV process | CD4 below 500. Night sweats, diarrhea, fatigue, lymphadenopathy |
| the end stage/terminal phase of HIV | AIDS. CD4 count below 200. |
| Fever; night sweats; productive cough; short of breath | PCP (pneumocystis carinii pneumonia) |
| Combination therapy, given around the clock, for HIV. | Antiretroviral. Cannot miss a dose. Usually initiated when CD4 drops below 350. |
| Major side effects of chemotherapy | leukopenia, anemia, thrombocytopneia, alopecia, stomatitis, n/v/d |
| Herpes Zoster | Aka Shingles. Unilateral inflammation of ganglia, painful rash on the nerve pathway. |
| Virus causes scaly lesions with pink center, widespread rash within 14 days. | Pityriasis Rosea - there is no treatment. |
| Lesions that start as macules, then develop and rupture a honey color exudate. | Impetigo - caused by staph viruses, highly contagious. |
| Dermatophytoses - 4 types | These are fungal infections. | Tinea capitis - ringworm on scalp | Tinea corporis - ringworm of body | Tinea cruris - jock itch | Tinea pedis - athletes foot |
| Dermatitis venenata | skin rash/allergic reaction to certain plants. |
| Hives of the subcutaneous tissue, causing a reaction similar to anaphylaxis. | Angioedema. Should be treated with epinephrine and corticosteroids. |
| Noninfectious raised, silvery plaques on the skin. | Psoriasis |
| Autoimmune disorder that causes inflammation of any body part. | Systemic Lupus Erythematosus. |
| Verruca | A benign wart |
| A burn involving the epidermis, dermis, and subcutaneous tissue. | Full thickness burn. Skin will not blanch, patient will not feel pain any longer in that area. |
| Treatment for burns | Respiratory, Fluids, THEN Pain. First 48 hours, fluids are crucial. 48-72 hours, high protein/calorie/viatamin diet, ROM. |
| What functions as both an endocrine and exocrine gland? | Panceas - it releases via a duct into the duodenum, and releases insulin directly in the bloodstream |
| Hormones secreted by the anterior pituitary gland | TSH, ACTH, FSH, LH, GH. All are indirect except GH. |
| Hormones secreted by posterior pituitary | ADH and Oxytocin. |
| What are the targets of TSH, ACTH, FSH, and LH? | TSH - thyroid | ACTH - adrenals | FSH - ovaries | LH - testes |
| Hormone necessary for reabsorption of water in kidneys | Antidiuretic hormone (ADH) |
| The gland that secretes melatonin, gonadotropin, and is a matrix for calcium | Pineal gland |
| The 3 hormones of the thyroid gland. | T3, T4, and calcitonin. | T3 and T4 regulate metabolism/growth | Calcitonin returns blood calcium to the bones. |
| PTH | Parathormone - maintains calcium and phosphate balance in the body |
| 2 hormones of the Thymus gland | Thymosin - causes T lymphocytes to mature | Thymin - blocks transmission of neuro impulses. |
| Causes hypoglycemic effects by interfering with GH and glucagons | Somatostatin |
| 3 corticosteroids released by the adrenal cortex. | glucocorticods - cortisol | Mineral corticoids - aldosterone | gonadocorticoids - sex hormones |
| Secretions of the adrenal medulla | Epinephrine and norepinephrine |
| Disorder of the anterior pituitary in which too much GH is secreted. | Hyperpituitarism. Causes gigantism if it occurs prior to the closing of the epiphysis. If in adults, its called acromegaly. The hands and feet and face enlarge, very painful skeletal growth. |
| Posterior pituitary secretes too much ADH | SIADH - Syndrome of Inappropriate Antidiuretic Hormone | too much water is reabsorbed, diluting the blood and decreasing osmolarity. |
| Manifestations and treatment of SIADH | Increased BP, muscle weakness, concentrated urine (Specific gravity > 1.030 | Treated by fluid restriction and diuretics |
| Not enough secretion of ADH | Diabetes Insipidus - kidneys do not reabsorb enough water, so urine is diluted. | can be caused by tumor, meds, alcohol, or head trauma |
| Manifestations and treatment of Diabetes Insipidus | Urinate 3 to 15 L every 24 hours, always thirsty, intense desire for ice water. Specific gravity of near 1.000. LEADS TO HYPOVOLEMIC SHOCK IF UNTREATED. | Treatment: sodium restrictions, electrolytes/fluids by IV |
| The main admissions information of a client with pituitary disorder? | Excessive weight gain/loss, intake vs output, and a child's height/weight vs growth charts |
| Hyperparathyroidism | aka Graves Disease | Oversecretion of T3 and T4, causing: tachy, hypertension, heat intolerance, weight loss, fatigue. |
| Lack of T4 & T3 | Myxedema (cretinism in infants). May be autoimmune, due to iodine deficiency, or because of a thyroidectomy. Manifested by goiter, weight gain, cold intolerance. |
| Differentiation of types of diabetes | DM1 - pancreas stops producing insulin | DM2 - pancreas produces some, but cells are resistant | Gestational - due to pregnancy | IGT - borderline diabetes | Secondary - due to pancreatic trauma or disease, birth control | |
| Addison's disease & crisis | Low in aldosterone. Causes the skin to be a bronze color. | Addisonian crisis is life threatening, manifesting through hypotension, weak pulse, FV deficit, and collapse. |
| Cushings disease | Overproduction of cortisol - manifested by buffalo hump, moon face, muscle wasting. |
| Benign tumor in adrenal medulla, causing excessive epinephrine and norepinephrine production. | Pheochromacytoma. Symptoms include very high hypertension, pounding headache, tachycardia, diaphoresis. |
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sskatygirl
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