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Med Surg Final 2011

Study cards for Med Surg 1 Final Review 2011 Complete

QuestionAnswer
Directions for instilling eye drops proper hand washing; inner to outer*
Application and care of contacts proper hand washing;keep case clean;remove for sleep w/cleaning and storage as recommended by manufacturer; use cleaning and wetting solutions as recommended; do not use water or homemade solutions
Detached retina complaints of black spots and curtain dropping*
Glaucoma meds Adernergic agonist; Beta blockers (NOT W/COPD, ASTHMA, HF); Treatment will be life long*
Normal eye function eye tears if cornea is touched*
Atropine eye drops cause poor consensual light response*
serous otitis media s/s complain of loud popping and hearing loss*
Care of otitis media post tube placement avoid water in ears
Meniere’s disease (chronic vertigo) Medications Meclizine hydrochloride (Antivert) Anti /against vert /vertigo*
Causes of vertigo hearing and balance disorders*
NI for Vertigo assist with ADL's (ABC Safety); Ambulating specifically*
Meds for vertigo diazepam (Valium); lorazepam (Ativan)*
labyrinth of the ear is responsible for equilibrium*
loss of hearing in elderly usually due to? middle ear structure stiffining
how to talk to someone with hearing loss talk in normal voice, facing directly
information about body/head position comes from? ears*
most common complaint of inner ear disorder tinnitus*
enucleation surgical removal of the eye*
positioning for examination of ear canal in an adult hold ear backwards, upwards, and slightly outward*
Application and care of contacts if redness, tearing, vision loss or pain occurs, remove and contact HCP;do not share*
Weber test if increase in hearing during test = possible build up of cerumen or otitis media in ear
Whisper test is a rough indication of ability to hear
punch biopsy small section of dermis and SQ fat
incisional biopsy incision made and part of tumor is removed; differentiate between benign & cancer
excisional biopsy entire skin lesion or tumor removed; differentiate between benign & cancer
shaved skin biopsy w/razor shave off superficial lesion; differentiate between inflammatory & infectious
Indication of cyanosis in blacks blueish nail beds
Nevi (moles) potential to become malignant
linear pattern of painful vesicles over left thorax; what to ask? did you have chicken pox when young; as it may be shingles
what is Lichenification rough thickened areas from chronic dermatitis
Mechanism of action for allergy meds reduces histamines which reduces itching
Head lice s/s itching, hair clumpy and smells bad
Herpes Zoster (shingles) s/s strange painful rash on (usually) one half of body – esp upper body
Teaching for acne keep hair clean with frequent shampoo's
basal cell tends to reoccur
melanoma diet eat a rich in protein diet and high calories
nursing diagnosis for skin cancer impaired skin integrity
Tattoo removal Dermabrasion
basis of surgical asepsis is to keep area free from microorganisms
Psoriasis treatments topical application of corticosteroids
Scabies highly contagious – may infest anyone
Lupus signs and symptoms distinct butterfly rash across nose and cheeks
Pressure ulcer care supportive care assessment, emollients applied, dressing changed,turn every 2 hrs
autograft from own body
xenograft (or heterograft) from animal usually a pig
allograft (or homograft) from same species, usually cadaver
Definition of “tepid bath” close to body temp; 98 to 100 degrees Fahrenheit
Cushing’s Syndrome can manifest as DM because glucocorticoids accelerate the process of gluconogenesis
Cushing's Syndrome most commonly caused by hyperplasia of adrenal cortex
Cushing's Syndrome S/S lability of mood, ectomorphism with a moon face
Cushing's Syndrome need to asses diet for protein and vitamin intake
skin assessment for hypothyroidism rough dry skin
skin assessment for hyperthyroidism cool clammy
deep tendon reflexes can be used to diagnose hyperthyroidism
facial sign of hyperthyroidism eyes extremely wide open and bulging
what do you need to teach about hyperthyroid meds can take several weeks to work
Edema +1 slight pitting no obvious distortion
Edema +2 pitting remains w/ obvious distortion
Edema +3 pitting is obvious, extremities are swollen
Edema +4 deep pitting, no obvious distortion
Documentation of herpatic lesions ulcerated
Vitiligo abnormal loss of melanin in patches usually on face, hands,and groin
Addison’s teaching: physical activity encourage exercise and protect from exertion
Addison's teaching: diet and why high protein, high calories, and extra salt /its needed to regain weight lost
Addison's therapy is targeted at restoring electrolyte balance
Addison's: in crisis need to set up asap an IV
Addison's adverse skin effect the steroids taken to treat can cause skin to look tanned
steroids should be given prior to adrenalectomy why compensated for sudden lack of hormones
what to do post surgery adrenalectomy asses for onset of adrenal insufficiency – monitor I
oral hypoglycemic agents are used when if patient has some insulin production
s/s hypoglycemic reaction to insulin pallor, perspiration, and tremors
what do you need to do 3 days prior to oral glucose test stop vitamins
what causes diabetic acidosis due to breakdown of fat stores for energy
poly neuropathy s/s numb extremities leading to loss of extremities
Diabetic coma results from ketones from fat rapidly breaking down, causing acidosis
DKA is often seen in the presence of infection
DKA: when admin insulin IV solution needs K in order to replace K that has moved into intracellular fluid compartment DKA after treatment observe for signs of hypoglycemia
what is the basic control for a Diabetic diet regulating food intake
What do you do for diabetics in the hospital prior to meals check blood glucose levels
S/S of hyper and hypoglycemia: skin hot and dry sugar high cold and clammy need some candy
hyperglycemia s/s nervousness, weight loss, increased appetite
T3 and T4 low levels s/s cold intolerance
some times you can have faulsly elevate T3 and T4 levels when being treated for seizure disorder with medication
Graves’s disease treatment: radioactivity precautions mild and should be treated with routine safety precautions
Graves's disease diet high calorie diet
Thyroid storm caused by elevated (T3) triiodothyronine levels
the Pituitary gland is important because it regulates eight hormones and related functions
Thyroidectomy after, what to do is sore throat is preventing eating admin pain meds prior to meals
Thyroidectomy; you will need hormone replacement why most likely also lost the parathyroid gland
Thyroidectomy: w/parathyroid removal will need Ca otherwise bone breakdown accelerated w/release of Ca into blood
S/s ADH dehydration and excess urination
Average Urine output 1.5L (1500mL)/day
Average I 2.5L (2500mL)/day
Hypovolemia S/S postural hypotention, oliguria, muscle weakness NOT Bradycardia
NI's: hyponatremia S/S N, monitor neruolgic status, restrict tap water, D, abdominal and muscle cramping
NI's : hyponatremia weigh every morining use bed scale, raise salt intake
hypokalemia caused by inadequate potassium intake
hypokalemia diet fruits like bananas and apricots
hypokalemia how to take meds take potassium chloride with juice
Chevostek’s sign sign of hypocalcemia tap finger in front of eat at angle of the jaw
hypocalemia clinical manifestation neuromuscular hyper excitability
hypercalemia s/s diminished bowel sounds; hyperactive deep tendon reflexes
hypermagnesiemia s/s hypotention, warmth, sweaty, N,.V
hypermagnesiemia is often seen in critically ill and alcoholics
Magnesium 1.5 - 3.5
HC03 22 - 26
Potassium 3.5 - 5.5
pH 7.35 - 7.45
Calcium 5.5- 8.5
pCO2 35 - 45
Sodium 135 - 145
specific gravity of urine 1.010 – 1.015 (distilled water is 0)
BUN 10-20 (if you have 10 buns you have 20 cheeks)
creatinin 0.6 – 1.4
IV Fluid: LR is used because most like blood plasma
Take potassium chloride with juice
diet to elevate potassium bananas and apricots to elevate potassium
pH levels acidosis 7.35 - 7.45 alkalosis
First name means compensated/uncompensated
HCO3 levels acidosis 22 - 27 alkalosis
Middle name which ever matches pH
pCO2 levels alkalosis 35 - 45 acidosis
Last name pH is or leaning toward
compensated means pH in range
uncompensated means pH out of range
what decides if respiratory or metabolic which ever one matches pH
Example: pH 7.35, CO2 55, HCO3 30 pH in range but, leaning acidosis, CO2 acidosis (matching pH) and HCO3 alkalosis (not matching) so, compensated respiratory acidosis
What does potassium do to acid base balance K helps regulate acid base balance
Ca and phosphate have what relationship an inverse relationship
Systems most affected by potassium renal failure
Special consideration for administering replacement electrolytes age (elderly), rate, levels of others
Important history assessment questions to assess for most accurate nutritional status What did you eat yesterday; describe what a healthy diet is; any episodes of indigestion, N, V, D, or constipation? Change in appetite?
recommended nutritional values calories to maintain weight 30 cal/kg
recommended nutritional values for protien 0.8kcal/kg; men 56g and women 45g
recommended nutritional values calories: carbs 125 – 175g/day (4kcal/g);)
recommended nutritional values calories: fat total 20 -35% of cal intake, less than 10% from saturated fatty acids and less than 300 mg/day of cholesterol
flat plate or abdominal X-ray; what to document time & date; toleration
thrush creamy white lesions on tongue, inner cheeks somtimes roof of mouth, gums, tonsils (cottage cheese like), PAIN, slight bleeding if scraped, craking at corners of mouth, a cottony feeling in mouth; loss of taste; poss. diff swallowing, feel like food stuck
What is the most important thing for the nurse to communicate to radiologist about CT scan allergy to Iodine and shellfish; watch BUN, cretinin, make sure consent given
H. pylori can cause stomach ulcers, gastritis (sever inflammation of the stomach lining), increased risk of gastric cancer, MALT lymphoma (tumor from white blood cell in stomach lining)
how is H. pylori spread person to person, oral to oral, and fecal to oral
ways to diagnos H. pylori invasive methods - gastroscopy; biopsy specimine/biopsy urease test noninvasive - serological testing (to detect IgG antibodies); fecal antigen immunoassay and urea breath test
S/S of H pylori abdominal pain/burning sensation, bad breath, blood in stool or vomit, excessive burping, flatulence, loss of appetite, N, V, weight loss
treatment of H pylori two antibiotics and a proton pump inhibitor (PPI); bismuth (peptobismol)has a antibacterial action against H pylori
New J tube can and can not do don''t cut gauze pads; sterile procedure until healed
hematocrit levels Men 40 - 45%; Women 37 - 47%
hemoglobin levels Men 14 - 18; Women 12 - 16
what is third spacing fluids passing into interstitial space
what do you do when a hemodyalisis patient complains of pain, abdominal pain and/or experiances confusion, disorientation, headache need to lower the flow rate
what do you need to do to gain accurate fluid assesments check weight daily, in the morning, on the same scale, and in the same clothing
Chevostek's sign is a sign for; and what should you do if you see it hypocalcemia; remove BP cuff and administer Oxygen
what are two critical steps in collecting and transporting ABG's put pressure on collection site; put immediatly into ice
S/S of NG tube malfunction can't talk/coiled at back of throat; pull back reposition
Diet as tolerated - what should you offer first Post op = ice chips; clear liquid (jello, coffee, and tea are clear liquids)
If Zantac and Mylanta are ordered houw should the be administered Mylanta should be given at least 1 hour prior to Zantac; Mylanta an antacid that neutralizes gastric secretions and Zantac inhibits gastric secretions
Fecal Occult Blood Testing (FOBT or Guiac) - out patient teaching Blue color indicates presence of blood - call HCP. need 3 consecutive BM's; NO NSAID's
Bariatric clients are at high risk for respiratory problems immediately after surgery. Why? adipose tissue holds onto anesthesia longer
what is VCLD(very low calorie diet) BMI <30; 400 to 800 kcal a day; 45 to 70g high quality protein, 30 - 50g carbs, about 2g fat a day for 30 to 60 days. Under strict doctor supervion dramatic weight loss with out loss of lean muscle mass
weight loss requires more out than in; requires behavior modification; usually 1000 - 1200 kcal daily for women and 1200 - 1600 kcal daily for men
how to compute protien intake for a person to maintain body weight kg X 0.8
3500 kcal = 1 pound in body fat; must reduce intake by 500kcal a day for 7 days to lose one pound
Zofran indication: Chemo - nausea; give 30 -60 minutes before chemo; monitor liver function; headache common; administer w/o regard to food
Mylanta in regards to GERD and IBS neutralizes secretions but, can't stop overproduction
purpose of gastric tube insertion decompression, gastric ANALYSIS, lavage, tube feeding
nitrates in urine bacterium
purcussion of the bladder dull sound is normal
hrs after cholecystectomy and patient complaines of abdominal distention, nausea, elevated abdominal pain: nurse should check position of the NG tube
patient with a a catherter in place complains of a sever headache; nurse should first check catheter for kinks or obstructions
NG tube is set on low suciton and the patient complaine of nausea, abdominial distention what should the nurse do first irrigate NG with 30mL of NS
steps to keep skin from breaking down around ileal pouch keep clean and dry; apply moisture barrier/skin protectant
what procedure is used to breakdown a 4 - 5 mm stone Ureteroscopy
what is a common cause of kidney disease diabetes
dulcolax - how does it work by increaseing peristasis by stimulating enteric nerves and by pulling liquid into the intestines
what is cystitis bladder inflamation and irritation
s/s cystitis urgency frequency; painful bladder
sign of possible accute pancreatits elevated serum amylase
Glomerulonephritis diet increase dairy and decrease protien
Rovsing Sign re: apendicitis; refered pain on left side of abdomen
Chevostek sign abnormal spasm of the facial muscles elicited by light taps on the cheek to stimulate the facial nerve in patients who are hypocalcemis - sign of tetany
s/s C. diff D, abdominal cramping, malaise, fever, anorexia; often misdiagnosed as crohn's disease
C. diff oportunistic bacteria; brought on by cessation of causative antibiotic; antibiotic therapy w/ vancomycin or metronidazole;contactisolation
ALP 20-90
ALT 5-35
AST 5-40
bilirubin 0.3-1.2
s/s peptic ulcer pain (gawning, burning, aching, or hunger like); a pain - food-relief pattern; heartburn, regurgitation, may vomit
persistant N, V, can cause dehydration, hypokalemia, metabolic acidosis, aspiration w/resulting pneumonia, ruptures or tears of the esophagus
persistand D can cause dehydration, hypokalemia, hypomagnesiemia, metabolic acidosis, if sever - vascular collapse and hypovolemic shock
cause of obesity ultimatly more intake that out put but, has many contributing factors: psychological, genetic, enviromental, hormonal, - Multifactorial
cholecystitis d/c teaching inflammation of the gallbladder; high instance of recurrent stone formaion with d/c
steatorrhea bulky foul smelling stool;
administration of Nexium PPI, take first 8 weeks BID at bedtime, and before breakfast; after 8 weeks 1 daily at bed; do not crush; monitor liver function (AST, ALT, ALP), avoid ASA, NSAID's, alcohol, and smoking
Dumping syndrome is brought on by ecess sugars; cut back carbs and cut back or eliminate simple sugars
what should a stoma look like pink or red, moist, about 2 cm high; measure diameter and appearance
Celiac diet gluten free. No wheat, rye, barley
how to asses the abdomen ausculate, palpate
most common surgury for Hiatal hernias Nissen fundoplication - the fundas of the stomac is wrapped around the lower esophagus and the edges are sutured together
how is placement of a gastric tube confirmed flate plate abdominal xray; pH test of aspirates
what test is used to diagnos pancreatitis ERCP (endoscopic retrograde cholangiopancreatography), Blood = Serum Amylase
NI for ERCP (endoscopic retrograde cholangiopancreatography) NPO 8 hrs, following test vitals, gag reflex, and monitor for complications
what can a nurse delgate to a CNA regarding a TPN patient monitor I
Hepatitis clients often have decreased apitite; cancer of the liver, cirrhosis of the liver (specifically posthepatic cirrhosis where the liver is shrunken and nodular with extensive liver cell fibrosis
Inguinal hernia (usually males) sac of abdominal contents through the internal inguinal ring into the inguinal canal
indirect inguinal hernia congenital defect, often not evident until adulthood, caused by improper closure of the tract that develops as the testes descend into the scrotum before birth
direct inguinal hernia acquired resulting from weakness of the posterior inguinal wall (usually older adults),
femoral hernia acquired defect (obese or pregnant women) peritoneal sac through femoral ring
Umbilical hernia (pregnancy and obesity – in adults, more common in women, multi para w/prolonged labor, ascites, and large intro-abdomial tumors) can be congenital and evident during infancy. Abdominal contents through the umbilical ring
Incisional hernia at a previous surgical incision or following abdominal muscle tear, contributing factors – poor wound care, postoperative infection, age or debility, obesity, inadequate nutrition, and excess incision stress caused by vigorous coughing
Ventral hernia often asymptomatic characterized by a bulge at incision site
Created by: freenpackn