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Med Surg Final 2011
Study cards for Med Surg 1 Final Review 2011 Complete
| Question | Answer |
|---|---|
| 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 |
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