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MEDSURG2FINAL

QuestionAnswer
Burn Stages Superficial partial thickness, deep partial thickness, full thickness, deep full thickness
superficial full thickness,layer/S&S/HT ?/4/1 scalds, brief contact, epidermis and upper 1/3 of dermis, Red, blanch-able, blisters, painful, 10-21 days
deep partial burns S&S layer/S&S/HT ?/4/1 epidermis and entire dermis, dry white waxy ,extend through entire dermis sometimes into subQ fat,usually no blisters, slow blanching or none, moderate edema, heals in 3-6 weeks, often w/skin graft
deep partial thickness, complications can progress to deeper tissue due to hypoxie and ischemia
deep partial thickness, treatments adaquate hydration, nutrients, O2, antiinfectives, skin grafting
full thickness description (anatomical) destruction of entire dermis and epidermis, does not regrow,
full thickness description
Full thickness
2) Pulmonary edema, definition, crackles, dyspnea at rest, pink frothy sputum, tachycardia reduced UO PVC's anxiety
3) Patient w/ burn, what are nursing interventions? ABC, Oxygen, fluids, hypervolomia, Bun Creatinine PEdemea
4) How will a deep full thickness burn in the emergent phase present? black, extends beyond the skin, no edema , no pain, hard inelastic eshar
5) What are the S&S of an infected burn? edema around the edges, purulent discharge, foul smelling, fever, blood colinization, WBC elevations, pale granulation tissue, sloughing grafts
6a) Prostate Cancer, S&S hematuria, urinary infrequency, hesitancy
6b) Prostate Cancer, labs PSA
6c) Prostate Cancer, interventions leak proof cathetere, irrigation,
6d) prostate cancers surgical interventions TURP, Cryo
6e) prostate cancer: pre-operative interventions
6f) prostate cancer: postoperative interventions PSA 6wks post surg, Q 4-6 months
6g) prostate cancer: patient education indwelling cath may be in place up to 2 weeks, restrict lifting, 15 lbs, ambulate short distance, erect, no vigourous exercise, do not bear down to defecate
7) origins of cancers patho anuepeudy, annaplasias,
8a) origins of cancers, cell physiology chromome
8b) What is Tumor Lysis Syndrome positive sign , K increASe, Na down , hydration 3-5 L per day, aloprim osmotic diuretics, K killers
8c) Tumor lysis syndrome S&S
8d) Tumor Lysis syndrome treatment/interventions hydration, monitor for K increase, administer diuretics, gout meds,
1a) Burn classifactions Superficial, superficial partial thickness, deep partial thickness, full thickness, deep full thickness
9) Who do you care for first, delegation and triage principlles ABC, urgentcy, requiring RN, new onset vs. chronic
10a) What is Xerostomia? Dry mouth. The condition of not having enough saliva to keep the mouth wet due to inadequate function of the salivary glands
10b) what are S$S of Xerostomia? Dry mouth can cause difficulties in tasting, chewing, swallowing, and speaking.
10c) What are interventions fro xerostomia? among patients who take medications, have certain connective tissue or immunological disorders or have been treated with radiation therapy. When xerostomia is the result of a reduction in salivary flow, significant oral complications can occur. xerostomia
10d) Teaching for Xerostomia Condition not a disease, associated with Sjögren’s syndrome, treatment is palliative
11) How would you introduce topic of Hospice care to a patient? stressing palliative nature of care, emphasis on dignity, diligence in carrying out patient end of life options
12) What are the goals of end of life care? (patient) comfort, pain relief, dignity, promote interactions
12b) end of life care (family) comfort, pain relief, dignity, saying goodbye
13) S&S that death is near? Cheyne-Stokes” breathing, anorexia, skin color duller, darker, grayish hue. fingernail beds may also become bluish .sensory changes, hallucination, body temperature can go down by a degree or more. BP and blood flow to the hands and feet will decrease.
14) therapeutic responses when a patient says, "I'm dying" this must be difficult, I'm sorry this is happening
15a) RSHF causes LEFT SIDED HEART FAILURE, COPD, sclereosis.
15b) RSHF S&S dependent edema, jugular distension
15c) CHF treatments/interventions weight monitor, lasix,
15d) CHF MEDICATIONS lasix, dig, amiodorone, beta blockers,
15e) Why does CHF increase preload? because pool isn't pumping
16 ) what are S&S of right sided heart failure? dependent edema, jugular distension
17) What should you teach to a patient with right sided heart failure? MAWDS medications, activity, weight, diet, symptoms
18) What should you teach a patient about digoxin therapy? notify doc if change in HR or rythym, hold if below 60 , same time of day don't take w/antacid of lax, report for scheduled labs
19a) What is goal of digoxin therapy? increase contractility, CO, slow rate
19b) What are counterindications of digoxin therapy?
19c) What are signs of digixin toxicity? muscle weakness, anorexia, fatigue, confusion
19d) Heart failure and rehabilitation, what are patient education highlights? walk 200-400 ft. per day, walk 3X p/week, keep an exercise diary, HR
20) What are the jobs roles for nurses in in ER, case manger, Psych nursing, etc
21) What is the main reason for ACLS certification? train medical proffessionals to respond properly and quickly to Code situations using advanced survey skills, advanced interventions and algorithmic approach
22a) Triage urgent, urgent, urgent, quickly but not immediately no immediate threat to life,,abdominal pain, colic, new onset resp
22b) Triage urgent, emergent emergent, Airway, MI, Stroke, Hemmorhage,
23A) Trauma centers level I what kind of care/patients/ comprehensive trauma care, regional resource, leadership in education, research, required to have immediate availability of trauma surgeons, anesthesiologists, physician specialists, nurses, and resuscitation equipment
23B) Trauma centers level II what kind of care/patients/ a supplement to a level I trauma center in a large urban area or as the lead a less population-dense area. must meet essentially the same criteria as level I Centers are not expected to provide leadership in teaching and research.
23C) Trauma centers level III what kind of care/patients/ Provides prompt assessment, resuscitation, emergency surgery, and stabilization with transfer to a level I or II as indicated. Level III facilities typically serve communities that do not have immediate access to a level I or II trauma center.
23D) Trauma centers level IV what kind of care/patients/ advanced trauma life support prior to patient transfer in remote areas in which no higher level of care is available. resuscitate and stabilize patients and arrange for their transfer to the closest, most appropriate trauma center level facility.
24) Priority of care, what determines…check sample questions
25a) corticosteroid treatment what is it for?
25b) what are side effects of corticosteroid treatment infections, cushings, hypoaldosteronism, insulinemia, bone porosity
25c) what are adverse effects of corticosteroid treatment bone porosity , fractures, infections,
26) How does Diabetis Melitis affect renal function high glucose causes filtrering of nephrons to fail
27) How can you best determine Blood sugar is under control? H1AC below 7 for DM patient, below 6 for non DM
28a) What are the clinical manifestations of DKA? Fruity smelling breath, Decreased consciousness. Kussmall breathing (Deep, rapid breathing), Dry skin and mouth, Flushed face, Frequent urination or thirst that lasts for a day or more, Nausea and vomiting
28b) what are clinical manifestations of DKA? (labs) Hyperglycemia (500-800) , anion gap metabolic acidosis, and ketonemia. Metabolic acidosis is often the major finding, Bicarb 15-18, cirrhosis, Hypophosphatemia(Normal RAnge: 2.5-4.9 mg/dl) hYPOPHOSPHATEMIA
29) ABG
30a) What are the clinical manifestations of renal failure in a patient with Diabetes Melitis? (non lab) BP↑, fluid↑, plasma oncotic pressure↓, periorbital edema, foamy appearance or excessive frothing of the urine (caused by the proteinuria),unintentional weight gain (from fluid accumulation), anorexia , N&V, malaise , fatigue, headache, hiccups, pruritis,
30b) What are the clinical manifestations of renal failure in a patient with Diabetes Melitis? (lab) positive microalbuminuria test. glycosuria. Serum creatinine↑ and BUN↑ may increase as kidney damage progresses. H&H↓↓
30c) What are the clinical manifestations of renal failure in a patient with Diabetes Melitis? General intrarenal symptomology, glomeruloneprotic,
30d) What are the interventions for pt with renal failure in a patient with Diabetes Melitis? General teach pt about glucose control, avoidance of nephrotoxins, low fat die
30e) What are the goals of treatment for pt. w/ renal failure in a patient with Diabetes Melitis? General The goal of treatment is to keep the kidney disease from getting worse. Keep BP (under 130/80) , Control sugars, ACE inhibitors and angiotensin receptor blockers (ARBs) antilipidemics, exercise, .
30f) What patient teaching is needed for p/t w/renal failure due to diabetes? avoid Ibruprofin, naproxin, celebrex, iodine,
31) what is the priortiy treatment for Diabetes Melitis? controlling Blood sugars, diet, exercise
32) what is the proper technique for NG tube insertion? tilt head forward, swallow water,lub with wat sol oil, ice water to stiffen end measure nose to ear to xyphoid, check placement , check residual,
33) what are the complications of end stage cirrhossis of the liver? hepatetic encephalopathy, portal hypertension, ascites, esophogeal varices, spontaneous bacterial meningitis, coagulation defects, hepato-renal syndrome
34) what lab value will decrease in/with ascites? hypoalbuminemia 3.5-4.9 gm/dlserum albumin, hyponatremia (normal 125-135), serum coloid onsmotic pressure decreased
35a) what are the parameters for Pulmonary Artery (PA) pressure in a Schwann Catheter 15-26 systolic, 5-15 diastolic, mean is 15
35b) What does a high PA pressuere indicate? lventricular failure, pulmonary shunting,
35c) What does a Low PA pressure indicate? hypovolemia
36a) What are parameters of PWP in Schwann? 4-12
36b) What does high PWP pressure indicate? lshf, mitral stenosis, pericardial tampoonade, fluid overload
36c) What does a low PWP indicate? hypovolemia
37a) what are nursing implications w/r to arterial line
37b) where is an arterial line inserted? brachial, radial, jugular , femoral,
37c) What are nursing interventions for Arterial Line? allen's test, plebostatic level, signed consent, supine or trendelenberg for insertion, verify placement w/ xray, look for trends
38a) What are normal parameters for MAP? 70-110
38b) What does a low MAP portend/indicate? inadaquate tissue perfusion
38c) What does a high MAP portend/indicate? increased cardiac workload
38d) What is priority intervention for low MAP? fluids, find cause, dopamine, norephineperine
38e) What is priority intervention for high MAP? dig, nitropruss, inotropic, dobitamine
39a) what is contractility? stretch of fibers of heart, at end of diastole and just before systole
39b) What is definition of preload? pool, blood in heart after diastole
39c) What is definition of after load? peripheral resistance against which heart must pump
39d) What are pathologies associated with high preload? pulmonary edema,
39e) What are pathologies associated with high afterload? lventricual failure, atherosclerosis
39f) what is stroke volume? amount of bloodpumped by the heart per beat
39g) What is ejection fraction? amount ejected from left ventriculle per beat /stroke
39h) What drugs increase contractility? inoitropic drugs, dig, dobutamine, dopamine,
39i) What drugs correct problems with preload? dieuretics, dig?
39j) what drugs correct problems with afterload? dig, nitropruss, inotropic, dobitamine
39k) what drugs increase stroke volume?
39l) What drugs increase heart rate?
39m) What drugs lower heart rte?
40a) what is use of atropine? adrenergic, antiarrythmic, , bronchodilator, bradycardia or asystole,
40b) what class of drug is atropine? antiarythmis, bronchodilator
40c) what is class of drug of ativan? Benzodiazepene
40d) what is use of ativan? antianxiety, preanesthesia
40e) what class of drug is inderol inotropic, anatiarrythmic, antihypertensive
40j) theophyline bronchodialtor,prophylactic use for asthma, Paroxsysmal Cardica dysrythmia and EDEMA of CHF
40f) what is use of inderol? management of dysrytmias, MI, Tachy arrythmias assoc. with dig tox
40g) what are counterindications of atropine?
40h) what are contraindications of ativan??
40i) What are contraindications of inderol??
41) What are expected manifestations of a spinal cord injury at level of T5? lower body parylized, self catheterize, Ability to breathe normal, although respiration capacity and endurance may be compromised.self care , can move from bed to chair
42) what does a nurse need to do/know for a cervical spinal cord injury immobilize, glasgow, airway, ABC, intraabdominal hemorrhage , Hypotension, Tachycardia
43) what does a nurse need to know/do for a vertebral fracture? Spinal shock, autodysreflexia, bladder care, sheets, malignant hypothermia, infection, further loss of function.
44) What are factors that predispose a person to having a stroke? diabetes, HBP, Age, weight, family history, TIA history, african american male, brain trauma, ETOH, ORAL CONTRACEPTIVES, HYPERCHOLESTEREMIA , d/c OF HYPERTENSIVE MEDS
45) What is the function of nephrons in renal function filter unit
46) What are S&S of acute glomerulonephritis and what does a nurse need to know or pick up on?? oliguria, protinuria, diet high in calories and low in protein, sodium, potassium, and fluids. preventing contact with infected people. vital signs and electrolyte values FLUID OUTPUT +500-700 ML.
47a) What are prescribed treatments for glomerulonephritis? TREATMENT FOR UNDERLYING CAUSE, strep infection, lupus,
47b) What is best indication to nurse that treatment for glomerulonephritis is working? In general, the goal of treatment is to protect your kidneys from further damage, Bun Creaqtinine return to normal, GFR, USG
48a) what is a radical nephrectomy? removal of entire kidney
48b) Why is a radical nephrectomy ordered? cancer, chronic kidney failure, donation
48c) what are post operative nursing considerations for radical nephrectomy?? Depending in part on your ability to get out of bed and the type of procedure performed, the urinary catheter will likely be removed sometime during the first 24 to 48 hours after the surgery.
49 ) what are S&S of UTI? hematuria, urinary infrequency, hesitancy
49) What are nursing interventions for UTI? burning, , urinary frequency, urgency,hesitancy elev. temp
49) What should nurse teach a patient with a UTI? Fluidate, pee before and after sex, perenial care, cotton underwear, wipe front to back, avoid irritating substances, empty bladder regularly and immediately on urge
50) What are the stages of shock? initial, nonprogressive, progressive, refractory
50) What are types of shock? cardiogenic, distributive, , obstructive, hypovolemic
51) What are S&S of hypovolemic shock? (initial) HR, RR elevat from baseline, slight increase in diastolic
51) IV fluids for Hypovolemic? crystalloids, NS,
52) What are the treatments for hypovolemic shock? fluids, coag, transfusions, ns, PLASMA EXPANDERS, COLLOIDS, ELEVATE FEET OR hob overt bleeds, increase rate of IV
53) what is dopamine used for-high dosage? heart/cardio
54) what is dopamine used for -lower dosage? renal
54) what are side affects of dopamine? hypotension, tachycaria, anginal pain palpitations, cold extremities, N&V
54) what are adverse effects of dopamine? Severe allergic reactions (); chest pain; dizziness; irregular heartbeat; pain, redness, or swelling at the injection site; severe headache.
55) what class of drug is Sodium Nitroprusside? Nitrate, nitroglycerin, vasodilator
55) what is sodium nitroprusside used for? angina
55) What class of drug is Prussin? Nitrate, nitroglycerin, vasodilator
56) what is distributive shock? neural enduced, chemical induced, decreased vascular volume or tone,
56) what are manifestations of distributive shock? 3rd spacing, shifting of fluids,
57) what is septic shock ? systemic infection and respinse
57) How is it distinguished from other shock? blood cultures, eleveted temd, SIRS (Systemic inflamatory response, leads to ARDS, DIC, MODS
58) what are characteristics of the late stage of septic shock? MODS, Coma
59) what are interventions for late stage septic shock treat the cause, Vanco, treat like hyppovolemia
60) incentive spirometry CLOSE LIPS AROUND BREATHE IN HOLD AND RELEASE, 10 PER HR. Increases alveolar compliance
61) early clinical manifestations of sepss mild hypotension, low UO, elevated RR, decreased CO, elevated WBC
61) signs and symptoms of sepsis, early CO decreased, SV decreased, serum lactate normal to slight increase, blood glucose 110-120, O2 sat <95
62) signs and syptoms of sepsis late CO increased, SV increased, serum lactate increased, (2-4) Blood Glucose 120-150, 02<85, Sirs, dic
63) S&s SEVERE SEPSIS LOW GRADE FEVER, HYPOTENSION, REDUCED uo AND rr
65) Vent associated pneumonia, interventions to prevent prevent colonization, prevent aspiration, SUCTION, ORAL CARE hob SEMIFOWLER,
66) vents, wdnntk (what does a nurse need to know) settings done by pulmo, avoid aspiration , suction properly, maintain o2 , keep obdurator and spare trrach at bedside, empty vet tubes when condensation is evident, Auscultate lungs q4 cracklesetc, look for pressure ulcers
67) treatment for PE heparin, anticothrombolytics, anticoagulants, O2 therapy, evaluate chest pain, auscultate for adventitious sounds, monitorfor bleeding
68) patient teaching to prevent PE walk, keep antiembolytic stocking on,. Quit smoking, do not cross legs, no knee gatch, avoid valsalva, do not massage or compress leg muscles, avoid tiight clothing
69) Atropine uses, how given given IV push, 1 mg. 3-5 min.
70) dopamine math calc
71) parkland formula 4ml/kg*%BSAB per 24 hourws, 1/2 given in first 8 hrs from injury, not presentation
72) blood transfusion WATCH FOR REACTIONS, ns DRIP ONLY, y set, confoirm type and cross, Stay for 1st 30 VS Q hr
Created by: jrjct1