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medsurg ques

1. Hospice care- How would you treat this patient? Provide comfort care, Treat pain, Reduce anxiety, Whatever they want
2. The family of a patient who is dying comfort, reminisce, goodbyes, educate on hospice care
4. Atrial fib, clinical significance causes decreased CO because of ineffective atrial contractions or loss of kick and/or rapid ventricular response. This can result in thrombi formation in atria and blood stasis
3. Review the Parkland formula. 4 X %BSA burned X wieght in KG for hrs. 1/ in first 8 hrs, remaining in final 16, from Time of burn
4. Atrial fib, clinical significance causes decreased CO because of ineffective atrial contractions or loss of kick and/or rapid ventricular response. This can result in thrombi formation in atria and blood stasis
most effective method of terminating VF and pulseless VT defibrillation
asystole, c.inical significance patient unresponsive, pulsless, and apneic, prolonged arrest, ussually cannot be resuscitated
4. Atrial Fib, interventions, and treatments chemical cardioversion w/ CCB's, Beta blockers,(amiodorone) , cardiversion.
SVT description HR: 100-300 bpm, Rhythm: regular or slightly, irregular P WAVE: often hidden in the preceding T wave
4b. SVT or PSVT interventions, treatments, drugs, vagal stimulation, adenosine, IV beta blockers, digoxin, amioderone
4c. Vtach description "ghosts holding hand"s
Vtach drugs, interventions, treatments IMMEDIATELY AND RAPIDLY ASSESS THE PATIENT! , If the patient is pulseless with this rhythm. If so START CPR AND CALL A CODE! Amiodorone, procainimide, cardioversion
V Fib description
Vfib: interventions, treatments, drugs immediate CPR, defib, drug therapy
Asystole treatment treat cause,
Blocks, descriptions, classes, interventions expected
5. Med: Addenosine- Adenocard
6. Meds: Atropine, Digoxin, Lidocaine, Metropolol
6a1. Meds: Atropine AKA lopressor
6a2. Meds: Atropine Classification Beta blocker, antihypertensive, antianginal
6a3. Meds: Atropine Therapeutic uses Antihypertensive, antianginal
6a4. Meds: Atropine Route for MI IV 5 mg q 2min X 3
6a5. Meds: Atropine Route for hypertensive PO 50-100 mg. /day divided doses
6a5. Meds: Atropine nursing interventions Take apical pulse, BP, monitor EKG during IV administration, monitor Blood glucose, I&O, Auscultate lungs for rales
6b. Meds: Digoxin AKA Lanoxin
6b1. Meds: Digoxin Classification/therapeutic uses Cardiac glycoside/inotropic/antiarrythmic
6b2. Meds: Digoxin Route po/IV
6b3. Meds: Digoxin nursing interventions Draw blood samples for determining plasma digoxin levels at least 6 h after daily dose and preferably just before next scheduled daily dosegr, take apical pulse, monitor I&O, withhold med if pulse < 60 BPM
6b4. Meds: Digoxin signs of toxicity muscle weakness, visual disturbances anorexia, fatigue, confusion
6b5. Meds: Digoxin therapeutic levels 0.8-2 ng/
pt. TEACHING FOR DIGOXIN 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
6c. Meds: Lidocaine IRRITABLE HEART
6d. Meds: Metoprolol AKA lopressor, Beta blocker, antihypertensive,
7. Teaching for bradycardia. Only treated if symptomatic w/ fatigue, mental status change, SOB, Chest pain, hypotension. Treatment of choice Atropine.
8. Atrial fibrillation- What does the nurse need to know? Clots may form and be ejected,
9. Meds: Sotolol, Heparin, Atropine,Lidocaine Sotalol(Amiodorone)- Antiarrhythmic used to treat life threatening ventricular arrhythmias (sustained ventricular tachycardia) and maintinence of normal sinus rhythm in patients with afib/ flutter.
9a. Meds: Sotolol Heparin- Anticoagulant, Atropine- antiarrhythmic, increases heart rate, Lidocaine- antiarrhythmic, slows the heart rate
9b. Meds: , Heparin Heparin- Anticoagulant
9c. Meds: Atropine Atropine- antiarrhythmic, increases heart rate
9d. Meds: ,Lidocaine Lidocaine- antiarrhythmic, slows the heart rate
10.Meds: Digoxin, Lidocaine, Atropine, Dobutamine
10A. Meds: Digoxin increase contraction, slows heart rate
10B.Meds: Lidocaine Lidocaine- slows HR, irratable heart
10C.Meds: Atropine increases HR
10d.Meds:dobutamine Used in CHF or cardiogenic shock to increase cardiac output. Enhances renal perfusion, increases renal output
11.Superventricular tachycardia- What are the different treatments? Adenosine- see #5, Treatment of fast rates:pain and anxiety reliefvagal maneuvers (bear down) Carotid massage – NURSE WILL NEVER DO THIS. Tell the Doc he can do it and go get the crash cart!
12.List nursing diagnosis associated with 3rd degree Av Block. Drug Therapy: Beta Blockers to decrease HR and BP (Metoprolol, Inderal, Labetolol), Calcium Channel Blockers slow conduction of electrical activity of the heart (Diltiazem, Verapamil), Digoxin suppresses SA depolarization and atrial irritability, slows co
13.Look at heart failure and preload. How is affected by preload?
What is definition of preload? pool, blood in heart after diastole
What is definition of after load? peripheral resistance against which heart must pump
What are pathologies associated with high preload? pulmonary edema,
What are pathologies associated with high afterload? lventricual failure, atherosclerosis
14.Ejection fraction- What does it mean? percentage of blood ejected from the heart during systole, normal above 50, below 40, ventricular dilation
What are normal parameters for MAP? 70-110
What does a low MAP portend/indicate? inadaquate tissue perfusion
What does a high MAP portend/indicate? increased cardiac workload
What is priority intervention for low MAP? fluids, find cause, dopamine, norephineperine
What is priority intervention for high MAP? dig, nitropruss, inotropic, dobutamine
15.List the S/S of left sided heart failure. Who is at risk? Decreased CO, Fatigue, weakness, oliguria during day, tachycardia, weak peripheral pulses, cool extremities.Pulmonary Congestion Hacking cough dyspnea, crackles or wheezes, HTN, Coronary artery disease, cardiomyopathy, cardiac infections, dysrhythmias,
16.List the S/S of right sided heart failure. Who is at risk? Systemic congestion, Jugular vein distention, enlarged liver or spleen, dependent edema, polyuria at night, Right sided HF in the absence of Left sided HF is usually the result of pulmonary problems, African Americans are higher risk
17. Patient teaching for nitroglycerine patch. Remove the patch from the patient before defibrillation, Rotate application sites, Apply to clean, dry, hairless area, Remove patch after 12-14 hours each day
18.What diagnostic tests are used to determine heart failure? radiography best tool in diagnosing heart failure, Chest X-ray - helpful in diagnosing left ventricular failure, Radionuclide studies, Multigated angiographic (MUGA)
19.Interpret EKG
20.Acid-base balance with compensation
21.ABG interpretation- recognize buffering. 3 kinds repiratory, renal, chemical resp is quickist to kick in renal takes up to 24 hrs.
22.Renal compensation Renal compensation results when a healthy kidney works to correct for changes in blood pH . The kidneys regulate the amount of hydrogen and bicarbonate ions that are retained or excreted by the body.
23.Interpret ABG’s per scenario.
24.Interpret ABG’s per scenario.
25.List common causes of burn injuries in the home. House fires, explosions, scalds chemicals for pools oven cleaners, Hot metal(space heater/ iron)
26.Psychosocial effect of a burn injury. Alteration in body image
27. List the types and stages of burns. Superficial, superficial partial thickness, deep partial thickness, full thickness, deep full thickness
28.Review emergent phase of deep full thickness burns. What do yo expect to see? may be white, charred, black, brown, or leathery, extends beyond the skin, no edema , no pain, hard inelastic eshar. Extends beyond skin to underlying tissues exposing bone, muscle, and tendons. Black and depressed.
29.Liver failure- Know how to care for the patient. What do you monitor for? Fatigue, significant change in weight, GI symptoms, abdominal pain and liver tenderness , pruritus, Jaundice of skin and sclera, dry skin, rashes, petechiae and ecchymosis, (palmar erythema), spider angiomas, peripheral dependent edema of the extremit
Liver failure labs Elevated AST (most specific indicator), - ALT, LDH, alkaline phosphatase, bilirubin , , elevated serum globulin, elevated NH4, PT/ INR, decreased serum albumin
30.Know how to assess for jaundice. Skin, sclera, nail beds, must be present in two places
31.What do you teach a pt. with a low WBC? Normal Value: 5,000 – 10,000/mm3, Monitor for fever, infection, promote sufficient nutritional intake, encourage fluids as appropriate, S&S Teach patient to prevent infection. Avoid crowds, children, gown and glove (reverse isolation), good hand washi
32.Know lab values for: protein, lymphocytes, thromboxin, erythopoeitin. Know which is being taken care of properly. protien: 7-8, lymphocytes:; 1500-4500, thromboxane, 0-1100 pg/m, erythropoeitin 4-27 mU/mL.
32a. Know lab values for: protein, interventions high/low Total Protein: 6.0-8.0g/dL BOOK says 7-8g/dL, Ringers
32b. Know lab values for: lymphocytes//interventions high/low 1500-4500, low, infection preventiuon, high, treat for infectio
32c.Know lab values for: thromboxin//interventions high/low 0-1100, bleeding precautions if low, clotting precautions if high
32d. Know lab values for: erythopoeitin 4-27 mu/ml
33.Platelets- Know nursing diagnosis for decreased and increased platelets. At risk for bleeding, At risk for clotting, At risk for polycythemia vera, Decreased Cardiac Output, Impaired tissue perfusion
34.Patient who is an alcoholic and has intake of ETOH daily. What type of lab values would you expect/assess? AST, ALT, albumin, and ammonia, > amylase, lipid functin
"35. Thrombocytopenia- According to book “ autoimmune thrombocytopenic purpura” low platelets (below 150,00), nursing considerations
Bleeding Precautions (Your spleen destroys platelets causing bleeding)"
37.Diabetes mellitus- patient teaching monitor sugar, inspect feet daily, no lotion between toes, respond promptly to skin breakdowns
38. assessment of a patient with DM s&S
38. assessment of a patient with decreased renal function. S&S
38.Compare an assessment of a patient with DM and decreased renal function. (differential) glycosuria vs. protinuria
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,
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↓↓
What are the clinical manifestations of renal failure in a patient with Diabetes Melitis? General intrarenal symptomology, glomeruloneprotic,
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
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, .
What patient teaching is needed for p/t w/renal failure due to diabetes? avoid Ibruprofin, naproxin, celebrex, iodine,
39.Patient teaching for retinopathy, neuropathy, peripheral neuropathy Reduction in sensory responses or increase in pain can lead to injury. Use caution with any action requiring sensory feedback.
39a. Patient teaching for retinopathy development of blood vessels in eyes, check eyes yearly, damage permanent
39b.Patient teaching for neuropathy damage to nerves, can cause numbness, or pain. Loss of balance can occur, sudden falls
39c. Patient teaching for peripheral neuropathy be carefull with foot care, bath water temp, new shoes,
40.DM teaching r/t exercise wear ID, don't exercise in extreme temps, maintain hydration status, refrain from exercise immediately following insulin administration or during peak periods, monito BGL snacks with readily absorbable carbs, 30 gms Carbs for every 30-60 minutes of vigour
41.Type of questions to ask the family of a patient who comes into the ED unresponsive MVA?, wearing a seat belt?, speed at impact, blunt or penetraating trauma, did patient fall?
42.Care of a patient with a brain attack. Know positioning. ischemic, flat, hemmorragic, lob 30 or less. Head midline, neutral, log roll
43.Interventions to perform 72 hours post brain attack to prevent complications. monitor ICP, LOC neuro checks, VS q1-2hrs, monitor for rebleed and hypovolemic shock
45.Know how to determine cardiogenic shock. S&S decreased heart function, CO and MAP reduced, Oliguric, HTN, Tachycardia dimished heart sounds, LOC, cool pale skin CHF symptoms Systolic BP 30 less than base line
46.Compare hypovolemic shock and acidosis. Hypovolemia will tend to cause metabolic acidosis, however, lactic acid is main culprit.
47.Know the stages of septic shock. How will the patient present? early, Reversible)
Initial Phase During the initial stage of shock, adaptive mechanisms are so effective at returning MAP to normal levels that oxygenated blood flow to all vital organs is maintained.
nonprogressive/compensatory ·      During the nonprogressive or compensatory stage of shock, kidney and hormonal adaptive mechanisms are activated because cardiovascular adjustments alone are not enough to maintain MAP and supply needed oxygen to the vital organs.
progressive ·      In the life-threatening progressive stage of shock, adaptive or compensatory mechanisms are functioning but can no longer deliver sufficient oxygen, even to vital organs.
refractory/irreversible ·      Vital organs develop hypoxia, and less vital organs become anoxic and ischemic resulting in tissue damage or death. MODS, DIC
48.Septic shock- Who is at risk? Elderly, burn victims, surgical patients,
49.Treatment for the late phase of septic shock. Antibiotics, fluids, heparin?, treat the cause
50.Disaster- know the role of everyone in the ED after a disaster.
51. ED.Role of the nurse caring for a patient in the ED after a disaster. stabilize, providce comfort/pain management, initiate IV, initial assessment
52. Scenario: Man with anthrax, what should you do? Gown and mask, then Escort them out of the building, notify security, begin isolation protocols outside of facility, wash, remove cloths
53.Cirrhosis- Type of history that leads to diagnosis. ETOH, chemicals, toxins, hepatitis
54.Cirrhosis- How to assess for venous congestion? look spider angiomas, petechiae, ascites, esophogeal varicies,
55.S/S of end stage cirrhosis. esophogeal varices, hepatic encephalopathy, death smell, ascites,
56.Cirrhosis- What is happening to cause ascites? hyperalbinemia, Xeroestemia, fluid shift,
57.End stage cirrhosis- What is the patient at the risk for- GI bleed +confusion + combativeness =? portalsystemic encephalopathy
58.Measuring abdominal girth patient uspine, at the end of exhalation, at umbilicus
59.Complication of pericentisis. hypovolemia
"60.Pancreatitis- Things done to confirm diagnosis.Know labs and S/S. elevated amylase, lipase, trypsin (most accurate for acute pain) pain radiating to back, vomitting, fever, Plasma amylase: 70-200 U/L.
Plasma lipase: 7-58 U/L.
Urine amylase: Less than 1200 U/L."
60a.Pancreatitis- Things done to confirm diagnosis xray, CT, MRI, Ultrasound, Cholycystogrtam,
61.Patient with acute pancreatitis- What does the nurse do? encourage NPO, Encourage sitting upright may reduce pain, SIDE LYING BED POSITION, encourage fluids, assess Abg, BOWEL SOUNDS, iv, ng TUBE SUCTIONING, Proton pump inhibitor
62.Pancreas that is being drained-Know things the nurse can do to decrease complications. provide skin care , skin barrier cream, mionitorfor signds of inflamation, infection
63.Pancreatic enzymes- Patient teaching r/t when to take. just befoe meals or slightly before
64.Patient teaching for chronic pancreatitis r/t self care. avoid ETOH/tobacco, high carb, high protien low fat diet, maintain fluids, reduce stress
65.Patient returns from the OR, know how to assess the patient. assess VS q30 min , loc, O2 sat, repiratory status, bleeding, gag reflex, U/O, cough
66.Pancreatitis- how to care for the patient. support
67.Abdominal assessment of an older client. What abnormal findings are considered normal decreased peristalsis, reduced liver size, fluid status ,
68.EGD- Type of things you do for the patient after the procedure. Ø  Test to examine the lining of the esophagus, stomach, and first part of the small intestine. It is done with a small camera (flexible endoscope) which is inserted down the throat. Ø  Check if gag reflex has returned before offering any food
69.S/S of acute pylonephritis. fever, burning urine, chills, back (flank pain)
70.Assessment for a patient with acute glomerulonephritis. secondary to recent infections, lesion, olguric, facial hands, eyelids (periorbital) , crackles in lungs, cola colored urine,
71.Glomerulonephritis-.How do you know treatment is working? UO returns to normal, infection symptoms, i.e fever etc. subside.
72.Post esophagogastrotmy_Patient care 2days after procedure. Monitor for anastomotic leak (fever, saliva seeping through incision).Provide the client with suction for oral secretions.Closely observe for aspiration when oral feedings are resumed. Keep the client upright for at least 2 hr after meals.
72.Post esophagogastrotmy_Patient care 2days after procedure. Maintain the in a semi-Fowler’s position or higher., Monitor chest tube and drainage.Maintain NG tube patency and monitor drainage –.do not manipulate or irrigate NG tube unless prescribed by the provider.Provide enteral feedings if jejunostomy tube was p
73.End of life.- Pain management. opiods, morphine,
74.Simple question r/t blood transfusion. WATCH FOR REACTIONS, ns DRIP ONLY, y set, confoirm type and cross, Stay for 1st 30 VS Q hr
75.Blood transfusion- What to do if there is a reaction, type of lab work before and after stop transfusion,
Created by: jrjct1