Study cards for Med Surg 1 Final Review 2011 Complete
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| Directions for instilling eye drops | proper hand washing; inner to outer*
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| 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
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| Detached retina | complaints of black spots and curtain dropping*
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| Glaucoma meds | Adernergic agonist; Beta blockers (NOT W/COPD, ASTHMA, HF); Treatment will be life long*
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| Normal eye function | eye tears if cornea is touched*
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| Atropine eye drops cause | poor consensual light response*
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| serous otitis media s/s | complain of loud popping and hearing loss*
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| Care of otitis media post tube placement | avoid water in ears
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| Meniere’s disease (chronic vertigo) Medications | Meclizine hydrochloride (Antivert) Anti /against vert /vertigo*
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| Causes of vertigo | hearing and balance disorders*
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| NI for Vertigo | assist with ADL's (ABC Safety); Ambulating specifically*
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| Meds for vertigo | diazepam (Valium); lorazepam (Ativan)*
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| labyrinth of the ear is responsible for | equilibrium*
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| loss of hearing in elderly usually due to? | middle ear structure stiffining
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| how to talk to someone with hearing loss | talk in normal voice, facing directly
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| information about body/head position comes from? | ears*
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| most common complaint of inner ear disorder | tinnitus*
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| enucleation | surgical removal of the eye*
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| positioning for examination of ear canal in an adult | hold ear backwards, upwards, and slightly outward*
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| Application and care of contacts | if redness, tearing, vision loss or pain occurs, remove and contact HCP;do not share*
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| Weber test | if increase in hearing during test = possible build up of cerumen or otitis media in ear
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| Whisper test | is a rough indication of ability to hear
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| punch biopsy | small section of dermis and SQ fat
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| incisional biopsy | incision made and part of tumor is removed; differentiate between benign & cancer
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| excisional biopsy | entire skin lesion or tumor removed; differentiate between benign & cancer
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| shaved skin biopsy | w/razor shave off superficial lesion; differentiate between inflammatory & infectious
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| Indication of cyanosis in blacks | blueish nail beds
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| Nevi (moles) | potential to become malignant
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| linear pattern of painful vesicles over left thorax; what to ask? | did you have chicken pox when young; as it may be shingles
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| what is Lichenification | rough thickened areas from chronic dermatitis
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| Mechanism of action for allergy meds | reduces histamines which reduces itching
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| Head lice s/s | itching, hair clumpy and smells bad
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| Herpes Zoster (shingles) s/s | strange painful rash on (usually) one half of body – esp upper body
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| Teaching for acne | keep hair clean with frequent shampoo's
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| basal cell | tends to reoccur
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| melanoma diet | eat a rich in protein diet and high calories
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| nursing diagnosis for skin cancer | impaired skin integrity
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| Tattoo removal | Dermabrasion
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| basis of surgical asepsis is to | keep area free from microorganisms
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| Psoriasis treatments | topical application of corticosteroids
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| Scabies | highly contagious – may infest anyone
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| Lupus signs and symptoms | distinct butterfly rash across nose and cheeks
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| Pressure ulcer care supportive care | assessment, emollients applied, dressing changed,turn every 2 hrs
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| autograft | from own body
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| xenograft (or heterograft) | from animal usually a pig
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| allograft (or homograft) | from same species, usually cadaver
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| Definition of “tepid bath” | close to body temp; 98 to 100 degrees Fahrenheit
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| Cushing’s Syndrome can manifest as | DM because glucocorticoids accelerate the process of gluconogenesis
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| Cushing's Syndrome most commonly caused by | hyperplasia of adrenal cortex
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| Cushing's Syndrome S/S | lability of mood, ectomorphism with a moon face
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| Cushing's Syndrome need to asses diet for | protein and vitamin intake
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| skin assessment for hypothyroidism | rough dry skin
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| skin assessment for hyperthyroidism | cool clammy
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| deep tendon reflexes can be used to diagnose | hyperthyroidism
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| facial sign of hyperthyroidism | eyes extremely wide open and bulging
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| what do you need to teach about hyperthyroid meds | can take several weeks to work
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| Edema +1 | slight pitting no obvious distortion
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| Edema +2 | pitting remains w/ obvious distortion
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| Edema +3 | pitting is obvious, extremities are swollen
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| Edema +4 | deep pitting, no obvious distortion
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| Documentation of herpatic lesions | ulcerated
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| Vitiligo | abnormal loss of melanin in patches usually on face, hands,and groin
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| Addison’s teaching: physical activity | encourage exercise and protect from exertion
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| Addison's teaching: diet and why | high protein, high calories, and extra salt /its needed to regain weight lost
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| Addison's therapy is targeted at | restoring electrolyte balance
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| Addison's: in crisis need to set up asap | an IV
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| Addison's adverse skin effect | the steroids taken to treat can cause skin to look tanned
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| steroids should be given prior to adrenalectomy why | compensated for sudden lack of hormones
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| what to do post surgery adrenalectomy | asses for onset of adrenal insufficiency – monitor I
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| oral hypoglycemic agents are used when | if patient has some insulin production
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| s/s hypoglycemic reaction to insulin | pallor, perspiration, and tremors
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| what do you need to do 3 days prior to oral glucose test | stop vitamins
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| what causes diabetic acidosis | due to breakdown of fat stores for energy
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| poly neuropathy s/s | numb extremities leading to loss of extremities
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| Diabetic coma results from | ketones from fat rapidly breaking down, causing acidosis
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| DKA is often seen in the presence of | infection
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| 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
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| what is the basic control for a Diabetic diet | regulating food intake
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| What do you do for diabetics in the hospital prior to meals | check blood glucose levels
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| S/S of hyper and hypoglycemia: skin | hot and dry sugar high cold and clammy need some candy
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| hyperglycemia s/s | nervousness, weight loss, increased appetite
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| T3 and T4 low levels s/s | cold intolerance
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| some times you can have faulsly elevate T3 and T4 levels when | being treated for seizure disorder with medication
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| Graves’s disease treatment: radioactivity precautions | mild and should be treated with routine safety precautions
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| Graves's disease diet | high calorie diet
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| Thyroid storm caused by | elevated (T3) triiodothyronine levels
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| the Pituitary gland is important because it | regulates eight hormones and related functions
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| Thyroidectomy after, what to do is sore throat is preventing eating | admin pain meds prior to meals
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| Thyroidectomy; you will need hormone replacement why | most likely also lost the parathyroid gland
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| Thyroidectomy: w/parathyroid removal will need | Ca otherwise bone breakdown accelerated w/release of Ca into blood
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| S/s ADH | dehydration and excess urination
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| Average Urine output | 1.5L (1500mL)/day
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| Average I | 2.5L (2500mL)/day
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| Hypovolemia S/S | postural hypotention, oliguria, muscle weakness NOT Bradycardia
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| NI's: hyponatremia S/S | N, monitor neruolgic status, restrict tap water, D, abdominal and muscle cramping
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| NI's : hyponatremia | weigh every morining use bed scale, raise salt intake
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| hypokalemia caused by | inadequate potassium intake
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| hypokalemia diet | fruits like bananas and apricots
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| hypokalemia how to take meds | take potassium chloride with juice
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| Chevostek’s sign | sign of hypocalcemia tap finger in front of eat at angle of the jaw
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| hypocalemia clinical manifestation | neuromuscular hyper excitability
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| hypercalemia s/s | diminished bowel sounds; hyperactive deep tendon reflexes
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| hypermagnesiemia s/s | hypotention, warmth, sweaty, N,.V
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| hypermagnesiemia is often seen in | critically ill and alcoholics
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| Magnesium | 1.5 - 3.5
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| HC03 | 22 - 26
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| Potassium | 3.5 - 5.5
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| pH | 7.35 - 7.45
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| Calcium | 5.5- 8.5
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| pCO2 | 35 - 45
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| Sodium | 135 - 145
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| specific gravity of urine | 1.010 – 1.015 (distilled water is 0)
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| BUN | 10-20 (if you have 10 buns you have 20 cheeks)
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| creatinin | 0.6 – 1.4
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| IV Fluid: LR is used because | most like blood plasma
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| Take potassium chloride | with juice
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| diet to elevate potassium | bananas and apricots to elevate potassium
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| pH levels | acidosis 7.35 - 7.45 alkalosis
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| First name means | compensated/uncompensated
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| HCO3 levels | acidosis 22 - 27 alkalosis
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| Middle name | which ever matches pH
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| pCO2 levels | alkalosis 35 - 45 acidosis
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| Last name | pH is or leaning toward
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| compensated means | pH in range
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| uncompensated means | pH out of range
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| what decides if respiratory or metabolic | which ever one matches pH
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| 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
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| What does potassium do to acid base balance | K helps regulate acid base balance
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| Ca and phosphate have what relationship | an inverse relationship
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| Systems most affected by potassium | renal failure
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| Special consideration for administering replacement electrolytes | age (elderly), rate, levels of others
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| 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?
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| recommended nutritional values calories to maintain weight | 30 cal/kg
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| recommended nutritional values for protien | 0.8kcal/kg; men 56g and women 45g
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| recommended nutritional values calories: carbs | 125 – 175g/day (4kcal/g);)
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| 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
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| flat plate or abdominal X-ray; what to document | time & date; toleration
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| 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
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| 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
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| 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)
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| how is H. pylori spread | person to person, oral to oral, and fecal to oral
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| 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
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| 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
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| treatment of H pylori | two antibiotics and a proton pump inhibitor (PPI); bismuth (peptobismol)has a antibacterial action against H pylori
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| New J tube can and can not do | don''t cut gauze pads; sterile procedure until healed
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| hematocrit levels | Men 40 - 45%; Women 37 - 47%
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| hemoglobin levels | Men 14 - 18; Women 12 - 16
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| what is third spacing | fluids passing into interstitial space
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| 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
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| 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
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| Chevostek's sign is a sign for; and what should you do if you see it | hypocalcemia; remove BP cuff and administer Oxygen
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| what are two critical steps in collecting and transporting ABG's | put pressure on collection site; put immediatly into ice
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| S/S of NG tube malfunction | can't talk/coiled at back of throat; pull back reposition
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| Diet as tolerated - what should you offer first | Post op = ice chips; clear liquid (jello, coffee, and tea are clear liquids)
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| 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
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| 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
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| Bariatric clients are at high risk for respiratory problems immediately after surgery. Why? | adipose tissue holds onto anesthesia longer
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| 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
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| weight loss requires | more out than in; requires behavior modification; usually 1000 - 1200 kcal daily for women and 1200 - 1600 kcal daily for men
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| how to compute protien intake for a person to maintain body weight | kg X 0.8
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| 3500 kcal = | 1 pound in body fat; must reduce intake by 500kcal a day for 7 days to lose one pound
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| Zofran | indication: Chemo - nausea; give 30 -60 minutes before chemo; monitor liver function; headache common; administer w/o regard to food
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| Mylanta in regards to GERD and IBS | neutralizes secretions but, can't stop overproduction
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| purpose of gastric tube insertion | decompression, gastric ANALYSIS, lavage, tube feeding
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| nitrates in urine | bacterium
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| purcussion of the bladder | dull sound is normal
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| hrs after cholecystectomy and patient complaines of abdominal distention, nausea, elevated abdominal pain: nurse should | check position of the NG tube
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| patient with a a catherter in place complains of a sever headache; nurse should first | check catheter for kinks or obstructions
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| 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
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| steps to keep skin from breaking down around ileal pouch | keep clean and dry; apply moisture barrier/skin protectant
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| what procedure is used to breakdown a 4 - 5 mm stone | Ureteroscopy
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| what is a common cause of kidney disease | diabetes
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| dulcolax - how does it work | by increaseing peristasis by stimulating enteric nerves and by pulling liquid into the intestines
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| what is cystitis | bladder inflamation and irritation
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| s/s cystitis | urgency frequency; painful bladder
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| sign of possible accute pancreatits | elevated serum amylase
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| Glomerulonephritis diet | increase dairy and decrease protien
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| Rovsing Sign | re: apendicitis; refered pain on left side of abdomen
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| 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
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| s/s C. diff | D, abdominal cramping, malaise, fever, anorexia; often misdiagnosed as crohn's disease
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| C. diff | oportunistic bacteria; brought on by cessation of causative antibiotic; antibiotic therapy w/ vancomycin or metronidazole;contactisolation
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| ALP | 20-90
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| ALT | 5-35
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| AST | 5-40
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| bilirubin | 0.3-1.2
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| s/s peptic ulcer | pain (gawning, burning, aching, or hunger like); a pain - food-relief pattern; heartburn, regurgitation, may vomit
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| persistant N, V, can cause | dehydration, hypokalemia, metabolic acidosis, aspiration w/resulting pneumonia, ruptures or tears of the esophagus
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| persistand D can cause | dehydration, hypokalemia, hypomagnesiemia, metabolic acidosis, if sever - vascular collapse and hypovolemic shock
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| cause of obesity | ultimatly more intake that out put but, has many contributing factors: psychological, genetic, enviromental, hormonal, - Multifactorial
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| cholecystitis d/c teaching | inflammation of the gallbladder; high instance of recurrent stone formaion with d/c
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| steatorrhea | bulky foul smelling stool;
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| 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
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| Dumping syndrome is brought on by | ecess sugars; cut back carbs and cut back or eliminate simple sugars
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| what should a stoma look like | pink or red, moist, about 2 cm high; measure diameter and appearance
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| Celiac diet | gluten free. No wheat, rye, barley
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| how to asses the abdomen | ausculate, palpate
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| 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
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| how is placement of a gastric tube confirmed | flate plate abdominal xray; pH test of aspirates
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| what test is used to diagnos pancreatitis | ERCP (endoscopic retrograde cholangiopancreatography), Blood = Serum Amylase
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| NI for ERCP (endoscopic retrograde cholangiopancreatography) | NPO 8 hrs, following test vitals, gag reflex, and monitor for complications
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| what can a nurse delgate to a CNA regarding a TPN patient | monitor I
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| 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
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| Inguinal hernia | (usually males) sac of abdominal contents through the internal inguinal ring into the inguinal canal
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| 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
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| direct inguinal hernia | acquired resulting from weakness of the posterior inguinal wall (usually older adults),
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| femoral hernia | acquired defect (obese or pregnant women) peritoneal sac through femoral ring
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| 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
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| 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
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| Ventral hernia | often asymptomatic characterized by a bulge at incision site
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