Med Surg II Hesi Flashcards
Stroke-Dysphagia
Stroke can result in dysphagia (difficulty swallowing) due to impaired function of the mouth, tongue, palate, larynx, pharynx, or upper esophagus. Patients must be observed for paroxysms of coughing, food dribbling out of or pooling in one side of the mouth, foodretained for long periods in the mouth, or nasal regurgitation when swallowing liquids. Swallowing difficulties place the patient at risk for aspiration, pneumonia, dehydration, and malnutrition
Ischemic Stroke- Medications
Normalize INR to 2-3 with Warfarin or anticoagulant
● Platelet inhibiting medications like aspirin
● After the acute stroke period, antihypertensive medications are also used, if indicated, for secondary stroke prevention. Preferred drugs include angiotensin-converting enzyme(ACE) inhibitors and diuretics, or a combination of both
● Thrombolytic agents are used to treat ischemic stroke by dissolving the blood clot that is blocking blood flow to the brain. Recombinant t-PA is a genetically engineered form of t-PA (a thrombolytic substance made naturally by the body). Must be given in a 3 hour window from the start of symptoms.
Benign vs. Neoplasm
Benign tumors are not cancerous, thereas cancerous cells are described as malignant neoplasm
Secondary Tumor
Patients who were previously treated for one cancer are at increased risk for secondary cancers
Chemotherapy-Renal Failure
Renal System
● Some chemotherapy agents damage the kidneys because they impair water secretion, leading to syndrome of inappropriate secretion of antidiuretic hormone (SIADH), decrease renal perfusion, precipitate end products after cell lysis, and cause interstitial nephritis. Cisplatin (Platinol), methotrexate, and mitomycin (Mutamycin) are particularly toxic to the kidneys. Rapid tumor cell lysis after chemotherapy results in increased urinary excretion of uric acid, which can cause renal damage.
● Monitoring laboratory values of blood urea nitrogen (BUN), serum creatinine, creatinine clearance, and serum electrolytes is essential (Comerford, 2015). Adequate hydration, diuresis, alkalinization of the urine to prevent formation of uric acid crystals, and administration of allopurinol (Zyloprim) may be used to prevent renal toxicity. Amifostine has demonstrated an ability to minimize renal toxicities associated with cisplatin, cyclophosphamide (Cytoxan), and ifosfamide (Ifex) therapy.
● Hemorrhagic cystitis is a bladder toxicity that can result from cyclophosphamide and ifosfamide therapy. Hematuria can range from microscopic to frank bleeding with symptoms ranging from transient irritation during urination, dysuria, and suprapubic pain to life-threatening hemorrhage. Protection of the bladder focuses on aggressive IV hydration, frequent voiding, and diuresis. Mesna (Mesnex) is a cytoprotectant agent that binds with the toxic metabolites of cyclophosphamide or ifosfamide in the kidneys to prevent hemorrhagic cystitis
Chemotherapy Teach
Nurses provide patient and family education that emphasizes two key points: the importance of adhering to prescribed self-administered premedication before presenting to the infusion center, and recognizing and reporting the signs and symptoms to the nurse once the infusion has started. Patients and families are also educated about signs and symptoms that may occur at home following discharge from the infusion area that may warrant medication administration or immediate transport to the emergency department for further assessment and treatment
Radiation Mouth
Alterations in oral mucosa secondary to radiation therapy in the head and neck region include stomatitis (inflammation of the oral tissues), decreased salivation and xerostomia(dryness of the mouth), and change in or loss of taste. Depending on the targeted region, any portion of the gastrointestinal mucosa may be involved, causing mucositis (inflammation of the lining of the mouth, throat, and gastrointestinal tract)
Meningitis Symptoms and Hyponatremia
● Nuchal rigidity
● Kernig’s sign, thigh flexed up to abdomen, cannot complete extend
● Brudzinski: neck flexed
● Vomiting due to increased ICP, hyponatremia can cause brain swelling, increased ICP
Guillain Barre- Swallow
Patients are at risk for aspiration and dysphagia
Guillain Barre- Paralysis
Ascending weakness, but they can recover. Good chance they will be intubated
Myasthenia Gravis- Cold
● Avoid Cold, can make symptoms worse
● Also can be diagnosed through ice test
Macular Degeneration Patho
● Central vision is affected
● Most people older than 60 years have at least a few small drusen, which are clusters of debris or waste material. When drusen are located in the macular area, they can affect vision. Patients with AMD have a wide range of visual loss, but only a small portion experience total blindness. Central vision is generally the most affected, with most patients retaining peripheral vision.
● Wet is more abrupt onset and more damaging to the vision than dry
● Amsler Grid - Several times a week
Fibromyalgia Patho
The amplified pain experienced by patients with fibromyalgia is neurogenic in origin. Specifically, the central nervous system’s ascending and descending pathways (that regulate and moderate pain processing) function abnormally, causing amplification of pain signals. Some scientists describe this as if the “volume control setting” for pain were abnormally high. Therefore, stimulation that may not normally elicit pain, such as touch, may do so. In addition, there are a number of predisposing factors to pain, including anxiety, depression, physical trauma, emotional stress, sleep disorder, and viral infection
MS Triggers
● Avoid Heat (Heat, depression, anemia, deconditioning, and medication may contribute tofatigue. Avoiding hot temperatures, effective treatment of depression and anemia, a change in medication as well as occupational and physical therapies may help manage fatigue)
● Relapses may be associated with emotional and physical stress.
● MS Teach
● Relaxation and coordination exercises promote muscle efficiency.
● The patient is encouraged to work and exercise to a point just short of fatigue. Very strenuous physical exercise is not advisable, because it raises the body temperature andmay aggravate symptoms
● Nurses also need to be certain to include family members in interventions and nutrition education, because they are often the gatekeepers for food preparation and selection. Additional strategies include avoidance of alcohol and cigarette smoking
● Bowel problems include constipation, fecal impaction, and incontinence. Adequate fluids,dietary fiber, and a bowel training program are frequently effective in solving these problems
● Avoid Heat
● The patient is instructed to drink a measured amount of fluid every 2 hours and then attempt to void 30 minutes after drinking. The use of a timer or wristwatch with an alarm may be helpful for the patient who does not have enough sensation to signal the need toempty the bladder
atrial flutter
● Atrial flutter is an abnormal rhythm that occurs in the atria of the heart. Atrial flutter has an atrial rhythm that is regular but has an atrial rate of 250 to 400 beats/minute. It has saw tooth appearance. QRS complexes are uniform in shape but often irregular in rate.
● Normal atrial rhythm
● Abnormal atrial rate: 250 to 400 beats/minute
● Saw tooth P wave configuration
● QRS complexes uniform in shape but irregular in rate
● Causes include heart failure, tricuspid valve or mitral valve diseases, pulmonary embolism, cor pulmonale, inferior wall MI, carditis, and digoxin toxicity
atrial flutter tx
● In management if the patient is unstable with ventricular rate of greater than 150 bpm, prepare for immediate cardioversion.
● If the patient is stable, drug therapy may include calcium channel blocker (Diltiazem), beta-adrenergic blockers (Propranolol), or antiarrhythmic. Procainamide (antidysrhythmic), Amiodarone (antidysrhythmic)
● Anticoagulation (Warfarin, Heparin) may be necessary as there would be pooling of blood in the atria
● Atrial flutter can cause serious signs and symptoms, such as chest pain, shortness of breath, and low blood pressure. Medical management involves the use of vagal maneuvers or a trial administration of adenosine, which causes sympathetic block and slowing of conduction through the AV node. This may terminate the tachycardia; optimally, it will facilitate visualization of flutter waves for diagnostic purposes. Adenosineis given intravenously by rapid administration, and immediately followed by a 20-mL saline flush and elevation of the arm with the IV line to promote rapid circulation of the medication.
● Atrial flutter is treated with antithrombotic therapy, rate control, and rhythm control in the same manner as atrial
first step with angina
O2
anginal pain
● Cardiac pain due to decreased blood flow
● Primary goal is to restore the oxygen to the heart
Mitral Valve Prolaspe, what to get?
● Mitral Valve Prolapse: could be asymptomatic (if have any fatigue and SOB)
● Get an Echocardiogram
Cardiomyopathy, symptoms, risks, medications, and one intervention
● Signs and Symptoms: similar to CHF
○ Extra heart sounds
○ Cough
○ Orthopnea
○ Chest Pain
○ Nausea
● Treatments: anticoagulation, diuretics
● Risks: Pregnancy, Alcohol
● Interventions:
○ Sit with legs hanging down, pulls water down
