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1
Q

Type of angina pectoris

A

Stable angina
Predictable and consistent pain, relieve by rest or nitroglycerin

Unstable angina
Unpredictably increase symptoms frequency and severity, may not relieve by TNG, predictably an MI coming

Intractable angina
Severe chest pain and recurrent condition after medical treatment

Variant angina
Pain at rest with reverisble ST elevation, caused by coronary vasospasm, rare, very painful. Can be controlled by TNG

Silent ischemia
Evidenced with ischemia symptoms yet no pain reported from the client

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2
Q

Pain of angina

A
  1. Describe as tightness, choking or heavy sensation
  2. At retrosterno or radiate to neck jaw, shoulder, back or arm
  3. S/s shortness of breathe, dizziness, nausea, vomitting
  4. Subside by trinitroglycerin nitroglycerin
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3
Q

Treatment of angina

A

TNG, NTG

calcium channel blocker agent

Aspirin

Heparin

Combination therapy

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4
Q

Nursing intervention for angina pain

A

1.Drink 2L water daily
2. Immediately stop all activity and sit ir rest on bed( semi-fowlers position)
3. Continuius monitoring: vital sign, respiratory distress, any pain, ECG can be assessed
4. Administer TNG / NTG and reassess pain, up to 3 dose
5. If can be relieved by TNG / NTG, then not MI

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5
Q

Angina-preventing pain

A

Observe the level of activity cause prodromal symptoms of pain

Plan activities accordingly

Alternate rest period in activities

Family and client education

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6
Q

Difference between ACG and MI

A

ACG is plaque rupture but artery hvnt completely blocked

MI means permanent destroyed myocardium
Reduced blood flow from rupture of an plaque, caused complete occlusion

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7
Q

Clinical menifestation of MI

1.Sudden chest pain unless rest or medication
2. Heartburn, nausea, anxiety, cool, pale skin, increased hr rr

A
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8
Q

Lab test of cardiac enzyme

A

Troponin T / I
Protein found in myocardial cells
Regulate myocardial contractile process

Creatine kinsse
Cardiac-specific isoenzyme , more when damaged

Myoglobin
Heme protein for transporting oxygen

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9
Q

Hypertension

A

Normal BP below 120/80

Elevated 120-129/<80

High blood pressure >130/>80

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10
Q

Risk factors of HT

A

Smoking
Obese
Physical inactivity
Alcohol

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11
Q

ICP

A

Pressure exerted by volume of intracranial content

Normally 3-15mmHG

In disease of injury, csf increase because of decrease cerebral perfusion and cause ischemia, cell hence dead and cause more edema

Autoregulation: blood vessel adjust their width to maintain constant blood flow( co2+ vasodilation -vasoconstriction)

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12
Q

Early sign of ICP

A

Restlessness, confusion, increase drowsiness, hard to breath
Weakness in one side of extremity

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13
Q

Late sign of increased ICP

A

Vasomotor change: increase SBP, low hr, high temp

Cushion triad: Bradycardia, HT bradypnea

Loss of brain stem reflexes
Pupillary, cornela, gag, swallow reflexes, near of death

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14
Q

Glascow coma scale

A

Eye opening response 4

Verbal response 5

Motor response 6

Total 15, lower than 8 is comatose

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15
Q

How to monitor ICP

A

Ventriculostomy 腦室造口手術

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16
Q

Intracranial surgery

A

Craniotomy 開顱手術
Purpose: remove tumor/ relief ICP/ evacuate blood clot

Craniectomy 顱骨切除手術
Purpose: remove a portion of skull

Cranioplasty 顱骨成形術
Purpose: Repair skull defect with plastic or metal plate

Burr hole 鑽孔
Purpose: provide assess to ventricle for shunting

Aspirate hematoma/ abscess

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17
Q

Infectious neurological disorder

A

Meningitis
Brain abscesses 腦腫膿
Encephalitis 腦炎
Creutzfeldt-Jakob disease

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18
Q

Meningitis

A

Definition: inflammation of the meninges, which are the membranes and fluid space surrounding the brain and spinal cord

Types:
Septic: bacteria- streptococcus
Aseptic: viral infection, brain abscesses

Menifestation:
headache
Behavioural change
Stiff snd painful neck
Photophobia 畏光

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19
Q

Nursing management for meningitis

A
  1. Continuous assesment to vital sogn and level of consciousness
  2. Prevent complications associated with immobility
  3. Infection control precautions
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20
Q

Brain abscesses

A

Infection of brain tissue
More affecting to immunocompromised client
Preventable by treating mastoiditis, dental infection

Manifestation: morning strong headache, fever, vomiting, s/s of increasing ICP

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21
Q

Encephalitis

A

Acute inflammation of brain tissue

Cause by viral infection (herpes simplex/ fungal infection)

Manifestation: headache, fever, confusion, change in LOC

Medical management: acyclovir for HSV, amphoterecin fro antifungal treatmemt

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22
Q

Creutzfeldt-Jakob disease/ variant

A

Csused by prions, which is resistant to sterillization

VCJD may caused by infected beef

No treatment

Prevention of disease transmission, blood and body fluid precaution

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23
Q

Location of subdural/ intracerebral/ Epidural hemorrhages

A

Epidural hemorrhage
Between skull and dura

Subdural hemorrhage
Hemorrhage developed between dura and cerebral

Intracerebral hemorrhage
Haemorrhage developed in brain

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24
Q

Endocrine system

Anterior pituitary glands:

hyper: cushing syndrome, gigantism, acromegaly
Hypo: dwafism, panhypopituitarism

Neurotransmitter-) Hypothalamas-) Thyroid releasing hormone-) thyroid-) liver-) target organ

A
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25
Blood test for thyroid 1. Serum t3 t4 2. Serum tsh 3. Thyroid antibodies
26
Thyroid disorder
Hyperthyroidism Hypothyroidism Gooter Thyroiditis Thyroid cancer
27
Hypothyroidism vs hyperthyroidism
Serum level: low vs high Metabolic rate: low vs high Goiter: endemic goiter vs graves’ disease Skin: pale and cold vs flush and warm Temperature tolerance: cold intolerance vs heat intolerance Eyes: normal vs exophthalmos Cardiovascular: bradycardia with enlarged heart vs tachycardia+ higher BP Nervous system: Body weight:
28
Treatment for hypothyroidism- synthetic levothyroxine replacement therapy
29
Hyperthyroidism Excessive secretion of thyroid hormone Graves disease= most common hyperthyroidism Rapid pulse, warm skin, flushed, bulging eyes, increased appetite, weight loss, elevated systolic BP
30
Thyroid storm- cause severe hyperthyroidism Manifestation: High fever Extreme tachycardia Altered neurological or mental state
31
Parathyroid glands- posterior thyroid gland (4) Maintain calcium & phosphorus balance
32
Hyperparathyroidism s/s: elevated serum calcium, bone decalcification, renal calculi, Fatique, muscle weakness Management: parathyroidectomy, hydration therapy Hypoparathyroidism Caused by thyroidectomy, parathyroidectomy S/s: numbness, tingling in extremities, stiffness in hand and feet, bronchospasm, anxiety, irritability, depression
33
Adrenocoritcal insufficiency - Addison’s disease S/s bronze pigment skin, hypoglycemia, change of body hair, postural hypotension, weakness, weight loss.
34
Cushing syndrome S/s: thining scalp, increased facial hair, thin extremities, moon face, buffalo humps, trunk obesity, Diagnosis(有咩問題): risk of injury (weakness) Risk of infection (inflammatory response) Self-care deficit (weakness, fatigue, muscle wasting) Impaired skin integrity (edema) Disturbed body image (altered physical appearance, impaired sexual functioning) Ineffective coping (mood swings, depression) Goals Decrease risk of injury Decrease risk of infection Improve skin integrity Improve self image
35
Diabetes mellitus Functions of insulin
Disease hyperglycemia to defeat insulin secretion Insulin- 1. transport and metabolise glucose for energy 2. Stimulate storage of glucose in the liver and in muscle as glycogen 3. Signal the liver to stop releasing glucose
36
Type 1 diabetes: autoimmune attacks insulin producing cells, acute onset with <30yo Type 2 diabetes: body less sensitive to insulin, less tolerate to glucose, usually >30yo, slow and progressive Initially diet and exercise treatment
37
Risk factors of type 1 type 2 diabetes Type 1: genetic issue and also immunologic issue Type 2: family history, obesity, age, HT, impaired glucose intolerance.
38
Clinical manifestation of diabetes Polyuria, polydypsia, polyphagia, fatigue, numbness of extremities, slow healing skin lesion
39
Acute complication of diabetes: 1. Hypoglycemia 2. Diabetic ketoacidosis 1. Abnormally low blood glucose rate (2.8-3.3) Cause: too much insulin, too little food Manifestation: sweating, tremor, cns issue cannot concentrate Solution: dextrise solution 2. Absense of insulin-) abnormal metabolism of carbohydrate Manifestation: hyperglycemia, dehydration, acidosis Treatment: rehydrate in iv fluid Reverse acidosis and restore electrolyte balance.
40
Education of diabetes 1. Education on disease process and pharmacological treatment 2. Demonstration: demonstrate for self-monitoring blood glucose 3. Current diet, habbit in included in lifestyle modification 4. Continue education related to exercising, meal planning, stress management
41
Short/ long term goals for diabetes dm Short: routine glucose monitoring Stick with the plan Maintain blood glucose level to avoid or stop diabetes related complication Long:adjusted diet, consistant exercise, lose weight, stop smoking. Ideal blood glucose level Before meal 4-7mmHG After meal 9(1) 8.5(2) mmHG
42
Goals Before meal 4-7 After meal: type 1 <9 type 2 <8.5 BMI<25 Prevent fluctuation of blood glucose level Decrease serum lipid level if needed
43
Long term complication of diabetes Macrovascular: accelerated atherosclerotic disease, coronary artery disease, cerebralvascular disease Microvascular: nethropathy Neuropathic: peripheral neuropathy, autonomic neuropathy, sexual dyfunction
44
Visual and auditory Impaired vision Myopia: nearsighted Hyperopia: farsighted Astigmatism: distortion due to irregularity of cornea Glaucoma
45
Glaucoma Damaged optic nerve related to increased intraocular pressure Caused by increased aqueous humor Patho of glaucoma: 1. Aqueous production is not balanced 2. Aqueous outflow blocked builds up pressure within the eye 3. The increased intraocular pressure cause irreversible mechanical or ischemic issue
46
S/s of glaucoma Progression vision field defects Peripheral vision loss Difficult to adjust eye into low lighting Aching/ discomfort around eyes
47
Diagnosis of glaucoma （點揾） Tonometry to assess IOP Perimetry to assess vision loss
48
Treatment for glaucoma Goal: prevent further optic damage Maintain IOP in a level doesn’t bring damage Surgery: Laser trabeculoplasty Laser iridotomy
49
Cataract Defin: cloudiness of the lens Risk factor: Aging Poor nutrition Physical factors- blunt trauma, electric shock Clinical manifestation: Painless yet blurry vision Sensitive to glare Reduce visual acuity Double vision, color shifts
50
Surgery for Cataract Phacoemulsification An ECCE that uses ultrasonic device suction which has smaller cut than traditional ECCE Lens replacement Replace the intraocular lens after ECCE removed old lens
51
Retinal disorder
Retinal detachment Retinal vascular disorder Macular degeneration 黃斑病變
52
Check Ear：middle ear endoscopy 中耳內窺鏡 Guidelines communicating with impaired hearing patient 1. Low tone normal voice 2. Speak slowly and distinctly 3. Reduce background noise and distraction 4. Speak to less impaired ears 5. Use gesture and facial expression 6. Write if necessary
53
Tympanic membrane perforation 穿鼓膜 Acute otits: 耳炎 Streptococcus pneumonia Usually seen in kids Treatment: antibiotic Tympanotomy Chronic otitis media: recurrent of acute symptoms Damage tympanic membrane, mastoid Surgery: tympanoplasty
54
Middle ear surgical Tympanoplasty reconstruct the tympanic memebrane Ossiculoplasty reconstruct the bone of middle ear Mastoidectomy remove diseased bone, mastoid air cells
55
Common sport injury Contusion, strains, sprains, dislocation Prevent sport injury: 1. Wear proper equipement e.g. running shoes for runner, wrist guard for skaters 2. Effective training 3. Stretching before engaging in a sport 4. Change in activity should be gradually 5. Modify activity to minimise injury and promote healing 6. Be aware of limits snd capabilities
56
Fracture types Complete fracture 完整斷開 Incomplete fractures 未斷晒 Comminuted fracture 粉碎 Closed fracture: does not break the skin Open / compound / complex fracture: skin / membrane extends to the fracture
57
Clinical manifestation of fracture Pain Loss of function Deformity Shorten of extremity Local swelling
58
Urinary elimination *urinary tract infection Upper: pyelonephritis Lower: 1. Cytitis 2. Prostatitis 3. Urethritis
59
Urinary incontinence 1. Stress incontinence 2. Urge incontinence 3. Functional incontinence 4. Iatrogenic incontinence
Stress incontinence Loss of urine through intact urethra without detrusor contraction when intravesical pressure excedd urethral pressure. Pressure of Intravesical pressure increase when sneezing, coughing, changing position. Dysfunction of urethral sphincter Cause: women: vaginal delivers, decrease ligament and pelvic floor support Men: Benign prostatic hyperplasia 前列腺發大
60
Urge incontinence
Involuntary loss of urine associated with strong urge to void the urine, which cannot be suppressed Can aware but cannot reach toilet in time Uninhibited detrusor contraction Cause: neurological dysfunction-) uncontrolled contraction
61
Functional incontinence
Unable to identify the needs to void due to physical / cognitive impairment E.g. Alzheimer’s dementia.
62
Iatrogenic incontinensce Involuntary loss of urine due to medical factors
63
Urolithiasis Nephrolithiasis
75% are calcium stone, caused by hypercalcemia, hypercalciuria 15% are struvite stone
64
How to prevent kidney stone
Daily 2L of water if no contraindicated Avoid intake of oxalate-containing food ( strawberries, tea, peanuts) Maintain regular toileting habit
65
Kidney surgery pre-op + post-op
Preoperation 1. Evaluate kidney function 2. Ensure optimal renal function 3. Encourage fluid intake to promote increased excretion 4. Antibiotics 5. Undergo coagulation studies 6. Recognise and verbalise concerns with patients and family Post-op: Monitor for complication 1. Hemmorhage and shock 2. Liquid and blood imbalance 3. Infection 4. Urinary tract obstructed 5. Abdominal distention 6. Deep vein thrombosis
66
Kidney surgery post-operation and monitor for common complications
1. Respi Monitor rate, depth and pattern of respiration 2. Status Vital sign Skin colour & temperature Urine output Drainage output 3. Pain Monitor and manage wound care Abdominal distension 4. Urinary drainage Monitor for amount, colour, type and characteristics Common complication Hemorrhage and shock Fluid & blood imbalance Infection Urinary tract obstruction Deep vein thrombosis
67
Digestive system assesment order
Inspection, auscultation, palpation, percussion. Pqrst Provocation Quality Region Severity Time
68
Appendicitis
Infection of appendix Usually age 10-30 Small, finger-like, attaching caecum Insufficient emptying leads to obstruction
69
Appendicitis manifestation
1. Vague (模糊) epigastric or periumbilical pain, dull and not localized -) right lower quadrant pain, sharp and well localized, distinct 2. The appendix may be ruptured if pain suddenly stops without any medical intervention 3. Low grade fever, nausea, vomiting, loss of appetite 4. Rebound tederness, intense pain released under pressure 5. Loacl tenderness at McBurney’s point 6. Constipation, laxatives shd not be used
70
Appendicitis complications
Perforation of appendix (usually 24hrs later) Abscess formation Portal pylephlebitis
71
Appendicitis-goals
Pain management Prevention of fluid volume deficit Reduce anxiety Eliminate infection Maintaining skin integrity Attaining optimal nutrition
72
Appendicitis post-op
Continuous monitoring vital sign Pain relief by high fowlers position (reduce tension on the organs) Pain medication Iv infusion Allow fluid diet if bowel sound presents Discharge care: Wound care Appoinment for suture removal 5-7 days later Avoid heavy lifting Resume normal activity after 2-4 weeks
73
Pneumonia education
1. Encourage breathing exercise to promote lung expansion 2. Teach the client proper administration of antibiotics 3. Encourage the client on observing their medical intolerance and potential side effects of using antibiotics 4. Introduce symptoms that client should consult physicians 5. Encourage client to return to the clinic to follow up chest x-ray and physical examination 6. Encourage patient to quit smoking 7. Encourage patient to obtain adequate nutrition 8. Encourage client to promote rest and conserve energy 9. Monitor potential complications e.g. persistent recurrent fever 10. Gradually increase activity after fever subside
74
Pneumonia patient education
1. Encourage client to do breathing exercise to promote lung expansion. 2. Instruct client to administrate antibiotic correctly 3. Instruct client to observe their medical intolerance and potential side effects of using antibiotics 4. Instruct symptoms that should consult physicians 5. Instruct patient to be aware of complications such as persistemt recurrent fever 6. Encourage client to return to office to follow up the chest x-ray and physical examination 7. Encourage quit smoking 8. Encourage adequate nutrition intake 9. Promote rest and conserve energy 10. Increase level of activity gradually after fever subside
75
Surgical of ears
Tympanoplasty 修補耳膜 Ossiculoplasty 修補耳骨 Mastoidectomy 切乳突
76
Peritonitis complication
Sepsis Shock Intestinal obstruction
77
Tuberculosis test
Tuberculin test ( the mantoux method) Inject small amount of TB antigen into skin React and form a bump >10mm then positive
78
Aims if chest drainage
Aims to remove excessive air, fluid or blood. By placing vacuum suction tube in pleural space, maintain the negative pressure of the lung
79
Skin infection Bacteria vs viral infection
Bacteria: follicultis Viral: herpes zoster / herpes simplex Fungal: tinea pedis / tinea capitis Bacterial treatment: mupironcin, apply on lesion several times per day, last 5-7 days Education: 1. Do not share towel, soap… 2. Shiwer daily with antibacterial soap. 3. Never squeeze the blister or pimple. 4. For viral, use acyclovir for zoster and simplex Viral education: 1. Do not share towels and soap 2. Use clean towel and wash cloth everyday 3. Keep skin fold and feet dry 4. Wear clean, dry cloth, avoid tight cloths, avoid synthetic underwears. Avoid wet bathing suit, plastic sleepers

Medical and Surgical Nursing (4 decks)

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