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Med Surg > Final Exam > Flashcards

Final Exam Flashcards

1
Q

Infiltration

A

=leakage of non-vesicant solution into surrounding tissues
-stop infusion, remove site, elevate extremity, cold/warm compress

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2
Q

Extravasation

A

=leaking of vesicant solution
-stop infusion, surgical intervention may be necessary

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3
Q

Phlebitis

A

=inflammation of the vein
-remove site, heat, and elevate extremity

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4
Q

Site Infection

A

=infection at the insertion point, port pocket, or subq tunnel
-clean site, remove cath, send for culture, cover with a dry sterile dressing

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5
Q

PICC vs. PIV- techniques for use and care

A

PICC=10mL barrel syringes only, contrast injection-power PICC only
PIV=3mL-10mL flush
-avoid joint flexion, choose most distal site, avoid the dominant side, do NOT use the side of mastectomy, AV fistula, lymph nose dissection or paralysis, limit unsuccessful attempts to 2 per clinician

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6
Q

Fluid Imbalances- care of a patient with fluid overload

A
  • Airways, breathing, circulation, stop fluid infusions -
    Ensure patient safety, restore normal fluid balance, Provide supportive care,
    Prevent future fluid overload
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7
Q

Hypokalemia

A

-weak thready pulse
-Ortho hypo
-shallow resp
-anxiety, lethargy, confusion, coma
-paresthesias
-hyporeflexia
-hypoactive bowel sounds

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8
Q

Hyperkalemia

A

-tight and contracted
-muscle cramping and weakness
-urine abnormalities
-resp depression
-decreased cardiac contractility (low HR, BP)
-increased DTR

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9
Q

Hypernatremia

A

-big and bloated
-flushed skin
-restlessness, anxiety, confusion, irritable
-increased BP and fluid retention
-edema (pitting)
-decreased urine output
-skin flushed and dry
-agitation
-low-grade fever
-thirst

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10
Q

Hypocalcemia

A

-Convulsions
-arrhythmias
-tetany
-spasms and stridor
-Positive trousseau’s and chvostek’s

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11
Q

Fluid and Electrolyte Imbalances- Laboratory Values Associated with Dehydration

A

-high H&H
-high BUN
-high urine specific gravity
-high sodium
-high glucose
-high protein

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12
Q

ABG Interpretation – Respiratory Insufficiency

A

pH <7.35 PaCO2 > 45mmHg
-Respiratory acidosis: increasingly difficult breathing, dyspnea, weakness, dizziness, sleepiness, change in alertness

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13
Q

ABG – Indication of Metabolic Acidosis

A

-pH < 7.35 HCO3 < 21mEq/L
-weakness, lethargy, confusion, headache, stupor/unconsciousness, coma or death

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14
Q

Right-sided Heart Failure- Assessment Findings

A
  • peripheral edema, distended jugular veins, distended abdomen, enlarged liver and spleen (hepatomegaly), polyuria at night
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15
Q

Left-sided Heart Failure- Assessment Findings

A

-SOB, pulmonary edema, pink frothy sputum, crackles or wheezing, fluid in lungs, S3/S4 summation gallop, tachypnea, confusion/dizziness, oliguria during day

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16
Q

Heart Failure- Loop Diuretics and Adverse Effects

A

Hypokalemia

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17
Q

Heart Failure- Digoxin and Adverse Effects

A

-Digoxin= lowers BPand heart rate
-Adverse effects= fatigue, bradycardia, anorexia, N/V, dysrhythmias, digoxin toxicity (>2ng/mL), GI distress, CNS effects

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18
Q

Right-sided Heart Failure- Nursing Actions

A

-daily weight @ same time each day

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19
Q

Heart Failure- Patient Education

A

-low sodium diet, low fat, take medications as prescribed, take breaks when exercising, be able to hold a conversation while exercising

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20
Q

Left-sided Heart Failure: Manifestations and Risk Factors

A

Manifestations
-dyspnea (exertional dyspnea, paroxysmal nocturnal dyspnea)
-fatigue
-weakness
-arm heaviness
-chest pain or palpations, skipped beats, fast rate
Risk Factors
-hypertension
-coronary artery disease
-valvular disease

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21
Q

MI- Interventions (consider medication management)

A

-M-morphine
-O-oxygen
-N-nitroglycerin
-A-aspirin

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22
Q

Angina- Teaching about Sublingual Nitroglycerin

A

-3 tabs max every 5 minutes until chest pain is absent

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23
Q

MI- Diagnostic Testing

A

-EKG
-troponin t and I value (normal 0-0.04ng.mL >0.04 for MI)

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24
Q

Coronary Artery Bypass Graft Surgery- Psychosocial Integrity- Relieving Patient’s Anxiety

A

-statement patient makes ab being anxious, have to pick response

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25
Q

Angina and MI- Purpose of Cardiac Enzyme Studies

A

-to help healthcare providers know if symptoms are due to a heart attack, angina, heart failure, or another problem

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26
Q

Patient and Family teaching about Heparin

A

-s/s of bleeding should be reported immediately

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27
Q

PAD vs PVD- plan of care

A

PAD
-promote vasodilation (maintain warm environment, wear socks and avoid cold when possible, avoid caffeine and nicotine-cause vasoconstriction)
-encourage appropriate positioning (do NOT cross legs, refrain from wearing restrictive garments, cautiously elevate extremities
-dangle legs

PVD
-encourage ambulation after anticoagulation therapy is initiated, warm moist compress, do NOT massage affected limb
-elevate legs
-avoid crossing legs
-elevate legs for 20min, 4-5/day
-elevate legs above heart when in bed

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28
Q

Hypertension- Medications used for Drug Therapy, consider the effectiveness of drug therapy

A

-Diuretics
-Calcium Channel Blockers
-ACE inhibitors
-Angiotensin II receptor blockers (ARBs)
-Beta-adrenergic blockers

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29
Q

Deep Vein Thrombosis (DVT)

A

Drug Therapy, Heparin, and Coumadin

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30
Q

Diabetes- Criteria for Diagnosis

A

A1C

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31
Q

Hypoglycemia vs Hyperglycemia- Clinical Manifestations

A

Hypoglycemia
-Skin: Cool, Clammy, sweaty
-Dehydration: absent
-Respirations: No particular or consistent change
-Mental status: anxious, nervous, irritable, mental confusion, seizure, coma
-Symptoms: weakness, double vision, blurred vision, hunger, tachycardia, palpitations

Hyperglycemia
-extreme thirst (polydipsia)
-frequent urination (polyuria)
-hunger (polyphagia)
-dry skin
-blurred vision
-drowsiness
-decreased healing

32
Q

Insulin Administration- Technique for Administering

A

-clean with alcohol, scrub the hub, Administer SQ, 2 inches for the umbilicus, rotate injection site

33
Q

Insulin Administration- Sliding Scale

A

-know how to use
-match the glucose # to number on the sliding scale to know the amount of insulin to administer

34
Q

Preventing Complications – Labs (peri-op)

A

-WBC
-H & H low (indicates bleeding)
-Ptt
-INR
-platelet

35
Q

Surgical Classifications – Elective, Urgent, Emergent

A

Elective =planned for correction of a nonacute problem (ex. cataract removal, hernia repair)
Urgent= requires prompt intervention, potentially life-threatening if delayed more than 24-48 hours (ex intestinal obstruction, bone fracture)
Emergent= requires immediate intervention, life-threatening consequences (ex gunshot/ stab, severe bleeding, appendectomy)

35
Q

Informed Consent

A

-review consent
-verify and clarifies facts
-confirms consent is signed, dated, and times
-may serve as a witness

36
Q

Stage 1 Pressure Injury- Assessment Findings

A

-intact skin with localized area of non-blanchable erythema
-may be precede by changes in sensation, temp, or firmness
-color changes are not purple or maroon

37
Q

Stage 2 Pressure Injury- Assessment Findings

A

-partial-thickness loss of skin with exposed dermis
-wound bed is visible, pink, or red and moist
-may look like intact or ruptured serum-filled blister

38
Q

Risk for a Pressure Injury- Nursing Actions

A

-Determine Risk Level (Braden score)
-Reduce pressure
-Improve pressure tolerance

39
Q

Pressure Injury- Description for Stages 1-4, Unstageable, DTI

A

stage 1: intact skin with localized area of non-blanchable erythema

stage 2: partial thickness loss of skin with the exposed dermis, wound bed pink/red/ moist

stage 3: full thickness skin loss with adipose visible in the ulcer, slough, or eschar may be present, undermining and tunneling may be present

stage 4: full-thickness skin loss with exposed or palpable fascia, muscle, tendon, ligaments, cartilage, or bone, may have slough, eschar, undermining, tunneling

unstageable: full thickness covered by eschar or necrotic tissue

DTI: unstageable with suspected deep tissue injury

40
Q

Non Healing Pressure Injury- Nursing Action

A

-adjuvant therapies
-electrical stimulation
-therapeutic ultrasound
-negative-pressure wound therapy (NPWT)
-hyperbaric oxygen

41
Q

Pressure Injury- Patient with Greatest Risk

A

-low braden score
-older adults
-incontinect patients, excessive moisture
-not being turned

42
Q

Pressure Injury- Lab Assessment

A

-elevated WBC (4000-11000)
-positive blood cultures

43
Q

COPD- Plan of Care- Hydration

A

drug therapy, airway maintenance, monitoring, breathing techniques, positioning, effective coughing, oxygen therapy, exercise condition, suctioning, and hydration

44
Q

Pulmonary Embolism- Medication Management

A

-Heparin: anticoagulant

45
Q

Pulmonary Embolism – Interventions

A

Manage hypoxemia
-apply oxygen, elevate HOP, and reassure the patient
-oxygen therapy
-monitor the patient for changes in status
-administer anticoagulation or fibrinolytic therapy
Managing hypotension
-IV fluid therapy used (using crystalloid solutions) to restore plasma volume and prevent shock
-drug therapy with vasopressors (norepinephrine, epinephrine, or dopamine) used if fluid therapy does not help
Controlling bleeding
-assess for evidence of bleeding, ensure correct dosing and timing of medication, monitor lab values
Minimizing anxiety
-patient with PE struggles with anxiety, fear and pain
-maintain proper communication with your patients
-anti-anxiety medication
-pain management

46
Q

Asthma Attack- Medication Therapy

A

-Albuterol inhaler

47
Q

Pneumonia- Assessment Criteria

A

-General appearance- assess for flushed cheeks, anxious look, chest pain/discomfort, myalgia, headache, chills, fever, cough, tachycardia, dyspnea, hemoptysis (bloody sputum), sputum production
-Respiratory assessment- breathing pattern, use of accessory muscles, positioning, cough, sputum assessment, lung sounds (such as crackers)
-Vital signs- increased resp rate, hypotension, tachycardia
-Dysrhythmias

48
Q

Oxygen Therapy- Tasks to Delegate to a PCA related to oxygen therapy

A

-measure pt pulse ox
-positioning (elevate HOB)
-keeping nairs moist

49
Q

Chronic Kidney Disease- Interpreting Lab Values

A

-reduced GFR <60
-BUN increases >20, urine output decreases

50
Q

Acute Kidney Injury- Interpreting Lab Values

A

-increase in serum creatinine by 0.3mg/dL or more within 48 hours
-increase serum creatinine to 1.5 times or more occurring in the previous 7 days

51
Q

Chronic Kidney Disease- Assessing fluid volume increase

A

-daily weight
-fluid restriction
-fluid overload due to the inability of disease kidneys to maintain body fluid balance

52
Q

Know the difference between Types of Incontinence

A

Stress= when urine leaks out at times when your bladder is under pressure (cough of laugh)
Urge= when urine leaks as you feel a sudden, intense urge to pee, or soon afterward
Mixed=stress and urge incontinence
Overflow (reflex)= when you’re unable to fully empty your bladder, which causes frequent leaking
Functional= leakage of urine caused by factors other than disease of the lower urinary tract

53
Q

Urinary Incontinence- Interventions for Preventing Skin Breakdown

A

-chech regulary, keep skin dry
-barrier cream
-changing and cleaning after an incontinet episode
-checking for skin breakdown

54
Q

Urolithiasis- Interventions

A

-high fluid intake (3L/day or more)
-accurate measurement of I/O’s
-drug therapy
-nutrition therapy/ diet modification

55
Q

Cystitis- Interventions

A

Nonsurgical
-drug therapy
-fluid intake
-comfort measures such as pain relief
-no cranberry juice, no spices, soy, tomato, caffeinated drinks, alcohol

56
Q

Bladder Cancer- Risk Factors

A

-GREATEST RISK FACTOR Tobacco use
-exposure to toxins such as gasoline and diesel fuel, chemicals used in hair dyes and in rubber paint, electric cable, and textile industries
-family history, Schistosoma haematobium (a parasite) infection, excessive use of drugs containing phenacetin, and long-term use of cyclophosphamide

57
Q

Peptic Ulcer Disease- Complications

A

-Hematemesis

Hemorrhage
-occurs more often in patients with gastric ulcers and in older adults
-patients have a second episode of bleeding if underlying infection with H. Pylori remains untreated or if therapy does not include H2 antagonist
-massive bleeding = vomiting bright red or coffee-ground blood
-minimal bleeding from ulcers = minimal occult bleeding in a dark “tarry” stool, melena may occur with gastric ulcers, more common with duodenal ulcers
Perforation
-occurs when the ulcer becomes so deep that the entire thickness of the stomach or duodenum is worn away
-the stomach or duodenal contents can then leak into the peritoneal cavity
-patients can experience sudden, and sharp pain, peritonitis infection, severe illness within hours, bacterial septicemia and hypovolemic shock, paralytic ileus
Pyloric obstruction
-vomiting caused by stasis and gastric dilation
-symptoms of obstruction include abdominal bloating, nausea, and vomiting
Intractable disease
-ulcers, excessive stressors in the pt life, or an inability to adhere to long-term therapy

58
Q

Gastrointestinal Perforation- Assessment Findings

A

-board-like/rigid abdomen
-abdomen pain

59
Q

Ulcerative Colitis- Assessment findings and Interventions for Acute Exacerbation

A

-manage diarrhea
-consider nutritional therapy and rest
-drug therapy (aminosalicylates, glucocorticoids, antidiarrheal drugs, and immunomodulatory)
-complementary and integrative health (herbs (flaxseed), selenium, and vitamin C)

60
Q

Inflammatory Bowel Disease- Manifestations of Ulcerative Colitis

A

-low grade fever
-abd distention along the colon
-assess for signs and symptoms associated with extraintestinal complications, such as inflamed joints and lesions inside mouth
-usually findings are nonspecific

61
Q

Ulcerative Colitis- Managing Skin Integrity

A

-barrier cream

62
Q

Crohn’s Disease- Recommended Diet

A

-bowel rest and nutrition support with TPN, nutritional supplements, avoid caffeine and alcohol
-bland food: toast, banana

63
Q

Acute Gastritis- Patient Teaching

A

-avoid caffeine, highly acidic foods, spicy foods

64
Q

Cirrhosis- Client Teaching for Lactulose

A

-will be pooping 2-3 times a day
-used to reduce the amount of ammonia in the blood of patients with liver disease

65
Q

Cirrhosis and Ascites- Plan of Care

A

-Go on a low-sodium diet

66
Q

Chronic Cholecystitis- Dietary Teaching

A

-high-fat diet puts pt at risk
-avoid fatty foods, withhold food and fluid if nausea and vomiting occur

67
Q

Chronic Cholecystitis- Assessment Findings

A

-persistent recurrent RUQ pain
-afebrile; may have localized tenderness over a palpable gallbladder

68
Q

Acute Pancreatitis- Lab Findings

A

-serum amylase elevated
-Lipase elevates
serum bilirubin and alkaline phosphatase elevated
-ALT
-WBC
-ERS

69
Q

Pancreatitis- Appropriate Diet

A

-bland diet= chicken, rice, pasta
-foods high in carb and protein assist in the healing process, avoid foods high in fat because it causes or increases diarrhea
-avoid caffeine and alcohol

70
Q

Colostomy- Assessment Findings, Normal and Abnormal

A

-healthy: red, beefy, moist, shouldn’t be painful
-unhealthy: purple/ pale blue, dry
-avoid lifting heavy objects, or straining on defecation to prevent tension on the anastomosis site
-avoid drinking and extreme physical activity for 4-6 weeks while the incision heals

71
Q

Osteomyelitis – Interventions and Treatment (include considerations of medication)

A

Nonsurgical
-4-6 weeks of antimicrobial therapy
-contact precautions with wound drainage
-treatment for MRSA infection- IV vancomycin, linezoid
-irrigate wound with antimicrobial solution
-drug therapy for acute and chronic pain (opioid)
-administer hyperbaric oxygen (HBO) therapy=wound healing
Surgical
-surgical techniques include incision and drainage of skin and subcutaneous infection, wound debridement, and bone excision
-sequestrectomy- removes the necrotic bone and allows revascularization of tissue
-bone grafts to repair bone defects
-microvascular bone transfers or bone graft from donor bone

72
Q

Amputation – Pain Management

A

-IV infusions of calcitonin during the week after amputation can reduce phantom leg pain
-other pain management modalities may be used for pain management

73
Q

Fractures - Traction and purpose of traction

A

-Buck’s traction=for hip fracture
-the application of a pulling force to part of the body to provide bone reduction or as a last resort to decrease muscle spasm (thus REDUCING PAIN)

74
Q

Osteoarthritis – Interventions and Treatment

A

-Tylenol primary drug of choice
-topical for temporary relief of mild pian
-do not take more than 4000mg a day (weight over 150lbs)
-ketorolac, ibuprofen, Celebres
-tramadol

75
Q

Rheumatoid Arthritis – Diagnosis (Consider Lab Values)

A

-RF(rheumatoid factor=measures unusual antibodies)
-Anti-CCP (detects early RF)
-ANA (determines the cause of tissue death)
-ESR
-hsCRP

Med Surg (12 decks)

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