Med Surg 2 Final

Question 1

Retinal Detachment Vision

Answer 1

Floaters & Curtain Closing effect

Question 2

Retinal Reattachment Surgery Sclera Buckle Procedure? What position & why?

Answer 2

An extraocular procedure that repairs a retinal detachment and involves a silicone patch wrapped around the eye

Position of PT
* may be on bedrest
* keep HOB elevated at all times
* may need to lean forward
To help keep IOP low

Teach
* Activity restrictions
* do not bend over or strain with lifting/bowel movements
* Vigorous exercise should be avoided for 3-4 weeks

Question 3

Retinal Reattachment Surgery Pneumatic Retinopexy? What position & why?

Answer 3

An intraocular procedure/surgery for a detached retina (Gas Bubble)

Head down & to one side
(however, position depends on where the bubble is)

Why?
This position allows the bubble to apply maximal pressure on the retina by the force of gravity

Question 4

Cataracts Vision

Answer 4

Cloudy Vision
Flood Glare

Question 5

Glaucoma Vision

Answer 5

Decreased Peripheral Vision

Question 6

Macular Degeneration Vision

Answer 6

Decreased Center Vision

Question 7

O2 Devices

Answer 7

• nasal cannula - 1-6 L/min: 24-44%
• simple face mask - 6-12 L/min: 35-50% FI02
• partial rebreather - 10-15 L/min: 60%-90%; reservoir bag should remain partially inflated AAT
• non-rebreather - 10-15 L/min: 70%-90%; reservoir bag should remain partially inflated AAT
• Venturi (Venti) - 24-60% (COPD)

Question 8

Next thing after Non-Rebreather if not effective?

Answer 8

The next non-invasive ventilation is BiPAP or invasive ventilation like intubation for mechanical ventilation.

High-flow nasal cannula could also be considered as an intermediate step before progressing to invasive ventilation if the patient meets appropriate criteria.

Question 9

How we diagnose TB

Answer 9

• Mantoux test (Skin Bleb Test) 15 mm growth is positive in healthy people, 10 mm for 4 y/o & below & at risk people, 5 mm for HIV
• IGRA blood test
• CXR positive for ghon node active TB

Positive skin test & negative CXR indicates latent TB

Sputum Culture Confirmation

Question 10

How do we treat TB

Answer 10

ABX
* Most common Isoniazid (INH) SE: hepatotoxicity and peripheral neuropathy
* Rifampin SE: red/orange pee
* ethambutol (Myambutol) SE: decreased visual acuity, inability to differentiate between red and green

Question 11

Diet for Diverticulosis vs. Diverticulitis

Answer 11

Diverticulosis Prevention
* High fiber (asparagus, beans, canned peas, broccoli, squash-acorn, potatoes, blackberries, strawberries, raspberries, bran cereal, popcorn)
* Low fat/ red meat intake
* High levels of physical activity

Diverticulitis Diet
Acute diverticulitis flare rest bowel (NPO) than transition to a low-fiber or low-residue diet is advised until symptoms subside. Followed by back to high fiber diet.

Question 12

Malignant Hyperthermia

Answer 12

An inherited muscle disorder triggered by certain types of anesthesia that may cause a fast-acting life-threatening crisis from unregulated high calcium accumulations. Though inherited, 90% of patients have a negative family history.

Early S/s
* unexpected increase in end-tidal CO2 (hypercarbia)
* sinus tachycardia
* masseter or generalized muscle rigidity

• Antidote - dantrolene IV

Manifest
* Sustained muscle contractions
* Muscle breakdown (Rhabdomyolysis)
* Anaerobic metabolism
* Metabolic acidosis

Question 13

Right Sided Heart Failure

Answer 13

Commonly Caused by COPD

S/s
Fatigue
Increase Peripheral Venous Pressure
Ascites
Enlarged liver & spleen
Distended Jugular Veins
Anorexia & Compliants of GI distress
Swelling in hands and fingers
Dependent edema (feet…also in hands)

Question 14

Left Sided Heart Failure

Answer 14

Commonly caused by HTN

• Paroxysmal Nocturnal Dyspnea
• Pulmonary Congestion (Cough, Crackles, Wheeze, Blood-Tinged Sputum, Tachypnea)
• Restlessness
• Confusion
• Orthopneic
• Exertional Dyspnea
• Fatigue
• Cyanosis

Question 15

Med Math Equations

Answer 15

• (Dose X Kg X 60) / (mcg/ml)
• (volume (ml) x Drop factor (gtt/ml)) / time (min)
• (Desired/Have) x Form of Drug

Question 16

ABGs Respiratory

Answer 16

Remember pH and CO2 move in the different direction if Respiratory

Normal pH - 7.35 - 7.45
Normal CO2 - 35 -45
Normal HCO3 - 24-29

Resp Acid
Low pH below 7.35
Abnormal CO2 above 45
Normal HCO3

Resp Akl
High pH above 7.45
Abnormal CO2 below 35
Normal HCO3

Question 17

ABGs Metabolic

Answer 17

Remember pH and HCO3 move in the same direction if Metabolic

Normal pH - 7.35 - 7.45
Normal CO2 - 35 -45
Normal HCO3 - 24-29

Meta Acid
Low pH below 7.35
Normal CO2
Abnormal HCO3 below 24

Meta Akl
High pH above 7.45
Normal CO2
Abnormal HCO3 above 29

Question 18

Uncompensated vs. partial-compensated vs. compensated (ABGs)

Answer 18

• Uncompensated - the cause resp. or meta. cause value is high or low but the other value is normal.
• Partial-compensated - pH is abnormal but the meta or resp. compensation is trending up or down to help.
• Compensated - pH is normal and the meta or resp. compensation has helped balance pH.

Question 19

Atrial Dysrhythmias

Answer 19

• Premature Atrial Contraction (PAC)
• Atrial Fibrillation - irregularly irregular
• Atrial flutter - saw tooth
• Paroxysmal supraventricular tachycardia (PSVT) - Very Fast

Question 20

Ventricular Dysrhythmias

Answer 20

• Premature Ventricular Contraction (PVC)
• Ventricular tachycardia Dx: Amiodarone - Lidocaine
• Ventricular fibrillation Dx: Dfeb

Question 21

Dysrhythmias Treatment

Answer 21

SVT - Vagal Maneuver - Adenosine & Beta Blocker

VT - Amiodarone - Lidocaine

Sinus Brady - Atropine

VF - Defib - Amiodarone