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Exam Flashcards

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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
Q

Blood test for thyroid
1. Serum t3 t4
2. Serum tsh
3. Thyroid antibodies

A
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26
Q

Thyroid disorder

A

Hyperthyroidism

Hypothyroidism

Gooter

Thyroiditis

Thyroid cancer

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27
Q

Hypothyroidism vs hyperthyroidism

A

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:

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28
Q

Treatment for hypothyroidism- synthetic levothyroxine replacement therapy

A
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29
Q

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

A
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30
Q

Thyroid storm- cause severe hyperthyroidism

Manifestation:

High fever

Extreme tachycardia

Altered neurological or mental state

A
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31
Q

Parathyroid glands- posterior thyroid gland (4)
Maintain calcium & phosphorus balance

A
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32
Q

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

A
33
Q

Adrenocoritcal insufficiency - Addison’s disease

S/s bronze pigment skin, hypoglycemia, change of body hair, postural hypotension, weakness, weight loss.

A
34
Q

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

A
35
Q

Diabetes mellitus

Functions of insulin

A

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
Q

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

A
37
Q

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.

A
38
Q

Clinical manifestation of diabetes

Polyuria, polydypsia, polyphagia, fatigue, numbness of extremities, slow healing skin lesion

A
39
Q

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

  1. Absense of insulin-) abnormal metabolism of carbohydrate

Manifestation: hyperglycemia, dehydration, acidosis

Treatment: rehydrate in iv fluid
Reverse acidosis and restore electrolyte balance.

A
40
Q

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
A
41
Q

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

A
42
Q

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

A
43
Q

Long term complication of diabetes

Macrovascular: accelerated atherosclerotic disease, coronary artery disease, cerebralvascular disease

Microvascular: nethropathy

Neuropathic: peripheral neuropathy, autonomic neuropathy, sexual dyfunction

A
44
Q

Visual and auditory

Impaired vision
Myopia: nearsighted
Hyperopia: farsighted
Astigmatism: distortion due to irregularity of cornea

Glaucoma

A
45
Q

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

A
46
Q

S/s of glaucoma

Progression vision field defects

Peripheral vision loss

Difficult to adjust eye into low lighting

Aching/ discomfort around eyes

A
47
Q

Diagnosis of glaucoma （點揾）

Tonometry to assess IOP
Perimetry to assess vision loss

A
48
Q

Treatment for glaucoma

Goal: prevent further optic damage
Maintain IOP in a level doesn’t bring damage

Surgery:
Laser trabeculoplasty
Laser iridotomy

A
49
Q

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

A
50
Q

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

A
51
Q

Retinal disorder

A

Retinal detachment
Retinal vascular disorder
Macular degeneration 黃斑病變

52
Q

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

A
53
Q

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

A
54
Q

Middle ear surgical

Tympanoplasty reconstruct the tympanic memebrane

Ossiculoplasty reconstruct the bone of middle ear

Mastoidectomy remove diseased bone, mastoid air cells

A
55
Q

Common sport injury

Contusion, strains, sprains, dislocation

Prevent sport injury:
1. Wear proper equipement e.g. running shoes for runner, wrist guard for skaters

  1. Effective training
  2. Stretching before engaging in a sport
  3. Change in activity should be gradually
  4. Modify activity to minimise injury and promote healing
  5. Be aware of limits snd capabilities
A
56
Q

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

A
57
Q

Clinical manifestation of fracture

Pain
Loss of function
Deformity
Shorten of extremity
Local swelling

A
58
Q

Urinary elimination

*urinary tract infection
Upper: pyelonephritis
Lower:
1. Cytitis
2. Prostatitis
3. Urethritis

A
59
Q

Urinary incontinence

  1. Stress incontinence
  2. Urge incontinence
  3. Functional incontinence
  4. Iatrogenic incontinence
A

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
Q

Urge incontinence

A

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
Q

Functional incontinence

A

Unable to identify the needs to void due to physical / cognitive impairment

E.g. Alzheimer’s dementia.

62
Q

Iatrogenic incontinensce
Involuntary loss of urine due to medical factors

A
63
Q

Urolithiasis
Nephrolithiasis

A

75% are calcium stone, caused by hypercalcemia, hypercalciuria
15% are struvite stone

64
Q

How to prevent kidney stone

A

Daily 2L of water if no contraindicated

Avoid intake of oxalate-containing food ( strawberries, tea, peanuts)

Maintain regular toileting habit

65
Q

Kidney surgery pre-op + post-op

A

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
Q

Kidney surgery post-operation and monitor for common complications

A
  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
Q

Digestive system assesment order

A

Inspection, auscultation, palpation, percussion.

Pqrst

Provocation
Quality
Region
Severity
Time

68
Q

Appendicitis

A

Infection of appendix
Usually age 10-30
Small, finger-like, attaching caecum
Insufficient emptying leads to obstruction

69
Q

Appendicitis manifestation

A
  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
Q

Appendicitis complications

A

Perforation of appendix (usually 24hrs later)
Abscess formation
Portal pylephlebitis

71
Q

Appendicitis-goals

A

Pain management
Prevention of fluid volume deficit
Reduce anxiety
Eliminate infection
Maintaining skin integrity
Attaining optimal nutrition

72
Q

Appendicitis post-op

A

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
Q

Pneumonia education

A
  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
Q

Pneumonia patient education

A
  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
Q

Surgical of ears

A

Tympanoplasty 修補耳膜
Ossiculoplasty 修補耳骨
Mastoidectomy 切乳突

76
Q

Peritonitis complication

A

Sepsis

Shock

Intestinal obstruction

77
Q

Tuberculosis test

A

Tuberculin test ( the mantoux method)
Inject small amount of TB antigen into skin
React and form a bump >10mm then positive

78
Q

Aims if chest drainage

A

Aims to remove excessive air, fluid or blood.
By placing vacuum suction tube in pleural space, maintain the negative pressure of the lung

79
Q

Skin infection
Bacteria vs viral infection

A

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…

  1. Shiwer daily with antibacterial soap.
  2. Never squeeze the blister or pimple.
  3. 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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