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MedSurg > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

Bruit

A

Swishing sound as blood attempts to push through narrowed artery

Often carotid, aortic, popliteal or femoral artery

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2
Q

Murmur

A

Same sound as bruit but only related to heart

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3
Q

Sinus bradycardia

A

Normal for athletes or young people
<45 can cause syncope, weakness, confusion, sweating, SOB, angina

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4
Q

Tx for sinus bradycardia

A

Atropine

Transcutaneous pacing- avoid strenuous activity after placement of pacemaker until leads are healed

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5
Q

A fib

A

No discernible P waves
P rates of 300-600/min
QRS normal
High risk for developing clots
Need anticoagulants

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6
Q

A fib Tx

A

Diltiazem to reduce rate
Amiodarone
Cardioversion

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7
Q

V fib

A

“De-fib”
Squiggly lines- they’re dead- no pulse
Leading cause of cardiac arrest
Need defibrillation right away - 3-5 min
Administer antidysrrhythmic (Amiodarone)

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8
Q

V-Tach

A

Life threatening- ventricles take over as pacemaker
If pulse and no change in LOC- need synchronized Cardioversion
If no pulse, defibrillate

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9
Q

Asystole

A

Not a shockable rhythm

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10
Q

Dx of CHF

A

BNP(B-type natriuretic peptide) lvl high

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11
Q

Causes of left sided HF

A

HTN, CAD, mitral or aortic valve disorders

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12
Q

S/S of left sided HF

A

Tachypnea
Muscle weakness
Weak distal pulses
Pale
Cough w/ pink frothy sputum
Crackles/rales

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13
Q

Right sided HF causes

A

Left ventricle failure
Right ventricle MI
Pulmonary HTN
COPD
ARDS

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14
Q

S/S of right sided HF

A

Edema in extremities
JVD
Organ congestion-ascites

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15
Q

Teaching for right sided HF

A

Weigh daily- 2:5 rule
Energy conservative techniques
Eat small meals with rest afterwards

Possibly may need pacemaker for severe bradycardia

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16
Q

CAD causes

A

Inflammation and lipid deposits in wall of arteries

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17
Q

LDL

A

<100

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18
Q

HDL

A

> 40

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19
Q

Tx of CAD

A

CABG

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20
Q

CABG (coronary artery bypass graft)

A

Surgery to bypass blockage in one or more of coronary arteries using saphenous veins, mammary artery or radial artery

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21
Q

Atherosclerosis

A

Plaque in arterial wall causing narrowing or blockage of artery (bruit)
If blocked, ischemia or infarction possible
Progressive- begins early in life

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22
Q

Arteriosclerosis

A

Hardening/thickening of arteries

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23
Q

S/S of Arteriosclerosis

A

Angina
Arm/leg weakness or numbness
Difficulty speaking
Loss of vision in one eye
HTN
Kidney failure

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24
Q

HTN

A

Primary- develops gradually
Secondary- caused by something- usually back to normal if problem fixed

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25
Q

Malignant HTN S/S

A

Occurs suddenly-medical emergency
“Worst headache ever”
Swelling in legs/feet
Changes in eye (blurred vision)
Abnormal heart sounds
Fluid in lungs (dyspnea)
May leak fluid or blood (nosebleed)

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26
Q

Teaching for malignant HTN

A

Wt reduction
Eliminate saturated fats
Sodium restriction <2g

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27
Q

PAD teaching

A

Potential loss of limb/life
Warm compresses
Dont elevate or cross legs

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28
Q

PAD S/S

A

Pain in lower extremity with exercise (intermittent claudication)
Loss of hair on lower calf
Dry, scaly pale skin
Rubor with dependent position

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29
Q

PVD causes

A

> 40 yrs
Surgery
Immobility
Phlebitis
Prolonged travel
Stroke
Obesity
Pregnancy

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30
Q

Highest risk pts for PVD

A

Hx of orthopedic surgery

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31
Q

Teaching for DVT

A

PTT lvl on heparin needs to be <75 (50-70)
Calf painful, swollen, red - DVT
Don’t check homans sign
Elevate legs with slight knee bend
No high impact exercises

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32
Q

Acute peripheral occlusion

A

Arteries occluded from embolism, thrombosis, trauma, Vasospasm or edema

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33
Q

Tx of Acute peripheral occlusion

A

T-PA to dissolve clots

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34
Q

Dx of Acute peripheral occlusion

A

Cholesterol lvls
Arteriography of lower extremities
Stunting of narrowed vessel
Peripheral or femoral bypass surgery

Monitor plts and coagulants

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35
Q

Buergers disease

A

Inflammatory disease of distal small and medium sized arteries and veins of extremities

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36
Q

Risk factors for Buergers disease

A

Smoking
Men

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37
Q

Teaching for Buergers disease

A

Raising arm doesn’t help
Warm foot soaks
Avoid cold, caffeine, stress, smoking

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38
Q

S/S of buergers disease

A

Pain with walking- ulcers/gangrene- amputations
Weak pulses
Rubor or cyanotic

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39
Q

Reynauds disease

A

“Red, white and blue disease”
Color changes- white, blue, then red in hands from spasms of digital arteries

Exacerbated by vasoconstriction - stress, caffeine, nicotine, cold, chocolate

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40
Q

Teaching for Reynauds disease

A

Keep hands/feet warm and dry
Keep body from cold exposure
No caffeine or tobacco

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41
Q

Tx for Reynauds disease

A

Nifedipine (calcium channel blocker) - decreases frequency, duration and intensity
Could take prophylactically 1-2 hrs before cold exposure

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42
Q

Venous insufficiency

A

Obstruction of venous valves in legs or a reflux of blood back through the valves

43
Q

S/S of venous insufficiency

A

Edema
Altered pigmentation
Pain
Dilated superficial veins
Stasis ulcers

44
Q

Teaching for venous insufficiency

A

Elevate legs
Compression stockings
Walking
No crossing legs avoid restrictive clothing
Protect skin from trauma

45
Q

Varicose veins

A

Protruding veins that are dark, raised and crooked caused by weak vein valves, high venous pressure and incompetent valves

46
Q

Varicose veins common in

A

Standing for long periods of time
Pregnant
Obese
Systemic problems

47
Q

S/S of varicose veins

A

Aching pain in legs
Fatigue and heaviness
Stasis dermatitis
Heat in leg
Discolored skin above ankles

48
Q

Nursing interventions for varicose veins

A

Active ROM
Elevate legs
Stop smoking
Compression stockings

49
Q

Amputations teaching

A

Soft or rigid dressing after
Elevate stump for 24-48 hrs after ONLY
Move/turn slowly to prevent severe muscle spasms
Prone and push stump into bed to prevent contractures
No pillows under or between legs
Gabapentin to relieve phantom pain

50
Q

Migraines tx

A

Sumatriptan - don’t take with SSRIs or St. John’s wort
NSAIDs or Tylenol are okay

51
Q

Lumbar puncture

A

To obtain CSF sample to rule out meningitis
After procedure- monitor for nausea , LOC, respiratory status, assess sensation in legs/toes
DONT restrict fluids

52
Q

Tonic clonic seizures

A

“Grand mal”
Not able to hear, talk or sense
Loss of consciousness, no breathing, stiffening, shaking

53
Q

Tx of seizures

A

Lorazepam to break seizure
Midazolam if status epilepticus

54
Q

Anti epileptic drugs can cause

A

Osteoporosis in post menopausal women

55
Q

Parkinson’s s/s

A

Tremors at rest
Rigidity (pill rolling)
Bradykinesia
Loss of postural reflexes
Freezing movement
Mask like face

56
Q

Parkinson’s tx

A

Carbidopa/levodopa - no protein shakes with med, can cause orthostatic hypotension

57
Q

Multiple sclerosis

A

Affects myelin sheath of nerve

58
Q

S/S of multiple sclerosis

A

Weakness or tingling
Vision loss
Problems with coordination
Muscle spasticity
Slurred speech
Problems with bladder control

59
Q

Teaching for multiple sclerosis

A

Eye patch to block diplopia
Test bath water with unaffected extremity
Interferon beta subQ injection x3 a week- monitor for immunosuppression
Potholder when cooking
No heating pads
Gloves in cold weather
Drink fluids

60
Q

Transient ischemic attack

A

Sudden S/S of stroke that lasts minutes-hrs and resolves within 24 hrs
Warning sign for full blown stroke
Placed on anti platelets (ASA plavix)

61
Q

Tx of Transient ischemic attack

A

CT without contrast

62
Q

Ischemic stroke

A

Blockage of vessel

63
Q

Hemorrhagic stroke

A

Rupture of vessel

64
Q

Risk for stroke

A

DM
Stress
Obesity
Oral contraceptives

65
Q

Teaching for stroke

A

Vision changes - safety concern
No eating/drinking until swallow test

66
Q

tPA administration

A

For ischemic stroke only
Monitor in ICU q1hr x 24hrs for AMS, Headache, high BP, N/V and bleeding
Keep BP < 185/110
No venipuncture
No anticoags or anti-platelets
No recent surgery or head injury

67
Q

Decortication

A

To the core
Flexes extremities towards body

68
Q

Decerebration

A

Posturing that extends extremities outward

69
Q

Cataracts

A

Distorts image projected into retina causing blurry vision
Only Tx is surgery

70
Q

Teaching for cataracts

A

Eye protection from UV light

71
Q

Post op for cataract surgery

A

Elevate HOB 30-45
Eye drops several times a day for 3-4 weeks
Position on nonoperative side with belongings on same side
REPORT bruising, swelling or flashes of light
Clear discharge is okay

72
Q

Glaucoma

A

Increased intraocular pressure
2nd leading cause of blindness
Central vision not affected
If not treated, can damage optic nerve resulting in blindness

73
Q

Risk factors for glaucoma

A

HTN
DM
Cardiovascular disease
Obesity

74
Q

Nursing interventions for glaucoma

A

Timolol can cause bronchospasms and bradycardia

75
Q

Macular degeneration

A

Deterioration of central vision field
Lose vision faster if you smoke

76
Q

S/S of macular degeneration

A

Mild blurring and distortions REPORT
Color perception changes/diminishes

77
Q

Retinal detachment

A

Retina deprived of blood supply
Sudden onset

78
Q

S/S of retinal detachment

A

Shadow or curtain being drawn over vision
Flashes of light
Floaters or black spots (sign of bleeding)

79
Q

Retinal detachment Tx

A

Gas bubble that puts pressure on retina to keep it in place

Face down for weeks and no strain on eye for one week

80
Q

Risk factors for hearing loss

A

Age
Family hx
Injury
Exposure to excessive noise levels
Meds that are ototoxic

81
Q

Hearing aid teaching

A

Use at home first
Adjust to lowest volume
Turn off, remove battery and place in case when not using
Clean ear mold with soap and water, NOT alcohol

82
Q

Menieres disease

A

Excessive fluid in ear (usually one sided)

83
Q

S/S of Menieres disease

A

Vertigo
Tinnitus
Headache
N/V
Hearing loss

84
Q

Tx of Menieres disease

A

Low sodium diet and diuretics

85
Q

Osteoarthritis

A

Non symmetrical joint pain from deterioration of cartilage
Cause unknown
Triggered by aging, obesity, smoking, sports, trauma

86
Q

Heberdeem and bouchards nodes

A

Swelling of joints found in osteoarthritis pts
Heberdeem: joint by nail
Bouchards: joint in middle of finger

87
Q

Rheumatoid arthritis

A

Autoimmune
Ulnar deviation of fingers
Cause unknown
Symmetrical- happens on both sides of body
Hugh risk for smokers
Stiffness more in morning and relieved by moving

88
Q

Osteoporosis

A

Loss of bone strength
Preventable

89
Q

Risk factors for Osteoporosis

A

Corticosteroid use
Estrogen deficiency
Antiepileptic drug use
Smoking

90
Q

Teaching for osteoporosis

A

Increase Ca and vit D
Weight bearing exercises
Reduce carbonated drinks and caffeine

91
Q

Tx for osteoporosis

A

Biphosphonates

92
Q

Osteomyelitis

A

Bone infection

93
Q

S/S of Osteomyelitis

A

Tachycardia
Fever
Hx of pressure ulcer
Elevated ESR level
Constant bone pain

94
Q

Tx of Osteomyelitis

A

Long term IV Abts that can take up to 3 months

95
Q

Nursing care for fracture

A

Straps to hold abduction pillow
Bucks traction

96
Q

Bucks traction

A

Realigns broken bones
Helps with severe pain
Temporary
Weight not to exceed 10 lbs
Don’t let weights rest on floor

97
Q

Cast care

A

Check circulation - paresthesia 1st sign of compartment syndrome
Don’t allow to get soft or wet
Cold compresses to itchy areas

98
Q

Fat embolism syndrome S/S

A

Occurs with long bones

Lethargy
Petechiae
Hypoxemia
Tachypnea
Decreased LOC and confusion

99
Q

Arthroplasty

A

Hip and knee joints replaced
Complications- DVTs, bleeding, infection, loosening of prosthetic part
Post op: REPORT disoriented and restless

100
Q

Carpal tunnel tx

A

Non surgical splinting
Cool packs
NSAIDS
Corticosteroids
Hand yoga
Frequent breaks

101
Q

Sprains S/S

A

Stretching/tearing of ligaments

Pain
Swelling
Bruising
Unable to move or use joint

102
Q

STrains S/S

A

Stretching/tearing of tendon or muscle

Pain
Muscle spasms
Weakness
Swelling
Cramping
Trouble moving muscle

103
Q

Herniated disk

A

Common cause of disability
Place in Williams position- semi fowlers with pillow under knees

104
Q

Tx of Herniated disk

A

Discectomy
Laminectomy
Spinal fusion

Post op: need swallow test before oral intake

MedSurg (5 decks)

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