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Med-Surg 3 Final > Final > Flashcards

Final Flashcards

1
Q

S/Sx of hypernatremia

A

thirst, swollen tongue, sticky mucosa, flushed skin, low-grade fever, edema, confusion, restlessness, weakness
(SALT- Skin flushed, Agitation, Low-grade fever, Thirst)

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2
Q

S/sx of hyponatremia

A

neurologic changes- lethargy, confusion, personality changes, seizures

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3
Q

S/sx of hyperkalemia

A 
cardiac changes, dysrhythmias, muscle weakness, resp impairment, paresthesias, anxiety, and GI manifestations
M-muscle weakness
U-urine/oliguria
R-respiratory distress
D-decreased cardiac contract
E-ekg changes
R-reflexes/hyperreflexia
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4
Q

Tx for hyperkalemia

A
  • limit K intake
  • monitor ECG and use Ca gluconate for arrhythmias
  • Kayexalate
  • IV sodium bicarb
  • reg insulin and hypertonic dextrose IV if met. acidosis
  • albuterol
  • dialysis
  • diuretics to prevent pulm overload and excrete K
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5
Q

Hypophosphatemia lab value

A

serum phosphorus <2.0

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6
Q

Causes of hypophosphatemia

A

vit D deficiency, malabsorption syndromes, over-use of phosphate binding antacids, alcoholism

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7
Q

s/sx of hypophosphatemia

A

confusion, seizures, symptoms mimicking Guillian Barre, decreased oxygen capacity of RBC

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8
Q

tx for hypophosphatemia

A

high-phosphorus diet (beans, peas, eggs, chicken, fish, nuts, grains)
P.O. meds (Neutra Phos)

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9
Q

Normal osmolality of blood

A

275-295 mOsm/Kg

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10
Q

Labs and diagnostic testing for hypoparathyroidism

A
  • Low serum Ca
  • High phosphorus (PTH is overwhelmed due to hyperphosphatemia)
  • Get hx (heredity and nutritional), duration, clinical s/sx, renal failure-PTH ineffective c renal failure, med analysis
  • PTH immunoassay
  • Vit D metabolites
  • Transient (trauma, burns, meds, illness) vs. chronic
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11
Q

Labs and Diagnostic testing for hyperparathyroidism

A

-high PTH levels
-Hypercalcemia
alkaline phosphatase levels

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12
Q

Causes of Diabetes Insipidus

A

-A deficiency in the synthesis or release of ADH
or
-A decreased renal responsiveness to ADH

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13
Q

Treatment for Addison’s disease

A
  • Administer cortisone, hydrocortisone, prednisone, or Cortef to replace cortisol
  • Administer fludrocortisone to regulate Na and K balance from aldosterone insufficiency
  • maintain fluid balance
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14
Q

how to administer hydrocortisone

A

with meals, milk, or antacids to avoid GI distress

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15
Q

Nursing interventions for Addison’s disease

A
  • monitor F&E
  • admin hormones
  • weigh daily
  • I&Os
  • bone density test for osteoporosis due to decrease in mineralcorticoids
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16
Q

Pt teaching for Addison’s

A
  • meds must be taken every day
  • wear medic alert bracelet
  • keep emergency supply of meds available
  • Need for increased cortisol replacements during stress and illness and increased flurocortisone acetate during exercise and sweating*
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17
Q

Nursing interventions for Cushing’s

A
  • daily weight and monitor fluid status
  • I&Os (adequate hydration)
  • monitor for glucose and acetone in urine
  • allow adequate rest
  • avoid trauma to skin (delayed wound healing)
  • bone density scan to assess for osteoporosis bc corticosteroids can leech calcium from bone
  • ongoing CV and musculoskeletal asmts
  • suicide precautions
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18
Q

Pt teaching for Cushing’s

A

-maintain high calorie, high-calcium diet to aid in wound repair and replace Ca

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19
Q

What is Conn’s Syndrome?

A

aka Primary Aldosteronism

  • Adrenal cortex is secreting excessive amounts of aldosterone
  • This results in kidneys retaining Na and excreting K
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20
Q

S/Sx of Conn’s

A
  • increased BP
  • HA
  • orthostatic hypotension
  • muscle weakness and cramps (low K)
  • fatigue
  • temp paralysis
  • constipation
  • numbness, prickling, tingling
  • polydipsia & polyuria
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21
Q

Interpreting test results for Conn’s

A
  • low serum K
  • 24 hr urine to monitor aldosterone, creatinine, and cortisol
  • increased urinary aldosterone
  • oral salt or saline loading test
  • presence of adrenal tumor on CT
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22
Q

Tx for Conn’s

A
  • Diuretcs (spironolactone for women and amiloride for men to increase K)
  • Ca channel blockers (HTN)
  • eplerenone (blocks effects of aldosterone)
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23
Q

NSG Dx for Conn’s

A

Risk for imbalanced fluid volume
Risk for activity intol
Impaired physical mobility

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24
Q

NSG for Conn’s

A

Monitor VS, restrict Na intake, I&Os, daily weights

Pt teaching: thirst, dry mucous membranes are caused by low sodium. Allow sips of water, ice chips

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25
Q

Nasal Polyps usually associated with:

A

Ashma, Hay fever, Sinus infection, Cystic Fibrosis <16yrs

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26
Q

Samter’s Triad

A

asthma, nasal polyps, aspirin intolerance

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27
Q

Teaching c nasal polyps

A

polyps can be recurring even after removal, may need to stay on steroid sprays for extended time to prevent recurrence

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28
Q

Causes of mucormycosis

A

weakened immune system, diabetes, DKA, kidney failure, organ transplant, chemo, Desferal tx for acute iron poisoning, exposure to construction, removal of nonsterile adhesive tape, tongue depressors as splints in neonates

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29
Q

Teaching for mucormycosis

A
  • Seek health care immediately if facial swelling and a black discharge from nose occurs
  • high-risk pts should avoid sugary foods, decaying plants, moldy bread, manure, and other sources of fungi
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30
Q

Clinical Manifestations of Vocal Cord Paralysis

A
  • change in voice (croaky, rough, breathy, aphonic)
  • SOB
  • noisy breathing
  • choking, coughing c eating/swallowing
  • need for frequent breaths while speaking
  • inability to speak loudly
  • inability to “bear down”
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31
Q

Medical tx for vocal cord paralysis

A

For uncontrolled aspiration:

  • permanent gastrostomy tube
  • tracheostomy
  • Semi-Laryngectomy
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32
Q

S/sx of Post-obstructive pulmonary edema (POPE)

A

frothy sputum and moist rales

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33
Q

Trach assessment

A
  • auscultate lungs
  • monitor 02
  • assess for blood in the sputum*, sub-Q emphysema in the neck, resp distress, and tube patency
  • monitor for POPE*
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34
Q

teaching for sarcoidosis

A
  • limit Ca rich foods, vit D, & sunlight
  • take prednisone
  • seek medical care with increasing dyspnea, weight gain, more productive cough, or change in sputum from clear to yellowish-brown
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35
Q

Chronic Bronchitis

A

inflammation and increased mucous production in the trachea and bronchi with chronic productive cough

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36
Q

Emphysema

A

chronic inflammation reduces flexibility of walls of alveoli, resulting in over-distention of the alveolar walls. This causes air to be trapped in the lungs, impeding gas exchange

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37
Q

s/sx of pulmonary hypertension

A 
Most common:
exertional dyspnea
fatigue and lethargy
angina
syncope 
Raynaud's
edema

Less common:
cough, hemoptysis, hoarsness

38
Q

Other s/sx of pulm htn (heart sounds mainly)

A

right ventricular heave, split heart sound, accentuated S2, ejection click, third heart sound, JVD, liver congestion, peripheral edema

39
Q

Cor Pulmonale

A

failure of the right side of the heart due to pulmonary HTN

40
Q

Functions of the Integumentary System

A 
Protection
Thermoregulation
Tactile Stimulation
Excretion
Synthesis of Vit D
Determines Identity
Storage of blood and fats
Reflection of emotion
41
Q

contributing factors to diabetic wounds

A

neuropathy
macro/microvascular changes
slow, decreased immune response

42
Q

Venous ulcers

A
  • most occur on lower extremities

- margins not well defined

43
Q

Arterial ulcers

A
  • located on lower tibia area of leg
  • cool to touch, discolored, hair loss
  • “punched-out” appearance, well-defined margin
44
Q

Adjunctive Wound Healing Treatments

A
  • Negative pressure therapy
  • Skin and tissue grafts or flaps
  • Whirlpool therapy
  • Hyperbaric oxygen therapy
  • Electrical stimulation
  • Normothermia
  • Pressure reduction and relief
45
Q

First degree burn

A
  • Partial-thickness
  • involve only superficial dermis
  • heal spontaneously
46
Q

Second degree burn

A
  • Partial-thickness
  • involve deep dermis
  • may require a prolonged period to heal
47
Q

Third degree burn

A
  • Full-thickness

- All skin layers

48
Q

Emergency/Resuscitative Period: Burns (when it is and goals)

A

-From time of injury to 2-3 days
-emergency care: Stop the burning process
Goals:
-maintain airway and oxygen
-correct fluid imbalance
-conserve body heat
-prevent wound infection
-relieve pain
-emotional support

49
Q

Emergency/Resuscitative Period of Burns includes:

A
  • assessments (esp resp and CV)
  • saline soaks, keep warm
  • prepare catheters, tubes
  • protect against infection
  • baseline studies, measurements
  • fluid resuscitation (after airway stabilization)
  • pain mgmt
50
Q

Acute Phase of Burns (when it is and goals)

A 
-From hemodynamic stability to wound closure
Goals:
-wound cleansing and healing
-pain relief
-preserve body heat
-prevent infection
-promote nutrition
-splint, position, and exercise affected joints
51
Q

Acute phase of burns includes:

A
  • wound debridement
  • escharotomies
  • topical meds, dressings
  • surgeries (wound excision, closures, grafts)
  • promote and maintain normal mobility
  • nutrition
52
Q

Rehabilitative Phase of Burns (when it is and goals)

A 
starts when wound <20% open (2wks-yrs after injury)
Goals:
-physical therapy
-reconstruction
-psychological prep
-pain mgmt
-nutrition
53
Q

Rehabilitative Phase Includes:

A
  • scar contracture formation
  • functional and cosmetic reconstruction
  • psychological, occupational recovery
54
Q

Contraction prevention for burn scars

A
  • Exercise, stretching, scar massage

- use pressure dressing 23 hours/day (decreases hypertrophic scar formation and increases wound pliability)

55
Q

Rebound tenderness is often a sign of?

A

Peritonitis

56
Q

Iliopsoas sign

A

indicates an inflammation of the psoas muscle

57
Q

Obturator sign

A

indicates inflammation along the obturator internus muscle

-Positive tests can be related to appendicitis, diverticulitis, PID

58
Q

Murphy’s sign

A

positive with inflammation of the gallbladder

59
Q

Ulcerative Colitis

A
  • affects colon and rectum
  • affects only mucosal and submucosal layers
  • bloody stools
60
Q

Crohn’s Disease

A
  • inflammation can occur in any part of the GI tract
  • involves ALL layers of intestinal wall
  • results in obstruction, abscess, and fistula formation
61
Q

S/Sx of intestinal obstruction

A

abdominal swelling, pain, N/V/D, constipation

62
Q

Complications of Gastric Surgery

A 
Dumping Syndrome
-undigested contents of stomach move too rapidly into SI
-nervous system symptoms
-secondary hypoglycemia
Vitamin/Mineral Insufficiencies
-pernicious anemia
63
Q

S/sx of Prodromal Phase of Hepatitis

A

Vague, flu-like symptoms

  • anorexia, N/V, fatigue
  • myalgia, arthralgia
  • mild abdominal pain
  • fever <103
  • increased AST, ALT, ALP
64
Q

S/Sx of Icteric Phase of Hepatitis

A
  • Begins with the onset of jaundice
  • worsening of prodromal sx
  • dark urine (increased bili)
  • clay-colored stools
  • increased serum bili
65
Q

S/Sx of Convalescent Phase of Hepatitis

A
  • Begins after 2-3 weeks of acute illness
  • Symptoms subside, appetite and energy increase
  • jaundice and abdominal pain disappear
  • duration of illness varies c different types of hep
66
Q

Early s/sx of Cirrhosis of Liver

A
  • Fatigue
  • significant change in weight
  • GI sx
  • abdominal pain and liver tenderness
  • pruritis
67
Q

Late s/sx of Cirrhosis

A
  • jaundice and icterus
  • clay-colored stools
  • tea-colored urine
  • dry skin, rashes, petechiae, ecchymosis
  • warm, bright red palms
  • spider angiomas
  • peripheral dependent edema of extremities and sacrum
68
Q

preparation for liver biopsy

A
  • informed consent
  • assess PT, aPTT, INR, and platelet counts
  • NPO 6-8 hrs
  • placed in supine or left lateral
69
Q

post liver biopsy

A
  • position on right side for 1-2 hrs

- monitor for bleeding, pneumothorax, infection

70
Q

s/sx of hepatic encephalopathy

A
  • asterixis (tremor of hand when wrist is extended)
  • agitation
  • combativeness
  • confusion
  • exaggerated reflexes (DTRs)

(AACCE)

71
Q

tx for hepatic encephalopathy

A

lactulose- reduces ammonia
neomycin-sterilizes bowel
oxazepam-tx agitation

72
Q

NSG for hepatic encephalopathy

A
  • Mini Mental Stat Exam
  • **PROTEIN RESTRICTED diet
  • monitor DTRs
73
Q

s/sx of Acute Pancreatitis

A
  • sudden, severe epigastric pain radiating to back
  • N/V
  • abd distention, decreased bowel sounds, rigidity
  • elevated amylase and lipase
  • hypocalcemia
  • Grey Turner’s and Cullen’s
  • hyperglycemia
74
Q

S/sx of Chronic Pancreatitis

A
  • recurrent epigastric and LUQ pain (less severe than acute)
  • tender abdomen, mild muscle guarding over pancreas
  • anorexia
  • N/V
  • flatulence
  • constipation
  • steatorrhea (excess fat in stool)
75
Q

Med mgmt of acute pancreatitis

A
  • tx focused on resting pancreas
  • NPO
  • NG tube
  • bed rest
  • lg amt of IV fluids
  • clear liquid diet when bowel sounds return
  • slow transition to low-fat diet
  • pain mgmt c narcotics
76
Q

Med mgmt for chronic pancreatitis

A
  • supplementation c pancreatic enzymes (always give with food!!)
  • narcotics NOT used due to addiction risk
  • lifelong lifestyle changes (no alcohol, low-fat diet)
77
Q

gerontologic considerations for musculoskeletal

A
  • decreased flexibility
  • decreased Ca absorption
  • decreased ROM d/t thinning cartilage
  • decreased muscle mass
78
Q

Grade 1 open fracture

A
  • Inside-out fracture
  • wound bed clean, <1cm
  • minimal soft tissue injury and comminution (crushing, shattering)
79
Q

Grade 2 open fracture

A
  • soft tissue wound >1cm

- moderate contamination, comminution

80
Q

Grade 3 A open fracture

A

wound <10cm, crushed tissue, contamination

81
Q

Grade 3 B open fracture

A

wound >10cm, crushed tissue, contamination, regional or free flap

82
Q

Grade 3 C open fracture

A

major vascular injury, limb salvage

83
Q

patho behind osteoarthritis

A
  • bony formations on weight-bearing joints
  • decrease in collagen synthesis, increase in collagen breakdown
  • asymmetrical joint cartilage loss
84
Q

clinical manifestations of osteoarthritis

A
  • morning stiffness
  • pain with overuse of joint
  • joint bone deformity
85
Q

foods that are high in purine (gout pts cannot eat these)

A

mushrooms, sardines, asparagus, peas, beans, alcohol, gravy, animal broths

86
Q

NSG dx for Osteoarthritis

A 
Pain, chronic
mobility: physical, impaired
falls: risk for
body image: disturbed
readiness for enhanced self-care
imbalanced nutrition: more than body requirements
-powerlessness
87
Q

what are usually the first s/sx of IICP?

A

sudden drowsiness and restlessness

88
Q

other signs of IICP:

A
  • decrease in motor function with presenting weakness in the extremities
  • pathologic posturing (decorticate, decerebrate)
  • Unusual headache and vomiting
  • changes in vital signs that may indicate pressure on the brainstem or hypothalamus (Cushing’s triad- HTN, bradycardia, irreg respirations)
89
Q

S/Es of Dilantin

A

gum hypertrophy, ataxia, diplopia, hirsutism

90
Q

s/sx of autonomic hyperreflexia

A
  • HTN
  • headache, flushing, nausea
  • blurred vision/restlessness
  • bradycardia
91
Q

Spinal Shock

A
  • flaccid paralysis below level of injury followed by spastic reflexes
  • loss of sensation
92
Q

Neurogenic Shock

A 
-loss of vasomotor and sympathetic nervous system tone
Features:
-Hypotension
-Bradycardia
-Poikilothermia

Med-Surg 3 Final (1 decks)

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