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Med-Surg II > Final Exam > Flashcards

Final Exam Flashcards

1
Q

3 pacemakers of the heart

A

SA node (60-100)
AV node (40-60)
purkinje fibers (20-40)

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2
Q

afib S&S

A

dizziness, palpitations, syncope, dyspnea, fatigue

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3
Q

management for afib

A

Manage obesity, HTN, obstructive sleep apnea, diabetes, smoking, alcohol, caffeine, surgery

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4
Q

meds for afib

A

anticoags (watch plt count)
BB (better than digitalis, not for pts in HF or hx bronchospasm)
Ca+ channel blockers (verapamil/diltiazem, good for pts w asthma, COPD, HTN, and HF)
digitalis (w BB)
amiodarone (converts rate and rhythm, ibutilide)
rhythm control for symptoms

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5
Q

procedures for afib

A

radiofrequency ablation
maze with cryoablation
Transesophageal echocardiogram for atrial thrombus
cardioversion (not for pts with clot)
catheter ablation

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6
Q

electrical cardioversion things to know

A

patient is NPO for 6 hours pre-procedure, IV access needed, anterior and posterior pads placed patient sedated with IV midazolam & propofol. Synchronized electrical shocks delivered. Observe for burns, alleviate discomfort

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7
Q

pharmacologic cardioversion

A

Using antiarrhythmics (amiodarone, sotalol, flecainide) for patient who developed afib within the past 7 days. Monitor HR, BP, K+, perform EKG to assess for QT prolongation. Contraindicated in digitalis toxicity, multifocal atrial tachycardia and sub-optimal anticoagulation

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8
Q

what anticoag to use in patients with mechanical heart valves

A

warfarin!! But watch vitamin K and do frequent INR draws

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9
Q

procedure for pts who can’t handle long term anticoags

A

left atrial appendage obliteration for stroke prevention as this is the main site for thrombus formation

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10
Q

target INR

A

2-3

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11
Q

complications of afib

A

clots causing CVA, MI, or cognitive decline (from micro emboli)
hypoperfusion from < CO (heart failure)

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12
Q

findings of angina

A

May be described as tightness, choking, or a heavy sensation
Frequently retrosternal (behind sternum, deep pain) and may radiate to neck, jaw, shoulders, back or arms (usually left)
Anxiety frequently accompanies the pain
Other symptoms may occur: dyspnea or shortness of breath, dizziness, nausea, and vomiting

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13
Q

unstable angina

A

characterized by increased frequency and severity and is not relieved by rest and NTG.
No longer managed with NTG, pain still exists

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14
Q

priorities for treating angina

A

no activity (semi-fowler)
VS, resp distress, pain
ECG
meds (NTG)
2L oxygen

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15
Q

pt teaching for angina

A

avoid extreme temps
avoid OTC meds that > HR or BP
no nic or fat
high fiber
maintain normal BP and glucose

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16
Q

NTG bottle

A

dark, keep away from kids and sunlight

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17
Q

unstable angina vs STEMI vs NSTEMI

A

Unstable angina, coronary ischemia but no acute MI
STEMI: acute MI, damage to myocardium
NSTEMI: elevated biomarkers, no ECG evidence of MI, less damage

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18
Q

manifestations of MI

A

Chest pain: Occurs suddenly and continues despite rest and medication
SOB; C/O indigestion; nausea; anxiety; cool, pale skin; increased HR, RR
ECG changes: Elevation in the ST segment in two contiguous leads is a key diagnostic indicator for MI
Lab studies: cardiac enzymes, troponin, creatine kinase (muscle damage), myoglobin

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19
Q

MONA and VOMIT

A

morphine, oxygen, nitrates, aspirin
vitals, oxygen, monitor, IV, time (if few hrs, give clot busters)

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20
Q

S&S of MI in women

A

Sweating: Similar to stress sweat, rather than sweating from exercise
SOB: Typically trouble breathing for no reason
Fatigue: Extreme tiredness
Chest pain or discomfort: The pain can be anywhere in the chest, not just the left side
Pain in the arms, back, neck, or jaw
Pain can be gradual or sudden
Nausea
Flu-like symptoms, including nausea, may occur a few days before a heart attack
Stomach pain: Can range in intensity from heartburn-like pain to severe abdominal pressure

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21
Q

emergency procedure for MI

A

CABG

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22
Q

hypertrophic and dilated heart

A

cardiomyopathy

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23
Q

right sided HF

A

Viscera (near abdominal area, ASCITES) and peripheral congestion
JVD
Dependent edema
Hepatomegaly
Ascites
Weight gain

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24
Q

Left sided HF

A

Pulmonary congestion, crackles
S3 or ventricular gallop (happens with HTN, right after S2, S4 is right before S1)
Dyspnea on exertion (DOE)
Activity level before you feel out of breath
Diet
How many pillows
Low O2 sat
Dry, nonproductive cough initially
Ace inhibitors, arbs taken instead
Oliguria

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25
Q

systolic HF

A

blood can’t pump
Impaired contractile function (like scar tissue from MI)
Increased afterload
Cardiomyopathy (hypertrophic & dilated)
Mechanical abnormalities (valve disease)
Decreased left ventricular ejection fraction (EF)

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26
Q

when to get heart transplant

A

EF: 5-10%

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27
Q

diastolic HF

A

Impaired ability of the ventricles to relax and fill during diastole, resulting in decreased stroke volume and CO
Heart failure with normal (preserved) EF
Problem filling, not getting blood out
Result of left ventricular hypertrophy from hypertension, MI, valve disease, or cardiomyopathy

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28
Q

mixed HF

A

Seen in disease states such as dilated cardiomyopathy (DCM)
Poor EFs (<35%)
High pulmonary pressures
Biventricular failure
Both ventricles may be dilated and have poor filling and emptying capacity

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29
Q

compensatory mechanism for HF

A

adrenal glands

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30
Q

catecholamines

A

nor and epi

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31
Q

compensatory mechanisms for HF

A

SNS
neurohormonal responses
ventricular remodeling
dilation
hypertrophy

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32
Q

SNS in HF

A

released epi and norepi
increased HR, contractility, peripheral vasoconstriction
helps then harms

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33
Q

neurohormonal responses in HF

A

kidneys release renin and initiate RAAS
ADH secretion
endothelin released
proinflammatory cytokines (CRP and homocysteine, seen in MI and HF)

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34
Q

what lab value indicates HF

A

BMP

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35
Q

ventricular remodeling

A

Results from SNS activation and neurohormonal responses
Hypertrophy of ventricular myocytes
Ventricles larger but less effective in pumping
Can cause life-threatening dysrhythmias and sudden cardiac death
Might get implantable defibrillator in case this happens

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36
Q

dilation in HF

A

enlargement of chambers
initially effective then CO decreases

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37
Q

hypertrophy in HF

A

increased cardiac wall thickness
effective at first then leads to poor contractility, increased O2 needs, poor circulation, and v-dysrhythmias

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38
Q

FACES in chronic HF

A

fatigue
activity intolerance
chest congestion/cough
edema
SOB

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39
Q

Paroxysmal nocturnal dyspnea

A

SOB that wakes the pt up

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40
Q

anasarca

A

entire body has pitting edema, fluid comes from pores, soaking bed, end stage
very uncomfy, give morphine

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41
Q

weight gain in ADHF

A

> 3lbs in 2 days

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42
Q

meds for HF

A

ACE inhibitors (vasodilation, diuresis, watch for hypotension, hyperkalemia, bad renal, cough)
angiotensin II (alternative to ace)
Hydralazine and isosorbide dinitrate (alternative to ace)
BB (careful w asthma)
diuretics (watch electrolytes)
digitalis (watch for toxicity esp with hypokalemia)
IV milrinone (hypotension) and dobutamine

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43
Q

gerontologic considerations for HF

A

May present with atypical signs and symptoms such as fatigue, weakness, and somnolence
Decreased renal function can make older patients resistant to diuretics and more sensitive to changes in volume
Administration of diuretics to older men requires nursing surveillance for bladder distention caused by urethral obstruction from an enlarged prostate gland

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44
Q

activity for HF patient

A

30-45 mins daily
2 hrs after eating
avoid extreme temps

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45
Q

manifestations of pulmonary edema

A

restlessness, anxiety, dyspnea, cool and clammy skin, cyanosis, weak and rapid pulse, cough, lung congestion (moist, noisy respirations), increased sputum production (sputum may be frothy and blood tinged), decreased LOC

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46
Q

meds for cardiogenic shock

A

diuretics
positive inotrope (+ contractility)
vasopressors

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47
Q

circulatory assist devices

A

intra-aortic balloon pump (temporary, does work for the heart)

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48
Q

mani of cardiac tamponade

A

ill-defined chest pain or fullness, pulsus paradoxus, engorged neck veins, labile or low BP, shortness of breath
Cardinal signs of cardiac tamponade: falling systolic BP, narrowing pulse pressure, rising venous pressure, distant heart sounds

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49
Q

treatments for cardiac tamponade

A

Pericardiocentesis: Puncture of the pericardial sac to aspirate pericardial fluid
Pericardiotomy: Under general anesthesia, a portion of the pericardium is excised to permit the exudative pericardial fluid to drain into the lymphatic system

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50
Q

endocarditis

A

from unresolved strep-A
incompetent valves

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51
Q

treatment for endocarditis

A

spironolactone (can cause gynecomastia/big boobs)
use eplerenone instead
empagliflozin

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52
Q

Classes I-IV of HF

A

I: No limitation
II: Slight limitation, rest is good but lots of activity causes fatigue
III: Less activity causes fatigue but rest is good
IV: Fatigue even at rest

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53
Q

manifestations of ischemic stroke

A

Symptoms depend on the location and size of the affected area
Numbness or weakness of face, arm, or leg, especially on one side
Confusion or change in mental status
Trouble speaking or understanding speech
Difficulty in walking, dizziness, or loss of balance or coordination
Sudden, severe headache
Perceptual disturbances

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54
Q

hemiplegia

A

one side paralysis

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55
Q

hemiparesis

A

one side weakness

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56
Q

hemianopsia

A

only seeing on one side

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57
Q

agnosia

A

not recognizing objects

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58
Q

care of patient after stroke

A

primarily supportive
Bed rest with sedation
Oxygen
Treatment of vasospasm, increased ICP, hypertension, potential seizures, and prevention of further bleeding
Deliberate CALM care!!
watch for fever and high bp (ischemic stroke and > ICP)
check glucose (high is bad) don’t give dextrose
HOB 30

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59
Q

mani of hemorrhagic stroke

A

Similar to ischemic stroke
Severe headache
Early and sudden changes in LOC
Vomiting
Bleeding

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60
Q

assessment during acute phase of stroke

A

LOC and neuro assessment
GCS
pupil
I&Os
BP
bleeding
O2

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61
Q

nursing care after acute phase of stroke

A

Mental status
Sensation/perception
Motor control
Swallowing ability
Nutritional and hydration status
Skin integrity
Activity tolerance
Bowel and bladder function
Get men ready to pee again once they’re stable enough to stand

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62
Q

how often to turn patient after stroke

A

q2h
prom or arom 4-5x/day

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63
Q

diet for post CVA

A

Chin tuck or swallowing method
Use of thickened liquids or pureed diet
Ice chips bad!!

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64
Q

how often to do neuro assessment post CVA

A

q2-4h

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65
Q

aneurysm precautions

A

Absolute bed rest with HOB 30 degrees
Avoid all activity that may increase ICP or BP; Valsalva maneuver, acute flexion or rotation of neck or head
Stool softener and mild laxatives so they don’t bear down
Non-stimulating, non-stressful environment; dim lighting, no reading, no TV, no radio
Visitors are restricted

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66
Q

early identification of aneurysm rupture

A

Call RRT (neuro)
Initiating stroke algorithm
Ensure labs are sent prior to CT scan
CBC, BMP, coags, T&S

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67
Q

nursing interventions to maintain airway

A

HOB >30
suction and O2 assessment

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68
Q

modified massey bedside swallow test

A

complete with time and date (cva and tia)
within 24h of new tia/cva
can’t just document +/- gag
when in doubt, NPO

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69
Q

right sided stroke

A

Left paralysis
Spatial difficulties
Impulsive behavior
Poor judgment
Time blindness

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70
Q

left stroke

A

Right paralysis
difficulty knowing left and right
slow cautious movements
impaired cognition
dep and anxiety

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71
Q

decorticate

A

Plantar flexed (feet point OUTWARD)
Legs internally rotated
Arms flexed and adducted (towards midline)
Hands flexed
BETTER PROGNOSIS

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72
Q

decerebrate

A

Plantar flexed (feet point OUTWARD)
Arms adducted (toward midline), extended, pronated, and hands flexed outward

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73
Q

GCS-eye

A

4 Spontaneous
3 Loud voice
2 Pain
1 None

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74
Q

GCS-verbal

A

5 Normal conversation
4 Disoriented conversation
3 Non coherent
2 No words, only sounds
1 None

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75
Q

GCS-motor

A
  1. Normal
  2. Localized to pain
  3. Withdraws to pain
  4. Flexion
  5. Extension
  6. None
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76
Q

CN1 and test

A

olfactory
smell stuff

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77
Q

CN2 and test

A

optic
snellen
wiggle fingers and move hand medially, ask when pt sees it
ishihara for color blindness
pt looks at you while you wiggle fingers in each quadrant
pupil reflex
fundoscope

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78
Q

CN3 and test

A

oculomotor
6 cardinal points in H
PERRLA

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79
Q

CN4 and test

A

trochlear
6 cardinal points in H
PERRLA

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80
Q

CN5 and test

A

trigeminal
dull sharp
corneal reflex with cotton, pt should blink
resist jaw against hand
jaw jerk should cause protrusion

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81
Q

CN6 and test

A

abducens
6 cardinal points in H
PERRLA

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82
Q

CN7 and test

A

facial
raise eyebrows
close eyes tight
puff cheeks and show teeth
taste

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83
Q

CN8 and test

A

vestibulocochlear/acoustic
rinne (forehead > ear)
weber (ear=ear)

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84
Q

CN9 and test

A

glossopharyngeal
swallow/gag reflex
phonation
taste

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85
Q

CN10 and test

A

vagus
swallow/gag reflex
phonation
taste

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86
Q

CN11 and test

A

spinal accessory
shrug against resistance

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87
Q

CN12 and test

A

hypoglossal
stick out tongue, is it straight

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88
Q

obtunded

A

Difficult to arouse, needs constant stimulation to follow a simple command

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89
Q

stupor

A

Arouses to vigorous, continuous stimulation (can’t follow a simple command)
severe impairment to brain circulation
may become comatose

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90
Q

akinetic mutism

A

unresponsiveness, no movement or sound, sometimes opens eyes

91
Q

PVS

A

sleep-wake! no cognitive function

92
Q

locked in syndrome

A

Inability to move or respond except for eye movements due to a lesion affecting the pons (according to Chicago Med, some pts can move eyes up and down but not side to side)

93
Q

cushing’s triad

A

Increased SBP w widening pulse pressure
Bradycardia
Bradypnea
seen in herniation syndrome

94
Q

normal ICP

A

1-15

95
Q

early mani of increased ICP

A

Changes in LOC
Any change in condition
Restlessness, confusion, increased drowsiness, increased respiratory effort, purposeless movements (loss of spontaneous movement), hemianopsia, lost taste for sweet and salty, pulse and pulse pressure changes
Pupillary changes and impaired ocular movements
Weakness in one extremity or one side
Headache: constant, increasing in intensity, or aggravated by movement or straining

96
Q

late mani of increased ICP

A

Respiratory and vasomotor changes
VS: major changes
Cushing triad: bradycardia/pnea, HTN
Projectile vomiting
Further deterioration of LOC
Going from stupor to coma
Hemiplegia, decortication, decerebration, or flaccidity
Respiratory pattern alterations including cheyne-stokes breathing and arrest
Loss of brainstem reflexes: pupil, gag, corneal, and swallowing

97
Q

brain tumor mani

A

depends on location and size
Localized or generalized neurologic symptoms
Symptoms of increased ICP
Headache
Vomiting
Visual disturbances
Seizures
hormonal if pituitary
loss of hearing, tinnitus, and vertigo if acoustic

98
Q

planning for radical neck dissection

A

absence of infection
viability of graft
nutrition and fluids

99
Q

laryngeal cancer early S&S

A

Hoarseness (lower voice) of more than 2 weeks’ duration occurs
ACE inhibitors (-prils) cause cough and polyps in throat (not cancer but check!
Persistent cough or sore throat and pain and burning in the throat
A lump may be felt in the neck.

100
Q

later symptoms of laryngeal cancer

A

Dysphagia
Dyspnea
Unilateral nasal obstruction or discharge
Persistent hoarseness
Persistent ulceration and foul breath (late symptoms)
Cervical lymphadenopathy
Unintentional weight loss
General debilitated state
Pain radiating to the ear may occur with metastasis

101
Q

S&S of resp alkalosis

A

lightheadedness, inability to concentrate, numbness and tingling, sometimes loss of consciousness

102
Q

S&S of resp acidosis

A

may be asymptomatic
Symptoms may be suddenly increased pulse, respiratory rate and BP, mental changes, feeling of fullness in head

103
Q

what type of pressure do we want in lungs

A

negative!

104
Q

internal beam radiation

A

implant that is right next to tumor, less systemic side effects

105
Q

brachytherapy

A

seeds, don’t be near pregnant women and be cautious with immune system threat

106
Q

external radiation

A

Can be scary bc mimics pulmonary cancer S&S
fatigue bc of bone marrow suppression

107
Q

risk factors for breast ca

A

longer exposure to estrogen
obesity
high fat diet
alc
fibrositis (dense tissue)

108
Q

breast cancer screening

A

20-30s, breast exam q3y
annual after age 40
annual mammo at 40

109
Q

fine needle aspiration biopsy for breast cancer

A

fluid=cyst=benign

110
Q

hormonal therapy for breast ca

A

Estrogen and progesterone receptor assay (Moms genetic coding is checked and meds are given for specific type of cancer)
SERMs (tamoxifen/causes uterine)
aromatase inhibitors (anastrozole, letrozole, exemestane)

111
Q

physical therapy after mastectomy

A

exercise 3x/day for 20 mins
do not lift over 5-10 lbs

112
Q

when to remove drains after mastectomy

A

<30ml drainage in 24 hrs for 2 days
usually 7-10 days

113
Q

palliative surgery

A

DEBULKING
radiation, chemo, pain control

114
Q

specific gravity

A

1.010-1.025

115
Q

serum creatinine

A

0.6-1.2

116
Q

BUN

A

7-18
8-20 for >60

117
Q

3 way bladder irrigation

A

Urine should be a little pinkish first day, should NOT look cranberry color. If clots are there, they should be small enough to pass
Irrigating bladder wall, VERY vascular so minimize bleeding

118
Q

mani of cirrhosis

A

Jaundice is late manifestation
Portal hypertension, ascites, and varices (a varicose vein, outpouching of the vein, can rupture)
Hepatic encephalopathy or coma
Nutritional deficiencies

119
Q

hepatocellular jaundice

A

May appear mildly or severely ill
Lack of appetite, nausea, weight loss
Malaise, fatigue, weakness
Headache chills and fever if infectious in origin (like hepatitis)

120
Q

obstructive jaundice

A

Dark orange-brown urine and light clay-colored stools
Dyspepsia and intolerance of fats, impaired digestion
Pruritus (can also be a sign of hodgkin’s lymphoma)

121
Q

treatment of ascites

A

Low-sodium diet
Diuretics (often a combination of diff classes)
Bed rest
Paracentesis
Administration of salt-poor albumin
Transjugular intrahepatic portosystemic shunt (TIPS) to continually remove fluid

122
Q

hepatic encephalopathy

A

A life-threatening complication of liver disease. May result from the accumulation of ammonia and other toxic metabolites in the blood

123
Q

assessments with hepatic encephalopathy

A

LOC q15-30 minutes
seizures
fetor hepaticus (shit breath)
f&e and ammonia
asterixis

124
Q

medical management of hepatic encephalopathy

A

Lactulose to reduce serum ammonia levels
IV glucose to minimize protein catabolism
Protein restriction
Reduction of ammonia from GI tract by gastric suction, enemas, oral antibiotics (not eating, they have an NG tube, meds go IV, not NG)
Discontinue sedatives analgesics and tranquilizers
Monitor for and promptly treat complications and infections

125
Q

portal HTN

A

Obstructed blood flow through the liver results in increased pressure throughout the portal venous system (everything is backing up, like a reflux)

126
Q

results of portal HTN

A

Ascites (abdominal fluid buildup, usually peritoneal, puts pressure on diaphragm which causes SOB)
Esophageal varices (when these rupture, pt vomits bright red BADDD smelling blood)

127
Q

pancreatic (pancreatitis) cancer treatment

A

Use of analgesics
Nasogastric suction to relieve nausea and distention
Frequent oral care
Bed rest
Measures to promote comfort and relieve anxiety

128
Q

common bile duct obstruction complications

A

chronic pancreatitis
type 1 diabetes
Fluid and electrolyte disturbances
Necrosis of the pancreas
Shock
Multiple organ dysfunction syndrome
DIC
jaundice
pruritus
RUQ pain
anorexia
fever, fatigue
If left untreated, infections, sepsis, and liver disease

129
Q

complications of pancreatitis

A

Fluid and electrolyte disturbances
Necrosis of the pancreas
Shock
Multiple organ dysfunction syndrome
DIC

130
Q

SIADH fluid restriction

A

<800ml/day

131
Q

S&S of SIADH

A

Weight gain without edema, weakness, anorexia, N/V, personality changes, seizures, oliguria, decreased reflexes, coma, hyponatremia

132
Q

treatment of SIADH

A

Treat underlying malignancy & correct the sodium- water imbalance (fluid restriction, oral salt tablets or isotonic [0.9]) saline and IV administration of 3% sodium chloride solution.
Furosemide (Lasix) may also be a helpful treatment in the initial phases.
Demeclocycline (Declomycin) may be needed on an ongoing basis
Monitor sodium level

133
Q

diabetes insipidus

A

decreased ADH
Excessive urine output
Decreased urine osmolality
Serum hyperosmolality
Give IV fluids, electrolyte replacement and desmopressin (synthetic vasopressin)
Hypopituitary

134
Q

addison’s disease

A

adrenocortical insufficiency
adrenal suppression

135
Q

addison’s disease S&S

A

Muscle weakness, anorexia, GI symptoms, fatigue, dark pigmentation of skin and mucosa, hypotension, low blood glucose, low serum sodium, high serum potassium, apathy, emotional lability, confusion

136
Q

diagnostic tests for addison’s

A

adrenocortical hormone levels, ACTH levels, ACTH stimulation test
low sodium, high potassium
bronze skin

137
Q

assessments for addison’s

A

Note any illness or stressors that may precipitate problems
Fluid and electrolyte status
VS and orthostatic blood pressures
Note signs and symptoms related to adrenocortical insufficiency: weight changes, muscle weakness, fatigue

138
Q

interventions for addison’s

A

monitor for signs and symptoms of fluid volume deficit; encourage fluids and foods; select foods high in sodium; administer hormone replacement as prescribed
Activity intolerance; avoid stress and activity until stable, perform all activities for patient when in crisis; maintain a quiet, non stressful environment; measures to reduce anxiety

139
Q

cushings

A

Excessive adrenocortical activity or corticosteroid medications

140
Q

mani of cushings

A

Hyperglycemia; central-type obesity with “buffalo hump;” heavy trunk and thin extremities; fragile, thin skin; ecchymosis; striae; weakness; lassitude; sleep disturbances; osteoporosis; muscle wasting; hypertension; “moon-face”; acne; infection; slow healing; virilization in women; loss of libido; mood changes; increased serum sodium; decreased serum potassium

141
Q

**tests for cushing’s

A

ACTH stimulation test and dexamethasone suppression

142
Q

assessment for cushings

A

Activity level and ability to carry out self-care
Skin assessment
Changes in physical appearance and patient responses to these changes
Mental function
Emotional status
Medications

143
Q

addisonian crisis

A

complication of addison’s
too much too little
Profound fatigue
Dehydration
Vascular collapse (low BP)
Renal shutdown
Decreased sodium, increased potassium

144
Q

planning for cushings

A

decreased risk of injury, decreased risk of infection, increased ability to carry out self-care activities, improved skin integrity, improved body image, improved mental function, and absence of complications

145
Q

corticosteroid therapy

A

Suppress inflammation and autoimmune response, control allergic reactions, and reduce transplant rejection
long half life, same time per day TAPER!
blister pack to taper
immunosuppression
increased glucose
personality in kids

146
Q

SNS

A

Pupils dilate
Bronchodilation
Increased HR
Smaller blood vessels constrict
Relaxed GI
Relaxed bladder and uterus

147
Q

PNS

A

Constricted pupils
Constricted bronchioles and increased secretions
Decreased HR
Dilated blood vessels
Increased peristalsis and secretions
Contracted bladder
Increased salivation

148
Q

treatment for hyperthyroidism

A

treatment of choice is removal
modified or radical neck dissection, possible radioactive iodine to minimize mets
seeds to shrink tumor before surgery

149
Q

caffeine and thyroid

A

avoid caffeine
thyroid storm!

150
Q

preop education for thyroid surgery

A

dietary guidance
no caffeine and stimulants
explain tests and procedures
head + neck support
look for shoulder drop to make sure we didn’t cut into sternocleidomastoid muscle

151
Q

postop management for thyroid surgery

A

Monitor respirations; potential airway impairment
Monitor for potential bleeding and hematoma formation; check posterior dressing
Assess pain and provide pain relief measures
Semi-Fowler position, support head and neck
Assess voice, discourage talking
Potential hypocalcemia related to injury or removal of parathyroid glands

152
Q

parathormone regulates what 2 electrolytes and how

A

calcium and phosphorus
increases serum Ca and decreases ph

153
Q

hyperparathyroidism

A

may have no symptoms
apathy, fatigue, muscle weakness, nausea, vomiting, constipation, hypertension, and cardiac dysrhythmias may occur
mimics depression

154
Q

hypercalcemic crisis**

A

neuro, cardio, and renal symptoms
life threatening
rapid isotonic rehydration
calcitonin and corticosteroids given

155
Q

3 causes of hypoparathyroid

A

Abnormal parathyroid development
Destruction of the parathyroid glands (surgical removal or autoimmune response)
Vitamin D deficiency

156
Q

clinical mani of hypoparathyroid

A

Tetany, numbness, tingling in extremities, stiffness of hands and feet, bronchospasm, laryngeal spasm, carpopedal spasm, anxiety, irritability, depression, delirium, ECG changes
Carpopedal spasm = chvostek trousseau

157
Q

chvostek and trousseau

A

chvostek: sharp tap in front of parotid and ear, spasm of mouth, nose, and eye
trousseau: BP cuff for 3 mins, gay italian hand

158
Q

management of hypoparathyroid

A

increase calcium to 9-10
calcium gluconate
pentobarbital to decrease muscular irritability
parathormone
low stim environment
high calcium, low phosphorus
vit d

159
Q

medical management of pituitary tumors

A

Stereotactic radiation (external beam)
bromocriptine/octreotide (inhibits GH and octreotide shrinks tumor)

160
Q

surgical management of pituitary tumor

A

Hypophysectomy (removal of pituitary gland, also for cushing’s and palliation for bone pain)
Irradiation
Cryosurgery
Menstruation stops
Infertility after total or near-total ablation of pituitary
Replacement therapy with corticosteroids and thyroid hormone

161
Q

adrenal crisis S&S

A

low cortisol
dizziness, weakness, sweating, abd pain, N/V, LOC, rapid weak pulse, rapid RR, pallor

162
Q

CLL

A

Malignant clone of B lymphocyte (T lymphocyte CLL is rare) *Most of leukemic cells of CLL are mature, (may have escaped/resisted apoptosis)
men > 60
2-14 year survival

163
Q

diagnosis and mani of CLL

A

Normal or ↓erythrocytes and platelet
Early: ↑lymphocyte count
Lymphadenopathy- Swollen painful nodes;
Enlarged liver and spleen
Later stage: Thrombocytopenia
Auto-immune complications can occur at any stage.
B symptoms: Night sweats, unintentional wt loss; infections

164
Q

medical management of CLL

A

early: no treatment, monitor
late: begin!
chemo, monoclonal antibody therapy, IVIG, HSCT

165
Q

hodgkin’s lab findings

A

Reed Sternberg cell or be of viral etiology.
Mediastinal mass on X-ray
Assess for B symptoms
PET scan; CT of chest, abd and/or pelvis
Lab: EST, Liver & Renal studies
Unilateral, painless enlargement of lymph node on neck

166
Q

hodgkin’s S&S

A

related to compression of organs involved ie: Compression of trachea cough; pleural effusion; abdominal pain; Pruritus; Herpes Zoster
Severe pain on ingestion of alcohol; anemia; B symptoms; normal or slightly decreased platelet count; decrease skin sensitivity test

167
Q

lab findings of tumor lysis

A

HYPERuricemia
HYPERphosphatemia
HYPERkalemia
HYPOcalcemia

168
Q

S&S of tumor lysis

A

N/D, muscle cramps, confusion, weakness, seizures

169
Q

resp mani at EOL

A

cheyne stokes
accessory muscles
irregular and slowing down
can’t cough or clear secretions
death rattle is fluid from lungs building up

170
Q

hearing and touch mani at EOL

A

hearing is the last sense to go
decreased sensation to hot and cold
decreased perception of pain and touch

171
Q

taste, smell, and sight mani at EOL

A

blurred vision
no blinking
eyelids half open
decreased taste and smell

172
Q

skin mani at EOL

A

mottling
cold, clammy
cyanosis of nose, nails, knees
wax like skin when close to death (looks wet)

173
Q

urinary mani at EOL

A

decrease in output
incontinent
unable to urinate

174
Q

GI mani at EOL

A

slow GI tract and possible cessation
accumulation of gas
distension and nausea
incontinent
BM before or at time of death

175
Q

musculoskeletal mani at EOL

A

loss of ability to move
trouble holding body posture and alignment
loss of facial muscle tone (sagging jaw, difficulty speaking, no gag reflex, go from normal to puree to NPO)

176
Q

cardio mani at EOL

A

tachy then slow, weak pulse
irregular
decreased BP
delayed absorption of IM or SQ

177
Q

HIV

A

Targets CD4+ lymphocytes AKA T-cells
T-cells and B-cells work together
HIV integrates its RNA into host cell DNA through reverse transcriptase, reshaping the host’s immune system

178
Q

3 infection stages of HIV

A

stage 1: CD4+ 500
Stage 2: CD4+ 200-499
Stage 3 (AIDS): CD4+ <200, T-lymphocytes >14%

179
Q

B-cell lymphoma

A

non-hodgkins

180
Q

non-hodgkin’s lymphoma

A

b-lymphocyte
average age 50-60

181
Q

diagnosis of non-hodgkins

A

CT
PET
Bone marrow biopsy
CNS fluid analysis

182
Q

S&S of non-hodgkins

A

multiple lymph nodes!
B symptoms (33%)
Less aggressive forms can wax and wane
Asymptomatic in early stage.
Lymphadenopathy in stage 3-4.
Lymph masses can compromise organ functions e.g. respiratory, spleen CNS; urinary

183
Q

treatment for non-hodgkins

A

Bone marrow transplant & stem cell transplant may be considered for younger patients.
Chemo
Radiation: If the disease is not aggressive radiation alone may be needed.
Lifetime screening

184
Q

kaposi sarcoma

A

Oncologic manifestation of HIV
a malignancy of endothelial cells that line the blood vessels
chronic, benign

185
Q

kaposi sarcoma mani

A

dark reddish-purple lesions of the skin, oral cavity, gi tract, and lungs

186
Q

kaposi sarcoma risk factors

A

older men mediterranean or jewish
endemic (african) ks: eastern half of africa, men, resembles classic
iatrogenic/organ transplant-associated ks: organ transplant patients and immunosuppressants
occurs with AIDS, aggressive

187
Q

AIDS defining illnesses

A

HIV encephalopathy, pneumocystis, recurrent PNA

188
Q

complications of AIDS

A

Opportunistic (secondary) infections
Most common are fungal
Impaired breathing or respiratory failure
Wasting syndrome and f&e imbalance
Electrolyte imbalance kills most ppl, same w chemo
Adverse effects of medications

189
Q

4 causes of blindness

A

macular degeneration
glaucoma
cataracts
diabetic retinopathy

190
Q

glaucoma

A

Disturbance of the functional or structural integrity of the optic nerve. This is characterized by increased fluid secretion or decreased fluid drainage which increases intraocular pressure and can cause atrophy of the optic nerve and deterioration of vision

191
Q

open angle glaucoma

A

more common
aqueous humor secretion decreased bc of blockage in schlemm
increased pressure in eye

192
Q

S&S of open angle glaucoma

A

headache
mild pain
loss of peripheral vision
halos around lights
IOP 22-23

193
Q

treatment of open angle glaucoma

A

cholinergics (carbachol, echothiophate, pilocarpine)
adrenergic agonists (Apraclonidine, brimonidine tartrate, dipivefrin)
BB
Carbonic anhydrase inhibitors (-lamide)
prostaglandin analogs (-prost)

194
Q

surgery for open angle glaucoma

A

Laser trabeculectomy
Iridotomy
Placement of shunts to allow fluid to circulate better

195
Q

closed angle glaucoma

A

There is a closure of the angle of the iris and the sclera which causes a sudden and dramatic rise in intraocular pressure
This is an emergent situation

196
Q

S&S of closed angle glaucoma

A

Severe pain
Blurred vision, decreased vision, loss of vision
Pupils that do not respond to light
Light sensitivity
Halos around lights are seen
IOP greater than 30 mm Hg

197
Q

treatment of closed angle glaucoma

A

osmotics (mannitol or glycerin)
cholinergics
adrenergic agonist
BB
carbonic anhydrase inhibitors (-lamide)
prostaglandin analogs (-prost)

198
Q

surgery for closed angle glaucoma

A

Laser trabeculectomy
Iridotomy
Placement of shunts to allow fluid to circulate better
same as open angle

199
Q

administering eye drops

A

antiseptic technique
sit upright or lay down with chin up
-dropper held 1-2cm above conjunctival sac
-don’t drop onto cornea
-gentle pressure on tear duct to prevent systemic absorption
-wait 5 min if multiple
-ointments should go inner to outer corner

200
Q

administering ear drops

A

aseptic technique
room temp
sit upright or lie on side
straighten ear canal by pulling UP AND OUT for adults and BACK for children <3
dropper 1cm above canal
apply gentle pressure to tragus unless too painful
no cotton inside ear, just outermost part of canal
stay in side-lying for 2-3 mins

201
Q

meniere’s disease

A

A chronic disorder of the inner ear involving sensorineural hearing loss, severe vertigo and tinnitus

202
Q

meniere’s and aspirin

A

no aspirin

203
Q

meds for meniere’s

A

antihistamines
tranquilizers
antiemetic
diuretic
gentamycin

204
Q

2 surgeries for meniere’s

A

Endolymphatic sac decompression: shunting. Basically a drain, first-line, safe, effective, and quick
Vestibular nerve sectioning: preserves hearing if done that way. Cutting the nerves stops auditory input
brief stay

205
Q

basal cell carcinoma

A

appears on sun exposed hands,face, neck, scalp
small waxy nodule
may appear shiny, flat, gray, yellow
rarely metastasizes
reoccurrence common

206
Q

surgery of basal cell carcinoma

A

surgical incision
mohs micrographic surgery
electrosurgery
cryosurgery

207
Q

alternatives to surgery for basal cell carcinoma

A

radiation, photodynamic, topical chemotherapeutic creams

208
Q

malignant melanoma

A

cancerous neoplasm present in dermis and epidermis
manifests as a change in nevus or a new growth on the skin
color is dark, red, blue colored or a mix, irregular shape
itching, rapid growth, ulceration, bleeding

209
Q

treatment of malignant melanoma

A

surgical excision, chemotherapy

210
Q

what to ask about with malignant melanoma

A

pruritus, tenderness, pain, changes in moles, or new pigmented lesions

211
Q

squamous cell carcinoma

A

arises from epidermis, sun damaged skin
less aggressive than melanoma, can cause death
may metastasize by blood or lymph
rough, thickened, scaly tumor
may be asymptomatic or bleed
border is wide, more infiltrated, more inflammatory

212
Q

psoriatic plaques complications

A

infection and psoriatic arthritis

213
Q

what aggravates psoriasis

A

stress, trauma, seasonal and hormonal changes

214
Q

treatment of psoriasis

A

baths to remove scales and medications
remove scales with soft brush
emollient creams after
maintain routine
pharmacologic therapy
topical
phototherapy
ASSESS NAIL AND SCALP

215
Q

CABG complications

A

Bleeding
Clots
Infection
PNA
Breathing issues
Pancreatitis
Kidney failure
Abnormal heart rhythms
Graft failure
Death

216
Q

Post-op gallbladder care

A

low fowlers
fluids and NG suction for distention
soft diet when bowel sounds return
avoid turning
splint affected side
shallow breaths
analgesics to help pt turn, cough, and deep breathe
ambulate

217
Q

treatment of adrenal crisis

A

IV glucose, fluids, electrolytes (sodium), missing steroid hormones, and vasopressors

218
Q

S&S of thrombocytopenia come from (4)

A

enlarged spleen, vascular occlusion, headaches, and hemorrhage

219
Q

leukemia S&S

A

From inadequate production of normal blood cells
Neutropenia (fever and infection)
Anemia (pallor, fatigue, weakness, dyspnea on exertion, dizziness)
Thrombocytopenia (ecchymoses, petechiae, nosebleeds, gingival bleeding
S&S from enlarged liver or spleen
Hyperplasia of gums and bone pain from expansion of marrow

220
Q

HIV encephalopathy early mani

A

Memory deficits, HA, difficulty concentrating, confusion, psychomotor slowing, apathy, and ataxia

221
Q

HIV encephalopathy late mani

A

global cognitive impairments, delay in verbal responses, vacant stare, spastic paraparesis, hyperreflexia, psychosis, hyperreflexia, tremor, incontinence, seizures, mutism, and death

222
Q

herpes virus presentation

A

Blisters, painful and can take 2-4w to heal, or asymptomatic
Itching and pain on infected area, red and edematous
May begin with macules and papules and progress to vesicles and ulcers
Labia is usually primary site
Men is usually foreskin, glans penis, or shaft
Inguinal lymphadenopathy (groin lymph nodes), minor temp, malaise, HA, myalgia (muscle aches), dysuria

223
Q

herpes virus treatment

A

No cure
Relieve symptoms
Prevent spread of infection, make pt comfy, decrease health risks, counseling
Oral antivirals (acyclovir, valacyclovir, famciclovir) can suppress symptoms and shorten course of infection
Antispasmodics and saline compress

224
Q

tamponade nursing actions

A

IV fluids for hypotension
chest x-ray or ECG
prep pt for pericardiocentesis
monitor hemodynamic pressures
monitor heart rhythm, changes indicate improper needle position
monitor for dyspnea and give O2 prn

Med-Surg II (5 decks)

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