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Med Surg I > Final Exam Blueprint > Flashcards

Final Exam Blueprint Flashcards

1
Q

priorities of care for patient with peripheral neuropathy

A

SAFETY

assess sensation, mobility, wounds

avoiding extreme temperatures, soaking feet, and poorly fitting shoes

teach patients to check their feet DAILY

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2
Q

which organ is most affected by blood glucose?

A

brain

cannot store glucose and uses a LOT for functioning, so important to maintain blood glucose control

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3
Q

s+s of DKA, what type of onset + associated with which DM?

A
  1. rapid onset
  2. CBG >300
  3. ketones in urine
  4. acidosis (low pH)
  5. kussmaul breathing

type 1

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4
Q

interventions for DKA

A
  1. ABC (don’t intubate b/c kussmaul helping to blow off CO2)
  2. telemetry
  3. fluids (NS for CBG >250, D5 1/2 NS CBG <250)
  4. potassium (slowly to prevent heart issues)
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5
Q

s+s of HHS, what type of onset + associated with which type of DM?

A
  1. gradual onset
  2. CBG >600
  3. profound dehydration
  4. hyperosmolar state (>320)

type 2

higher mortality rate

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6
Q

interventions for HHS

A
  1. ABC
  2. telemetry
  3. fix osmolarity SLOWLY (avoid neuro complications)
  4. fluids (1/2 NS b/c of osmolarity)
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7
Q

would you expect weight loss or weight gain with DKA? why?

would you expect hypo or hypertension?

A

weight loss b/c of hyperglycemia –> body breaking down fat –> diuresis

HYPOtension b/c of fluid loss

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8
Q

DM diagnostic for fasting glucose

A

> 126 on 2+ occasions

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9
Q

DM diagnostic for HgA1C

A

> 6.5%

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10
Q

DM diagnostic for non fasting glucose

A

> 200 w/symptoms of hyperglycemia

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11
Q

DM diagnostic for glucose tolerance test (preggos)

A

> 200

and increased risk of developing TIIDM later on

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12
Q

what is normal fasting glucose? and when is best time to take this?

A

80-110

morning labs after NPO

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13
Q

what is normal HgA1C?

A

<4-6%

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14
Q

what is HgA1C that indicates risk of Diabetes?

A

5.7-6.4%

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15
Q

re: urinalysis, what would you see present in urine with early stage diabetic nephropathy?

A

albumin

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16
Q

s+s of hyperglycemia

A

“hot and dry, sugar’s high”

kussmaul breathing, weight loss, 3 P’s, fatigue, hypotension, blurred vision

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17
Q

s+s of hypoglycemia

A

“cool and clammy, need some candy”

diaphoretic, tremors, tachycardia, irritability, confusion, hunger, fatigue, nausea

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18
Q

what are the 3 P’s r/t hyperglycemia and describe why they occur (KISS)

A
  1. polyphagia: cells starving
  2. polyuria: diuresis r/t hyperglycemia
  3. polydipsia: secondary to polyuria and dehydration
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19
Q

compare type 1 DM with type 2 DM

A
  1. type 1: autoimmune, beta cells destroyed + don’t produce insulin; complication: DKA
  2. type 2: insulin resistance; often treated with lifestyle mods + oral drugs, sometimes insulin; complication: HHS
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20
Q

expected ABG values for DKA

A 
pH low (<7.35)
CO2 low (<35)
HCO3 low (<22)
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21
Q

expected lab findings for pyelonephritis

A
  1. WBCs elevated
  2. presence of RBCs in urine
  3. presence of bacteria in urine
  4. culture: E. coli
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22
Q

deficiencies for hypoparathyroidism

A
  1. vitamin D
  2. Calcium
  3. magnesium (maybe)
  4. PTH
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23
Q

comfort interventions for post lithotripsy

A

pain management: ice packs, tylenol, NSAIDs

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24
Q

dietary restrictions for acute glomerulonephritis

A

K+ and protein

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25
Q

how should fluids be increased with acute glomerulonephritis?

A

output from the day before + 500-600mL

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26
Q

s+s of hypothyroidism

A
  1. low HR, BP, RR
  2. fatigue
  3. sleeping a lot
  4. anorexia
  5. weight gain
  6. intolerance to cold
  7. depression
  8. thickened tongue (changes in speech)
  9. edema in eyes/face
  10. dry skin
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27
Q

T3 + T4 levels for:

hypothyroidism

hyperthyroidism

A

hypo = low = low T3+T4

hyper = high = hight T3+T4

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28
Q

s+s of hyperthyroidism

A
  1. high HR, BP, RR
  2. intolerance to heat
  3. insomnia
  4. weight loss
  5. excess hunger
  6. dry brittle hair
  7. hot, moist skin
  8. irritability
  9. tremors
  10. diaphoresis
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29
Q

main complications/manifestations of FES

A
  1. brain: HA, confusion, seizure, altered LOC
  2. lungs: dyspnea, breathlessness, tachypnea how it’s similar to PE
  3. skin: petechiae

(up to 72 hours after long bone fracture or hip/knee arthroplasty)

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30
Q

s+s of PE

A
  1. dyspnea
  2. low O2
  3. tachypnea
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31
Q

s+s of acute glomerulonephritis (5)

A
  • fluid overload issues*
    1. edema
    2. BP
    3. decreased urination
    4. weight gain
    5. respiratory issues
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32
Q

what history is good to collect for acute glomerulonephritis?

A

recent infection (strep within 10 days)

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33
Q

how would we know acute glomerulonephritis is resolving and patient is getting better?

A

weight loss, less edema, increased urine output, no respiratory issues

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34
Q

3 body systems mainly affected by malignant hypertension

A
  1. brain (stroke)
  2. kidneys (failure)
  3. heart (failure)
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35
Q

what s+s would you see in the brain related to malignant hypertension?

A
  1. change in LOC

2. HA

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36
Q

what s+s would you see in the kidneys related to malignant hypertension?

A
  1. uremia
  2. decreased GFR
  3. increased BUN/creatinine
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37
Q

what s+s would you see in the heart related to malignant hypertension?

A
  1. EKG changes
  2. dyspnea
  3. fluid retention/weight gain
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38
Q

what is tx for malignant hypertension? how slow should we do this?

A

reduce BP with antihypertensives

25% reduction in 2-6 hrs

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39
Q

s+s of hyperparathyroidism

“mneumonic” + it’s s+s, plus 3 extras

A

= hypercalcemia (serum)
= hypocalcemia (bones)

“bones, grones, stones, moans”

bone fractures, GI issues (constipation, N/V), kidney stones, irritability, lethargy, confusion

waxy pallor, weakness, cardiac issues

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40
Q

patient teaching for hyperparathyroidism (3)

A
  1. 3-4L H2O/day
  2. injury prevention (b/c of hypocalcemia in bones)
  3. monitor cardiac fxn
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41
Q

s+s of PKD

A
  1. HTN
  2. Edema
  3. distended abdomen
  4. pain
  5. low GFR
  6. increased BUN/creatinine
  7. kidney stones
  8. dysuria
  9. nocturia
  10. foul smelling urine
  11. cola colored urine
  12. bloody urine
  13. cysts in other areas of body
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42
Q

re: PKD and cysts forming in other areas of the body, what’s our concern with the brain? what might be a s+S of this?

A

aneurysm

HA!

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43
Q

what is an early sign of PKD?

+ what is a late sign of PKD?

A

early: nocturia (can’t regulate urine)
late: edema (periorbital edema is an example –> notify provider)

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44
Q

dull and aching pain with PKD could indicate what?

A

pressure on organs

kidneys can grow to be the size of a football!

45
Q

sharp + intermittent pain with PKD could indicate what?

A

cyst rupture

46
Q

sodium intake with PKD:

early:
late:

A

early: moderate intake
late: limit (<2.5g per Messer/<2g per Iggy)

47
Q

what is the common indicator for thyroid storm?

A

fever: 1 degree increase should be reported!!!!!

48
Q

what are other s+s of thyroid storm (aside from fever) (5)

+ what can this lead to?

A
  1. tachycardia
  2. HTN (SBP 200)
  3. tremors
  4. anxiety
  5. GI issues

…….can lead to seizure + death

49
Q

death from thyroid storm is often related to what?

A

high BP –> MI, stroke, seizure

50
Q

priority actions for thyroid storm (5)

A

ABC

  1. airway
  2. cardiac monitor
  3. decrease BP + HR (meds - thyroid + BP)
  4. reduce fever (tylenol + ice packs)
  5. fluids
51
Q

normal calcium level

A

8.5-10.5

52
Q

s+s of hypocalcemia (10) + your priority concern

A

“CATS”

  1. convulsions
  2. arrhythmias
  3. tetany
  4. stridor / spasms
  5. trousseau’s sign
  6. chvostek’s sign
  7. tingling/numbness
  8. cramps
  9. seizures
  10. irritability

priority: AIRWAY (stridor)

53
Q

what is trousseau’s sign?

A

hand spasm when BP cuff inflated

54
Q

what is Chvostek’s sign?

A

face spasm when tapped on cheek

55
Q

s+s of hypercalcemia

A

“bones, grones, stones, moans”

  1. bone fractures + pain
  2. GI issues: constipation, N/V
  3. kidney stones
  4. irritability, coma
  5. weakness
  6. cardiac issues
56
Q

glucose admin for:

  • alert + oriented:
  • obtunded w/IV:
  • no IV access:
A
  • alert: oral glucose
  • obtunded w/IV: IV D50
  • no IV: IM or subQ glucagon
57
Q

according to messer, “if patient has an acute change in mental status, we should do what 2 things?”

A
  1. check CBG
  2. give IV D50

quickest option

58
Q

if patient is NPO, what insulin would we hold and not hold?

A

hold: short acting

keep giving: basal

59
Q

T score for osteoporosis

A

-2.5 or lower

60
Q

T score for osteopenia

A

-1 to -2.5

61
Q

risk factors for colon cancer

A
  1. age
  2. genetics
  3. IBD
  4. sedentary lifestyle
  5. diet high in fat + low fiber
  6. smoking
  7. ETOH
  8. obesity
62
Q

blood transfusion musts……

A
  1. verify order + consent
  2. patient ID w/type and crossmatch
  3. 2nd nurse or BCA
  4. large gauge (18 is preferred)
  5. NS + blood filter tubing only
  6. start within 15 mins
  7. finish in 4 hrs
  8. stay with patient 1st 15 minutes
  9. monitor frequently
63
Q

restrictions after mastectomy

A
  1. no heavy lifting

2. no BP readings or venipuncture or anything invasive on that arm or arms

64
Q

patient education for gout

A
  1. drink plenty of fluids
  2. avoid foods high in purine (oily fish, fish with bones, organ meat, shellfish)
  3. avoid ETOH, ASA, diuretics, stress
  4. consume citrus foods
65
Q

what is common cause of sensorineural hearing loss?

A

noise pollution (loud machinery, frequent exposure) + ear probing

66
Q

when do we use abduction pillow with hip replacement surgery?

A

posterior approach

+ confused older adult is good candidate as well

67
Q

restrictions post hip replacement

A
  1. don’t cross legs
  2. avoid hip rotation
  3. avoid extreme bending at waist
  4. keep knees 90 degrees
  5. abduction pillow for posterior approach
68
Q

press fit vs cement press for hip replacement

A
  1. press fitted takes longer to heal/form around bone: NWB immediately after (lasts longer so usually used for younger folks)
  2. cement press: weight bearing immediately after (older folks bc doesn’t last as long)
69
Q

s+s of osteoarthritis

A
  1. pain after activity
  2. relief after rest
  3. stiffness
  4. large, hardened joints (Heberden’s: distal/Bouchard’s: proximal)
  5. crepitus
  6. decreased ROM –> muscle atrophy
70
Q

normal magnesium (Iggy/Messer)

A

1.5 - 3

71
Q

normal phosphorus (Iggy/Messer)

A

2 - 4.5

72
Q

normal BUN (Iggy/Messer)

A

8-20

73
Q

normal creatinine (Iggy/Messer)

A

0.6-1.5

74
Q

normal albumin (Iggy/messer)

A

3- 5.5

75
Q

seizure precautions (5)

A
  1. airway kit
  2. suction
  3. O2
  4. bed lowered + locked
  5. IV access
76
Q

what is most common cause of embolic stroke?

A

atherosclerotic plaque breaking off

a fib

77
Q

what is our assessment priority for stroke patient?

A

ABC

can they maintain an airway? (aspiration + dysphagia)

78
Q

what is early sign of increased ICP (after stroke)

A

changes in LOC

79
Q

what is late sign of increased ICP (after stroke)

A

pupil constriction + cushing’s triad (HTN, wide pulse pressure, bradycardia)

80
Q

after stroke, we should ensure SBP doesn’t exceed what?

A

180

81
Q

osteomyelitis priority

A

prevent worsening –> gangrene and amputation

antimicrobial therapy on board ASAP!!!!

82
Q

if there is a trauma fracture, what framework should you think in?

A

ABC

ex: chest fracture –> think airway/breathing

83
Q

priority assessment for fracture

A

CMS: circulation, movement, sensation

84
Q

post fracture, numbness + tingling could be a sign of what?

A

neurovascular compromise/compartment syndrome

85
Q

s+s of acute compartment syndrome

A

6 P’s

  1. pain
  2. poikilothermia
  3. paralysis
  4. paresthesia
  5. pallor
  6. pulselessness
86
Q

education for glaucoma

A
  1. avoid anything causing increased IOP
  2. treat early (annual eye exams)
  3. eye drop management: wash hands, conjunctival sac, occlude tear duct to avoid systemic absorption
87
Q

patient education with retinal detachment surgery/repair (4)

A
  1. avoid rapid/fine eye movements (reading)
  2. wear eye patch + rest
  3. monitor for infection
  4. inform them it can happen again
88
Q

education how to avoid UTIs

A
  1. urinate after sex
  2. dry, cotton breathable underwear
  3. hand hygiene
  4. wipe front to back
  5. HYDRATE (2-3L/day)
89
Q

UTI prevention with DM

A
  1. blood glucose control

2. avoid urinary retention (drugs, holding urine, etc)

90
Q

re: TB testing, what is screening vs definitive diagnosis?

A

screening: PPD
definitive: sputum + culture

91
Q

re: PPD test, positive reading of these values for which type of populations?

> 15mm:
10mm:
5mm:

A

> 15: general public w/no risk factors

> 10: LTCF, homeless, crowded living situations, HCW

> 5: HIV, immunocompromised, recent exposure to active TB

92
Q

what does BNP signify? what is normal?

A

stretch of the heart (r/t HF)

normal <100

93
Q

s+s of Right sided HF (7)

A
  1. edema
  2. weight gain
  3. hepatomegaly
  4. ascites / abdominal distention
  5. JVD
  6. bounding pulses
  7. respiratory issues (most common cause of right sided HF is left sided HF)
94
Q

s+s of left sided HF (8)

A

= oxygenation + perfusion issues

  1. fatigue
  2. weakness
  3. low urine output
  4. pallor
  5. weak pulse
  6. SHOB
  7. dyspnea
  8. crackles
95
Q

education for person with COPD (8)

A
  1. small, frequent meals with high calories, low carbs
  2. pulmonary hygiene
  3. hydration
  4. exercise w/rest breaks
  5. smoking cessation
  6. breathing techniques: pursed lip + diaphragmatic
  7. O2 therapy PRN
  8. premedicate before meals
96
Q

what should a person avoid with diverticulitis?

A

nuts
fruits with seeds
no fiber with acute inflammation

97
Q

s+s of Chron’s (9)

including lab findings

A
  1. cobblestone appearance
  2. abd pain (RLQ + umbilicus)
  3. steatorrhea
  4. fistula + abscess (fever)
  5. weight loss
  6. diarrhea
  7. deficiencies in folic acid + B12 + electrolytes
  8. low H+H
  9. low albumin
98
Q

priority of care for pt with influenza

A

= supportive

  1. O2 PRN
  2. raise HOB
  3. fluids
  4. ABX if needed
  5. antipyretics
  6. rest
99
Q

what precautions should person with influenza be on?

A

droplet

100
Q

some complications of chronic bronchitis (5)

A
  1. mucus/congestion
  2. infection
  3. impaired gas exchange
  4. dysrhythmias
  5. cor pulmonale
101
Q

common cause of stress incontinence + what is intervention?

A
  1. pregnancy
  2. obesity
  3. low estrogen (loss of tone in pelvic floor)
    = weak pelvic floor muscles

intervention: kegel (strengthen pelvic floor)

102
Q

common cause of overflow incontinence + what is intervention?

A

obstruction (BPH)

intervention: remove obstruction, pharmaceuticals

103
Q

common cause of urge incontinence + what is intervention?

A

bladder irritants

intervention: avoid irritants + train bladder

104
Q

common cause of functional incontinence + what is intervention?

A

loss of functional or cognitive ability - cannot get to toilet in time

intervention: treat cause, indwelling catheter, habit training, help people get to toilet, containment

105
Q

what diagnostic tool for consciousness would we used for stroke patient?

A

Glasgow coma scale

15 = highest score = fully awake patient

106
Q

what diagnostic tool could be used to determine the deficits after a stroke?

A

NIH SS

107
Q

PNA manifestations (10)

A
  1. crackles
  2. chest pain/dyspnea
  3. SHOB
  4. fever (maybe)
  5. malaise
  6. tachypnea
  7. tachycardia
  8. chills
  9. hypoxia
  10. cough
108
Q

PNA interventions (10)

A
  1. raise HOB
  2. O2 therapy if needed
  3. ABX
  4. antipyretics
  5. fluids
  6. rest
  7. hand hygiene
  8. oral care
  9. pulmonary hygiene
  10. mobility

Med Surg I (6 decks)

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