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med surge > final exam med surge > Flashcards

final exam med surge Flashcards

1
Q

pre-op considerations

A
  • NPO prevents aspiration

* sleep apnea is a problem before a surgery

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2
Q

pre-op considerations before abdominal surgery

A

give them an enema to prevent peritonitis

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3
Q

during surgery, what does the nurse do if there is hypo-pharyngeal obstruction?

A

person cant breath, wheezing…. therefore tilt their head

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4
Q

what are s/s symptoms of anemia

A

cold, fatigue, low O2, low hbg levels

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5
Q

during a sickle cell disease crisis, what do you do?

A

give oxygen, hydrate patient, pain medications

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6
Q

postoperative postural hypotension nursing management

A

dangle legs before standing, stand upright before ambulation

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7
Q

low platelet levels indicate

A

thrombocytopenia

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8
Q

HIV to AIDS occurs when

A

CD4 count less than 200 and there is a detectable viral load

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9
Q

HIV s/s

A

fever, headache, muscle aches, rash

that is why people get confused with the flu!

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10
Q

AIDS patients are at risk for developing opportunistic infections such as…

A

pneumocystis pneumonia

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11
Q

what are s/s of anaphylactic shock

A

itching, rash, throat closing, low O2

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12
Q

first line drug for anaphylaxis

A

epinephrine

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13
Q

healthcare procedure most likely associated with anaphylaxis

A

CT scan with contrast

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14
Q

if a post-op patient with a cast feels warm under their case what should you do

A

elevate, assess, and reposition

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15
Q

RA s/s and tx

A

morning stiffness, bilateral pain, positive Rh factor, swelling/redness in joints

tx: passive ROM and low impact exercise, DMARDs (methotrexate or hydroxychloroquine)

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16
Q

gout s/s and tx

A

high levels of uric acid!

avoid high purine foods, avoid aspirin and alcohol, avoid intense weight loss

colchine (acute) and allopurinol (lowers uric acid)

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17
Q

candida s/s

A

Red, irritated skin; White curdlike plaques in mouth; Itching, burning, petechiae

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18
Q

NG tubes can go where

A

into the stomach or jejunum

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19
Q

mangement for a misplaced NG tube

A

sit the pt up straight

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20
Q

medication for indigestion

A

pantoprazole (PPI)

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21
Q

dumping syndrome s/s and tx

A

cramping, fullness, nausea, diaphoresis, diarrhea

slow down infusion, room temp infusion, limit water intake

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22
Q

viral gastritis s/s and managment

A

(bad hangover)
nausea, vomiting, dehydration, fever

place an NG tube, increase fluids, maintain NPO status, -azole meds (omeprazole, pantoprazole), cimetidine

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23
Q

cimetidine MOA

A

coats the stomach

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24
Q

what should you monitor for in a patient that had an appendectomy

A

peritonitis, urine output, pain medications, bowel sounds (before eating), ambulation

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25
Q

Cause of hepatic encephalopathy

A

ammonia

When you have liver disease, the liver struggles to filter natural toxins out of the body. Toxins, such as ammonia, accumulate in the blood. Toxins in the bloodstream can travel to the brain and temporarily (or sometimes permanently) affect brain function

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26
Q

s/s of hepatic encephalopathy

A

asterixis (a disorder in which a person loses motor control of some parts of the body),

mental status changes

Fetor hepaticus ( the characteristic breath of patients with severe parenchymal liver disease)

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27
Q

tx for hepatic encephalopathy

A

lactulose

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28
Q

monitor for with hepatic encephalopathy

A

potassium lab

lactulose makes you poop=K+

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29
Q

nursing considerations for pt with esophageal varicosities

A

keep NPO status

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30
Q

what are early signs of ICP

A

behavioral changes, pupillary response to light

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31
Q

monitor ______________ in a client post intracranial surgery

A

behavior changes

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32
Q

cushings triad s/s

A

bradycardia, irregular respirations, widened pulse pressure

note: Cushing’s triad refers to a set of signs that are indicative of increased intracranial pressure (ICP), or increased pressure in the brain. Cushing’s triad consists of bradycardia (also known as a low heart rate), irregular respirations, and a widened pulse pressure.

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33
Q

what causes cushing’s triad?

A

due to ICP and lack of oxygen

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34
Q

difference between sepsis and cushings triad

A

sepsis looks like SOB, rapid HR, and confusion

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35
Q

SIADH s/s (soaked inside)

A

no urine output (HIGH URINE SPECIFIC GRAVITY), high bP, edema, hypo-osmolality, seizures, headaches due to low sodium

CAUTION: headaches, confusion are a huge priority
LOW Na+ (135 or less) > Seizures> DEATH

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36
Q

Diabetes Insipidous s/s (dried inside)

A

high output, hyperosmolarity, thirsty, low BP

37
Q

nursing interventions with a Pt with seizures

A

put them on their side

38
Q

seizure medication….

A

phenytoin

39
Q

four patients on the unit need to be seen:
- patient with MS who is incontinent
- client with a high BG level
- client with lower leg burns and a temp of 99
- client with new facial drooping
who do you see first?

A

client with facial drooping

40
Q

Stroke signs

A

Face (facial droop)
Arms (arm weakness)
Speech (changes)
Time (go to CT)

facial droop, blurry vision, speech problems , hemiparesis

41
Q

s/s with hemorrhagic stroke

A

increased BP

High blood pressure and trauma are two leading causes. Taking blood-thinning drugs may also increase a person’s risk.

42
Q

what order does the nurse expect with a patient suspected with a stroke

A

CT scan without contrast

43
Q

ischemic stroke medications (and time frame)

A

thrombolytics (alteplase, streptokinase) within 4 hours of symptoms starting

44
Q

a patient is improving from an ischemic stroke if what is observed

A

neuro-assessment (speech, bilateral response in hands and feet)

45
Q

a stroke patient was just approved to move to a pureed diet, what nursing intervention would you include for this patient?

A

encourage them to swallow their food with their chin to chest

46
Q

drugs you give for ischemic stroke and not hemorrhagic stroke

A

streptokinase, alteplase (thrombolytics)

47
Q

nursing interventions for patient experiencing a hemorrhagic stroke

A

quiet room, dim lights, rest - aneurysm can usually clot off

48
Q

what is a hemorrhagic stroke patient at risk for early on

A

rebleeding

49
Q

what is an indication that an aneurysm is rebleeding

A

increased BP

50
Q

left stroke

A

language, learning

51
Q

right stroke

A

judgement, behavior

52
Q

physiologic signs of increased ICP

A

slow HR, increase in systolic BP, widening pulse pressure, hyperthermia, rise in body temp

53
Q

widening pulse pressure

A

systolic gets higher and diastolic gets lower (bad when HR and RR also go down)

54
Q

glasgow coma scale

A

glasgow coma scale

55
Q

what medication would you expect to see for a patient in a coma

A

propofol

56
Q

why would propofol be used for a patient in a coma

A

you can titrate the dose down to conduct a neuro exam and titrate it back up when you are finished

57
Q

nursing interventions after giving propofol

A

elevate HOB to decrease ICP

58
Q

epidural hemotoma

A

emergency

59
Q

arterial epidural hematoma

A

bleeds fast, medical emergency, craniectomy is possible

60
Q

subdural hematoma

A

slower to form and less serious than arterial hematomas

61
Q

spinal cord injury assessment for patient

A

breathing pattern and strength of cough, changes in motor and sensory function, neuro exams, spinal shock assessment, temperature

62
Q

complications of spinal cord injury

A

VTE and orthostatic hypotension

63
Q

diagnostics for spinal cord injury

A

x-ray and CT scan

64
Q

goal for spinal cord injury

A

improve breathing and airway, improve mobility, prevention of injury, maintenance of skin, relief of urinary retention, decrease pain

65
Q

medical management for spinal cord injury

A

O2, corticosteroids, skeletal fracture reduction and traction

66
Q

medication to give for spinal cord injury with muscle spasms

A

baclofen

BACK-o-flen

67
Q

autonomic dysreflexia occurrence and s/s

A

pt with spinal cord injuries; sweating, shivering, shaking

triggers include: UTI, urinary retention, kinks in a catheter

68
Q

level C5 spinal cord injury

A

autonomic dysreflexia
flaccid in all extremities, client develops muscle contractures, diaphoretic and lightheaded when raising HOB; monitor BP

would you give a patient a bolus every time you stand them if they get dizzy?… NO!

69
Q

Promote independence in all neurological disease

A

Disuse
MS
Parkinson’s

70
Q

s/s of head injury

A

increased ICP (posturing), high glucose, respiratory distress, LOC, fluid leakage

71
Q

diagnostics for head injury

A

CT scan

72
Q

medication for head injury

A

benzodiazepines (which is propofol), Lorazepam, and Medazalam

73
Q

increased ICP s/s

A

altered mental status, LOC, drowsiness

74
Q

increased ICP diagnostics

A

CT scan, avoid lumbar puncture

75
Q

nursing interventions for increased ICP

A

elevate HOB, neuro assessment

76
Q

meds for increased ICP

A

phenytoin (seizure prevention), dexamethasone (swelling), mannitol (for getting rid of extra fluid)

77
Q

s/s of meningitis

A

headache, fever, high WBC, stiff neck, positive brudnizki sign, rash, disorientation

78
Q

orders to anticipate for meningitis

A

neuro checks every 2 hours, droplet precautions if its bacterial, seizure precautions, daily weights

79
Q

positive brudnizki sign

A

neck stiffness, causes pt hips and knees to flex when neck is flexed

CALL PROVIDER

80
Q

MS assessment, s/s, complications

A

neurologic deficits and impact of disease, fall risk assessment, weakness, spasticity, visual impairment, incontinence, swallowing or speech impairment

COMPLICATIONS constipation, aspiration, cognitive changes, urinary incontinence

S/S- optic neuritis, fatigue, intention tremors, unsteady gait, fall risk, suicide risk

81
Q

MS flare up occurs when

A

hot weather, hot temperatures (avoid hot baths)

82
Q

medication to give for muscle spasms for MS

A

baclofen

83
Q

bells palsy s/s

A

facial paralysis, drooping of mouth, drooling, excessive lacrimation, painful sensation behind ears and eyes, speech difficulties

84
Q

tx for bellys palsy

A
  • NOTE: protect eye from injury

prednisone, corticosteroids

85
Q

tonic clonic seizure medication

A

phenytoin

86
Q

tx for parkinsons

A

levodopa and cardidopa

87
Q

T or F: a patient can be vomiting without nausea

A

true - this is bad; can be related to brain tumor

88
Q

complications of parkinsons

A

aspiration, pneumonia, dysphagia, fall, sleep disturbance

med surge (5 decks)

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