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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
Cause of hepatic encephalopathy
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
26
s/s of hepatic encephalopathy
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)
27
tx for hepatic encephalopathy
lactulose
28
monitor for with hepatic encephalopathy
potassium lab | lactulose makes you poop=K+
29
nursing considerations for pt with esophageal varicosities
keep NPO status
30
what are early signs of ICP
behavioral changes, pupillary response to light
31
monitor ______________ in a client post intracranial surgery
behavior changes
32
cushings triad s/s
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.
33
what causes cushing's triad?
due to ICP and lack of oxygen
34
difference between sepsis and cushings triad
sepsis looks like SOB, rapid HR, and confusion
35
SIADH s/s (soaked inside)
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
36
Diabetes Insipidous s/s (dried inside)
high output, hyperosmolarity, thirsty, low BP
37
nursing interventions with a Pt with seizures
put them on their side
38
seizure medication....
phenytoin
39
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?
client with facial drooping
40
Stroke signs
Face (facial droop) Arms (arm weakness) Speech (changes) Time (go to CT) facial droop, blurry vision, speech problems , hemiparesis
41
s/s with hemorrhagic stroke
increased BP High blood pressure and trauma are two leading causes. Taking blood-thinning drugs may also increase a person's risk.
42
what order does the nurse expect with a patient suspected with a stroke
CT scan without contrast
43
ischemic stroke medications (and time frame)
thrombolytics (alteplase, streptokinase) within 4 hours of symptoms starting
44
a patient is improving from an ischemic stroke if what is observed
neuro-assessment (speech, bilateral response in hands and feet)
45
a stroke patient was just approved to move to a pureed diet, what nursing intervention would you include for this patient?
encourage them to swallow their food with their chin to chest
46
drugs you give for ischemic stroke and not hemorrhagic stroke
streptokinase, alteplase (thrombolytics)
47
nursing interventions for patient experiencing a hemorrhagic stroke
quiet room, dim lights, rest - aneurysm can usually clot off
48
what is a hemorrhagic stroke patient at risk for early on
rebleeding
49
what is an indication that an aneurysm is rebleeding
increased BP
50
left stroke
language, learning
51
right stroke
judgement, behavior
52
physiologic signs of increased ICP
slow HR, increase in systolic BP, widening pulse pressure, hyperthermia, rise in body temp
53
widening pulse pressure
systolic gets higher and diastolic gets lower (bad when HR and RR also go down)
54
glasgow coma scale
glasgow coma scale
55
what medication would you expect to see for a patient in a coma
propofol
56
why would propofol be used for a patient in a coma
you can titrate the dose down to conduct a neuro exam and titrate it back up when you are finished
57
nursing interventions after giving propofol
elevate HOB to decrease ICP
58
epidural hemotoma
emergency
59
arterial epidural hematoma
bleeds fast, medical emergency, craniectomy is possible
60
subdural hematoma
slower to form and less serious than arterial hematomas
61
spinal cord injury assessment for patient
breathing pattern and strength of cough, changes in motor and sensory function, neuro exams, spinal shock assessment, temperature
62
complications of spinal cord injury
VTE and orthostatic hypotension
63
diagnostics for spinal cord injury
x-ray and CT scan
64
goal for spinal cord injury
improve breathing and airway, improve mobility, prevention of injury, maintenance of skin, relief of urinary retention, decrease pain
65
medical management for spinal cord injury
O2, corticosteroids, skeletal fracture reduction and traction
66
medication to give for spinal cord injury with muscle spasms
baclofen | BACK-o-flen
67
autonomic dysreflexia occurrence and s/s
pt with spinal cord injuries; sweating, shivering, shaking triggers include: UTI, urinary retention, kinks in a catheter
68
level C5 spinal cord injury
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
Promote independence in all neurological disease
Disuse MS Parkinson’s
70
s/s of head injury
increased ICP (posturing), high glucose, respiratory distress, LOC, fluid leakage
71
diagnostics for head injury
CT scan
72
medication for head injury
benzodiazepines (which is propofol), Lorazepam, and Medazalam
73
increased ICP s/s
altered mental status, LOC, drowsiness
74
increased ICP diagnostics
CT scan, avoid lumbar puncture
75
nursing interventions for increased ICP
elevate HOB, neuro assessment
76
meds for increased ICP
phenytoin (seizure prevention), dexamethasone (swelling), mannitol (for getting rid of extra fluid)
77
s/s of meningitis
headache, fever, high WBC, stiff neck, positive brudnizki sign, rash, disorientation
78
orders to anticipate for meningitis
neuro checks every 2 hours, droplet precautions if its bacterial, seizure precautions, daily weights
79
positive brudnizki sign
neck stiffness, causes pt hips and knees to flex when neck is flexed CALL PROVIDER
80
MS assessment, s/s, complications
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
MS flare up occurs when
hot weather, hot temperatures (avoid hot baths)
82
medication to give for muscle spasms for MS
baclofen
83
bells palsy s/s
facial paralysis, drooping of mouth, drooling, excessive lacrimation, painful sensation behind ears and eyes, speech difficulties
84
tx for bellys palsy
* NOTE: protect eye from injury prednisone, corticosteroids
85
tonic clonic seizure medication
phenytoin
86
tx for parkinsons
levodopa and cardidopa
87
T or F: a patient can be vomiting without nausea
true - this is bad; can be related to brain tumor
88
complications of parkinsons
aspiration, pneumonia, dysphagia, fall, sleep disturbance

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