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Med Surg > Final Review > Flashcards

Final Review Flashcards

1
Q

Preoperative steps

A

Teaching
Consent
Site marking
NPO
Psychosocial

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2
Q

Preoperative history

A

Age
General health status
Review of systems
Medical hx (current medical problems and tx, allergies and sensitivities, hx of prostheses)
Surgical hx including past surgeries, anesthesia, and post surgical pain control
Social history (tobacco, alcohol, drugs, current medications, alternative therapies
Family history
Psychosocial status
Cultural or spiritual needs

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3
Q

Post operative phase

A

Handoff
Airway
Vs
Fluids
LOC
I/O
Bowels

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4
Q

Postoperative complications (8)

A

Fluid deficits
Shock
Hemorrhage
DVT
Constipation
Pain
Dehiscence
Evisceration

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5
Q

Postoperative intervention

A

Teaching
Wound management
Pain management
Breathing exercises

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6
Q

Purpose of isotonic fluids

A

Give to increase volume

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7
Q

Examples of a isotonic fluids

A

0.9% normal saline
5% dextrose in water
5% dextrose in 0.225% water
Lactated Ringers

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8
Q

Purpose of hypertonic fluids

A

Use cautiously to correct imbalance (can cause fluid overload)

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9
Q

Examples of hypertonic fluids

A

Any saline over 0.9 %
Any dextrose over 5%, or 5% with any saline, or with Lactated Ringers

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10
Q

Purpose of hypotonic fluids

A

Replace fluids in DKA when blood is hypertonic, not for hypovolemia

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11
Q

Sodium limits

A

Na 136-145

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12
Q

Low sodium intervention

A

Watch for seizure
Give diuretics
Restrict fluids

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13
Q

High sodium interventions

A

Replace Na
Oral hydration

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14
Q

Potassium range

A

3.5 - 5

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15
Q

Low potassium interventions

A

ECG
K supplement
Slow infusion via pump

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16
Q

High Potassium interventions (4)

A

Safety
Kayexalate
Insulin
Glucose

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17
Q

Calcium range

A

9 - 10.5

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18
Q

Low calcium interventions (3)

A

IV administration
Vitamin D (needed to absorb Ca)
Seizure/fall precautions

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19
Q

High calcium interventions (5)

A

Stop diuretics
Stop vitamin D
Stop calcium
Rehydrate
Cardiac monitoring

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20
Q

Magnesium range

A

1.3 - 2.1

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21
Q

Low Magnesium interventions

A

Stop diuretics
Administer replacement
Monitor for Safety / LOC

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22
Q

High magnesium interventions

A

Diuretics
Fluids
Lower Na level
Monitor EKG

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23
Q

Chloride Range

A

99 - 106

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24
Q

Low Chloride interventions

A

Hypertonic IV
I/O
Labs
Restrict water

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25
Q

High chloride interventions (4)

A

Hypotonic fluids
Limit Na
Monitor LOC
Monitor I/O

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26
Q

Phosphate range

A

3 - 4.5

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27
Q

Low phosphate interventions

A

Vs
Neuro signs
Avoid Phosphate binding antacids

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28
Q

High phosphate intervention

A

Monitor for signs of low calcium

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29
Q

Types of IV access (7)

A

Peripheral
Midline
PICC
Tunneled
Nontunneled
Ports
HD catheters

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30
Q

24-26 gauge catheters
Indication and flow rate

A

Preferred for infants and small children
Not ideal for viscous infusions
Expect blood transfusion to take longer
24 mL/hr

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31
Q

22 gauge catheter
Indication and flow rate

A

Adequate for most therapies
Blood can infuse without damage
38 mL/min

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32
Q

20 gauge (1 - 1.25 inch length) catheter
Indications and flow rate

A

Adequate for all therapies
Most providers of anesthesia prefer at least this large for surgery
65 mL/min

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33
Q

18 gauge catheter
Indications and flow rate

A

Preferred for surgery
Vein must be large enough to accommodate catheter
110 mL/min

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34
Q

14-16 gauge catheter
Indications and flow rate

A

For trauma and surgical patients requiring rapid fluid resuscitation
Needs to be in a vein that can accommodate
Over 200 mL/min

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35
Q

Midline catheter gauge, length

A

2 to 5 Fr, sometimes 18 to 22 gauge, double or single lumen
3 to 8 inches long

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36
Q

Midline catheter site

A

Above antecubital fossa in basilic vein

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37
Q

Advantages of midline catheter

A

Reduce patient discomfort by reducing # of attempts at vein puncture for infusion or lab draws
Possible when shorter peripheral iv catheters won’t work due to skin integrity or limited peripheral veins

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38
Q

Midline catheter indications

A

IV fluid or drug therapy for 6-14 days

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39
Q

Sign of CSF leak after nasal hypophysectomy

A

Yellow edge around nasal discharge

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40
Q

Indication of arterial ulcer

A

Lack of hair
Thickened toenails
Diminished pedal pulse

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41
Q

Position for surgery for nasogastric ulcer

A

Semi-Fowler because it localizes spilled stomach contents and is best for comfort and breathing

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42
Q

Sign of heart failure

A

Dypsnea on exertion

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43
Q

Foods high in calcium

A

Cream, milk
Cheese
Orange juice
Broccoli
White meat chicken
Spinach

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44
Q

Calcium level that stimulates release of parathyroid hormone

A

Low; Below 9 mg/dL

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45
Q

Priority intervention in sepsis

A

Antibiotics

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46
Q

Diagnose fever, redness, skin breakdown, inflammation, an area that is edematous with diffused borders

A

Cellulitis

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47
Q

How is vitamin B12 (cyanocobalamin) administered for patients with pernicious anemia?

A

Weekly or Monthly injection (patients with pernicious anemia lack intrinsic factor so can’t absorb vitamin B12)

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48
Q

Parathyroid d/o with n/v, weight loss, epigastric pain because of what electrolyte imbalance?

A

Hypercalcemia

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49
Q

Thyrotoxic crisis (thyroid storm) causes what symptoms (3)

A

Pyrexia
Tachycardia
Exaggerated sx of thyrotoxicosis

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50
Q

Causes of thyrotoxic crisis (thyroid storm)

A

Surgery
Infection
Ablation therapy

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51
Q

Bleeding precautions

A

Electric razors only
Soft bristle toothbrush
No contact sports

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52
Q

Interventions (5) when client on anticoagulant

A
  1. Medical alert bracelet
  2. Bleeding precautions
  3. No estrogen therapy
  4. Get routine prothrombin time (PTT)
  5. Notify HCPs of anticoagulation
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53
Q

ST segment elevation emergency?

A

Yes. Called STEMI segment elevation myocardial infarction. Must go to cardiac catheterization lab for percutaneous coronary intervention within 90 minutes

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54
Q

Sharp pain with deep inspiration

A

Pericarditis or pleural effusion

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55
Q

Highest priority for patient with moderate substernal chest pain not relieved by rest and nitroglycerin

A

Get 12 lead electrocardiogram (ECG)

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56
Q

Intervention after PEG tube feeding

A

Elevate head of bed

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57
Q

Why early ambulation after surgery

A

Prevent blood from pooling in legs, thus preventing clots

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58
Q

Patient refuses hemoglobin, which may cause death if not given. What is best action by nurse

A

Notify HCP

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59
Q

Risk factors for women developing osteoporosis

A

Cigarette smoking
Familial disposition
Inadequate dietary calcium

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60
Q

Check for subcutaneous emphysema in patients with chest tube by_______?

A

Palpate around tube insertion site for crepitus

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61
Q

Sx of hypovolemia (4)?

A

Decreased urine
Hypotension
Dry mucous membranes
Poor skin turgor

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62
Q

Signs of pulmonary edema (4)

A

Crackles
Coughing
Orthopnea
Pulmonary interstitial edema

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63
Q

Left ventricular failure s/s

A

Dypsnea
Crackles
Frequent cough

No peripheral edema in left ventricular f.
No jugular vein distention in L ventricular failure

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64
Q

Right ventricular failure s/s

A

Pulmonary edema
Jugular vein distention

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65
Q

Dehydration s/s

A

Oliguria
Hypotension
Tenting skin turgor

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66
Q

Priority action if patient has hx of heart failure

A

O2 <90%: oxygenate
Crackles at bases of lungs: Diuretic

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67
Q

NG tube intervention before giving meds to prevent aspiration

A

Verify placement of tube

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68
Q

Teaching for client with intermittent claudification

A

Assess feet daily for injuries

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69
Q

Expected symptom for patient with varicose veins

A

Feeling of heaviness in legs

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70
Q

TSH range

A

0.3 - 5

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71
Q

T3 (age 20-50)

A

70 - 205

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72
Q

T3 over age 50

A

40 - 180

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73
Q

T4

A

4 - 12

(Females 5 - 12)

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74
Q

T4 over age 60

A

5 - 11

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75
Q

Free T4

A

0.8 - 2.8

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76
Q

What causes Heberden nodes?

A

Osteoarthritis

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77
Q

Deformities caused by rheumatoid arthritis (3)

A

Ulnar drift
Swan-neck deformity
Boutonnière deformity

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78
Q

Client consideration for rheumatoid arthritis

A

Comfort (minimize pain)

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79
Q

Patient has gastric ulcer causing metabolic alkalosis. Primary concern?

A

Electrolyte imbalance

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80
Q

Sign of functionality in water seal system

A

Fluid rises with inspiration and falls with expiration

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81
Q

Signs of hyperkalemia (high potassium)

A

Muscle weakness
Irregular heart rhythm
Hyperactive bowel tones

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82
Q

Hypertension sign

A

Severe pounding headache

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83
Q

Transurethral resection of prostate after care for urine

A

Indwelling urinary catheter for at least one day

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84
Q

First priority post thyroidectomy

A

Monitor for signs of respiratory obstruction

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85
Q

Patient just started transfusion of packed red blood cells reports chest pain, flank pain, difficulty breathing, & chills. What is happening?

A

Hemolytic reaction

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86
Q

Priority action if suspected anaphylaxis

A

Airway / oxygenation

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87
Q

Dark skinned client with grey tongue and lips

A

Cyanosis

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88
Q

Signs of cor pulmonale (R sided HF caused by pulmonary hypertension secondary to COPD)

A

Neck vein distension
Lower extremity edema
R upper quadrant abdominal tenderness
Elevated B-type natriuretic peptide (BNP)
Hepatomegaly causes R upper quad tenderness
High BNP caused by atrial enlargement

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89
Q

Decrease Dypsnea in patient with acute emphysema episode

A

Teach pursed lip breathing to prolong exhalation, which prevents bronchiolar collapse and air trapping

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90
Q

Left ventricular failure sign

A

Dypsnea on exertion

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91
Q

Left sided stroke sx

A

Slow performance and caution
Impaired speech/language aphasia
Awareness of deficit with depression and anxiety

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92
Q

Glaucoma teaching

A

Therapy needed for rest of life

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93
Q

Why low sodium diet if have HF

A

Decreased fluid retention

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94
Q

Besides sodium, most serious electrolyte depletion in older adults with diarrhea

A

Potassium

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95
Q

Intervention if serum ammonia elevated

A

Observe for increasing confusion

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96
Q

Hypoglycemia signs

A

Palpitations
Tachycardia
Nervousness
Cool moist skin

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97
Q

Hematocrit range

A

37-52%

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98
Q

Hemoglobin range

A

12-18

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99
Q

Sudden waking at night. With shortness of breath

A

Paroxysmal nocturnal dypsnea

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100
Q

After insertion of central venous catheter, client reports chest pain and dypsnea with decreased breath sounds on left side. Intervene

A
  1. Admin prescribed oxygen
  2. Activate Rapid Response Team
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101
Q

Polycythemia

A

Elevated hemoglobin and/or hematocrit

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102
Q

Signs of end stage kidney disease

A

Anemia from decreased production of erythropoietin by kidneys
Dypsnea caused by fluid overload

103
Q

Labs showing renal impairment

A

Elevated creatinine
Elevated potassium
Elevated BUN

104
Q

Med to withhold if diabetic patients getting CT with contrast

A

Metformin

105
Q

Obstructive jaundice signs

A

Dark or tea colored urine
Yellow skin
Clay colored stool

106
Q

Position after cardiac catheterization via femoral insertion site

A

Supine for 4 hours; avoid hip flexion

107
Q

Evaluate epoetin response with what lab value?

A

Hemoglobin

108
Q

Prothrombin Time (PT) range

A

11-12.5 seconds

109
Q

INR range (no anticoagulant)

A

0.8-1.1

110
Q

INR range (afib, dvt, pe)

A

2-3

111
Q

INR range (prosthetic heart valve)

A

3-4 seconds

112
Q

aPTT range

A

30-40 seconds

113
Q

PTT range

A

60-70 seconds

114
Q

Platelet range

A

150-400 x 10 to the third

115
Q

Tunneled central venous catheter

A

Surgically implanted VAD used for long-term infusion therapy in which the catheter lies in a subcutaneous tunnel, separating the points where the catheter enters the vein from where it enters the skin

116
Q

Nontunneled central venous catheter

A

Multi-lumen VAD inserted percutaneously through the subclavian or jugular vein

117
Q

When to check peripheral iv

A

At least every shift
Every 4 hours if continuous infusion
Every 1-2 hrs if critically ill or cognitive deficits
More often if receiving vesicant meds

118
Q

HANDS mnemonic for IV insertion

A

H hygiene: wash hands and skin of pt; use gloves

A antisepsis: prep with skin antiseptic w/back and forth motion for 30 seconds, allow to dry

N no-touch technique: do not touch after cleaning

D document: assessment of site, dressing, tubing; ensure date is clear for all infusion sites

S scrub the hub: scrub for at least 15 sec before accessing

119
Q

Central venous therapy

A

Long flexible tube inserted in neck, chest, arm, or groin leading to vena cava (empties into heart)
Emergency or long term

120
Q

IV access complications (4)

A

Infiltration
Extravasation
Phlebitis
Infection

121
Q

Intervention for prevention of IV complications

A

Arm board
Stabilization
Site selection
Vesicant recognition
Check blood return

122
Q

Shingles risk factors

A

Immunocompromised
Stress
Varicella

123
Q

Shingles sequence of inflammatory response (6 phases)

A
  1. Pain
  2. Redness
  3. Vesicles
  4. Weeping
  5. Crusting
  6. Post-herpetic neuralgia
124
Q

Shingles treatment

A

Acyclovir

125
Q

Shingles nursing intervention (7)

A
  1. Prevent spread
  2. Monitor vesicles
  3. Provide comfort
  4. Administer meds
  5. Compresses as needed
  6. Support
  7. Educate re: vaccine
126
Q

Shingles restrictions

A

Contact
Avoid contact w/pregnant staff, visitors

127
Q

Cellulitis risk factors

A

Diabetes mellitus
Malnutrition
Substance abuse
Obesity
Edema
Older adults
Recent surgery

128
Q

Cellulitis sx

A

Red
Warm
Swelling
Fever
Tender
Diffuse borders

129
Q

Cellulitis intervention

A
  1. Rule out DVT by getting culture (before antibiotics
  2. Outline border with pen
  3. Moist dressing
  4. Teach wound care
  5. Teach s/s to report
130
Q

Cellulitis treatment

A

Cephalexin, pain management

131
Q

signs of acute Osteomyelitis

A

Fever
Swelling
Heat
Tender w/movement

132
Q

Signs of chronic osteomyelitis

A

Ulcer
Bone surgery
Sinus tract
Abscess

133
Q

Osteomyelitis treatment priority

A

Antibiotics (long course that will need to continue at home (teach patient, caregiver, or get VNA)

134
Q

Osteomyelitis teaching

A

Antibiotic administration
Wound care
What to report

135
Q

Osteomyelitis post op considerations

A

Amputation may be necessary (provide support)
Neurovascular assessment
Distal pulses
Capillary refill
Elevation
Wound care

136
Q

Rheumatoid arthritis pathophysiology

A

Inflammatory autoimmune process that affects synovial joints

137
Q

Rheumatoid arthritis cause

A

Environment or genetics

138
Q

Rheumatoid arthritis symptoms

A

Weakness
Fatigue
Morning stiffness
May be disability

139
Q

Rheumatoid arthritis diagnosis

A

Elevated ESR
Rheumatoid factors
Antinuclear antibody test (ANA)
X-ray & MRI changes

140
Q

Rheumatoid arthritis treatment

A

NSAIDs
Biologics
Immunosuppressants
Prednisone
Promote mobility and self esteem

141
Q

osteoarthritis patho

A

Deterioration of bone cartilage

142
Q

Osteoarthritis cause

A

Wear and tear

143
Q

Osteoarthritis sx

A

Joint pain and stiffness that is relieved by rest

144
Q

Osteoarthritis diagnosis

A

Structural change on X ray

145
Q

Osteoarthritis treatment

A

NSAIDs
Acetaminophen
Joint replacement

146
Q

Gout patho

A

Recurrent error in purine metabolism

147
Q

Gout cause

A

Urate crystals in joints

148
Q

Gout sx

A

Pain, especially big toe
Tophi (enlarged joints from uric acid crystals)

149
Q

Gout treatment

A

NSAIDs
Prednisone (taper)
Allopurinal (if chronic)
Colchicine (acute attack)
Avoid triggers (alcohol, high protein foods, seafood)

150
Q

Joint replacement teaching

A

Expected post op exercises

151
Q

Joint replacement monitoring

A

VS
LOC
Pain
Neurovascular signs
Incision
Bowels

152
Q

Joint replacement complications

A

DVT
PE
Infection
Pain
Joint dislocation (shortening, pain at groin, internal rotation)

153
Q

Joint replacement intervention

A

Remove foley within 24 hours to prevent UTI
Consider geriatric pain dosing

154
Q

Pneumonia sx

A

Fever
Chills
Cough
Sputum
Tripod position
Crackles and/or decreased breath sounds
Dull percussion
Tachycardia
Tachypnea

155
Q

Pneumonia diagnosis

A

Look at sputum
X-ray
CBC
ABG

156
Q

Pneumonia treatment

A

O2
IS
Bronchodilators
Steroids
Antibiotics
Fluids
Rest

157
Q

Pneumonia teaching

A

Vaccinations
What to report

158
Q

COPD patho

A

Emphysema is hyperinflation of lung: obstructive
Chronic bronchitis is inflammation of lung

159
Q

COPD risk factors

A

Smoking
Genetics
Occupational exposure

160
Q

COPD sx

A

Wheezing
Fatigue
Hypoxia
Clubbing
Tripod position
Barrel chest
Shallow breathing
Increased work of breathing
Polycythemia (compensating w/ increased # of RBCs

161
Q

COPD diagnosis

A

Chest X-ray
Sputum sample
PFT (pulmonary function test)
CBC
ABG

162
Q

COPD treatment

A

Bronchodilator
Steroid
Expectorant
Anxiolytic / anxiety reduction
Antibiotics
Weight management
O2 sat monitoring
Smoking cessation
Positioning

163
Q

Chest tubes indication and description

A

Allows for lungs to re-expand
3 chambers on system
Water seal stops bubbling when all air has passed out

164
Q

Chest tube intervention

A

-Check for tracheal alignment and report deviation from midline
-Auscultation: report puffiness or crackling
-Do not strip or clamp chest tube
-Empty drainage chamber before drainage reaches tube
-If tube falls out of patient, cover with dry sterile gauze
-if tube disconnects from system, put in sterile water and keep below chest

165
Q

Tracheostomy intervention

A

-Secure trach in place to prevent accidental decannulation
-preoxygenate before suctioning
-do not suction more than 10-15 sec
-humidify air
-support out of bed activity
-elevate head of bed after meals, speech eval as needed, small frequent meals
- support communication
- support psychosocial needs

166
Q

Right sided Heart failure causes

A

Left ventricular failure
Right ventricular MI
Pulmonary hypertension

167
Q

Right sided HF sx

A

Systemic congestion
Jugular vein distention
Enlarged liver and spleen
Edema
Weight gain
Polyuria at night
Distended abdomen

168
Q

Left sided heart failure causes

A

Hypertension
Coronary artery disease
Valvular disease

169
Q

Left sided HF sx

A

Fatigue
Weakness
Oliguria
Angina
Confusion
Dizziness
Pink sputum
Hacking cough (worse at night)

170
Q

HF interventions

A

Reduce Na in diet -3g / day
Fluid restriction
Daily weight: 1 kg=1L
Diuretics
MWADS Meds/Weight/Active/Diet/Sx
Teach when to report

171
Q

Angina characteristics

A

-Chest pain that occurs in familiar pattern with moderate to prolonged exertion
-doesn’t limit activity too much
-associated with/atherosclerosis

172
Q

Angina treatment

A

Rest
Nitroglycerin (NTG)
Rarely requires aggressive treatment

173
Q

Pulmonary Embolism patho

A

Inappropriate blood clot forms DVT in legs or pelvis, then breaks off

174
Q

Pulmonary embolism risk factors

A

Immobilization
Cardiovascular arterial disease
Surgery
Pregnancy
Obesity
Older
Smoking
Heart failure
Stroke
Cancer

175
Q

Pulmonary embolism sx

A

Anxiety
Impending doom
Dypsnea
Cough
Hemoptysis
Low PaCO2 on ABG

176
Q

PaCO2 range

A

35-45

177
Q

PE interventions

A

O2
Manage hypoxemia
Minimize anxiety
Control BP
Control bleeding/clot

178
Q

Anemia patho

A

Iron deficiency caused by inadequate iron intake

179
Q

Anemia s/s

A

Pallor
Cool
Fatigue
Shortness of breath

180
Q

B12 deficiency patho

A

Caused by vegan diets, diverticula, tapeworm, deficiency in intrinsic factor (pernicious anemia)

181
Q

B 12 deficiency s/s

A

Pallor
Jaundice
Glossitis
Paresthesia

182
Q

Iron deficiency anemia treatment

A

Increase iron supplements, take with meals (cause tarry black stools)

183
Q

B12 deficiency treatment

A

-Increase foods with B12
-SL better absorbed
-pernicious anemia, monthly IM injections

184
Q

Folic acid deficiency causes

A

Anticonvulsants
Alcoholism
Oral contraceptives

185
Q

Folic acid deficiency sx

A

Pallor, jaundice, fatigue

186
Q

Folic acid deficiency treatment/prevention

A

Diet rich in folic acid

187
Q

Aplastic anemia cause and treatment

A

Decreasing circulation RBCs, exposure to toxins;
Treat by cause, may get transfusion

188
Q

Blood transfusion policy

A
  1. 2 RNs verify
  2. Hemolytic reaction from incompatible blood (apprehension, chest pain, hypotension
  3. Allergic reaction: urticaria, itching, bronchospasm
  4. Assess for fluid overload
  5. Graft versus host disease reaction (occurs in immune suppressed patients)
189
Q

Acute kidney injury
onset and course

A

Sudden onset
-Oliguric phase: 1-7 days; daily output 400 mL
-Diuretic phase 1-3 weeks; output increases as kidney recovers 1-3 L per day;
-Recovery phase up to 12 months

190
Q

Acute kidney injury diagnosis

A

Decreased GFR (normal is >90mL/min
Increased Cr (norm is 0.5-1.2)
Increased BUN (norm is 10-20)

191
Q

GFR range

A

> 90

192
Q

Creatinine range

A

0.5-1.2

193
Q

BUN range

A

10-20

194
Q

Acute kidney injury intervention

A

-I/O
-Daily weight
-Urine output
-Fluid restriction
-Monitor labs GFR, BUN, Creatinine
-Careful with nephrotoxic meds (Metformin)
-nutrition
-psychosocial support
- may need renal replacement therapy

195
Q

Chronic kidney disease
onset and course

A

-Onset is gradual over years
-5 stages based on GFR:
— stage 1 >90
— stage 2 60-89
— stage 3 30-59
— stage 4 15-29
— stage 5 <15 (end stage)
-end stage requires dialysis and is anuric; little or no filtration

196
Q

Chronic kidney disease diagnosis

A

Decreased GFR
Increased Creatinine
Increased BUN
Significant waste accumulation

197
Q

Chronic kidney disease intervention

A

-Goal: improve cardiac Fx and manage fluid volume
-diet: low protein, low Na, low PO4, low K
-fluid restriction
Meds: loop diuretic, vit D, phosphate binders, iron support, erythropoietin support, avoid straining,
-AVOID Mg
-end stage requires dialysis

198
Q

Diabetes Mellitus
def and type

A

-DM is a disorder of impaired nutrient metabolism
-T1: beta cells don’t produce insulin
-T2: result of insulin resistance

199
Q

Hypoglycemia sx

A

Sweating, anxiety, hunger, neuro changes, dizziness

200
Q

Hyperglycemia sx

A

Polyuria
Polydipsia
Polyphagia
Fruity breath
Dry mouth
Shortness of breath

201
Q

DM patient ed.

A

Sick day rules
Medications
Insulin
Exercise
Possible complications
Foot care
Eye exams

202
Q

Hypopituitary treatment

A

Replacement

203
Q

Hyperpituitary treatment

A

Possibly from tumor,
hypophysectomy (surgery)

204
Q

Hypothyroid complication (extreme)

A

Myxedema coma

205
Q

Hyperthyroid complications

A

-Exopthalmos: eye bulges out of socket
-Graves disease : autoimmune disease

206
Q

Graves’ disease / hyperthyroidism sx

A

Irritability
Muscle weakness
Sleeping problems
Tachycardia
Poor tolerance of heat
Diarrhea
Weight loss

207
Q

GERD sx

A

Heartburn
Dyspepsia
Regurgitation
May be respiratory sx

208
Q

GERD complications

A

Esophagitis
Dental carries

209
Q

GERD
Diagnosis and treatment

A

-Diagnosis: EGD (upper endoscopy)
-treatment: PPIs (proton pump inhibitors), H2 receptor blockers
-avoid irritating foods

210
Q

Hiatal hernia sx and treatment

A

-Same as GERD (heartburn, dyspepsia, regurgitation) treated with (PPI and H2 receptor blockers)
-may also need surgery to reduce intra abdominal pressure and reduce the hernia

211
Q

Peptic Ulcer Disease (PUD) patho

A

Erosion of GI mucosa from HCl acid and pepsin;
May be gastric and/or duodenal

212
Q

PUD risk factors

A

H.pylori
NSAIDs
Smoking
Caffeine
Stress

213
Q

PUD complications

A

Hemorrhage
Perforation
Obstruction
Intractable disease

214
Q

PUD upper GI bleed (Gastric) sx

A

Hematemisis
Malnourished
Sx occur after meals
Food makes worse

215
Q

PUD Lower GI bleed (Duodenal)

A

Melena (passes through GI tract)
Patient tolerates meals; food alleviates

216
Q

PUD treatment

A

Triple therapy
1. PPI
2. Antibiotics
3. EGD

217
Q

Upper GI bleed treatment

A

NPO
Endoscopy
NGT (nasogastric tube)
IV fluids
PPI
Blood replacement
O2 support

218
Q

Diverticulitis patho

A

Sacular dilations in colon mucosa

219
Q

Diverticulitis risk factors

A

Constipation
Lack of dietary fiber

220
Q

Diverticulitis complications

A

Inflammation
Abscess

221
Q

Diverticulitis prevention

A

High fiber diet
Diet low in red meat and fat

222
Q

Diverticulitis treatment

A

-Fluids
-Avoid alcohol
-If acute inflammation, avoid fiber, avoid laxatives, avoid enemas
-patient may need bowel rest and surgery with temporary ostomy ( teach ostomy care, importance of psyllium laxatives)

223
Q

Cholecystitis patho

A

Inflammation of gall bladder
Possibly with stones (cholelithiasis)

224
Q

Cholecystitis risk factors

A

Female
Pregnancy
Obesity
DM
Estrogen
Sedentary
Fatty foods

225
Q

Cholecystitis sx

A

RUQ pain
Tachycardia
Jaundice
Fatty stools
Clay colored stools
Indigestion

226
Q

Cholecystitis medicine

A

Ursodeozycholic acid

227
Q

Cholecystitis diagnostic and procedure

A

ERCP
May need shockwave therapy to break stones
Surgery may be needed to remove gallbladder

228
Q

Liver disease patho

A

Liver is body’s primary filter
Cirrhosis causes dysfunctional filtration

229
Q

Liver disease sx

A

-if compensated cirrhosis, patient may not look sick
-first sx is fatigue, weak, poor po intake, weight loss, n/v, mild pain/discomfort, fever
-later signs caused by accumulation of waste and ammonia include jaundice

230
Q

Seizure management (during seizure)

A

Safety is focus
Protect patient from injury
Don’t put things in patient’s mouth
Turn patient to side to prevent aspiration
Remove objects that may injure patient
Suction oral secretions without force
Loosen restrictive clothes
Guide movements, don’t restrain
Record time began and ended

231
Q

Parkinson disease patho

A

Neurodegenerative d/o

232
Q

Parkinson disease characteristics

A

T tremor at rest
R rigidity
A akinesia or bradykinesia
P postural changes

-also mask like facial expression

233
Q

Parkinson meds

A

Aimed at correcting imbalance of neurotransmitters by CNS
- first line carbidopa-levodopa must be given on time and w/out protein

234
Q

Parkinson intervention

A

Check airway
Check Swallowing
Teach energy conservation
Enable communication
Encourage independence
Refer to ancillary disciplines

235
Q

Stroke: TIA def

A

Transischemic attack; often precursor to more serious attack

236
Q

Stroke is emergency; intervention

A

F face (limp on one side?)
A arm (weak?)
S speech (abnormal difficulty?)
T time (get to stroke center ASAP)

237
Q

Stroke risk factor

A

Smoking
Obesity
DM
High Cholesterol

238
Q

Two types of stroke

A

-Ischemic (blockage prevents perfusion; thrombotic from atherosclerosis or embolic from clot reaching brain from elsewhere in body)
-Hemorrhagic (bleeding; sudden onset)

239
Q

Stroke on right side of brain effects

A

Impulsive
impaired judgment
Paralyzed left side

240
Q

Stroke on left side of brain effect

A

Impaired speech/language
Depression
Anxiety
Slow performance
Paralyzed right side

241
Q

Dementia intervention

A

Safety
Communication
Promote independence

242
Q

Dementia progression

A

-Sx may not be noticed at first stage
-Second stage: getting lost, wandering, disorientation, impaired ADLs
-final stage is total dependence
-

243
Q

Dementia medication

A

Donepezil to slow cognitive decline
Memantine to improve memory skills

244
Q

Cataracts sx

A

Blurry vision

245
Q

Cataracts cause

A

Age

246
Q

Cataract treatment

A

Surgery

247
Q

Cataract post surgery teaching

A

Keep IOP (introcular pressure) low:
-no lifting, bending, stooping, coughing

248
Q

Glaucoma patho

A

-Increased IOP leading to loss of peripheral vision;

249
Q

Acute angle glaucoma vs
Primary angle glaucoma

A

-Acute angle is Emergency with sudden pain
-primary angle glaucoma is gradual

250
Q

Glaucoma treatment and education

A

Drug therapy with eye drops
Teach eye administration and adherence to regimen

251
Q

Macular degeneration

A

Central vision loss
Affects all ADLs and IADLs
Teach eye protection

252
Q
A

Macular degeneration

253
Q
A

Glaucoma

254
Q
A

Retinopathy

Med Surg (4 decks)

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