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Medical Surgery Nursing > Med Surg > Flashcards

Med Surg Flashcards

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1
Q

To reduce the risk of HIV health care workers should…

A
  • Hand hygiene
  • wear PPE (gown, glove, mask)
  • DO NOT recap needles, if necessary usr scoop technique ONLY
  • put sharps in puncture proof container
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2
Q

What is the CDC criteria for AIDS diagnosis?

A
  • Lab confirmation

- CD4 t-lymphocytes less than 200 mcL or CD4 less than 4%

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3
Q

What are the early HIV symptoms?

A
  • 1st stage may be asymptomatic

- may show S&S of skin rash and fatigue

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4
Q

New diagnosed AIDS home care consist of…

A

Educating self-care

  • avoiding transmission
  • personal hygiene
  • avoiding smoking, alcohol, OTC and other street drugs
  • caregiver taught hot to administer drugs
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5
Q

HIV continuing care consist of…

A
  • Home health nurse maybe needed
  • complex wound care and respiratory care may be needed
  • home care and hospice nurse may be needed
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6
Q

Nursing intervention for Advanced AIDS- altered thought processes?

A
  • Assess mental status and neurological function
  • asses for medical interaction, infection, electrolyte imbalance, and depression
  • frequently orient patient to time place person reality and environment
  • use simple explanations
  • instruct the patient to perform task in incremental steps
  • give memory aids (clocks and calendars)
  • memory aids for medications
  • post activity schedule
  • give positive feedback
  • educate caretakers on time place person etc
  • encourage patient to choose a power of attorney
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7
Q

What does CD4 count less than 400 mean?

A

CD4 count serves as major lab indicator of immune function and deciding whether to initiate ART therapy and prophylaxis for opportunistic infections

-CD4

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8
Q

ART considerations…

A
  • ART targets stages of HIV life cycle
  • patient MUST take more than 1 med which causes non-comp
  • side effects cause non-comp as well
  • regular labs required to evaluate effectiveness of ART for patient
  • Adverse effects include
    • hepatotoxicity
    • nephrotoxicity
    • osteopenia
    • risk of CV disease and MI
  • Can cause dyslipedemia and insulin resistance (risk for heart disease and diabetes)
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9
Q

How do you prevent contracting HIV?

A
  • Preventive education (use condoms and avoid risky sexual behaviors)
  • Reproduction education (prevent transmission to infants in utero)
  • Dont share needles
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10
Q

Radical Mastectomy nursing interventions…

A

Pre-op

  • Educate and prep
  • Reduce fear and anxiety
  • promote autonomy and decision making

Post-op

  • Relieve pain and discomfort
  • manage post-op sensations
  • promote positive body image, adjustment, and coping
  • improve sexual function
  • NO BP, VENIPUNCTURE, OR IV on side of mastectomy
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11
Q

What is the breast cancer psychological impact?

A
  • difficulty making treatment decisions
  • fear of pain, mutilation, loss of attractiveness, fear caring for self and family, concern about missing work, coping with uncertain future
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12
Q

What to do for post op hysterectomy?

A
  • Relieve anxiety
  • improve body image; reassure patient that she can still have sex after temporary abstinence allowing tissue to heal.
  • relieving pain
  • monitor complications (Hemorrhage, VTE, and bladder dysfunction) may need catheter if having difficulty voiding
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13
Q

What are the BPH assessment findings if they have urine retention? (irritative)

A

BPH is slow enlargement of prostate gland, enlarging causes hypertrophy that causes prostate to obstruct bladder and urethra causing urinary retention and cause UTIs

  • Nocturia (waking up to pee)
  • urgency and urinary frequency
  • dysuria
  • bladder pain
  • incontinence
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14
Q

What are the BPH assessment findings if they have urine retention? (obstructive)

A
  • decrease in force of urinary symptoms
  • difficulty to initiating voiding
  • intermittency- starting and stopping several times
  • dribbling at the end of urination
  • all symptoms are due to urinary

chronic urinary retention
large residual volumes lead to azotemia (accumulation of waste products) and kidney failures

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15
Q

What is the Post-Op care for TURP (Trans Urethral Resection of the Prostate)?

A
  • maintain fluid balance
  • relieving pain
  • Monitor for complications (hemorrhage, infection, VTE, potential cath problems, urinary incontinence, sexual dysfunction
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16
Q

BPH patient will have….

A
  • a catheter (single of triple lumen)
  • bladder irrigation
  • nurse should note color of drainage (should be light pink with no clots)
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17
Q

When are health care workers most at risk to contract HIV?

HIV is spread through….

A

HIV is transmitted through body fluids

  • blood
  • seminal fluid
  • amniotic fluid
  • breast milk
  • vaginal secretions
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18
Q

Nursing management of BPH…

A
  • good peri care to prevent infection
  • blood clots expected first 24-36 hrs
  • large amount of blood could hemorrhage
  • no activities that increase abdominal pressure (sitting, walking prolonged periods, and straining during BM)
  • if bladder spasms happen, check cath for clots
  • cath removed 2-4 days after surgery
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19
Q

When catheter removed for BPH, patient should….

A
  • void on their own within 6 hours
  • poor sphincter tone, do kegal exercises (start and stop stream)
  • may take several weeks to achieve urinary continence
  • condom cath
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20
Q

What medications should be avoided when a patient has a history of BPH?

A

-AVOID anticholergenics, antihistamines, decongestants, and antidepressants (causes urine retention)

21
Q

What are the symptoms of anemia?

A
  • Tachycardia on exertion
  • Fatigue
  • dyspnea
  • chest pain
  • muscle pain
  • cramping
22
Q

What is iron deficiency?

A

decreased iron stores in the bone marrow, hemoglobin synthesis depressed, and erythrocytes are small and low in hemoglobin

23
Q

What labs should be monitored for patient with anemia and/or iron deficiency?

A

Hemoglobin, hematocrit, and iron

24
Q

What are nursing interventions for post-op thyroidectomy?

A
  • monitor for respiratory distress
  • have tracheostomy set, oxygen, and suction at bedside
  • limit patient talking, and assess hoarseness
  • monitor for laryngeal nerve damage
  • monitor for HYPOCALCEMIA and tetany which can be caused by trauma to the parathyroid
  • prepare to administer calcium gluconate for tetany
  • check for thyroid storm
25
Q

What is a Thyroid storm?

A

Very high levels of thyroid hormone (severe hyperthyroidism), seen in patients with GRAVES DISEASE.

  • drastically increased temperature
  • sweating
  • irregular heartbeat
  • delirium
  • weakness
  • jaundice
  • severely low BP
  • coma
26
Q

What are the signs of TETANY?

A
  • cardiac dysrhythmias
  • carpopedal spasms (trousseau sign)
  • dysphagia
  • muscle and abdominal cramps
  • positive chvostek’s (cheek) and trousseau signs (hand)
  • wheezing
  • seizures
27
Q

When would you use calcium gluconate?

A

When patient becomes HYPOcalcemic and there are signs of TETANY.

28
Q

What are the S&S for Hyperthyroidism?

A
  • irritability, agitation, and mood swings
  • tremors and nervousness
  • heat intolerance
  • weight loss
  • smooth soft skin and hair
  • tachycardia and A-Fib
  • diarrhea
  • EYEBALLS popping out (exophthalmos)
  • sweating
  • HYPERTENSION
  • enlarged thyroid gland (GOITER)
29
Q

What are the S&S for HYPOthyroidism?

A
  • lethargy and fatigue
  • intolerance to cold
  • weak, muscle ache, paresthesia
  • WEIGHT GAIN
  • dry skin, loss of body hair
  • bradycardia
  • constipation
  • puffiness and swelling around eyes
  • loss of memory
  • may or may not have goiter
30
Q

Nursing management of HYPOTHYROIDISM…

A

-Activity intolerance»> promote independence
-risk for temp imbalance»> provide extra clothing, discourage use of external heat source
-Constipation related to decreased GI function»>encourage fluids intake within limits
-ineffective breathing»> monitor RR, depth, pattern, O2 sat, and ABGs
Acute confusion»> reorient to time, place, person, etc. monitor for further changes
Myxedema and Myxedema coma»> severe HYPOthyroidism, difficulty arousing patient

31
Q

What is Myxedema?

A

Severe HYPOthyroidism that can be found in patients with Graves disease.

32
Q

What are the complications of Crohns disease?

A
  • intestinal obstruction
  • fluid and electrolyte imbalance
  • malnutrition and malabsorption
  • fistula and abscess formation
33
Q

What is C-Diff?

A

The most commonly identified agent in antibiotic diarrhea

  • loss of appetite
  • diarrhea
  • weight loss
  • severe abdominal pain
  • WASH with SOAP AND WATER EVERYTIME!!!
34
Q

How do you manage diarrhea?

A
  • monitor characteristics and pattern of diarrhea
  • get health history
  • stool samples
  • oral and IV rehydration
  • monitor electrolytes
35
Q

What are the findings of left-sided heart failure?

A
  • Crackles in the lungs (check sounds for congestion)
  • dyspnea
  • orthopnea
  • dry nonproductive cough
  • oliguria
36
Q

What are the findings for a patient with right-sided heart failure?

A
  • Edema (legs and sacrum)
  • jugular vein distention (JVD)
  • abdominal distention
  • hepatomegaly
  • splenomegaly
  • weight gain
  • swelling in fingertips and hands
37
Q

What labs should be monitored for CHF?

A
  • Serum electrolytes
  • BUN
  • Creatinine
  • liver function
  • TSH
  • CBC
  • BNP
38
Q

CHF medication teachings….

A 
ACE inhibitors
ARBs (angiotensin receptor blockers)
hydralazine and isosorbide
beta blockers
diuretics>>>remove fluid from body
digitalis>>> digoxin and can cause toxicity
39
Q

What pre-op labs should be watched?

A

CBC and electrolytes

40
Q

What medications need to be avoided prior to surgery?

A
  • Aspirin
  • corticosteroids (prednisone)
  • diuretics
  • phenthyazines (diazepam)
  • insulins
  • antibiotics
  • anticoagulants
  • thyroid hormone
  • opiods
41
Q

What are the post-op interventions?

A
  • assess the patient
  • maintain a patent airway
  • maintain CV stability (shock, hemorrhage, hypertension)
  • relieve pain and anxiety
  • determine readiness for PACU discharge
42
Q

What labs do you monitor for a patient with hypertension on diuretics?

A

Potassium

43
Q

If a patient starts a new antihypertensive, what do you need to assess?

A

Assess BP prior to giving med and check for orthostatic hypotension (systolic greater than 20 mmhg from original reading)

44
Q

What do you teach a patient with Hep B?

A
  • prevent transmission
  • recommend vaccination
  • avoid high risk behaviors
45
Q

What is jaundice?

A

condition where skin and eye sclera become yellow tinged or greenish yellow due to high billirubin levels.

46
Q

How do you assess for jaundice? what lab do you look at?

A

Check skin color and eye sclerae.

Monitor serum billirubin levels.

47
Q

What are the signs of severe Pancreatitis?

A
  • hypocalcemia (tetany)
  • severe abdominal and back pain
  • occurs 24 to 48 hours after heavy meal or alcohol ingestion
  • rigid boardlike abdomen
  • fever, jaundice, confusion
48
Q

What are the assessment findings for Fluid Volume Deficit?

A

-acute weight loss
-poor skin turgor
-concentrated urine
-prolonged cap refill
-decreased bp
thirst
muscle cramps
increased temp
cool, clammy, skin
increased osmolality, BUN, creatinine, and gravity

49
Q

What are the assessment findings for fluid volume overload?

A
  • acute weight gain
  • peripheral edema
  • distended jugular veins
  • crackles
  • SOB
  • increased BP
  • increased RR
  • increased urine output
  • decreased osmolality and gravity

Medical Surgery Nursing (1 decks)

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