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Preceptorship > med surg > Flashcards

med surg Flashcards

1
Q

signs of increasing ICP

A
  1. Cushing Triad
    - HTN,bradycardia, widening pulse pressure
  2. Pailledema
    - pressure agaisnt the the optic disc causing fleeting disturbances in vision, headache, and vomiting
  3. Slurred speech
  4. Decoriticate/Decerebrate
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2
Q

how much water is retained per 1 kg gained

A

1 L

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3
Q

late signs of fluid volume deficit

A
  1. oliguria
  2. decreased CVP
  3. flat neck veins
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4
Q

where can you check for skin tenting

A
  1. forehead

2. sterum

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5
Q

what are the isotonic solutions

A
  1. NS
  2. LR
  3. D5W
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6
Q

pulmonary edema assessment

A
  1. cough
  2. dyspnea
  3. crackles
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7
Q

hypokalemia manifestation

A
  1. muscle weakness
  2. fatigue
  3. flat or inverted T wave
  4. Decreased bowel motility
  5. irritability/confusion
  6. Paresthesia
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8
Q

Hyperkalemia manifestations

A
  1. muscle twitching and paresthesia (early)
  2. asceding muscle weakness (late)
  3. peaked t waves and widening QRS
  4. increased motility
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9
Q

hyponatremia manifestations

A
  1. headache
  2. anorexia, n/v
  3. muscle cramps/ twitchig
  4. seizures
  5. lethargy
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10
Q

non pharmacological treatment for nausea

A

ginger tea

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11
Q

2.Irritable bowel syndrome diet

A

1.increase fiber (atleast 30 g)

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12
Q

Right sided stroke

A
  1. Visual spaital deficit

2. One sided neglect

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13
Q

metformin admin

A

take it once daily at night with your evening meal. GI tract moves slower during night therefore more medication gets absorbed.

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14
Q

s/s of hemolytic reaction

A

backpain and headache

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15
Q

what is the main adverse effect of suctioning

A

can cause a vasovagal attack. if this happens stop and oxygenate

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16
Q

bladder irrigation

A
  1. always use NS
  2. color of urine should slowly progress to an amber color.
  3. initial void may be uncomfortable, red and contain clots
  4. if urine isnt clear or there is still blood clots by day 4 call doctor
  5. if there is bright red blood with clots then increase the rate
  6. if cath becomes obstructed flush with a 50ml syringe
  7. *sodium can be absorbed through bladder irrigation
  8. tell patient not to push pee as it can cause muscle spasms that lead to more bleeding
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17
Q

Walker teaching

A 
WWS
walker
weak leg
strong leg
6-8 inches
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18
Q

crutches

A
  1. 6 inches lateral of each foot. Also 6 inches in front of each foot
  2. never bear weight on axilla
  3. elbows flexed at 30 degrees
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19
Q

client education- dumping syndrome

A
  1. lay down after meal as it will slow the movement of food within the intestine
  2. limit the amount of fluid ingested at one time. Dont drink fluid within 1 hour after a meal
  3. low to moderate carbs everything else high. Carbs move fast as they are easily digested
  4. avoid milk, sugars as they can cause diarrhea
  5. small frequent meals
  6. Pernicious anemia is common (take vit b12)
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20
Q

signs of pernicious anemia

A
  1. fatigue
  2. parasthsia
  3. depressed reflexes
  4. smooth red tongue
  5. SOB
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21
Q

what is pernicious anemia usually caused by

A

lack of intrinsic factor which is a protein secreted by the stomach which helps the ileum absorb B12

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22
Q

crohns disease signs/s

A
  1. diarrhea and colicky pain often right lower quadrant
  2. megaloblatic (pernicious) anemia
  3. UTI due to fistula
  4. high pitched bowel sounds with steatorrhea
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23
Q

crohns treatment

A
  1. fluids and bowel rest during acute attack

2. low fiber diet for long term treatment

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24
Q

Ulcerative colitis

A
  1. toxin megacolon is common (dilated colon which leads to no peristalsis leading to a giant poop forming that may require surgery to remove)
  2. seen in the descending colon and rectum
  3. common to see joint pain/arthritis
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25
Q

how do you treat ulcerative colitis

A
  1. low fiber or NPO for acute attacks
  2. sulfasalazine (anti-inflammatory for autoimmune type diseases)
    - will cause yellowish orange discoloration of skin and urine
    - photosensitivity so wear sun block
26
Q

Interventions for ulcerative colitis

A
  1. NPO is priority (they will still have 20+ stools per day)

2. if only in rectum treat with sitz bath of witch hazel

27
Q

ulcerative colitis teaching

A
  1. high protein and calorie with low fiber diet
  2. avoid caffeine and alochol and take multiviatmins that contain iron
  3. small frequent meals
28
Q

Diverticulitis

A
  1. Usually in the sigmoid colon LLQ,
  2. put on high fiber high fluids diet to prevent attacks but during attack put on low fiber diet and probably NPO if severe
  3. encourage mild exercise like walking to decrease constipation but no strenous exercise
29
Q

where to not put heat therapy

A
  1. do not put over areas that have metal devices such as pacemakers to avoid deep tissues burns
  2. do not put on the abdomen of a pregnant women
  3. bony prominences are more sensitive to heat application
  4. do not put under an immobile client
30
Q

cholecystitis

A
  1. RUQ pain radiating to right shoulder
  2. Pain with deep inspiration during rigt subcostal palpation
  3. jaundice, decreased calcium levels, steatorrhea, dark urine, pruritus
  4. low fat diet, avoiding gas forming foods, and small meals are better tolerated
31
Q

what is nephrotic syndrome

A
  1. decreased blood albumin -> edema
  2. hyperlipidemia (low albumin causes the liver to synthesis lipoproteins)
  3. proteinuria
  4. hypercoagulabity (due to loss of antithrombin 3 in urine)
32
Q

what is nephritic syndrome

A

characterized by

  1. blood in urine (especially RBC casts with dysmorphic RBCs)
  2. Oliguria in the presence of HTN (this is due to destruction of the epithelial barrier which allows for blood in the urine and at the same time proliferation of mesangial cells which decreases perfusion to the kidneys. This decrease leads to activation of RAAS leading to HTN.)
33
Q

acute glomerulonephritis

A
  1. It is an immune complex disease that causes inflammation of the glomerular apparatus. Usually following a streptococcal infection
    - ask about recent sore throat.
  2. Main signs are edema, HTN, oliguria
  3. Diet: fluid restricted to urine output + 500 mL
    - low sodium, low protein and low potassium. If azotemia is present restrict protein intake
34
Q

how to avoid hyperuricemia

A
  1. avoid red meat and seafood
  2. avoid beans and legumes
  3. dark greenies, cauliflower, mushrooms
  4. limit alcohol
  5. low fat dairy
35
Q

Peritoneal dialysis interventions

  1. cloudy dialyisate
  2. abdominal cramping
  3. cleaning
A

This procedure is a sterile one

  1. call doctor
  2. slow infusion
  3. H2O2 and NS
36
Q

when is kayexalate contraindicated

A

paralytic ileus

37
Q

AV shunt interventions

A
  1. assess for thrill (palpated) and bruit (heard)

2. Take BP on opposite arm

38
Q

Ostomy care

A
  1. never let bag get more then 1/2 full
  2. SHOULD BE pink/red and moist
  3. normal post op output is less then 1000 ml/day
  4. the higher up in the intestine the more liquid and more acidic the output will be
  5. Foods that cause odor: fish, eggs, asparagus, garlic, beans, dark green leafies
  6. foods that cause gas: dark green leafies, carbonated drinks, dairy, corn
  7. Yogurt can reduce gas
  8. clients with ilesotomys should avoid fiber for the first 2 months and drink plenty of fluid.
  9. Do not put anything into the bag for odor such as mint
39
Q

autonomic dysreflexia

A
  1. occurs with above T6 spinal cord injuries but in rare cases can happen as low as T10
  2. HTN, bradycardia, super headache, diaphoresis, pallor below level of injury and flushing above, blurred vision, nausea
  3. sit the client up
  4. most common cause is distended bladder, can also be caused by fecal impaction, cold stress, or tight clothing
40
Q

Flaccid neurogenic bladder

A

caused by lower motor neuron injuries

1.Credes method where you apply downward pressure on the bladder to manually express urine

41
Q

Spastic neurogenic bladder

A

Upper motor neuron injuries.
1.tugg on pubic hair or put on condom cath. (bladder will randomly empty itself) Females will require an indwelling cath
2.upper motor neuron injuries are associated with
cervical spinal injuries

42
Q

Leukotrine modifiers prototypes

A
  1. Montelukast (singulair)
  2. Zileuton (zyflo)
  3. Zafirlukast (accolate)
43
Q

Everything about the leukotrine modifiers

A
  1. they supress inflammation, bronchoconstriction, edema, and mucus production
  2. used for long term therapy of asthma of children 15 and older.
  3. prevention of exercise induced asthma
44
Q

Gentamicin

A
  1. can cause ototoxicity
    - tinnitus, headache, dizziness, vertigo
  2. nephrotoxicity
    - monitor for azotemia, and I&O
45
Q

all nephrotoxic meds

A
  1. Ace inhibitors
  2. Amphoteracin B
  3. Cisplatin
  4. Cyclosporins
  5. NSAIDS
46
Q

Epogen

  1. how do we know its working
  2. what can happen if dose is to high
  3. how is it given
  4. adverse effects
  5. nursing interventions
A
  1. HCT goes up
  2. if HCT rises to fast it could raise BP leading to seizures or HTNive crisis
  3. subQ
  4. HTN, or cardiovascular events when Hgb increases more then 1 g in 2 weeks
  5. baseline BP
    - need adequate iron, folic acid, and B12 to work
    - Hgb and HCT needs to monitored twice a week.
47
Q
  1. what is anemia
  2. what is the main issue in anemia
  3. s/s
  4. drugs
  5. considerations
A
  1. low RBCs, Hgb or both
  2. decreased O2
  3. fatigue, pallor, SOB, dizziness
  4. Epogen, ferrous sulfate
  5. you dont want Hgb to rise more then 1 gram/dL in 2 weeks
48
Q

iron supplements teaching

A
  1. stool will be black
  2. take with vitamin C on empty stomach
  3. increase fiber intake
49
Q

foods high in iron

A
  1. red meat
  2. egg yolks
  3. dark leafies
  4. dried fruits
  5. Beans/lentils
50
Q

what does B12 do

A

converts folic acid to its active form.

51
Q

Magnesium

  1. signs of toxicity
  2. the antidote
A

a CNS depressant that can lead to decreased respirations, DTR, and bradycardia, and hypotension.
2.Calcium gluconate

52
Q

Dopamine

  1. whats it do
  2. what should you worry about
  3. what is the antidote
A
  1. vasoconstrictor
  2. extravastion
  3. Regitine
53
Q

which dieseases are airborne

A
  1. TB
  2. measeles
  3. varicella
54
Q

major side effect of antipsychotics

A

agranulocytosis

55
Q

what can cause potassium to shift into the cell

A
  1. alkalosis
  2. insulin
  3. TPN
  4. water intoxication
56
Q

which drug can fuck with captopril effects

A

aspirin and other NSAIDS

57
Q

Murpheys sign

A

pain on inspiration during deep palpation of right subcostal area. Indicates cholecystitis

58
Q

McBurneys point

A

right lower quadrant if their is tenderness here it indicates appendicitis

59
Q

Rovsing sign

A

Perform rebound tenderness assessment on left lower quadrant. If their is pain in the right lower quadrant then it indicates appendicitis

60
Q

mother tells nurse that she has found yellow exudate around penis post circumcision what should the nurse tell her

A

this is normal do not remove it and it will be gone within 3 days.

Preceptorship (9 decks)

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