Med Surg Final Review Flashcards
CD4 Count
800-1400
Anything <200, you have AIDS
<800, immunosuppressed
Interventions for Aids
- blood spills should be cleaned with 1:10 bleach
Sickle Cell Anemia
2 triggers: dehydration and hypoxia
Hypoxia: painful in varied tissues
Causes of leukemia
- radiation
- Immature WBC
- Infection
- Low platelets
- Decreased RBC
Anemia
- pale
- SOB
- Pica
Pernicious anemia- intrinsic factor for B12 insufficient, seen in bypass patients and elderly
Iron deficiency anemia- could be due to hemorrhage or low iron
DIC
decrease in clotting factor
Give heparin, clotting factors, and plasma because it has clotting factors in it
If patient is in kidney failure what lab should we check?
Creatinine
Test that differentiates Hodgkins from non-hodgkins
Reed Sternberg
Bone Marrow Transplant
Give chemo first to kill off everything, wait 2-3 days, give stem cells IV. If patient rejects stem cells, will get peeling in hands and feet
Chemotherapy
Costic- give through central line- can be oral, intrathecal, or IV- if IV, dilute!!!! Lots of water!!!- most important lab to watch is platelets
Radiation
SE: fatigue, pathological fractures later on
Parkinsons
Starts as a tremor, moves to shuffle, then the face.
RISK FOR: falls and aspiration
SE to dopamine: involuntary movement, anxiety, psychological SE such as dementia, allergy
Allergic reactions
Happen within 20-30 minutes of exposure. Give Epi: 1.3-1.5mL of 1/1,000
Lupus
Can impact all systems so we can’t predict what it will effect in each patient.
Mostly seen in females
Diagnostic test: First ANA, then Anti-Smith test
Treatment: Goal: prevent further deterioration of the organ attacked. Give Aspirin, NSAIDs, anti-rheumatic medications
Guillian Bare
Diagnostic test: EMG and spinal tap
Myasthenia graves
Often see ptosis
Diagnose: give tensilon- 20 minutes later they will be fine Can also put ice on the eyes
Treatment: Tensilon
Multiple Sclerosis
Treat with IV steroids
3 things to check when giving steroids:
- immunocompromised
- taper down
- blood glucose
Plasmaphoresis
Can do for antibody disorders. Take blood, remove antibodies and return blood to body.
Seizures
Grand mal- following seizure: check for injury, turn on side and let sleep
Epilepsy: will be on dilantin forever, should never take Coumadin
COPD
High H&H, High RBCs
Check blood gasses and pulmonary function
O2- 2-4L/min max
Postural drainage is involved in chest physiotherapy
Smoking increases mucous
PC: pneumonia
Incentive spirometer used to prevent what?
Pneumonia
TB
Night sweats
Diagnostics: has to be sputum
If you have a positive ID test, need to have 3 consecutive sputum negatives and then you go home
OSHA
protective clothing, hobbies, smoking, dust
Systemic IV
At risk for overload or air embolus
Cytoxic vs. Anaphylactic allergic reaction
Blood transfusion- cytoxic
Anaphylactic- bee sting, food- can prevent death by wearing a medical bracelet.
Transfusions
Plasma/albumin/platelets- special, shorter tubing
Thyroid
If the thyroid is the problem, TSH is high because the thyroid is not putting T3 and T4
Graves disease- Hyperthyroidism, poppy eyes
Hypothyroidism- goiter, tired, always cold, weight gain
Goiter- can happen with either hyper or hypo
Thyroid storm- hyperthyroidism, high temp, drug of choice to treat is PTU and tapisol
Adrenal Gland
Addison’s disease- hypo function. Give Salt and steroids. can be fatal without steroids (Addison’s crisis), Need more steroids with stressed. If they take too much steroids, could end up with cushings
Cushings disease- hyper function.
parathyroid
Hypoparathyroidism–> hypocalcemia–> tetany–> notify provider and give Calcium gluconate
Hyperparathyroidism- at risk for kidney stones–> push fluids
DI and SIADH
Diabetes Insipidus- Low specific gravity, peeing a lot so more electrolytes left inside the body- SG will be: 1.001-1.005
SIADH: Will have a high specific gravity. Not peeing enough so electrolytes are diluted in the body.
Hypertension
Impacts cardiovascular and kidney the most. Should lose weight. Should be on a low fat, low sodium diet. Exercise: walking
Meds: ACE inhibitors, Lasix- depletes potassium so watch if also on digoxin
Nitroglycerine
Vasodilator used to relieve angina. Give 1 every 5 minutes X3. If no relief, call 911, probably an MI.
CAD
Caused by Increased fat in diet and low activity level. If the artery is totally plugged we can give a thrombolytic within the first 6 hours. If it is not totally plugged, we will give heparin and a stent.
Should be on a low fat diet to prevent CAD
CHF
First sign of right sided HF- edema
First sign of left sided HF- dyspnea because fluid is backing up into lungs.
PC: pulmonary edema, LISTEN TO THE LUNGS and look for frothy pink sputum (also important to look for this in PEs)
Probably on Lasix, look at potassium and report any weight gain.
Angina
Ischemia of the heart- sit them down and stop activity.
Stable angina- goes away with rest
Unstable angina- does not go away even with rest, can be a precursor to an MI
Ballooning and Stenting are good for both stable and unstable angina- also good for kidney carotids and PAD
MI
means infarction- pain is unrelieved
Treat with MONA- Morphine, oxygen, nitroglycerine, and ***chewable aspirin. Also give beta blockers.
EKG can show an MI while it’s happening or it could not.
Acute Coronary Syndrome (ACS)
Any condition brought on by a sudden reduction or blockage of blood flow to the heart.
Algorithm- Nitro X3, O2, aspirin, beta blocker
ST elevation is very significant in diagnosing ACS
Need to sit down, rest, and take nitro. If no relief, could be unstable and lead to an MI.
Tissue Plaminogen Activator (TPA) (Thrombolytics)
Must be given within the first 6 hours of pain.
PC is a Pulmonary embolism (check for pink, frothy sputum), or stroke
Heparin
Prevents further damage but does not bust clots
Check aPTT levels
Give at same time as warfarin until warfarin levels are sufficient, then d/c heaprin
Antidote: Protamine sulfate
Antidote to warfarin- vitamin K
Infection of the heart
Named by location:
Pericarditis
Myocarditis
Endocarditis
At risk: IV drug users
Can lead to cardiomyopathies
Give antibiotics
Diagnose with echo
Aortic regurgitation
first sign: blood goes back into the lungs, difficulty breathing
Stenosis
A narrowing of the spinal canal
Often found in individuals with artificial valves
Need antibiotics
Arterial problems (Reynauds and bergers)
PC: deep and round ulcer
Experience pain at rest
Venous problems
PC- superficial and jagged edge ulcer- drainage
Pain with activity
PAD
Experience intermittent pain usually experienced in the legs
Can be arterial blockage, think about CAD
DVT
Leg care: don’t move the leg until you know the clot is stable. Even then, a physician or specially trained nurse should move patient.
