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MS3 -ADRN.210 -rotation 1 > Med. Surge 3 > Flashcards

Med. Surge 3 Flashcards

Exam Review

1
Q

describe HHS in type 2 diabetes.

A

-this is a blood glucose >600-100
-the patient is going through total dehydration because the water is leaving the cells to try and clear the blood of the excess glucose
-there are no ketones present because the body is still producing insulin

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2
Q

What is a fasting plasma glucose?

A

this is a fasted glucose test that is used in the process of diagnosing diabetes; >126 = a diagnoses

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3
Q

What are non pharmacological treatments for type 1 diabetes?

A

-Diet: “my plate” - a carb, veggie + a protein - this combination will slow absorption and glycemic response

-stop/no smoking
-exercise

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4
Q

What are some possible cardiac arrhythmias a patient with uncontrolled diabetes mellitus could experience?

A

-A fib
-A flutter
-V tach
V fib

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5
Q

What is causing a diabetic patient to experience an arrhythmia?

A

uncontrolled high blood sugar

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6
Q

What is the action taken for a diabetic patient experiencing an arrhythmia (or any high blood sugar episode) to get their blood sugar down?

A

-check the blood sugar level
-administer normal saline - this is going to thin the blood to try and get the excess sugar out
-then give insulin, you don’t want to do this first because you don’t want the sugar to drop too rapidly
- w/ dr.’s orders

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7
Q

What will you see on a EKG strip in a patient in A fib?

A

there will be missing P waves and the irregular QRS complexes

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8
Q

What medications are given to a patient in A fib or A flutter?

A

Cardizem + Heparin
(the heparin is given to prevent stroke)

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9
Q

What will V fib look like on a EKG strip or monitor?

A

-this will show multiple/ crazy QRS complexes
-irregular and sometimes unidentifiable
-the heart is not contracting effectively

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10
Q

What interventions are performed for a patient in V tach or v fib?

A

-you need to start CPR + get the code cart
-medications given include LIDOCAINE + AMIODERONE

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11
Q

What are some non pharmacological interventions for a patient in SVT?

A

-vagal maneuvers:

holding breath +bearing down, carotid massage (done by dr.), diving reflex (submerge face in cold water)
all of these things can help to stimulate the vagus nerve and slow the heart rate

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12
Q

What medication would you give to a patient in sinus bradycardia?
<60bpm

A

Atropine

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13
Q

When educating diabetic patients what should you teach them about stress related to their blood sugar?

A

their blood sugar will increase and how important exercise/ physical activity is

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14
Q

What would treatment be for a type 1 diabetic patient who is hypoglycemic?

A

-Glucagon
-dextrose in water (D5) - this will help rehydrate them

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15
Q

What is MICROALBUMINURIA and how does it relate to diabetes mellitus?

A

this is too much protein in the urine due to blood vessel damage in the kidneys, that means the kidneys are filtering properly

-if high blood sugar isn’t taken care of this can lead the patient to needing dialysis

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16
Q

What are some symptoms are peripheral neuropathy?

A

tingling + numbness

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17
Q

What are signs + symptoms a patient is in DKA?

A

-kussmaul respirations
-blurred vision
-fruity/ sweet smelling breath
-ketones
-altered mental status

(patient may seem intoxicated)

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18
Q

how would you describe kussmaul respirations?

A

this is rapid, deep and labored breathing

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19
Q

what is the SOMOGYI effect?

A

This is a low blood sugar in the middle of the night/ early morning. in response to that the body releases glucagon and epinephrine which results in the liver converting the glycogen stores into glucose to raise the blood sugar - this can result in a period of high blood sugar following

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20
Q

how can a diabetic try to avoid the somogyi effect?

A

they can eat a snack at bedtime with their insulin dose or decrease the amount of insulin taken before bed

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21
Q

What are some hormones that your body naturally releases in the early morning time that could effect blood sugar levels?

A

-cortisol
-growth hormone
-catecholamines

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22
Q

describe the DAWN PHENOMENON.

A

This is hyperglycemia due to the release of hormones early in the morning (naturally), but your body isn’t producing enough insulin to balance out those hormones

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23
Q

how can diabetics try to avoid the dawn phenomenon?

A

by adjusting their insulin dose at night before bed time

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24
Q

What are some things that would be included in discharge teaching of a diabetic patient?

A
  • diet (my plate)
    -exercise + activity
    -proper foot care
    -dr.’s check ups (eyes, etc.)
    -proper medication administration + monitoring glucose levels
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25
Q

What is a CGM and what is a concern related to it being used?

A

-continuous glucose monitor - this gives you a continuous blood glucose level
-worry about hyper + hypoglycemia

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26
Q

What is PVD + how would you describe the wounds it produces?

A

-peripheral vascular disease
-this is when blood circulation to extremities is very limited due to blocked or narrowed blood vessels
-venous stasis is present, deoxygenated blood isn’t getting back to the heart
-wounds caused by this will be very irregular looking

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27
Q

What is PAD + how would you describe the wounds it produces?

A

-peripheral arterial disease
-this is when arteries are narrowed and oxygenated blood isn’t making it’s way to peripheral extremities (causing necrosis/ gangrene)
-wounds will be round + smooth

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28
Q

Describe a insulin pump that a type 1 diabetics use.

A

this is used for continuous insulin delivery + regulation
- things to worry about: DKA, machine malfunctions, hypoglycemia

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29
Q

What is key in education for diabetics when it comes to their diet?

A

-“my plate” - they need to have a carb, a protein + half their plate needs to be a veggie

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30
Q

What is HSCT?

A

Hematopoietic Stem Cell Transplant - you have to worry about your patient accepting or rejecting especially in the first 100 days

31
Q

What is GVHD?

A

Graft VS Host Disease - this is the failure and rejection of the stem cell transplant, the patient may experience:
-N/V/D
-Allergies (skin issues)
New “features” that their donor had
-immune response
-liver function issues
-neurological issues such as tingling, numbness and decreased coordination

32
Q

What is a possible cardiac emergency related to pediatric lymphoma?

A

-Long QT syndrome
- this is related to hypokalemia

33
Q

what are some side effects of Diarrhea related to chemotherapy?

A

-dehydration
-electrolyte imbalances that can cause BRADYCARDIA
-skin breakdown
-pale/tired/ weak

34
Q

What are we worried about in a HL patient who has had a splenectomy?

A

-bleeding + infections

*they will have to be on antibiotics for a minimum of 2 years to the rest of their life

35
Q

Steroids are used to reduce inflammation, what is an important side effect to be aware of related to blood sugar?

A

-they can increase blood sugar, cause and mask infection

36
Q

What are the major concerns about a bone marrow aspiration you need to worry about as a nurse?

A

-bleeding - the patient needs to lay on the affected side post procedure with a pressure dressing
-make sure to premedicate prior to the procedure

37
Q

Describe the TNM cancer staging system.

A

T- size of the Tumor
N- number of lymph Nodes involved
M- Metastasis

38
Q

what is HSOS related to a HSCT?

A

Hepatic Sinusoidal Obstructive Syndrome
-this is when the small veins in the liver become obstructed

first 30 days

39
Q

What are the signs and symptoms of HSOS?

A

-increased bilirubin
-jaundice
-hepatomegaly
-ascites
-weight gain

40
Q

What are signs and symptoms of radiation you should educate the patient about prior to receiving the therapy?

A

-burns + skin redness
-N/V
-fatigue

41
Q

What is a Blast Crisis in CLL?

A

this is when large clusters of blasts or basophils, are in the bone marrow, then they start to spread beyond the marrow into the tissues and organs

42
Q

what are signs and symptoms that a CLL patient is experiencing an acute blast crisis?

A

-night sweats
-fever
-weight loss
-bone pain
-fatigue
-bleeding diathesis

43
Q

What are the major concerns you should be worried about as a nurse with a patient receiving chemotherapy?

A

-extravasation
-nutrition
-infections

44
Q

What are some signs and symptoms of thrombocytopenia related to receiving radiation therapy?

A

-petechiae
-bruising
-pain + weakness
-bloody bodily fluids

45
Q

What are some RISK FACTORS of developing leukemia?

A

-exposure to chemicals + radiation
-down syndrome chromosome/ genetics/ family Hx.
-chemo therapy

46
Q

What are some adverse effects of external radiation therapy

A

-tumor lysis syndrome
-severe burns/ reddened skin
-fatigue/ weakness
-tumor pain

47
Q

What is tumor lysis syndrome?

A

this is a group of metabolic abnormalities occurring due to the dead tumor cells floating around in your body

48
Q

What will you see when a patient is experiencing tumor lysis syndrome?

A

-hyperuricemia
-hypo/hyperkalemia
-hyperphosphatemia (w/ low calcium)
-azotemia
-leukostasis

49
Q

What is the difference between a midline and a picc line?

A

a mid line is shorter and its placed in the subclavian vein.
a picc line is longer, it sits just above the heart and it can be inserted into multiple different veins

50
Q

What is a water seal chest drainage system set up and used for?

A

this is used to drain blood/ fluid or air from the pleural space in the chest cavity

51
Q

Why is it SO IMPORTANT to listen to your patients lungs and airway after they have central line inserted?

A

the line insertion could have caused a pneumothorax, pleural wall was punctured, or a hemothorax, which is blood accumulating in the pleural cavity

52
Q

What are the interventions performed as a nurse after you perform percussion/ postural drainage to break up secretions?

A

-listen to lungs
-suction secretions out
-give Mucinex if needed
-hydrate the patient
incentive spirometry

53
Q

What are 2 key interventions when you are performing tracheal suction?

A

-monitor the patients O2 sat and hyperoxygenate them

54
Q

What are some lab values to look at when your checking a patients nutrition status?

A

-serum proteins
-glucose
-chem. 7 + 12 (CBC + BNP)
-iron/ folate
-vitamins

55
Q

How are we teaching the patient with a chest tube to water seal, to prevent a pneumothorax?

A

-taking deep breaths + using the incentive spirometer
-keep the tubes + chamber below their chest

56
Q

What are some things included in a cuff assessment in a trached patient on mechanical ventilation?

A

-these are done Q shift
-if you hear air hissing, that is BAD and it means the cuff is deflating

57
Q

what is the most important part of discharge teaching for a patient going home on a vent?

A

having a generator in case the power goes out

58
Q

What are some complications related to the insertion of an ET tube?

A

-can’t cough, talk and very irritated
-bifurcation - usually to the right

59
Q

What does it mean if a patient with a chest tube has constant/ rapid bubbling in the drainage system?

A

this means there is a leak somewhere and it needs to be found quickly

60
Q

What is part of your assessment when a patient is getting weaned off a ventilator?

A

-ABGs
-HR, RR, O2 sat
-listen to their breathing and lung sounds

61
Q

What is part of post op teaching for a patient who just had a thoracotomy? (

A

-*using the incentive spirometer + deep breathing
-infection prevention

62
Q

what can you do for a patient with osteosarcoma, who’s experiencing bone pain?

A

give them pain medicine

63
Q

What is the first thing you would do for a hospice patient experiencing SOB?

A

put them on O2

64
Q

What is the life expectancy for a patient who is put on hospice?

A

about 6 months

65
Q

Who needs to sign advanced directives in order for them to be viable?

A

The dr. and the patient (or their authorized representative/ medical proxy?

66
Q

What are you doing as a nurse to prevent Vent. Acquired Pneumonia?

A

-keep HOB at 30 degrees
-DVT prevention
-Q2 turns
- oral care w/ chlorohexidine
-monitoring vitals
-safety + comfort

67
Q

What are you concerned about with a hospice patient being discharged home on narcotics?

A

-someone else taking the medication
-constipation

68
Q

What would your intervention be on a palliative care patient w/ no end of life orders who is in V Fib?

A

-you would do CPR + try to bring them back to sinus rhythm
-make sure to read/ note what rhythm they’re in after CPR

69
Q

What are your actions after you walk into a patients room who’s on hospice who appears to have died on the ventilator?

A

you are going to touch NOTHING and call the provider

70
Q

What is the death rattle?

A

this is the noise from secretions that the patient (who’s dying) can’t handle anymore

71
Q

What would be included in the teaching to the family of a patient going home on hospice with a PCA?

A

-educate on the kind of medication
-their RR will decrease
-what it could look like if the medicine isn’t doing enough - make sure to monitor pain, if needed the dose may need to be adjusted if it’s not enough

72
Q

Why would radiotherapy be used on a patient who is also receiving palliative care?

A

to help w/ their pain

73
Q

Why are MD’s so reluctant to put patients on hospice?

A

because they want to save people - they don’t want to “give up”

74
Q

Which part of the nervous system does grief affect?

A

this affects the sympathetic nervous system, stimulating the fight or flight response

MS3 -ADRN.210 -rotation 1 (1 decks)

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