Med Surge Flashcards
What is Addison’s disease and what are the s/s?
Hyposecretion of adrenal hormones (mineralcorticoids, glucocorticoids - cortisol, and androgens - aldosterone) Occurs in all age groups and affects both sexes. Can be life-threatening. Treatment involves taking hormones to replace the insufficient amounts.
S/S: fatigue, weakness, dehydration, low BP, hyperpigmentation, low resistance to stress, alopecia, weight loss, pathological fractures, depression, lethargy, emotional lability. Patho: low na+ & dehydration, low blood volume / shock, high K+/metabolic acidosis/ arrythmias, low blood sugar and insulin shock
what are the precipitating factors of an addisonian crisis?
physical or emotional stress, sudden withdrawal of hormones
What are the s/s of an addisonian crisis?
n/v, abdominal pain, fever, extreme weakness, severe hypoglycemia, hyperkalemia, and dehydration. bp falls leading to shock/coma/death.
How do you treat an addisonian crisis?
Administer hydrocortisone
Carefully monitor IV infusion of 0.9% NaCl or DSW/ NaCl
Administer IV glucose, glucagon
Administer insulin with dextrose in normal saline
administer potassium-binding and excreting resin (e.g., sodium polystyrene sulfonate) Monitor vital signs
what is Reynaud’s disease?
excessively reduced blood flow in response to cold or emotional stress, causing discolouration of the fingers, toes, and occasionally other areas. This condition may also cause nails to become brittle with longitudinal ridges. Treatment involves encouraging circulation and avoiding vasoconstriction.
what is impetigo, s/s?
highly contagious bacterial skin infection most common among pre-school children. s/s : skin lesions/rash with honey-colored scabs. It is primarily caused by Staphylococcus. if intreated may cause glomerulrlonephritis. treat with antibiotics.
What are the s/s of toxic shock syndrome?
Temp
What is the diet for a patient with Meniere’s disease? why?
low-sodium diet to prevent fluid retention (specifically the endo-lymphatic fluid found in the laybrinth of the inner ear.
What is Meniere’s disease?
A disorder of the inner ear that causes spontaneous episodes of vertigo (a sensation of a spinning motion), fluctuating hearing loss, ringing in the ear (tinnitus), and sometimes a feeling of fullness or pressure in your ear. In many cases, Meniere’s disease affects only one ear. Chronic. Episodes usually last 20min-2H, but may last 24 h. severe N/V may occur. Vertigo is uncommon and could be a sign of stroke, brain tumor, multipul sclerosis or cardiovasc. disease.
Diet for cystic fibrosis.
High protein, high calorie b/c of impaired intestinal absorbtion. salty foods recommended due to excess sodium loss during sweating.
What foods help manage smells from a colostomy? other methods?
cranberry juice, buttermilk, parsley, and yogurt help prevent odors. crackers, toast and yogurts help prevent gas. may also use a commercial deodorant. avoid skipping meals, chewing gum, drinking beer, and smoking.
RX for ectopic pregnancy.
Abortion - if allowed to grow may kill mother because of hemorrhage. Methotrexate or surgery.
correct positioning after lumbar puncture
flat supine; to prevent headache by preventing leakage of CSF at site.
diet for dumping syndrome.
increase fat and protein. decrease carbs because they are the first to be digested (want to slow digestion), decrease fiber.
avoid drinking fluids with meals (none 1h before or 2h after), 5-6 small meals per day, lie down after eating.
what is the cerebrum and what are the 4 lobes?
The cerebrum controls emotions, hearing, vision, personality all voluntary actions and more. The 4 lobes are frontal, temporal, occipital, parietal
what is the the location and function of the temporal lobe?
Responsible for processing auditory information from the ears (hearing)
what is the the location and function of the frontal lobe?
Carries out higher mental processes such as thinking, decision making, and planning,where our personality is formed
what is the the location and function of the occipital lobe?
Responsible for processing visual information from the eyes
what is the the location and function of the parietal lobe?
Processes sensory information that had to do with taste, temperature, and touch
what are the functions of the left hemisphere of the brain?
Responsible for control of the right side of the body, and is the more academic and logical side of the brain: analytic thought, logic, language, reasoning, science, math, written, number skills, right hand control, speech
what are the functions of the right hemisphere of the brain?
Responsible for control of the left side of the body, and is the more artistic and creative side of the brain: art awareness, creativity, imagination, intuition, insight, holistic thought, music awareness, 3d forms, left hand control, spacial awareness
Symptoms of right hemisphere damage
issues with attention, perception, reasoning and problem solving, memory, social communication, organization, insight, orientation, may be unaware of his or her impairment and be certain that he or she can perform the same tasks as before, unmotivated, spatial-perceptual difficulties. (these individuals may be seen as uncooperative, confused, overly dependent or unmotivated.) , impulsive, disoriented to person place and time.
Symptoms of left hemisphere damage
personality changes, communication problems and some paralysis on the right side,behave in a cautious, compulsive, or disorganized way and are easily frustrated, may be slow to take action or to respond to questions, impaired speech
normal urine output
The normal range for 24-hour urine volume is 800 to 2000ml per day (33-83ml per hour) (with a normal fluid intake of about 2 liters per day). if output is below 30ml/h further eval is needed.
what is the effect of increased carbon dioxide on intracranial pressure? what are the potential implications for patients? (Nursing Care)
CO2 causes dilation of cerebral blood vessels. Ensuring adequate ABC’s is priority for patients with head injuries or increased ICP.
Name the 12 cranial nerves, their functions, and how to assess their functionality
oh oh oh tiny tits are fun and give virgins awkward hips:
I: Olfactory - smell - ASK IF THEY CAN SMELL
II: Optic - vision - VISUAL ACUITY TEST
III: Oculomotor - motor control of some eye muscles and eyelid - PERRLA (pupils equal round reactive to light and accommodation), GAZE UP, DOWN, OUT
IV: Trochlear - motor control of some eye muscles - GAZE DOWN AND IN
V: Trigeminal (dentist) - chewing - FACIAL SENSORY
VI: Abducens - motor control of some eye muscles - GAZE TEMPORARILY
VII: Facial - motor control of facial muscles, salivation, taste and cutanious sensations - FACIAL EXPRESSIONS
VIII: Vestibulococholear (auditory) - equilibrium, hearing - HEARING TEST
IX: Glossopharyengeal - salivation, sensations of skin taste and viscera - GAG REFLEX
X: Vagus - motor control of heart and viscera, sensation from thorax , pharynx, and abdominal viscera. - CHECK THE UVULA IS MIDLINE
XI: Accessory (spinal) - motor impulse to pharynx and shoulder - SHOULDER SHRUG
XII: Hypoglossal - motor control of tongue, some skeletal muscles, and some viscera , sensation from skin and viscera - TOUNGE MOVEMENT
What is Autonomic dysreflexia and what are the symptoms? What are a few nursing actions
Autonomic dysreflexia (AD), also known as autonomic hyperreflexia, is a potentially life-threatening condition which can be considered a medical emergency requiring immediate attention. AD occurs most often in spinal cord-injured individuals. Acute AD is a reaction of the autonomic (involuntary) nervous system to overstimulation. It is characterized by paroxysmal hypertension (the sudden onset of severe high blood pressure) associated with throbbing headaches, profuse sweating, nasal stuffiness, flushing of the skin above the level of the lesion, slow heart rate, anxiety, and sometimes by cognitive impairment.
Nursing actions: high fowlers, potentially admin hydralazine (vasodilator)
priority nursing actions for a woman in labor showing late decelerations on the fhr monitor.
position on left side, 02, IV, notify hcp
what is the timeline for alcohol withdrawal?
withdrawal : 5-35 hours after last drink, 48 hours grand mal seizures, 72-96 hours delirium tremens - at high risk for seizures.
priority assessments preceding femoral angiogram
location and description of peripheral pulses, color, mobility and temp of extremity
what is the priority assessment for a damaged parathyroid gland.
check blood calcium levels. parathyroid hormone level decreases, which causes a decrease in blood calcium level (pth pulls calcium from bones to use)
early s/s for hypocalcemia
tingling fingers , toes , and lips
level and s/s hypoglycemia
50mg/dl, dizzy, tremble, anxiety, hunger, weak
tracheostomy care: catheter size, 02 level, wall suction range
half the size of the trach opening, 100% 02, wall suction set at 80-120mmhg
chron’s diet
low fat, high protein, low residue, non-irritating, high in minerals, high cals.
what is a lumbar laminectomy and why is it done?
performed to relieve spinal stenosis. incision in lower back and removal of bone spurs and thickened tissues.
how do you perform a log roll?
need 2 people, draw sheet, and pillow. using draw sheet shift pt to one side of the bed. place pillow in between the 2 legs, with pt supine and arms either crossed or stretched forward, maintain spinal and hip alignment. put side rail up on side to roll toward, then both people should roll the pt to the side using the draw sheet. if the side position will be maintained prop with pillows.
what is lupus?
chronic autoimmune disease that occurs in flareups and remissions, most common in women of childbearing age and 2-3 times more likely in african women, but anyone can get. not contagious. severity ranges from mild to deadly and can usually be treated - pt can live a full life.
Symptoms vary but can include fatigue, joint pain, rash/butterfly rash on face, and fever.
may include:
Pain: in the muscles, can occur while breathing, can be sharp in the chest
Mouth: dryness or ulcers
Skin: scaly rashes or red rashes
Psychological: anxiety or major depression
Hair: hair loss or loss of scalp hair
Whole body: fever, malaise, anemia, or fatigue
Also common: sensitivity to light, blood in urine, raynaud’s syndrome, face rash, water retention, joint stiffness, swelling, headache, acute episodes, or weight loss
what conditions is a moist warm compress used for? Nursing considerations?
Dry eyes and other eye problems, cellulitis, thrombophlebitis, stiff joints or chronic muscle and joint pain.
Moist heat may penetrate better.
Don’t apply heat for longer than 20 minutes, unless your doctor or physical therapist recommends longer.
Don’t use heat if there’s swelling. Use cold first, then heat.
Don’t use heat if you have poor circulation or diabetes.
Don’t use heat on an open wound or stitches.
when to use cold therapy?
Any cold treatment should be used for 24 to 48 hours after an injury. Cold therapy is good for sprains, strains, bumps, and bruises that may occur in sports or lifting. Apply cold packs or ice bags to injured areas for no more than 20 minutes at a time, removing the cold for 10 minutes and reapplying it again.
how is lyme disease treated?
antibiotics - may result in total recovery , but may cause residual syndromes to develop.
s/s lyme disease?
Pain: in the joints or muscles
Skin: bull’s eye pattern rash or red rashes
Whole body: fatigue, fever, or malaise
Joints: stiffness or swelling
Also common: headache, redness, or weakness of limb
what is the incubation period for rubella?
14-21 days. it is contagious 7 days before rash appears to 5 days following onset.
can pregnant women receive the rubella vaccine?
no, it will put the baby at risk. also, exposure to rubella during pregnancy could harm the baby and abortion may be considered.
what syndrome can lithium use cause?
nephrogenic diabetes insipidus. this occurs when lithium is taken in doses that are toxic to the kidney, damaging nephrons and inducing DI.
what are the s/s of diabetes insipidus?
polyuria, excessive thirst. DI is the inability to regulate fluids
what are the dietary needs of a patient taking litihium?
adequate/increased consumption of water and adequate salt intake to compensate for the water and salt loss in polyuria
what is SIADH? what are the s/s? what are the causes?
SIADH is the syndrome of inappropriate anti-diuretic hormone secretion. too much ADH, causing water retention (diluting the blood and concentrating the urine. [edema is NOT a symptom]
ADH is found in the pituitary gland, so this could be caused by disruptions in the pituitary such as any increase in the ICP. It is commonly found in cancer patients as some cancers and cancer treatments cause it.
The following cancers can cause SIADH: small cell lung cancer non–small cell lung cancer mesothelioma lymphoma Ewing sarcoma thymoma, which is a type of thymus cancer primary brain tumours head and neck cancers stomach cancer duodenum cancer pancreatic cancer bladder cancer prostate cancer uterine cancer
Some cancer treatments can also lead to SIADH. These include chemotherapy drugs such as cyclophosphamide (Cytoxan, Procytox), ifosphamide (Ifex) and vincristine (Oncovin). Other medicines used in cancer treatment, including opiate pain medicines such as morphine, can also lead to SIADH.
if a pregnant woman has a drop in blood pressure from medication or other reasons, what is the best position to put her in and why?
lying on the left side in order to take pressure off of the vena cava , which will improve fetal circulation, and also with her legs flexed to increase venous return.
what is the first thing to do for a patient whose trach. tube has become dislodged and they cannot breathe?
extend their neck back to create a patent airway. after that, you may use a hemostat (clamp) to open the airway, perform mouth to stoma breaths, replace the trach tube, or bag either the stoma (while keeping the mouth and nose closed or visa versa).
Is there communication between the upper airway and the stoma of a patient who has undergone a tracheostomy or a laryengectomy?
it depends. often, if the person has a permanent stoma there is no communication, but best practice is to ask ahead of time and have a sign posted. this will effect how to resuscitate the patient in case of emergency, or how to give air if trach tube becomes dislodged.
after a vascectomy, can a man get a woman pregnant?
there may still be some sperm stored in the vas deferins for up to 6 weeks, so couples are encouraged to use condoms during this time.
how should a client be positioned for the first 24 hours after a below the knee amputation?
fowlers with effected leg elevated on pillows to decrease edema , venous return and comfort.
how should a client be positioned after the first 24 hours after a below the knee amputation?
every 2-3 hours they should lye prone for 25 min. this an other positions should be used to prevent hip contractures. adduction is good , abduction is bad. (another source says 30 min 3x day)
in terms of delegation, what are the rules of thumb for the types of patients to give to: Nursing assistive personelle
LVN/LPN?
NAPs should perform standard unchanging procedures.
LVNs should work with stable patients with expected outcomes. (can draw labs and give po and IV meds++, NG and G tube feedings, Insert foley, wound care)
Only RNs can assess, handle unstable patients, take phone orders, start IVs, care for central lines+
what causes metabolic acidosis?
hyperchloremin: losing too much base (diarrhea), kidney damage (cannot eliminate acid), diabetic ketoacidosis, lactic acidosis: chronic alcohol use, heart failure, cancer, seizures, liver failure, prolonged lack of oxygen, and low blood sugar, and prolonged exercise; aspirin or methanol poisoning
what causes respiratory acidosis?
Respiratory acidosis occurs when too much CO2 builds up in the body. Normally the lungs remove CO2 while you breathe. However, sometimes your body can’t get rid of enough CO2. This may happen because of:
chronic airway conditions, like asthma
injury to the chest
obesity, which can make breathing difficult
sedative misuse, including overuse of alcohol
muscle weakness in the chest
problems with the nervous system
deformed chest structure
what are the available vaccines that are considered to be live?
measles, mumps, rubella, chickenpox, and nasal spray flu vaccines contain live but weakened viruses
what amount of time must pass after a traumatic head injury for a patient to be eligible for thrombolytic therapy?
3 months
is it preferable for an altzheimer’s patient to be in a private room or a semi private room?
semiprivate room because they need to be oriented often and having another person to talk to will help with that.
what time of the day is the best for giving methylphenidate?
it is best to give ritalin after breakfast. had appetite reducing effects. med will last all day
what is a normal platlet range?
A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood.
Having more than 450,000 platelets is a condition called thrombocytosis; having less than 150,000 is known as thrombocytopenia. Risk of spontaneous bleeding occurs
what is the major difference between in-hospital catheterization and in -home catheterization ?
in the home it is not a sterile procedure, but a clean one. catheters can be washed and reused. sterile gloves not needed
s/s of preeclampsia
In addition to swelling, protein in the urine, and high blood pressure, preeclampsia symptoms can include: Rapid weight gain caused by a significant increase in bodily fluid. Abdominal pain. Severe headaches. Change in reflexes. Reduced urine or no urine output. Dizziness. Excessive vomiting and nausea. Vision changes.
Signs of severe preeclampsia include fetal distress, abdominal pain, seizures, impaired kidney function, and fluid in the mother’s lungs.
risk factors for preeclampsia
These include: being pregnant with multiple fetuses. advanced maternal age (over the age of 35) first pregnancy. obesity. history of hypertension or diabetes. history of kidney disorder. pregnancy in early teens.
when does fetal quickening occur?
20 weeks in mulitgravida and 18 weeks in a primigravida
treatment for preeclampsia
Delivery of your baby is the only cure for preeclampsia.
During pregnancy, your condition will be monitored and managed to ensure you and the baby remain healthy. If you are at 37 weeks gestation or later, you may be induced. At this point, the baby has developed enough and is only minimally premature.
If your preeclampsia is mild, your doctor may recommend:
bed rest
reduced salt intake
increased water consumption
regular doctor’s visits
do you need a clean catch or a sterile catch for a culture and sensitivity urine collection?
sterile. use antiseptic wipe then urinate into cup without anything touching cup.
what is one priority assessment after a cholecystectomy?
check the color of the feces (and urine) if the bile isnt reaching the intestines as it should it will result in clay colored stool. the bile duct may be blocked and the bile may be draining into the liver , which will cause more problems such as jaundice, n/v, itching and infection.
what are the appropriate actions for a mother in labor having late decelerations?
lye on left side, inrease IV, admin 02
how do you score an APGAR?
2 points for : HR (120-160), resp effort, color, muscle tone , reflex irritability
what level of precaution is warranted for disseminated herpes zoster?
airborne - neg pressure room , n95 mask, door closed at all times
what is the difference between herpes zoster and disseminated herpes zoster?
DHZ is the same virus , but is defined as 20 or more skin lesions, indicaing that the disease has likely spread to internal organs, and can be fatal. DHZ reqires airborne precautions while shingles does not. with shingles simply covering the leision will prevent the spread.
what is the timeframe for an expected low grade fever reaction to an immunization?
Fever with most vaccines begins within 24 hours and lasts 1 to 2 days.
With live vaccines (MMR and chickenpox), fever and systemic reactions usually begin between 1 and 4 weeks.
what is the expected onset and duration of swelling associated with vaccine injection?
Most local swelling, redness and pain at the injection site begins within 24 hours of the shot. It usually lasts 2 to 3 days, but with DTaP can last 7 days
what is cushings syndrome?
Cushing syndrome occurs when your body is exposed to high levels of the hormone cortisol for a long time. usually caused by medication, otherwise may be caused by pituitary tumor.
s/s: a fatty hump between your shoulders, a rounded face, and pink or purple stretch marks on your skin. Cushing syndrome can also result in high blood pressure, bone loss and, on occasion, diabetes.
Complete recovery possible, but chances increase with prompt treatment
how does medication induced cushings syndrome occur?
overuse of corticosteroids. treatment: taper off. if abruptly stopped, pt could die of adrenal insufficiency.
while hospitalized, how long should a post surgical client wear anti-embolism stockings?
the entire time they are in the hospital. they should only be removed for bathing and then replaced once the skin is dry. they should remain on at night and alway be on when out of bed.
what is multiple sclerosis?
A disease in which the immune system eats away at the protective covering of nerves.
s/s: Vision loss, pain, fatigue, and impaired coordination are symptoms. Remission may follow attacks.
Pain: in the back or eye, can occur in the back due to head nod or with eye movement
Tremor: can occur during precise movements, in the hands or limbs
Muscular: difficulty walking, inability to rapidly change motions, involuntary movements, muscle paralysis, muscle rigidity, muscle weakness, problems with coordination, stiff muscles, clumsiness, muscle spasms, or overactive reflexes
Urinary: excessive urination at night, leaking of urine, persistent urge to urinate, or urinary retention
Sensory: abnormality of taste, numbness, pins and needles, or uncomfortable tingling and burning
Whole body: dizziness, fatigue, heat intolerance, poor balance, vertigo, or weakness
Visual: blurred vision, double vision, or vision loss
Sexual: erectile dysfunction or sexual dysfunction
Speech: slurred speech or impaired voice
Psychological: anxiety or depression
Also common: acute episodes, constipation, cramping, difficulty swallowing, difficulty thinking and understanding, headache, heavy legs, mood swings, numbness of face, rapid involuntary eye movement, sleep deprivation, tongue numbness, or difficulty raising the foot
what are the recommendations regarding pregnancy for women with lupus?
wait until 2 years after DX, and wait 5 months after last flare up to get pregnant.
what is the recommended sleeping / bed arrangement for a person with Parkinson’s?
sleep on a firm mattress with no pillow, so that the spine can lay flat - not flexed. this will slow/ prevent the body from becoming permanently flexed over time.
what must patients with cystic fibrosis supplement in their diet ?
along with digestive enzymes, salt (sodium and chloride) must be replaced. diet must be high fat , high cal, high protein.
what is the recommended diet for patients with kidney disease?
maintain fluid balance with a normal fluid intake of 1-2 L/day, but avoid excess fluid due to potential retention.
avoid consuming excess salt, potassium, phosphorous or other electrolytes because the kidneys may not clear them.
cautiously take any medications that are cleared by the kidney
avoid consuming excess protein because protein not used by the body will be broken down into waste that may not be cleared by the kidney
eat high calorie foods to prevent weight loss. breads and pastas are recommended.
what is the target weight gain of a patient hospitalized for anorexia? What is this patient at risk for until they reach this weight?
the initial target weight, is 85% of ideal weight. Until they reach at least 80% of their ideal weight, they are at risk for hypotension, cardiac arrhythmias, poor muscle tone, increased risk for infection, abnormal liver function, and damaged kidneys.
How much weight gain is safe for a person recovering for anorexic wasting?
maximum of 2lbs per week because growth in excess of this could put excess strain on the heart, which has diminished output from starvation.
what is the best way for a patient with peripheral arterial insufficiency to increase blood flow to the limbs?
rather than apply heat directly to the periphery, it is best to apply heat, such as a heating pad to the center of the body, the abdomen for example, which will cause reflex vasodilation. otherwise the client may burn their skin as a result of decreased sensation in the periphery.
what is dissociative personality disorder?
multipul personality disorder
what is bells palsy? what causes it?
Bell’s palsy is a paralysis or weakness of the muscles on one side of your face. Damage to the facial nerve that controls muscles on one side of the face causes that side of your face to droop camera. The nerve damage may also affect your sense of taste and how you make tears and saliva. This condition comes on suddenly, often overnight, and usually gets better on its own within a few weeks.
The cause of Bell’s palsy is not clear. Most cases are thought to be caused by the herpes virus that causes cold sores.
In most cases of Bell’s palsy, the nerve that controls muscles on one side of the face is damaged by inflammation.
what is the treatment for bells palsy?
It is often caused from inflammation of the facial nerve, so it is treated with corticosteroids such as prednisone. Antiviral meds such as acyclovir may also be taken is herpes is suspected.
Extra care must be taken of the effected eye, oral care, ear care so that permanent damage is not caused due to inability to sense problems.
Any swelling or increased ICP or intra-ocular pressure must be addressed to promote healing and prevent permanent damage. moist heat can help with this and promote comfort as well.
Facial exercises are not recommended early on in treatment.
in an emergency situation, it is better for one person to take the role of leader, or for leadership to be assumed by everyone?
one person will be better able to manage a crisis because time will not be spent discussing different ideas, and more time will go into needed actions.
what is the purpose of the z-track method?
it is a way of administering substances via IM injection that are irritating to the skin and sub -q tissues. - it prevents leaking of the substance into sub-q and skin tissues
what is myxedema? s/s?
word used synonymously with severe hypothyroidism. also describes a characteristic shin change seen in hypothyroidism that involves swelling of the skin and underlying tissues giving a waxy consistency - causes a mask-like facial expression.
other s/s: lethargy, weight gain, cold intolerance, dry hair, thickened skin, enlarged tongue, drooling
what is myasthenia gravis? s/s?
chronic autoimmune neuromuscular disease characterized by muscle weakness that increases during periods of activity and improves after periods of rest. Certain muscles such as those that control eye and eyelid movement, facial expression, chewing, talking, and swallowing are often, but not always, involved in the disorder. The muscles that control breathing and neck and limb movements may also be affected.
s/s: drooping of one or both eyelids (ptosis), blurred or double vision (diplopia) due to weakness of the muscles that control eye movements, unstable or waddling gait, a change in facial expression, difficulty in swallowing, shortness of breath, impaired speech (dysarthria), and weakness in the arms, hands, fingers, legs, and neck.
has periods of remissions and exacerbations
are shingles contagious?
only to people who have not previously had chickenpox (or the vaccine)
when administering oral medication to an infant , what is the best method?
put liquid med in an empty nipple or medicine syringe for the baby to suck out. never recline the baby or squirt the medicine into their mouth to avoid aspiration. give meds before meals to encourage consumption and do not mix with needed foods such as formula.
