Medical Surgical - Week 3 Tips Flashcards
♥ Sounds (All People Enjoy The Movies)
Aortic - 2nd R intercostal Pulmonic - 2nd L intercostal Erb's - 3rd L intercostal Tricuspid - 4th L intercostal Mitral/Apex - 5th L intercostal
Stroke Signs (FAST)
Face
Arms
Speech
Time
Compartment Syndrome S/S (5Ps)
Pain Pallor Pulse declined/absent Pressure ↑ Paresthesia
Shock S/S (CHORD ITEM)
Cold, clammy skin Hypotension Oliguria Rapid, shallow breathing Drowsiness, confusion Irritability Tachycardia Elevated/↓ Central Venous Pressure Multi-Organ Damage
Hypoglycemia S/S (TIRED)
Tachycardia Irritability Restlessness Excessive Hunger Depression/Diaphoresis
Hypocalcemia S/S (CATS)
Convulsions
Arrhythmias
Tetany
Stridor/Spasms
Hypokalemia S/S (6Ls)
Lethargy Leg cramps Limp muscles Low, shallow respirations Lethal cardiac dysrhythmias Lots of urine (Polyuria)
Traction Patient Care (TRACTION)
Temperature of extremity Rope hang freely Alignment of body Circulation check Type/Location fracture Increase fluid intake Overhead trapeze No weights on bed/floor
Cancer Early Warning Signs (CAUTION UP)
▲ bowel/bladder A non-healing lesion Unusual bleeding Thickening of lump Indigestion/dysphagia Obvious ▲ to wart/mole Nagging cough Unexplained weight loss Pernicious anemia
Leukemia S/S (ANT)
Anemia/↓Hgb
Neutropenia/↓WBC
Thrombocytopenia/↑r/o bleeding
TIA
Transient Ischemic Attack (mini-stroke)
Pernicious Anemia
anemia r/t inability to absorb Vitamin B12
Uremia and S/S (3)
anemia r/t kidney failure
seizures, purpura, lethargy
Purpura
rash of purple spots r/t internal bleeding
Asthma Management (ASTHMA)
Adrenergics (Albuterol and bronchodilators) Steroids Theophylline Hydration IV Mask O2 therapy Antibiotics if +infx
Hypoxia (early RAT, late BED)
Restlessness
Anxiety
Tachycardia/pnea
Bradycardia
Extreme restlessness
Dyspnea
Pneumothorax S/S (P-THORAX)
Pleuretic pain Trachea deviation Hyperresonance Onset sudden Reduced breath sounds/dyspnea Absent fremitis X-ray shows collapsed lung
Constipation counters (3)
Exercise
High fiber
Fluid intake
Dysphagia causes (COIE)
Certain neuro disorders
Obstruction
Inflammation
Edema
Dysphagia counters (THOA)
Thick/textured foods
High Fowlers
Oral Care
Adequate time
Dumping Syndrome and (4) S/S
inability of pyloric sphincter to control movement of food into small intestine as r/o gastric surgeries
N/V, distention, cramping, diarrhea 15 minute post-eating
Dumping counters (5)
Small frequent meals Fluids 1 hr AFTER meals fat/protein Ø concentrated sugar Ø lactose
What is GERD?
indigestion and heartburn from backflow of acidic juices onto the mucosa of the lower esophagus
GERD Education (4)
Encourage weight loss (if overweight)
Avoid large meals/bedtime snacks
Avoid citrusy, spicy, and carbonated beverages
Avoid foods that reduce lower esophageal sphincter (LES) pressure
Things that lower LES pressure (6)
Alcohol Caffeine Chocolate Fatty foods Pepper/Spearmint Cigarettes
Peptic Ulcer Disease (PUD) is characterized by…?
erosion of mucosal layer of stomach or duodenum
Causes of PUD (2)?
Bacterial infection (H. Pylori) Chronic NSAID use (aspirin/ibuprofen)
PUD Education (2)
AVOID frequent meals/snacks
Avoid Bad things, NSAIDS, black pepper, spicy foods
Lactose Intolerance is caused by…?
inadequate lactase enzyme that digests lactose
S/S Lactose Intolerance (4)
distention, cramps, flatus, diarrhea
Lactose Intolerance Education
Avoid anything with lactose in it (including chocolate and puddings)
Diverticulosis/itis is…?
pouch(es) in the colon caused by a low-fiber diet which ↑ abdominal pressure
Diverticulosis/itis prevention*
High fiber diet
UNLESS ACUTE, keep low to reduce bowel stimulation
Diverticulosis/itis Education
Avoid seeds/husks
Cholecystitis is…?
inflammation of the gallbladder
Cholecystitis counter
Reduction of fat intake
Cholecystitis aggravators (3)
Things with lots of pieces, coffee, and seasoned foods
Acute Renal Failure (ARF) is…?
a sudden decline in renal function
Acute Renal Failure (ARF) causes (4)
trauma
sepsis
poor perfusion
medications
Acute Renal Failure (ARF) complications (4)
HYPOnatremia
HYPERkalemia
HYPOcalcemia
HYPERphosphatemia
ARF counter
Diet Therapy
Pre-End stage Renal Disease (pre-ERD) is…?
diminished renal reserve with ↑ in serum CK (predialysis condition)
Goals of nutrition therapy for pre-ESRD (3)
preserve renal function
control glucose levels
control HTN
pre-ESRB and protein
restrict to slow progression of disease, but not completely. Proteins needed for health.
pre-ESRB and phosphorus
restrict to slow progression of disease. High levels r/in calcium and phosphorus deposits in the kidneys.
End Stage Renal Disease (ESRD) is…?
Chronic renal failure when GFR is ↓ 24 mL/min and CK steadily rises
DIALYSIS/TRANSPLANT REQUIRED!!!
ESRD Diet (5)
HIGH protein LOW phosphorus LOW potassium LOW sodium Fluid restrictions
ESRD caution with 2 labs?
Calcium and VitD
Why HIGH protein with ESRD?
Alot of it (and amino acids) is lost in dialysis
ESRD 50% protein consumption source?
Biologic sources
ESRD calorie consumption ratio? Why?
35 cal/kg body weight to maintain protein stores
ESRD and phosphorus
RESTRICT, put Phosphate Binders with all meals/snacks
ESRD and VitD
Deficiency occurs b/c kidneys can’t convert it to active form
ESRD and Calcium
Deficiency because is often found in foods w/ K, which are restricted
ESRD and sodium/fluids
allowed depending on BP, weight, serum electrolytes, and urine output
Nephrolithiasis (Kidney Stones)
Renal calculi in kidneys due to excessive intake of protein, sodium, calcium, and oxalates
Oxalates? (3)
rhubarb
spinach
beets
Kidney Stone prevention?
↑ fluid intake
Orders of Prioritization (4)
- Tx immediate threats (ABCs)
- Tx actual problem (N/V, full bladder)
- Monitor for complications/education
- Tx potential problems
Maslow’s Hierarchy of Needs (5)
- Physiological
- Safety
- Social
- Esteem
- Self-Actualization
Erikson’s Stages of Development (8)
- Infant 0 - 1 year - Trust vs. Mistrust
- Toddler 1 - 3 years - Autonomy vs. Shame
- Preschooler 3 - 5 years - Initiative vs Guilt
- School Age 6 - 12 years - Industry vs. Inferiority
- Adolescent 12 - 18 years - Identity vs. Role Confusion
- Young Adult 18 - 35 - Intimacy vs. Isolation
- Middle-aged Adult 35 - 65 - Generativity vs. Stagnation
- Late Adult 65+ -
Integrity vs. Despair
