Med Surge Final

Front 1

hyponatremia - causes

Back 1

inadequate intake of sodium/excessive loss, fluid excess dilutes, third spacing; NPO, sweating, diuretics, GI suction, SIADH, excessive ingestions of hypotonic fluids, freshwater near drowning, decreased aldosterone

Front 2

hyponatremia - S&S

Back 2

dehydration/fluid excess; mental status changes (disoriented, confused, personality changes = cerebral edema), weakness, N/V, diarrhea

Front 3

hypokalemia - causes

Back 3

inadequate intake of potassium, excessive loss through kidneys, medications (potassium losing diuretics, digitalis, corticosteroids), severe vomiting, diarrhea, GI suction

Front 4

hypokalemia - treatment

Back 4

oral/IV potassium (premixed, never by IV push) - level should be 3.5-5 mEq
priorities: replace potassium, treat underlying causes

Front 5

hypokalemia - S&S

Back 5

muscle cramping, shallow/ineffective respirations, weak/irregular/thready pulse, irregular heartbeat, orthostatic hypertension, changes in mental status, N/V, abdominal distention, constipation

Front 6

hyperkalemia - causes

Back 6

increase in amount of potassium in body, intracellular potassium moves into blood (metabolic acidosis), overuse of potassium based salt supplements, excessive intake of oral/IV potassium, potassium sparing diuretics, renal failure = kidneys cannot excrete

Front 7

hyperkalemia - treatment

Back 7

dietary limitation of potassium, D/C supplements, give potassium losing diuretics, Kayexalate (oral/rectal), glucose and insulin to move back into cells

Front 8

hyperkalemia - S&S

Back 8

muscle twitches/cramps, muscle weakness, diarrhea, dysrhythmia, decreased BP

Front 9

hypocalcemia - s&S

Back 9

breaks a bone, increased/irregular heart beat, mental status changes, hyperactive deep tendon reflexes, increased GI motility (diarrhea/abdominal cramping), Trousseau's sign (spastic fingers/hand if BP cuff is inflated), Chvosteks sign (tap face = facial twitching)

Front 10

hypocalcemia - treatment

Back 10

oral calcium supplements 1-2 hours after meals, Iv calcium gluconate or calcium chloride, aluminum hydroxide (binds excess phosphate = increased serum calcium), diet therapy + vitamin D

Front 11

hypocalcemia causes

Back 11

lack of intake, inadequate absorption through intestines, insufficient intake of vitamin D, parathyroid dysfunction

Front 12

• Prioritization of care- who to see first, what to do first

Back 12

ABC, unstable to stable

Front 13

• HTN- Diet

Back 13

decrease salt (works for some), limit caffeine (increases aortic stiffness), get enough potassium/magnesium/calcium (bananas, oranges, broccoli, green veggies, nuts, seeds, whole grains, milk, yogurt, spinach), limit alcohol to 1 oz/day for men/.5 oz/day for women, exercise, decrease smoking
DASH diet - increased intake of commonly available foods

Front 14

• Anaphylactic shock - causes

Back 14

Distributive shock/massive vasodilation, extreme hypersensitivity reaction to antigen - bronchioles constrict = increased fluid/mucous in bronchial passages)

Front 15

• Anaphylactic shock - signs

Back 15

allergic reaction (urticaria, pruritis, wheezing, laryngeal edema, angiodema, bronchospasm, dyspnea, chest tightness, anxiety), hypotension, decreased LOC, respiratory distress

Front 16

• Anaphylactic shock - treatment

Back 16

ABCs, trendelenberg, LOC, take pulse frequently to monitor heart's contractions, monitor for skin temp/color changes, cap refilll, epi, antihistamines, steroids to prevent return of symptoms

Front 17

• PCA (Morphine/Dilaudid most common)

Back 17

o Basal dose (i.e. MS 2mg/hr)
o Lockout dose (i.e. MS 1mg every 15 minutes)
o What is purpose of PCA? patient controls for own pain
o Read every 4 hours (Amount in mg)
o Pain is assessed every 2 hours (minimum)

Front 18

• NSAIDS

Back 18

(Ibuprofen, Toradol), limited in use due to ceiling effect, do not produce tolerance of physical dependence, use care if also using opiods because of increased risk of toxicity

Front 19

• Opioids

Back 19

; durg of choice, long acting, Dilaudid: shorter acting, faster onset; Fentanyl: patch or IV; Oxycodone, Oxycontin, Percocet, Vicodin), no ceiling effect, need immediate release med for break through pain,

Front 20

Centrally-acting analgesic

Back 20

Ultram)

Front 21

• Adjunct pain medications (

Back 21

(Anti-seizure meds [i.e. Neurontin: relieve sharp, cutting pain caused by peripheral nerve syndromes)])
potentiate effects of opioids/nonopiods, treating pain that does not response to traditional analgesics

Front 22

Thrombocytopenia

Back 22

reduction in platelets that increases risk of bleeding/bruising and may require transfusions; may be side effect of chemo

Front 23

Thrombocytopenia - prevent bleeding

Back 23

prevent bleeding: safety razor, soft toothbrush/avoid flossing, avoid invasive procedures (douches, enemas, suppositories, rectal temp), avoid IM injections, do not pump BP cuff too high, avoid blood draws, maintain pressure on IV/puncture sites for at least 5 minutes, encourage use of shoes/slippers, keep area clutter free, avoid use of aspirin/NSAIDs, stool softeners, move and turn gently, avoid blowing nose

Front 24

• Leukopenia

Back 24

low WBC, increases susceptibility to infection/sepsis; side effect of chemo

Front 25

• Nadir of chemotherapy

Back 25

?? __drops_WBC _drops_Hgb drops_ Platelets; time when cell counts are at their lowest

Front 26

Increase Hgb, WBC, platelets

Back 26

Platelets: Interleukin 11
Hgb: erythropoietin (stem cells to RBC)
WBC: Granulocyte-macrophage colony stimulating factor (neutrophils, monocytes, macrophages, eosinophils), Granulocyte colony-stimulating factor (stem cells to neutrophils)

Front 27

nursing interventions for ↓WBC, ↓Hgb, ↓Platelets

Back 27

monitor temp every 4 hours, monitor WBC count daily, assess for inflammation/drainage @ potential infection sites, monitor for signs of respiratory infection, monitor for signs of UTI, teach administration of meds, good hand washing, limit visitors to healthy adults, keep fresh flowers/plants out of room

Front 28

• Preoperative teaching

Back 28

evaluate anxiety level, id knowledge deficiencies, reinforce info, include family/caregivers in education, variety of teaching methods
food/fluid restrictions, special preps (enema), how to report pain level, pain relief methods, anticipate dressings/tubes, post-op exercise (deep breathing, incentive spirometry, coughing, leg exercises, foot circles, how to turn, sit before standing)

Front 29

• Legal consent

Back 29

physicians responsibility; nurse may obtain signature, ensure understanding
1) physician must explain procedure in understandable terms 2) sign prior to meds 3) voluntary

Front 30

• Wound evisceration (p. 198)

Back 30

viscera spilling out of abdomen
malnourished, obese, elderly, poor wound healing
splint wound when coughing
keep in low fowlers, flex knees, notify physician immediately, gentle pressure, monitor vitals, cover wound with sterile dressing or towels

Front 31

• Triage in the ER during a disaster- who gets priority?

Back 31

seriously injured with greatest chance of full recovery

Front 32

• ABC’s

Back 32

airway (rule out spinal injury before extending head), breathing (Et tube if unconscious), circulation (pulse quality/rate, skin temp/color, assess for shock), D = disability, CNS

Front 33

• Middle aged- Erickson’s stage

Back 33

generativity vs self-absorption; productive/creative, vision for future generations, concern for others

Front 34

• Alzheimer’s patient care

Back 34

AChE inhibitors (donepezil/Aricept, rivastigmine/Exelon) to increase levels of acetylcholne
provide box of safe/familiar items, orient to time/season, focus on feelings if hallucinating, reduce stressors such as fatigue, overstimulation, pain, maintain usual routines, communicate clearly,

Front 35

• Psychiatric emergencies-

Back 35

no longer posses coping skills necessary to maintain their usual level of functioning, potential to harm self or others, crisis = state of emotional turmoil, unable to resolve situation with own resources; pain = loss of control
depression= physical ailments/somatizations
psychotic = impaired thought processes, hallucinations, delusions, thought broadcasting, through insertion
manic = bizarre, extreme, hyperactive behavior

Front 36

• Review chambers of the heart, valves and cardio-respiratory blood flow

Back 36

rt. atrium to tricuspid valve to rt. ventricle to pulmonary semilunar valve to pulmonary artery to lungs to pulmonary veins left atrium to mitral valve to left ventricle to aortic valve to

Front 37

• Review the pacemaker of the heart

Back 37

SA node, AV Node, perkenje fibers, bundle of His

Front 38

angiogram

Back 38

: dye injected into blood vessels to make them visible with cardiac cath, NPO 4-18 hours before, check for allergies, burning sensation from dye, may need pressure on insertion site, immobilize extremity for several hours

Front 39

echo

Back 39

transducer sound waves bounce of heart to produce images and show blood flow, provides audio and graphic data; patient lies on left side, may be done at bedside

Front 40

EKG

Back 40

transducer sound waves bounce of heart to produce images and show blood flow, provides audio and graphic data; patient lies on left side, may be done at bedside

Front 41

doppler

Back 41

sound waves bounce off moving blood, produces recordings; evaluates PVD

Front 42

VQ scan

Back 42

inhaled stuff to measure breathing and circulation in lungs

Front 43

• Review the use of Coumadin and PT/INR

Back 43

warfarin: INR and PTT to measure clotting

Front 44

beta blockers

Back 44

decrease sympathetic nervous system, resulting in decreased blood pressure, heart rate, contractility, cardiac output, and renin activity (-ol), check daily I&O and weight, check HR and Bp before giving

Front 45

diuretics

Back 45

increase urine output by inhibiting sodium and water reabsorption by the kidneys

Front 46

ACE inhibitors

Back 46

block production of angiotensin II, a potent vasoconstrictor; reduces peripheral artery resistance and BP (-pril); check for edema

Front 47

Ca channel blockers

Back 47

prevent movement of extracellular calcium into the cell, which vasodilates; take pulse, may cause dysrhythmias

Front 48

• Review stages of HTN and suggested follow-up and medications (

Back 48

normal: <120/80; follow-up in 2 years, no drugs
prehypertension: 120-139/80-89; follow-up in 1 year; no drugs
stage 1: 140-159/90-99; following in 2 months; thiazide type diuretics (ACEI, ARB, BB, CCB)
stage 2: >160/>100; follow-up in 1 month; both drugs above

Front 49

labs for MI/ Priorities in the treatment of MI

Back 49

labs: ECG, serum cardiac troponin I or T, myoglobin, CK-MB levels, magnesium levels, PT, PTT
Priorities: stop damage, oxygen therapy, meds

Front 50

lft sided heart failure causes

Back 50

hypertension forces left ventricle to work harder and it eventually fails, aortic stenosis (increased volume to pump), cardiomyopathy (increased workload due to poor contractility), coarctations of the aorta (increased resistance from elevated pressure), hypertension (resistance increased from elevated pressure), heart muscle infections (increased workload from damaged myocardium), myocardial infarction (increased workload from poor contractility), mitral regurgitation (increased volume to pump)

Front 51

lft sided heart failure S&S

Back 51

: lungs, increased pulmonary pressure from blood backing up into lungs, SOB, cyanosis, pulmonary edema, dry hacky cough when supine, crackles/wheezing, orthopnea, nocturnal dyspnea, cyanosis, tachypnea/tachycardia, nocturia

Front 52

rt sided heart failure causes

Back 52

left sided heart failure, atrial septal defect (increased volume to pump), cor pulmonale (resistance increased due to elevated pressure), pulmonary hypertension (resistance increased from elevated pressure), pulmonary stenosis (increased volume to pump)

Front 53

rt sided heart failure S&S

Back 53

engorged jugular neck veins, edema of peripheral tissues , engorged abdominal organs ,anorexia, N/V, abdominal pain. liver failure, engorgement of spleen/liver, peripheral edema, ascites, weight gain, fatigue, weakness, tachycardia, nocturia

Front 54

HF interventions

Back 54

oxygen, sodium restriction, fluid restriction, weigh daily, ICD, mechanical assistive decides, valvuplasty, heart valve replacement

Front 55

digoxin

Back 55

increased force of contraction = increased cardiac output, slows heart rate to reduce workload; apical pulse must be at least 60, take at same time each day, therapeutic levels + 0.5 to 2 mg/mL; FAB (digiband is antidote)

Front 56

Captopril:

Back 56

ACE inhibitor + diuretic; decreases afterload and cardiac hypertrophy, check BP, monitor WBC, take on empty stomach, report development of cough

Front 57

Fibrates:

Back 57

reduce triglycerides (tricor, atromid, lopid), take 30 minutes before morning nad evening meal, may increased effects of anticoagulants and hypoglycemia

Front 58

HMG CoA inhibitors (statins):

Back 58

reduces low density lipoprotein by reducing cholesterol synthesis, liptor, lecol, taken in evening because cholesterol synthesis is highest, report muscle pain, monitor liver function studies

Front 59

bile acid sequestrants

Back 59

: bind bile acids, so stored cholesterol is used to make more bile acids (Colestipol (Colestid), add fruits and veggies, may interefer with absorption of digoxin, thiazides, and beta blockers

Front 60

niacin

Back 60

prevents conversion of fats into very low-density lipoproteins

Front 61

bronchoscopy

Back 61

flexible endoscopy to examine larynx, trache, bronchial tree
biopsy/visualization/remove object
NPO for 6-8 hours prior
atropine to reduce secretions ,anesthetic spray
NPO till gag reflex returns, may have sore throat

Front 62

adrenergic bronchodilators

Back 62

stimulate beta receptors to dilate bronchioles, albuterol (VEntolin, Proventol), Metaproternol (ALupent, Metaprel), Pirbuterol (Maxair), Salmeterol (Serevent), Formoterol (Foradil)

Front 63

Steriods

Back 63

reduce inflammation in airways, methylprednisolone (Medrol), Prednison, Triamcinolone acetonide (Azmacort), Beclomethosone (Beclovent), Flticasone (FLovent), Budesonide (pulmicort)

Front 64

mast-cell inhibitors:

Back 64

stabilize mast cells to reduce histamine release, Cromolyn sodium (Intal), Nedocromyl (Tilade)

Front 65

Leukotrience inhibitors:

Back 65

inhibit mediator of inflammation in asthma, Zakirlukast (accolate), Montelukast (singulair), zileurone (Zyflo)

Front 66

• Tracheostomy- need for suctioning

Back 66

crackles or wheezes heard with or without stethoscope, dropping O2 saturation

Front 67

• Nasoseptoplasty- care for patient

Back 67

change moustache dressing as often as needed
do not blow nose, sneeze with mouth open
drink lots of fluids
cool mist vaporizer to humidify air
keep head elevate with two pillows
ice pack to reduce swelling
call physician if fever is more than 101 degrees

Front 68

• Oxygen delivery devices

Back 68

simple face mask - 5-10 L/min @ 40-60%
partial rebreather mask - concentrations of 50% or greater, captures some exhaled gas
nonrebreather: 70-100% concentration, do not allow reservoir to collapse to less than 1/2 full
venturi: precise concentration of oxygen

Front 69

• Thoracentesis

Back 69

insertion of needle in pleural space to aspirate fluid, sterile procedure - up to 2 L = reduction of dyspnea
void before procedure
may feel pressure
analgesic, local anesthetic
sitting position, relax
dresing to prevent air leakage
bedrest for 1 hour following
ensure lung is not punctured

Front 70

Upper GI series

Back 70

x=ray exam of esophgous, stomack, duodenum, jejenum using oral radiopaque liquid
detect strictures, ulcers, tumors, polyps, hiatal hernia, motility problems
NPO 6-8 hours, clear liquids night before
drinks barium, laxative following to expel, drink extra water to prevent constipation

Front 71

lower Gi series (barium enema

Back 71

position, movements, filling of colon
low residue diet for two days previous
bowel cleansing evening before
barium instilled rectally, x-rays taken, takes 15 minutes
ensure all barium is passed