Medical Surgical Nursing Board Highlights

8/14/2019 Medical Surgical Nursing Board Highlights

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BULLETS(Authored from previous board exam questions)

Chest X ray painless procedure

Bronchoscopyo AtSO4

Anticholinergic mimics SNR

Decreases saliva dry moutho NPO 6 to 8 hourso Local anesthesia check gag reflex before feeding

ABGo Hyperventilation decreased CO2 increased blood pH respiratory alkalosiso Hypoventilation increased CO2 decreased blood pH respiratory acidosiso Diarrhea decreased HCO3 decreased blood pH metabolic acidosiso Vomiting gastric content decreased HCL increased blood pH metabolic alkalosiso Vomiting blood decreased O2 anaerobic metabolism formation of lactic acid

decreased blood pH metabolic acidosiso Blood pH normal 7.35 to 7.45 If increased alkalosis; If decreased acidosiso Partial CO2 normal 35 to 45 If increased Respiratory Acidosis; if decreased Respiratory

Alkalosiso Partial HCO3 normal 22 to 26 If increased Metabolic alkalosis; If decreased metabolic

acidosis

Cancer of the larynx CS, alcohol and over usage of voice (choir member)o A - nterior neck masso B urning sensation with hot beverages / Bad breatho C - hange in the voice (hoarseness)o D ysphagia/dyspnea

Chronic Obstructive Pulmonary Diseaseo Chronic Bronchitis

Blue bloater Excessive mucus production

o AsthmaPeriods of bronchospasm and bronchoconstriction

o EmphysemaDisequilibrium of elastase and antielastasePink puffer

o Manifestations

A LTERATION IN LOC decreased O2 Thoracic anatomy over distention of alveoli TD = APD barrel chest Skin

o Temperature cool clammy skino Color pale to cyanotic

ABG Respiratory acidosis Increased CO2B reathing difficulty, purse lip expiration > inhalation removal of excess CO2(diet low CHO)C ough (mucus production); Chronic hypoxia (2 to 3 lpm of O2 therapy, decreased O2

demand by rest and SFF) clubbing of the fingers and decreased TP to the kidneyscausing polycythemiaD ecreased Metabolism

Anorexia weight loss (high calorie diet) fatigue weaknessBronchodilators

o Theophylline and aminophyllinePrimary effect stimulates beta 2 receptors smooth muscle relaxationbronchodilationSide effect stimulates beta 1 receptors increases cardiac rate need not to notifythe physician


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Adverse effect hypotension monitor BP sign of toxicityEvaluation check breath sounds

Acute Respiratory Distress Syndromeo Causes

A spirationR espiratory trauma (embolism)

fracture embolism ARDSD rug toxicity (ASA)S epsis and shock

Vomiting, bleeding, dehydration hypovolemia shock ARDSo Syndrome

Severe hypoxiaBilateral infiltratesDyspnea

Pulmonary embolismo Restlessness earliest sign

Water Seal Systemo Drainage Bottle marked the level every shifto Water seal bottle

Presence of fluctuation normalAbsence of fluctuation lungs are fully expanded assess first patient (X ray confirm) OR presence of obstructionIntermittent bubbling normal

Absent obstruction Continuous leakage

o Suction Control continuous bubbling normal

Risk factors for cardiovascular disorderso R ace non modifiableo I ncreased blood pressure modifiableo S tress SNR increased BP and CR, vasoconstriction modifiableo K nowing sedentary life style modifiableo F at foods atherosclerosis modifiableo A lcohol (modifiable) / Age above 40 (non modifiable)o C igarette smoking vasoconstriction (nicotine) modifiable / Contraceptive pills clotting

of blood thrombus formationo T ype A behavior (modifiable) competitiveness, perfectionist high stress levelo O besityo R esult of DM lipolysis increased fatty acids atherosclerosiso S ex gender males > female (before menopausal because estrogen decreases PVR)

after menopausal female eversible}[inverted T wave] Injury [elevated ST segment] > male

Decreased TP in heart Ischemia (Angina) {r necrosis (MI) {irreversible}[pathologic Qwave/permanent in the ECG]

Eating a heavy meal, strenuous exercise, sex, exposure to cold Decreased blood flow (heart)decreased TP (heart) decreased O2 (heart) anaerobic respiration production of lactic acidPAIN management decreased O2 demand by rest and SFF

Anginao Pain relieved by rest and NTGo NTG

Vasodilation orthostatic hypotension move gradually Monitor BPStore in a dark and amber container


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Effective tingling sensation no need to notify physicianMaximum of 3 tablets with 5 minute interval

MIo Pain relieved by Morphine SO4

Narcotic analgesicCan cause respiratory depression monitor RR and O2 saturationAntidote narcan

Cardioversion synchronous

Defibrillation unsynchronous

Buergers disease CS vasoconstriction stop CS common in men

Raynaud s stress and cold vasoconstriction common in female

Congestive heart failureo Left sided pulmonary

DyspneaCracklesPolycythemia due to decrease O2 to the kidneysClubbing of the fingers due to prolonged hyxiaOrthopnea

o Right sided systemicHepatomegalyDistended neck veinsEdemaPortal hypertension

Ascites weight gainVaricose veins

o DigoxinCardiac glycosidePositive inotrophic effect increased strength of myocardial contractionNegative chronotrophic effect decreased cardiac rate monitor CR never give if CR below 60 bpmAdverse effect

V omitting A norexia N ausea D iarrhea A bdominal pain REMEMBER : earliest GI; late halo vision Antidote Digibind

Decreased RBC Activity in tolerance, Fatigue, provide rest, Anemia

Decreased Platelets Prone to bleeding, avoid parenteral injection, appl pressure on injectionsite, high risk for injury

Decreased WBC prone to infection, reverse isolation

Increased WBC presence of infection

First Day/Newly diagnosed Knowledge deficit

Diuretico D iet high K diet except aldactoneo I input and Output expected increased outputo U ndesirable effect electrolyte imbalance (K)


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o R ecord weight expected decreased weighto E lderly special precautiono T ake in AM and with foodo I ncreased orthostatic hypotension monitor BP and move graduallyo C ancel alcohol because of mild diuretic effect

Heparin anticoagulant prevent further enlargement of clot not dissolve them monitor APTT/PTT antidote protamine SO4

Coumadin anticoagulant prevent further enlargement of clot not dissolve it monitor PTvitamin K is the antidote

Urokinase/Streptoase dissolves the clot

Pernicious anemia absence of intrinsic factor (gastric surgery) problem in absorption of VitaminB12 beefy red tongue schillings test definitive test 24 hour urine collection life long VitaminB12

Gastritis LUQ pain

Gastric ulcer affected area stomach pain (precipitated by food intake increased HCl) painrelieved by antacids

Duodenal ulcer affected area duodenum pain (2 hour after eating) pain relieved by food

Ulcers bleeding (+) occult blood test (guiac) high fiber diet, avoid red meat, iron, steroids,NSAIDs, indomethacin

Vagotomy resection of vagus nerve decreased cholinergic stimulation decreased HCl and

gastric movement

Dumping syndrome tachycardia and weakness 3 Ds (diarrhea, diaphoresis and dizziness)fluids after meals, lie down after meals and SFF

Appendicitis RLQ pain avoid heat pads cause rupture signs of ruptured appendixsudden cessation of pain, elevation of temperature and WBC

Diverticulitis LLQ pain low fiber diet

Diverticulosis high fiber diet

Ulcerative colitis bloody diarrhea 15 to 20 times a day fluid volume deficit, anemia

Liver cirrhosis alcohol and malnutrition (laennecs) , infection and drugs (post necrotic) , RSCHF(cardiac) and biliary obstruction (biliary)

o Portal hypertention can lead toBlood shifted to the different collateral

Esophageal varices Spider angioma (face and neck) Caput medusae (abdomen) Hemorrhoids (rectal) Management avoid rupture avoid shouting, valsalva maneuver

Increased hydstatic pressure fluid shifting asciteso Decreased albumin decreased oncotic / colloidal osmotic pressure fluid shifting ascites

management high protein dieto CHON metabolism by product ammonia liver cannot convert to urea increased level of

ammonia in the brain Alteration of LOC and changes of behavior and asterexis hepaticencephalopathy management low CHON diet and lactulose for removal of ammonia

Hepatitis A fecal oral prone plumber


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Hepatitis B body secretion prone working in a dialysis

Cholecystitis 5 Fs (fair, female, fat, fertile and forty) RUQ pain after ingestion of fatty fooddemerol to relieved pain

Cholecystectomy T tube level of the incision site drain excess bile

Pancreatitis alcohol autodigestion LUQ pain

Anterior Pituitary glando Growth hormone

Increased before the closure of the epiphysis of the long bones gigantism tallIncreased after the closure of the epiphysis acromegaly big hands (big gloves), bigfeet (big shoes) and big head (big hat)Decreased dwarfism

o ProlactinIncreased galactorrheaDecreased decreased milk production

o ACTH

Increased secondary cushingsDecreased secondary addisons

o TSHIncreased secondary hypethyroidismDecreased secondary hypothyroidism

Posterior pituitary glando ADH

Increased water retention oliguria edema (fluid volume excess) and weight gainconcentrated urine increased urine specific gravity

Decreased water excretion polyuria dehydration (fluid volume deficit and weightloss) diluted urine decreased urine specific gravity

Parathyroid glando Parathormone

Increased increased calcium in the blood and decrease calcium in the bones stoneformation and decreased bone mass osteoporosis management increased water intakeDecreased hypocalcemia calcium supplement

Thyroid Glando Increased (hyperthyroidism)

T3 and T4 increased BMR hyperactive inability to focus insomia increasedcatabolism weight loss increased appetite increased peristalsis Diarrheafluid volume deficit Increased CR and RR (due to increased BMR)

Increased T3 heat intoleranceCalcitonin decreased calcium in the blood tetany compensatory calciumwithdraws from the bones bone destruction (complication)PTU decreased synthesis of TH watch out for SE (similar to signs and symptomsof hypothyroidism) watch out for agrunulocytosis (fever, skin rash and sore throat)Lugols solution decreased released of TH before thyroidectomy decreasedvascularity of the thyroid gland

o Decreased (hypothyroidism)T3 and T4 decreased BMR hypoactive sleeps a lot decreased metabolismweight gain anorexia decreased peristalsis constipation decreased CR andRR due to decreased BMRT3 cold intoleranceCalcitonin hypercalcemia stone formationSynthroid and Proloid increased TH

Adrenal Glando Incresead (cushings)

Glucocorticoids hyperglycemia and decrease wound healing


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Mineral corticoids increased aldosterone sodium retention and potassium excretionhypernatremia and hypokalemia

Hypernatremia water retention oliguria edema (moon face,buffalohump,fluid volume excess and weight gain) concentrated urine increased urinespecific gravity low sodium diet

Hypokalemia weakness Prominent U wave high potassium dietEpinephrine and Norepinephrine Increased BP and CRSex hormones

Males gynecomastia and falling of hair Females hirsutism and deepening of the voice

o Decreased (addisons)Glucocorticoids hypoglycemia and inability to cope with stressMineralcorticoids decreased aldosterone sodium excretion and potassiumretention hyponatremia and hyperkalemia

Hyponatremia water excretion polyuria (dehydration, fluid volume deficitand weight loss) diluted urine --. Decreased urine specific gravity increasedfluids and Na

Hyperkalemia weakness tall or peaked T waves low K diet

Epinephrine and Norepinephrine decreased BP and CR

Diabetes Mellituso Type I absolutely no insulin thin insulino Type II insufficient insulin obese OHAo Diet 50% CHO, 30% Fats, 20% CHONo Exercise Increased uptake of glucose Decreased insulin requiremento Oral hypoglycemic agent (OHA)

Stimulates pancreas to produce insulin

o InsulinSC; IV if DKANever massage the areaNever administer cold insulinRotate the site of injection

PREVENTS LIPODYSTROPHYMix

Aspirate clear first Inject air to cloudy first

o HypoglycemiaW eaknessH unger pangsA alteration of LOCT achycardia and tremors

A bdominal painB blurring of visionC ool clammy skinD iaphoresisGive orange juice (simple sugars)

o DKA increased lipolysis increased ketoneso Hyperglycemia polyuria, polydipsia, polyphagia, kussmaul breathing, glycosuria, ketonuria

and warm flush skino Glycosylated hemoglobin reflect BSL for the past 3 to 4 months most accurateo Foot care

PodiatristAvoid removing corns and callusesCut toe nails straight acrossAvoid walking bare foot


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Hepatitis A fecal oral

Hepatitis B body and bloody secretions (hemodialysis)

Peritoneal Dialysiso Diasylate output is decreased turn patient from side to sideo Complication infection monitor WBC and temperature, diasylate is cloudy boardlike and

rigid abdomen peritonitiso Dont include diasylate solution in the output of the cliento Expected decreased weight monitor weight before and after decreased createnine and

BUN

Heart block decreased tissue perfusion

Parkinsons diaseaseo Decreased dopamine in the basal ganglia levodopa to increased dopamine avoid Vit B6

foodso Cardinals signs tremors (non intentional) muscle rigidity bradykinesiao Pill rollingo Microphonia ask your client to speak aloud to be awareo Artane and Cogentin anticholinergic decreased muscle rigidity

Myasthenia Graviso Tensilon test confirmatory testo Decreased Acetylcholine and increased cholinesteraseo Muscle weakness priority airwayo NO tranquilizer, Morphine SO4, Muscle relaxant and neomycino Cholinergics (mestinon) increased muscle strength antidote ATSO4

Undermedication myasthenic crisis give cholinergics

Over medication

cholinergic crisis

give ATSO4

Multiple Sclerosiso Demyelinization of the myelin sheatho Charcoats triad

Intentional tremors

Scanning of speechNystagmus

o Visual disturbances diplopia

Pancreatitis autodigestion alcohol bleeding shocko Elevated amylase

Rheumatoid Arthritiso No specific diagnostic testo NSAIDs and ASA (antipyretic, analgesic and anti-inflammatory)o Synovitis Pannus formation fibrous ankylosis (limited joint movement) Bony ankylosis

(joint fixation)o Avoid flexion and promote prone position

Gouty Arthritiso Increased uric acid allopurinol and avoid organ meats (liver) tophi (ears)

Osteoarthritiso Most common related with agingo Pain after weight bearing exercise or activity rest to relieved pain weight reduction


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Diverticulitis LLQ pain and low fiber diet

Cyclophosphamide (Cytoxan) can cause hemorrhagic cystitis to avoid increased fluid intake

Vincristine (Oncovin) increased fiber in the diet

Iron supplement When is the best time to take (empty stomach), How is best taken (with orange juice)

Steroids and NSAIDso DEATH inflammationo BIRTH side effects

B one marrow depression prone to infection monitor temperature and WBCI ncreased gastric irritation take it with food or after mealsR enal toxicityT innitusH epato toxic

Cataract common cause is aging (senile) opacity of the lens position on the unaffected side

Glaucoma increased IOP decreased of peripheral vision first halo, tunnel and gun barrel vision miotics (constricts pupils) avoid ATSO4 (dilates pupil)

Retinal detachment trauma blood clots floating spots dependent position scleral buckling

Avoid Increased Intraocular pressure PRIORITYo Avoid vomiting, coughing, valsalva maneuver, lifting heavy objects, bending, crying

Menieres Triad tinnitus, impaired hearing loss and vertigo low Na dieto Vertigo imbalance high risk for injury decreased vertigo by focusing on one side of the

room assume a flat or reclining position

ASA 8 th cranial nerve damage tinnitus, impaired hearing loss and vertigo

Antibiotics allergic reactions

Normal Valueso BUN = 10 20 mg/dlo Calcium = 9 to 10.5 mg/dlo Creatinine = 5 to 1.5 mg/dlo GTT = 70 to 115 mg/dlo O2 sat = 97 to 98%

Signs and Symptoms of Increased Intracranial Pressureo B lood pressure and temperature are elevatedo R espiratory and cardiac rate are decreasedo A lteration of LOCo I rritabilityo N ote for projectile vomitingo S eizure

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Medical Surgical Nursing Board Highlights