Hesi Med Surg Review Questions and Answers

Hesi Med Surg Review Questions and Answers IV medication administration . check IV sites (phlebitis (red, inflammation) vs filtration (cold, pale)) = remove the line, move to other site, and administer warm compresses. . phlebitis = administer antibiotic. Vesica medications for relive of phlebitis (be careful with these types of meds because can cause tissue damage - necrosis). You do not need a doctor's order to change IVs from sites. HTN (Risk Ethnic Groups) Afro-American population: It is also more difficult to manage HTN in these ethnic group (usually we have to use 2 meds instead of mono-therapy, although we always try to start with 1 medication, not 2). Monitor kidneys and microcirculation (DM - monitor metabolic panel) Nail Care for a Diabetic Patient Foot Care: Inspect feet daily using a mirror. Check shoes for objects. Apply moisturizer to feet, but not between toes. Wear cotton socks (no synthetic fabrics ) and shoes (do not go barefoot or wear open- toe shoes ). Cut nails straight across. Do not use OTC products (ex: corn/callus removal agents ) Do not use heating pads on feet . . advise to take care of their feet due to poor circulation which also damage peripheral nerves (neuropathy). Therefore, they will have decreased sensation, so they need to be seen regularly by podiatrist cannot care for their feet on their own. Allopurinol use is used to treat gout, high levels of uric acid in the body caused by certain cancer medications, and kidney stones. Allopurinol is in a class of medications called xanthine oxidase inhibitors. It works by reducing the production of uric acid in the body. Tx: of the gout, this medication decreases the level of uric acid. It is not for crisis; it is for maintenance and prevent the crisis. Gout cannot be cured, problem with RNA metabolism. For crisis we also need to add other meds (anti-inflammatory) Herpes Zoster viral disease affecting the peripheral nerves, characterized by painful blisters that spread over the skin following the affected nerves, usually unilateral; also known as shingles Labs / Dx : Clinical presentation , PCR test of vesicle. Tx : Antiviral medications , analgesics . Nursing Care : Isolate patient ( airborne contact precautions ) until lesions have crusted . Avoid patient contact with individuals who have not had chickenpox and are not vaccinated . Monitor for postherpetic neuralgia ( pain that lasts 1 month after onset ) . Patient Teaching : Prevention with Zostavax vaccine for adults 60 years old . Cholera Outbreak A bacterial disease causing severe diarrhea and dehydration, usually spread in water. Is fatal if not treated right away. Key symptoms: are diarrhea and dehydration. ( Rarely, shock and seizures may occur in severe cases.) Tx: Treatment includes rehydration, IV fluids, and antibiotics. Requires a medical diagnosis Iron Deficiency Anemia Diet Insufficient intake or poor absorption of iron . Common in children and pregnant women . SIS : Shortness of breath , pallor , fatigue , weakness , tachycardia TX: Ferrous sulfate , iron dextran . Diet - Food rich in iron red meats, chicken, poultry, grains, dark leafy vegetables, orange juice (because it helps improve the absorption and milk or food rich in calcium decreases the absorption of iron because the Ca competes with iron for the biding sites) AIDS Pathophysiology is caused by the HIV or human immunodeficiency virus. The infection causes progressive destruction of the cell-mediated immune (CMI) system, primarily by eliminating CD4+ T-helper lymphocytes. Pathophysiology: Each has different criteria not only the presence of opportunistic infections/diseases but we also monitor the CD4 T count less than 200..immunosuppression is the landmark. Rheumatoid Arthritis Treatment autoimmune condition that affects the joints and affects other organs systems. TX: Steroidal medication is used, Metrooxide antimetabolite medication -slows down the progression of the disease but it doesn't cure it. Anthrax Management a serious infectious disease caused by gram-positive, rod-shaped bacteria known as Bacillus anthracis. Anthrax can be found naturally in soil and commonly affects domestic and wild animals around the world. -is usually suspected in Pts who work with animals, working at the post office... .very contagious/transmissible -isolation is required to prevent exposure. The respiratory version is the most dangerous one. TX: Antibiotics: Oral, injectable or intravenous antibiotics fight infection. You may need antibiotics for 60 days. Commonly used antibiotics include ciprofloxacin (Cipro®) and doxycycline (Doryx®). Mantoux Test Interpretation - the first test for TB and we have to review the results 72 hours and we say is positive if induration occurs - if not immunocompromised 10mm if we are immunocompromised 5mm and the next step is Xray. -Collect sputum for 3 days and QuantiFERON TB.. - If negative, we do not do anything OA Exercise - degenerative disease where the cartilage is damage and loss. PT:Advise your Pt to engage in water exercises, walk, aerobic exercises, yoga, etc. TX:Acetaminophen in the medication preferred bc it is not an inflammatory process Triage - the assignment of degrees of urgency to wounds or illnesses to decide the order of treatment of a large number of patients or casualties - Pt that we will see first...check respiration, S/S of hypovolemia, ABCs, suspect some condition like MI, or losing blood, for instance Triage Tag Red (1)= immediate - critical patient Yellow (2)= delayed - serious patient that could wait until all reds have been transported Green(3) = ambulatory / hold - minor injuries Black = deceased (expectant) Burn patient fluid replacement (resuscitation) Urine Output : Provide IV fluid resuscitation to maintain a urine output of 0.5 mL/kg;in adults ( sim30-50 mL/hr);and 0.5-1.0 mL/kg/hr; hours in children Parkland Formula : Amount of fluid needed in first 24 h= 4 mL Lactated Ringer's x patient's weight body( in Kg) x % body burned ( using Rule of Nines ) Administer ½ that amount in first 8 hrs . Administer ¼ of that amount in second 8 hrs . Administer ¼ of that amount in third 8 hrs . Laboratory Assessment : Fluid shift ( third spacing ) : Hypovolemia , Hbg , Hct ( due to hemoconcentration ) , hyponatremia , hyperkalemia . Fluid remobilization ( diuresis ) : Hyponatremia , hypokalemia Manage of post Op infection S/S: of an infection are fever associated with increased RR, tachycardia due to increase of metabolism and BP goes down. Pay attention to fluid replacement because of vasodilation due to fever and administration of antibiotic. The most common one is hypovolemic shock. Thrombolytic Treatment adverse effects Adverse effects -Major bleeding in the brain -Kidney damage in patients with kidney disease -Severe hypertension (high blood pressure) -Severe blood loss or internal bleeding -Bruising or bleeding at the site of thrombolysis -Damage to the blood vessels -Fragments of the clot may migrate to other vessels and cause obstruction -Increased risk of bleeding in pregnant woman, elderly people, and people with bleeding disorders -Increased risk for infection -Allergic reactions - difference between anticoagulant and thrombolytic - in any case we have the risk for bleeding. Anticoagulant is to prevent thrombus. EKG Strip EKG Strip Chest Tube Care Obtain chest X-ray to verify tube position -Keep an occlusive dressing on the chest tube insertion site . -Assess insertion site for subcutaneous emphysema ( sx : edema , crepitus ) and infection . -Only clamp when ordered . Do not strip the tube . -Encourage patients to cough , breathe deeply , use an incentive spirometer to help w / lung expansion . -Keep padded clamps , sterile water , sterile gauze at bedside . -If chest tube disconnects from drainage system , place end of tube in sterile water ( to maintain water seal ) -If the chest tube is accidentally removed , place dry sterile gauze over site , notify the provider . -Monitor for complications ( tension pneumothorax ) . Ventilated patient complications - respiratory complications for instance the lungs do not expand as they should - One common complication is infections. - We set the machine for respirations because the Pt is not breathing on his own. - Pt can develop respiratory alkalosis and acidosis so we have to check acid-base balance. -We can have atelectasis also. ventricular fibrillation small wave that does not have the normal PQ RST..Pt is in cardiac arrest and we must activate code blue and follow protocol Compressions, way breathing.. Rapid ventricular rhythm100 beats/min usually due to ischemic heart disease. VT can often deteriorate into VF. Tx : VT WITH pulse : cardioversion , antiarrhythmics , correct electrolyte imbalances . VT WITHOUT pulse : Defibrillation . Blood Transfusion Outcomes they are generally considered safe, but there is some risk of complications. Mild complications and rarely severe ones can occur during the transfusion or several days or more after. More common reactions include allergic reactions, which might cause hives and itching, and fever. monitor reactions. We administer if low hemoglobin and hematocrit level. Therapeutic effect is the increase of the hemoglobin and hematocrit level after we administer blood. It should increase about 2% per unit in the case of hematocrit level. For instance, 4 units about 8% + what the Pt has. Shock patient management Nursing Care: Administer O2 maintain patent airwayprepare for intubation, place patient in supine position with legs elevated for hypotension . Monitor VS, LOC , urine output. Monitor for Multiple Organ Dysfunction Syndrome, Disseminated Intravascular Coagulation. S/S - BP low, and the 1st thing is to administer fluid. BP below 90 activate the rapid response team. Hyper-natremia management normal level of Na is 135 - 145. This is commonly related to dehydration. TX: We administer isotonic solution but with some Na bc we need to slowly reverse the problem. We can replace fluids orally first if tolerated instead of IV. Drug Calculation D/H x Q = x, or Desired dose (amount) = ordered Dose amount/amount on Hand x Quantity Total Hip Replacement Recovery immediately s/p Sx we cannot expect Pt to have full ROM. We do not want the prosthesis to be dislodged/dislocated, so we use abductor pillow during the 1st hour. CHF Patient Care Nursing Care : Monitor daily weight , & Os . Sit patient upright ( High - fowler's ) . Administer , restrict fluid and sodium intake as ordered . Monitor for complications , including pulmonary edema . NSAID Therapy __________________+__are medicines that are widely used to relieve pain, reduce inflammation, and bring down a high temperature. They're often used to relieve symptoms of headaches, painful periods, sprains and strains, colds and flu, arthritis, and other causes of long-term pain Jackson Pratt Drainage is used to help empty excess fluid from the body after surgery. - used in a wound using negative pressure by suctioning the fluid from the wound by closed-suction Signs of Infections Fever, redness, swelling, S/S of inflammation as well, tachycardia, increase in RR if fever is present. Complete CBC specifically WBC (within the agranular cells we have neutrophils (usually with bacteria), basophils..) in case of immunity Pt will be neutropenic Meniere's Syndrome hearing loss, vertigo, tinnitus are the main components. Commonly the Pt will have crisis. With vertigo sometimes there is some improvement. Tinnitus and hearing loss worsens. With vertigo - risk of injury. Hearing impairment we accommodate the interview but we do not speak louder; we speak slow and reads the lips. Glaucoma presentation Open-angle - no pain and affects peripheral vision and Pt does not notices that slowly is losing eyesight and places the Pt at risk for injury/accidents bc they cannot see the entire field. With closed-angle produces pain. TPA Contraindications Contraindications: Bleeding! Contraindicated in patients who have had a hemorrhagic stroke, internal bleeding, recent trauma/surgery, severe hypertension. Contraindications - medication for stroke. Tissue plasminogen activator for Tx of MI or stroke, antithrombotic medication that is not the same anticoagulant than normal ones (aspirin, warfarin, Xarelto, etc.) anticoagulant prevent the formation of thrombus and antithrombotic brakes the thrombus by going to the place where is the occlusion and produces the lysis, so we have to monitor for risk for bleeding. After 3 hours the Pt can have symptoms of necrosis????.. Ototoxicity Aminoglycosides (like Vancomycin) cause nephrotoxicity and ototoxicity. Drugs used to treat neonatal infections can be ototoxic and nephrotoxic. Close monitoring of therapeutic levels and observation for side effects are required. Use a loop diuretic such as furosemide and antibiotics like aminoglycoside and gentamicin leads to ototoxic medication Hypotonic Solutions Therapy adverse effects: the fluid goes into the cell and will swollen and with hypertonic the cell will dehydrate. The main cells affected with hypotonic solution are the nervous cells (neurons). Instillation of hypertonic or hypotonic solution into a body cavity will cause a shift in cellular fluid. Use only sterile saline for bladder irrigation after TURP since the irrigation must be isotonic to prevent fluid and electrolyte imbalance. Can cause hyponatremia! Communication with hearing impaired patients Do not speak loud instead speak slowly and allow them to read your lips. Peripheral Arterial Disease Risk Factors Smoking and DM are the major risk factors. We can have arterial problems. The Pt will report intermittent claudication because the muscles are not receiving O2 and pulses are absent and capillary refill decreased (Pt feels pain when walking and relieves when resting). With venous problems.... Risk Factors: Hypertension , diabetes, smoking, obesity, hyperlipidemia. Elderly abuse bruises at different stages of healing (we report elderly, minor, or disabled Pt). Bruises will change in color. Skin Variations in the elderly: elasticity, presence of wrinkles bc we are losing collagen fibers and elasticity; skin spots, lesions on hands, arms and are slightly elevated but not painful - senile lentiginous. PQRSTU Pain Assessment P- Provocative Q - Quality R - Region S - Severity scale T - Timing - onset, duration U - Understanding patients perception of problem Postural Drainage uses gravity to help move mucus from the lungs up to the throat. The person lies or sits in various positions so the part of the lung to be drained is as high as possible. That part of the lung is then drained using percussion, vibration and gravity. Respiratory infection commonly places the Pt in different positions to facilitate drainage. For instance, for upper lobe Fowlers, lower lobe is Trendelenburg....infection left we place the Pt on the left side. Knee Replacement patient care: the use of an abduction pillow. Any Pt that goes to Sx has pain. Post-op pain the best approach is PCA. Place a machine to produce passive range of motion. We administer pain medication before therapy otherwise the Pt will not be compliant. Malignant Hyperthermia Management: genetic predisposition of a reaction to anesthesia pr excessive production of heat, tachycardia, very high fever, increase of Ca. We treat it with Dantrolene to control S/S. Malignant Hyperthermia Life-threatening complication due to certain drugs (ex: succinylcholine) used in general anesthesia. Path:Anesthetic agents serum calcium and potassium levels in the skeletal muscle cells and muscle metabolism, resulting in a hypermetabolic state. S/S: Muscle rigidity, tachycardia , fever, dysrhythmias , tachypnea, hypotension, cyanosis. Labs:Myoglobinuria (muscle proteins in the urine)(metabolic acidosis) Tx: Discontinue surgery (if possible), administer antidote dantrolene, and 100% oxygen Implement cooling measures (cold IV fluids, ice packs) Administer sodium bicarbonate for metabolic acidosis. Post op complications hemorrhage and Pt will have low BP. During the postoperative phase, recognize that all patients remain at risk for pneumonia, shock, cardiac arrest, respiratory arrest, venous thromboembolism (VTE), and GI bleeding. These serious complications can be prevented, or consequences reduced, by using prudent clinical judgment. If any signs or symptoms of these conditions are noted, respond by immediately notifying the surgeon. SHOCK Response of the body to a decrease in the circulating blood volume, which results to poor tissue perfusion and inadequate tissue oxygenation hemorrhage Copious escape of blood from the blood vessel Manifestations: Apprehension, restlessness, thirst, cold, moist, pale skin • Deep rapid respiration, low body temperature, Low blood pressure, low hemoglobin, Circumoral pallor, Progressive weakness Management: Administer Vitamin K as ordered, Pressure dressings, Blood transfusion,IV fluids. Capillary HEMORRHAGE slow, generalized oozing Venous HEMORRHAGE dark in color and bubble out Arterial HEMORRHAGE spurts and is bright red in color fluid overload s/s edema, JVD, crackles in lungs, reduced urine output, bounding pulse, weight gain, elevated BP. Therapy: Lasix. Monitor for electrolyte changes. Especially EKG. Heparin Treatment Tx to help with coagulation and we need to monitor bleeding and will be placed on bleeding precautions. Heparin Subcutaneous (low molecular weight heparin)enoxaparin (Lovenox). The "H" in Heparin looks like two "put together, to remind you that you monitor with Heparin . Indications: Stroke, DVT, PE, and other thromboembolic disorders requiring fast anticoagulation. Mode of Action: Activates antithrombin , inhibiting thrombus formationPrevents new clots, does NOT break up existing clots. Side Effects: Bleeding, Heparin -induced Thrombocytopenia (H / T) , hypersensitivity. Les Closely monitor aPTT . Therapeutic aPTT is 1.5-2 times baseline. Antidote is protamine ! Monitor for bleeding (coffee ground emesis, tarry stools). Conversion from weight to volume Kg to L (1 Kg is 1 L - for instance to calculate the output of fluid in baby in the pamper) Sputum specimen collection The laboratory will test the sputum for tuberculosis (TB) germs. Checking your sputum is the best way to find out if you have TB disease.Collect in the morning, before brushing teeth bc the flora of the mouth affect the sample, breath and cough ....for TB collect 3 samples in 3 different days. Gout Pathophysiology Excessive uric acid that will deposit in joints. Metabolic disease that causes hyperuricemia (uric acid) and uric acid crystals to be deposited in the joints. Patho: acid causes tophi (crystals) to accumulate in connective tissue. This causes pain, inflammation, and acute arthritis. Primary gout: Overproduction of uric acid due to a genetic defect in purine metabolism. Secondary gout: Hyperuricemia caused by another disease (ex: langle D) or medication (ex: thiazide diuretics , beta blockers ) S/S: Joint pain, erythema, swelling, tophi in the great toe. Labs/Dx:Uric acid levels, synovial fluid examination shows urate crystals , - ray, CT scan. Tx: NSAIDs , colchicine (acute attack), allopurinol and/ or probenecid (chronic gout ), ice packs Patient Teaching:Avoid alcohol , purine -rich foods (red and organ meat , shellfish , fructose drinks) "starvation " dieting . Fluid intake . Reduce stress . Thromboembolic Risk Factors: immobility will create blood stasis which means that blood is not moving. Triade lipid panel - HDL, LDL (less than 200), cholesterol, VLDL, we want high HDL bc is the good cholesterol higher than 50. Triglycerides lower than 150 and total cholesterol level less than 200. Signs of left heart failure #1 risk factor is HTN,ECG Dysrhythmias (Atrial Fibrillation), Valvular Malfunction (mitral valve regurgitation) Cardiomyopathy Left heart failure you monitor respiration, peripheral edema, lung crackles, Right sided HF - ascites.... Metabolic Syndrome is a cluster of conditions that occur together, increasing your risk of heart disease, stroke and type 2 diabetes. These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels. Factors are high BP or already in Tx for High BP, cholesterol LDL, abdominal obesity (BMI) and hyperglycemia (stage of pre-diabetes) Metabolic Alkalosis vomiting, suctioning, high HCO3 and PaCO2, equals the CO2 bc lungs will try to compensate. Monitor K for hypokalemia (acidosis is related to hyperkalemia). Rheumatoid Arthritis Labs Specific: Anti-Cyclic Citrullinated peptide Increase ESR, ANA SLE complications inflammation of various parts of the heart may occur as pericarditis, endocarditis, myocarditis chest pain Bronchial Asthma Pathophysiology •exposure to allergen in susceptible persons - exaggerated hypersensitivity response -Type I hypersensitivity reaction •infections, cold air, exercise, drugs and chemicals, hormonal changes, emotional upsets antibiotic therapy common advice for Pts is to finish the Tx, we take a sample first and then we administer antibiotics. Complications with the use of Broad-spectrum antibiotics - monitor candidiasis and superinfections. Respiratory Acidosis Pathophysiology Increased CO2 retention from hypoventilation, compensatory response is increase in HCO3 by kidney MI diagnosis Right axis deviation (RAD) Occurs in left ventricle OA pathophysiology -Cartilage swells in response to damage as chondrocytes attempt to repair the damage -Cartilage begins to soften, lose elasticity and develops flaking and clefts -Breakdown of cartilage induces chronic synovial inflammation -As cartilage loss progresses the joint space is narrowed -Cartilage damage progresses until underlying bone is exposed -Irregular outgrowth of abnormal bone (osteophytes) form at areas of traumatized subchondral bone Metabolic Alkalosis Etiology results from a loss of H+ or an addition of base to body fluid Coronary Artery Disease Health Promotion Bronchial Asthma Health Promotion Place pt in upright position, administer O2 as prescribed. Monitor for complications (right sided Heart failure) Raynaud's Disease Management Vasodilators (ex:nifedipine), sympathectomy for severe symptoms The pt should wear gloves to protect the hands from extreme cold temperature Care of Legally Blind patients good idea to let the Pt know that we are in the room, maintain functionality and allow independence w/o risking Pt safety. IV Infusion Care Assess the machine if it starts beeping, when you're going to insert the line avoid the antecubital area bc the pt can flex the area, the area is used mostly for phlebotomy Preoperative Antibiotic Administration To help prevent surgical site infection, the perioperative antibiotic should be infused within one hour before incision. Triage System Category Red (1) immediate, critical pt Yellow (2) delayed, serious pt that could wait until al reds have been transported Green (3) ambulatory/hold-minor injuries Black- deceased (expectant) Respiratory Distress Management Maintain patent airway, monitor cardiac status (HR, BP), provide mechanical ventilation care TB Diagnosis Mantoux Skin test: intradermal injection, read within 48-72 hrs. Indurartion 10mm= positive result (5mm for immunocompromised pts) Note: past BCG vaccination may produce a false-positive result Respiratory Infection Management Collect the sample (usually sputum) prior to administering antibiotics Athlete's foot treatment Treatment is anti-fungal medication -do not advise antibiotic treatment for viral or fungal infection BP Range and HTN management Hypertension management :monitor for hypertensive crisis S/S: headache, chest pain, shortness of breath, dizziness OA management Medications: oral analgesics, topical analgesics, topical capsaicin, NSAIDs, glucosamine, injections (glucocorticoids, hyaluronic acid) Surgery: total joint arthoplasty