Summary Medical Surgical Study Guide 2021

Med-Surg Study Guide 2021 Heart Failure (HF) (10)  S/S left HF and S/S right HF  Signs & Symptoms  Left sided failure (blood backing up in lungs) Right sided failure (blood backing o up Venus system = edema)  *Dyspnea, orthopnea (shortness of breath while *Jugular vein distention  Lying down), nocturnal dyspnea *Ascending dependent edema (legs,  *Fatigue ankles, sacrum)  *Displaced apical pulse (hypertrophy) *Abdominal distention, ascites  *S3 heart sound (gallop) *Fatigue, weakness  *Pulmonary congestions (dyspnea, cough, *Nausea and anorexia  Bibasilar crackles) *Polyuria at rest (nocturnal)  *Frothy sputum (can be blood-tinged) *Liver enlargement (hepatomegaly)  *Altered mental status and tenderness  *Manifestations of organ failure, such as *Weight Gain  Oliguria (decrease in urine output)  Treatment o Diuretics o Ace inhibitors = Valsartan o ARB’s o CCB;s o Digoxin = strengthens heart o Beta Blockers o Vasodilators = Nitro o Warfarin, Plavix, blood thinner  How to monitor HF – patient education o Daily weight o Diet = low sodium o Smoking cessation o Position: high fowlers o Monitor VS o Monitor lab work o Heart rate = below 60 do not administer digitalis = listen to apical for a full minute  Nursing actions/interactions associated with monitoring HF o AROM o Fluid restriction o Low sodium diet o Weights o I & O o Medications = 2 | P a g e  diuretics  digitalis = increase myocardial contraction which slows conduction  normal 0.5 -2  Ace inhibitors = biggest side effects = cough  Dobutamine for severe heart failure  Digoxin = decrease in potassium  Toxic s/s = halos, vision changes, arrythmias, N/V  Oxygen above 92% o Monitor labs o Administer medications  Patient Education o Low sodium diet o Emotional support o Effective breathing techniques o Daily weight at same time everyday  notify dr. if more than 2lbs in a day or 5lb in a week. o Report swelling of feet or ankles o Report shortness of breath o Common adverse effects of medication  Key assessments with meds associated with HF o Respiratory assessment o Auscultation o Urinary output o Weight o I & O o Blood Pressure o Ascites  Patient education on meds used to treat HF o Lisinopril  Hypotension  Increased serum potassium  Worsening renal function  Cough o Losartan  Hypotension  Increased serum potassium  Worsening renal function o Hydralazine  Hypotension o Metoprolol  Decreased heart rate  Hypotension  Dizziness 3 | P a g e  Fatigue o Diuretics  Electrolyte imbalances  Renal dysfunction  Decreased  BP  I & O  Daily weights  Hypokalemia  Hypernatremia o Spironolactone  Hyperkalemia  Hyponatremia o Digoxin  Bradycardia  Toxicity Hemophilia (6)  Both types of hemophilia are inherited as X linked traits  so mostly men are affected o Hemophilia A (factor VIII deficiency) measured by aPTT (intrinsic Pathway) o Hemophilia B (Christmas Disease, factor IX deficiency) measured by aPTT (intrinsic Pathway)  Treatment o Replacement of the missing factor VIII or IX o Fresh frozen plasma o Recumbent (manmade) factor treatment o aPTT = 30 - 35  Nursing actions/interventions when caring for hemophiliac o Sign/Symptoms  Lethargy  Joint pain o Prevent bleeding o Safety precautions (fall precautions) o Avoid IM injections o Avoid meds that may encourage bleeding o Monitor for internal bleeding  Coffee ground emesis  Cola colored urine  Tarry stools  Patient education on living with hemophiliac o Can’t take aspirin/NSaids o Before dentist replace factors 4 | P a g e o Protect from injuries o Soft bristle tooth brush o Electric razor o RICE o Apply pressure to cuts o Genetic counseling Leukemia (AML, ALL, CML, CLL) (10)  Commonalities of all leukemia’s o Unregulated Proliferation of leukocytes in the bone marrow o Later stage of proliferation leaves little to no room for normal cell production o Exposure to radiation or chemicals, certain genetic disorders, and viral infections  Assessment findings of low platelets o Easy/excessive bruising o Petechia on lower limbs o Prolonged bleeding o Bleeding gums o Nose bleeds o Blood in urine or stools  Potential complications associated with leukemia (the TOP potential complications) o Infection  S/S of each leukemia and treatment regimen for all leukemia’s and complications: o Acute Myeloid Leukemia  results from a defect in the hematopoietic stem cell that differentiates into all myeloid cells.  Symptoms arise from insufficient production of normal blood cells  Fever, infection  Weakness fatigue  Dyspnea on exertion  Anemia = pallor  Petechiae  Ecchymosis  Bleeding tendencies  Treatment of AML  Aggressive Administration of chemo called induction therapy, which usually requires hospitalization  Complications: o Bleeding o Infection o Chronic Myeloid Leukemia (CML) arises from a mutation in the myeloid stem cell  Malaise  Anorexia 5 | P a g e  Enlarged/tender liver  Weight loss  Leukocyte above 100,000  Treatment  Tyrosine Kinase inhibitor (Gleevec) blocks signals within leukemia cells  Complications o Fatigue o Anemia o Acute lymphocytic Leukemia (ALL)  results from an uncontrolled proliferation of immature cells derived from the lymphoid stem cell  Enlarged liver & spleen with pain  Bone pain  Headache, vomiting  Treatment  Chemotherapeutic, dexamethasone, L Asparaginase treatment  Complications o Tumor lysis syndrome o Renal failure o Sepsis o Bleeding o Neuropathy o Encephalopathy o Chronic lymphocytic Leukemia (CLL) (most common)  derived from a malignant clone of B lymphocytes  Lymphadenopathy  Splenomegaly  Fever  Weight loss  anemia  Treatment  Immunotherapeutic antibody with chemotherapy agents  Complications o Frequent infections o Switch to more aggressive cancer  Patient education o Prescribed medications o Dx and Tx o Adverse effects to be looked for o S/S of infection and bleeding o Limit contact with infectious people o Immunizations not good for chemo patients o No fresh fruits or vegetable 6 | P a g e o No plants o Low bacteria diet o Low fever is not good  Induction therapy *acute myeloid leukemia* o Aggressive